Columnist Carrie N. Baker: Maternal health in Massachusetts during the pandemic

Published: 7/22/2020 3:46:30 PM

“If I had to pick a single word to define the impact of COVID-19 on my pregnancy and birthing experience, I would say isolated,” testified Emma Reidy at a June 3 virtual town hall organized by the Massachusetts COVID-19 Maternal Equity Coalition.

“I was isolated from my husband during my third trimester as I attended my routine prenatal appointments alone, because no visitors were allowed. Three weeks before my due date, I found out that I would need to be induced early in just two days ... In the hospital, where I stayed for five long nights, we couldn’t leave our room, not even to stretch our legs in the hallway or to visit our son in the nursery where he received a full day treatment.”

The Maternal Equity Coalition formed in May to develop policy recommendations for equitable, evidence-based best practices and standards of care and support for pregnancy, childbirth and postpartum in Massachusetts during the COVID-19 pandemic. Over 300 people attended the virtual town hall, including policymakers, pregnant and postpartum people, doctors, midwives, nurses and researchers.

“I’m being told by my clients that informed consent discussions about new hospital policies are not being had. This is leaving expectant parents feeling frightened, and coerced, and out of control,” Dr. Justine Leach testified.

Participants at the town hall and others who contacted the Coalition described hospital policies barring support persons from labor and delivery, separating people giving birth from their babies, and restrictions on breastfeeding. People testified about pressure to induce labor, higher rates of cesarean sections and forceps deliveries to speed up deliveries, reduced access to anesthesia, and denial of sterilization procedures after birth.

Many described fragmented and disrespectful health care, confusion about where to go for assistance, limited prenatal visits, and pressure to use telemedicine instead of in-person care. All of these conditions resulted in people experiencing high levels of anxiety and depression during pregnancy, labor, birth and postpartum.

Based on this testimony as well as research into maternal health care in Massachusetts — and informed by newly-developed national and international maternal health care standards relating to COVID-19 — the Coalition issued a report last week titled, “Giving Birth in a Pandemic: Policy Recommendations to Improve Maternal Equity During COVID-19.”

The Coalition concluded that the state is failing pregnant and birthing people, especially in Black and brown communities and in low-income communities.

In Massachusetts, maternal mortality and severe maternal morbidities have been rising for years, with persistent racial, economic, and geographic disparities, according to the Massachusetts State Health Assessment report. Black women are twice as likely to die from pregnancy-related causes and to experience severe complications during labor, delivery and postpartum as white women. Women covered by MassHealth are three times as likely to die from pregnancy-related causes, and also have higher rates of severe obstetrical complications than those who have private insurance.

But now, the pandemic is amplifying these preexisting inequities of our maternal health care system. The multiple crises of the COVID-19 pandemic, systemic racism and economic injustice are combining to make giving birth in Massachusetts more dangerous and difficult than ever.

It doesn’t have to be this way. According to the U.S. Centers for Disease Control, 60% of all maternal deaths are preventable. We just have to find the political will.

In order to improve maternal health outcomes, the Coalition report makes six recommendations: 1) form a COVID-19 emergency maternal equity task force; 2) collect data on pregnant and birthing people, race/ethnicity, and COVID-19; 3) ensure consistency in hospital perinatal policies, including support people and mother-infant separation; 4) ensure immediate access to ongoing mental health care for birthing people; 5) ensure ongoing comprehensive Medicaid coverage for birthing people; and 6) expand midwifery care and community birth options. The Coalition’s goal is to ensure that the care received by all birthing people is safe, equitable, respectful and evidence-based.

Unfortunately, we are moving in the opposite direction locally with the recent closure of the Holyoke Medical Center’s maternity services unit, which eliminates community-based midwifery care in Holyoke. The Center was formed in 1985 to address the city’s high infant mortality rate, particularly among the Latinx community.

Several bills currently before the Legislature could help improve maternal health outcomes, including H. 1948/S. 1332 on midwifery and out of hospital birth, H. 1182 on Medicaid coverage for doula services, and H. 4818, passed unanimously by the House on Jan. 30, to create a 23-member commission to study racial disparities in maternal health. Many of our local legislators are strong supporters these bills.

We need to act now. COVID-19 is not over. We will likely see more cases again in the fall. Let’s act now to be prepared.

Carrie Baker is a professor in the Program for the Study of Women and Gender at Smith College and a regular contributor to Ms. Magazine.

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