Overall U.S. maternal health outcomes for Black and Indigenous birthing people continue to trail far behind white birthing people. This includes parents from all socioeconomic backgrounds. International tennis star Serena Williams documented her own traumatic birthing experience in 2017 and — also in 2017 — prominent epidemiologist at the Centers for Disease Control and Prevention, Shalon Irving, died after childbirth from complications of high blood pressure.
In Massachusetts, according to a press release from the Office of the Attorney General, Black women and birthing people are twice as likely to die during pregnancy or within one year postpartum than their white counterparts.
Senator Liz Miranda filed a bill in the Massachusetts Legislature, S.1415, An Act Relative to Birthing Justice in the Commonwealth. This omnibus legislation includes many provisions to improve maternal health outcomes, particularly for Black and brown birthing people, including screenings for postnatal depression by pediatricians, and codifying MassHealth’s access and coverage of doulas in the birthing process, and postpartum home visits.
In a hearing in front of the Joint Committee on Public Health on June 6, 2023, Christina Yarrington, MD, FACOG director of Labor and Delivery at Boston Medical Center, testified in support of the bill. Yarrington highlighted the importance of centering the patient’s voice through a comprehensive, equitable approach to care. An excerpt of her testimony can be found below, and a video recording of the day’s proceedings can be found here.
How to close gaps in maternal health outcomes
Christina Yarrington, MD, FACOG
“BMC is not the biggest birthing hospital in the state. We deliver about 3,000 babies a year, but 75% of those families are Black and/or Hispanic. With our institutional Health Equity Accelerator, we are working to achieve health equity by centering the experience and outcomes of our mothers marginalized by structural racism. We are launching multiple interventions that respond to the pregnancy and birth experiences of our patients.
S.1415 takes a comprehensive approach to improve how we care for birthing people of color. Among these, I would like to highlight the support for doulas, postpartum home visiting, and birth centers. Doula support is associated with lower C-section rates and better birth experience.
We have run our Birth Sisters Program at BMC, a multicultural doula service, since 1999. Importantly, doula support is one of the few obstetric interventions that has research data demonstrating explicit improvement in these outcomes for Black mothers. I value my patients’ words as highly as medical research. I have learned that best care cannot be framed around a person coming to me — people need choices and power. The video visits we do to monitor blood pressure have identified sepsis, blood clots, and severe depression. The home visits proposed in S.1415 will pick up more and undoubtedly reduce harm and morbidity for people who are trying to be home with their newborns.
Further, in response to our patients’ desire for options in their birth experience, BMC is establishing a hospital-based “Birthing Center.” S.1415 directs [the Department of Public Health] to update the state’s birth center regulations, which would make it easier for our department and other freestanding birth centers to open, operate, and succeed.
Choice like this is critical to trauma-informed care and, in my opinion, every person who births in this state deserves to be treated with that person-centered framework.”
