The national maternal mortality rate for non-Hispanic Black women was nearly three times higher than that for non-Hispanic women in 2020.
In Connecticut, state health officials reported that babies born to Black mothers were significantly more likely to die before their first birthday than babies born to white women in 2017. Babies born to Black mothers are also twice as likely as babies from white mothers to have a low birth weight, under six pounds, which can lead to severe health and development issues.
"In our state and in this nation, we have a maternal health crisis where Black birthing people are suffering consequences more than any other birthing population," state Public Health Commissioner Dr. Manisha Juthani said testifying before the legislature’s Public Health Committee on Tuesday, describing the racial disparities in Connecticut’s infant and maternal mortality rates.
The committee hearing was held to discuss Gov. Ned Lamont's proposed Senate bill that would implement numerous statutes and programs to increase access to maternal health services.
SB 986 hopes to address these disparities by creating a license category for birth centers, establishing state certification processes for doulas and midwives and opening a universal nursing visitation program for new parents. Licensedbirth centers
Unlike a maternity ward in a hospital, birth centers are freestanding healthcare facilities licensed to provide prenatal, labor, delivery and postpartum care to persons with low-risk pregnancies, according to the bill. If passed, SB 986 would create a new license category to open more birthing centers throughout the state, said Juthani.
"This will allow birth centers to fill both geographic gaps that may exist within our state and also provide lower cost and family-friendly opportunities for earning people to have less medicalized births in our state," she said in her testimony.
Juthani explained that birth centers provide an alternative to traditional hospital delivery care, something many women of color feel more comfortable with. It also allows alternative pregnancy care providers, such as doulas and midwives, to enter the healthcare system and be more accessible to larger groups of people.
The Connecticut Childbirth and Women's Center is the only standalone birthing center in the state. Located in Danbury, the center is staffed by midwives and focuses on natural childbirths, according to its website. The two-story clinic has numerous birthing rooms with queen-sized beds and a big bathroom with a Jacuzzi tub.
According to its website, "some of the benefits of a birth center birth include the ability to move around freely without monitors or IVs, use of shower and jacuzzi tub, freedom to eat and drink as you see fit, unlimited number of support people, and early discharge home."
Birthing centers would be licensed through the state and may have specific service guidelines. Juthani explained that each certified birth center would work with nearby hospitals. So, if an emergency occurred during delivery, the patient would have access to a higher level of care.
For example, the Connecticut birth center is across the street from Danbury Hospital, which allows for a quick transfer.
"This is a continuum of care. Whenever you look at a condition, there's going to be a low-risk situation and a higher-risk situation. Having that breadth of care with the breadth of providers that can not only make the birthing person feel comfortable, make them feel heard, make them have advocates of their bedside, who could be a family member could be somebody who is able to help communicate things that they may need to communicate," Juthani said.
Committee Co-Chair, state Sen. Saud Anwar, D-South Windsor, raised concerns about the mandatory relationship between the birth centers and the larger healthcare system. Anwar, a physician, noted that the legislation could lead to unintended selection bias as the major hospitals would receive more complicated pregnancy cases.
For example, Anwar spoke of a friend who works as an OB/GYN at a major hospital and is often involved in pregnancy-related emergencies. He said she is overwhelmed and frustrated by the emergency calls and is considering transferring from the emergency room.
They “get disastrous things that were happening as disasters and nobody recommended them to be able to be seen at a higher level of care. And at the last minute in the emergency room, you have a patient bleeding out and then you have to go and run and take care of them," he said.
Similarly, the Connecticut Hospital Association submitted testimony saying that the bill's language doesn't mandate regulations and protocols for the license. Instead, they write that the language needs to be updated to ensure that "mandatory clinical guidelines" are met.
State Rep. Liz Linehan, D-Cheshire, told the Record-Journal she fully supports birthing centers but wants to ensure that their patients receive adequate post-delivery education, such as essential screening tests for newborns and vitamin K injections for blood clots caused by vitamin K deficiency bleeding.
"There has been a movement away from these important health concerns among new mothers as of late… I do believe an education component must be included through midwives and doulas," Linehan said. "My concerns can easily be allayed with further discussion with providers.”Certifying doulas
Founder and host of Labors of Love podcast, Hafeeza Ture, highlighted the importance of certifying doulas by speaking about her own pregnancy journey at Tuesday's hearing. The mother of three described the "sacred experience" of her delivery, saying that she did not use any medications or experience any complications, which she attributed to the constant support from her birth team and doulas.
Ture said her "birth team" consisted of friends, family, a doula and a midwife. She added that she had all her deliveries outside a hospital setting – one in a birth center and the others at home.
She was comforted that someone in the delivery room was focused entirely on her needs.
"To know someone who is knowledgeable outside of this vulnerable state that can convey your desires in this space to have that level of trust," Ture said. "It has an impact on a mother to allow them to relax, and really be in the process because a lot of the complications and the interventions wouldn't be necessary if we felt safe and grounded in our bodies to do what they do."
A doula is a trained, nonmedical professional that helps a pregnant person before, during and after birth. They work with the sole purpose of helping the mother have a "safe, memorable and empowering birthing experience," wrote Traci McComiskey, founder and director of Birth Support, Education and Beyond LLC, in her testimony.
The passage of SB 986 would create an optional state certification pathway for working doulas seeking those credentials. Streamlining the certification would outline a path to the doula workforce and create opportunities for insurance reimbursement, according to the DPH's written testimony.
In addition, McComiskey testified that a voluntary doula certification process would also increase the visibility of the profession, establish more sustainable funding options and improve the integration of doulas into the health systems.
"A certification process centers the voices of doulas and those with lived experiences throughout the process and ensures equitable access to certification for all doulas who wish to become state certified," she said.
State Rep. Lezlye Zupkus, R-Prospect, raised concerns about cost and its affordability, but noted the importance of doula services.
“There are all kinds of people that struggle and a doula could be a great thing for them. And so I want to make sure there's access for everybody,” she said. Universal nursing
State Early Childhood Commissioner Beth Bye spoke on the benefits of having a nurse visit new parents after birth.
The first few weeks are crucial and scary for both the baby and new parents, she said, so having a nurse can help ease the transition.
"You don't need any kind of degree to bring that baby home, but a little guidance can go a long way," she said.
A pilot of the universal nursing program is set to launch in May, Bye said. Based out of Bridgeport, new parents will be paired with a nurse who would visit their home one to three times to provide suggestions and guidance as they settle into their new life. Afterward, the nurse will connect the parents with a local community health worker so they have easy access to resources.
Bye said the nursing program follows the Family Connects International model. According to its website, FCI nurses are trained to assess the needs of the family and provide services at no cost to the families. The model is currently used in 19 other states.
However, a community health worker is a unique addition. The other participating states only work with nurses, said Debbie Poerio, durational project manager for the Universal Home Nurse Visitation Program, in her testimony.
She added that the Connecticut program was built in collaboration with five commissioners from different state agencies.
"It's integrated and so all of the services from those five agencies are also integrated to create a comprehensive, seamless continuum of care for these parents," Poerio said.
Bye said the program is funded by multiple sources: Medicaid, preschool development funds, federal funds, CDC grants and COVID-19 relief funds. She added that the pilot program provides them an opportunity to find ways to "leverage" the funds and ultimately create a cost-saving program that would provide the same services without the cost.
"When you put together federal opportunities, looking early, and looking at maternal health and child health and newborn health and safety, we think this is a homerun. "
Although supportive of this section of SB 986, Zupkus said she's concerned about the price and sustainability of a universal nursing program. She hopes that with a few more discussions and a few tweaks to the language of the bill that SB 986 could make a tremendous, positive impact.
“We need to make sure that people that need services get them, but we need to make sure that they're stable. They're going to continue to be there,” she said.
CORRECTION: The number of the Senate Bill was incorrect in an earlier version of this story.
Health Equity reporter Cris Villalonga-Vivoni is a corps member with Report for America, a national service program that places journalists in local newsrooms. Support RFA reporters at the Record-Journal through a donation at https://bit.ly/3Pdb0re. To learn more about RFA, visit www.reportforamerica.org.