DPH eyes improvements amid worsening maternal healthcare outcomes
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The Massachusetts Department of Public Health headquarters in Boston
Aiming to curb worsening maternal health care outcomes, state health officials are working to implement recommendations outlined in their November report, including updating regulations for birth centers, spurred by a wave of facility closures in recent years.
But ensuring enough funding and providers could pose barriers to the state's efforts, a maternal fetal medicine expert indicated.
The Department of Public Health is working to implement a new classification system into its hospital licensing regulations, which would specify the types of facilities that are suited to treat pregnant patients depending on their risk levels, said Beth Buxton, director of DPH's maternal and infant health initiatives.
The framework provides five levels of maternal care (LoMC), with higher levels indicating patients face heightened risk due to various health conditions, such as asthma, maternal cardiac disease or autoimmune disorders. The guidelines, based on national health care standards, are "designed to promote collaboration among maternal facilities and health care providers with the goal that pregnant patients receive care at a facility appropriate for their risk," according to DPH's maternal health report.
The lowest level in the framework would be considered a birth center for patients who are expected to have "uncomplicated" births, according to the maternal health report requested by Gov. Maura Healey in the fall following the controversial closure of Leominster Hospital's maternity ward.
"We are going to be moving forward with levels of maternal care. We are going to be moving forward with opening up the regulations and addressing all of the needs that need to happen," Buxton said Tuesday during a meeting of the Ellen Story Commission on Postpartum Depression, a legislative body composed of lawmakers, state health officials and medical providers.
"We got over the holidays, the budget, and now we're going to try to get into staffing -- who's going to take the lead of DPH on each of these components. So it's more a planning phase right now, and yes, it will be part of our strategic plan," Buxton continued in response to commission coordinator Ashley Healy, who said DPH's maternal health review will flow into a strategic plan the department plans to release later this year.
Patients are more likely to experience severe complications if they deliver babies at health care facilities that aren't equipped to handle their "individual needs," Healy said. The rate of severe maternal morbidity nearly doubled from 2011 to 2020, with rates among Black non-Hispanic people 2.3 times higher than their white counterparts, DPH said last year.
DPH's November report also recommended updating regulations for birth centers and midwives, creating a certification program for doulas, expanding prenatal and postnatal care at federally qualified health centers, improving data collection around stillbirths and pregnancy-related deaths, and boosting postpartum home visiting services, among other strategies.
"The report also recommends that DPH develop, in collaboration, a robust public awareness and education campaign describing LoMC and emphasizing that levels correspond to risk-appropriate care, rather than quality of care. So in other words, being a tier I facility does not mean the quality of care is lower because it's Level I, it just means it's a lower-risk facility," Healy said. "And this public awareness and education campaign certainly is something this commission could help with, as part of our statutory mission is raising awareness and doing these types of things."
Chloe Zera, commission member and chief of the maternal fetal medicine division at Beth Israel Deaconess Medical Center, cautioned that planned initiatives require funding sources.
"It's a big challenge to not have sufficient funding for providers in this area. It also requires provider capacity," said Zera, as she invoked DPH's push to provide perinatal care at federally qualified health centers.
She added, "Capacity building is just a huge need in the commonwealth, certainly for doulas. Capacity building is an issue for all of us just trying to refer our patients to doulas -- there aren't enough to go around at this moment in time. And so, funding, funding, funding."
MassHealth is slated to start covering doula services this spring, the state announced last month.
Some of DPH's recommendations are echoed in maternal health bills that the commission is tracking. Rep. Brandy Fluker Oakley, the commission's House co-chair, noted the upcoming Joint Rule 10 deadline for Feb. 7, when committees make bill recommendations.
"There are several bills that have been filed and have been filed for quite a while to specifically advance maternal health care," commission member Sen. Becca Rausch said, adding the proposals -- such as those dealing with doulas and midwives -- are considered priorities by the DPH report and a report released in July 2022 from the Special Commission on Racial Inequities in Maternal Health.
"Those are bills that are led by several of us here, so to whatever extent that we in this commission and the Healey-Driscoll administration can get those bills across the finish line this term, that I think is a wonderful opportunity for the legislators who are leading and supporting those efforts and the administration to partner to achieve our mutually desired goals," Rausch said.
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