The act’s core objective is to mitigate the rising maternal mortality rates in the United States, which, according to the Centers for Disease Control and Prevention (CDC), are the highest in the developed world and continue to increase. These mortality rates vary starkly by race and ethnicity: for every 100,000 live births, 26.6 White women die, compared to 69.9 Black women, 49.2 American Indian and Alaskan Native women, and 28 Hispanic women. Such a disparity highlights an urgent public health crisis transcending race, socioeconomic status, educational background, and geography.
Significantly, the bill highlights that four out of five maternal deaths are preventable. To combat this grim statistic, the legislation leans on research from the National Institutes of Health (NIH), which suggests that mothers assisted by doulas are four times less likely to have low-birth-weight babies, twice as likely to avoid birth complications, and significantly more likely to initiate breastfeeding. Parallel research indicates that midwife-led care correlates with cost savings, fewer medical interventions, lower cesarean rates, reduced preterm births, and overall better health outcomes for mothers and their babies. Furthermore, midwives are noted for their flexibility, providing care in a variety of settings including homes, hospitals, birth centers, clinics, and even via telehealth.
The draft legislation outlines specific amendments to Section 1905 of the Social Security Act, which would result in Medicaid covering culturally congruent prenatal, delivery, and postpartum services by certified doulas and midwives, including tribal midwives. The act defines a doula as an individual who has completed at least 60 hours of foundational training, is certified to provide non-medical support during pregnancy and postpartum periods, and maintains this certification through continuing education. Alternatively, a doula may also be someone who has gathered three letters of recommendation from former clients or is already authorized to serve within their respective state.
A midwife, under the bill’s terms, meets the minimum international definition and global standards for midwifery education as established by the International Confederation of Midwives. Additionally, a tribal midwife is described as an individual recognized by an Indian tribe to practice midwifery for that community.
In terms of implementation, the bill mandates that states include these services in their Medicaid plans starting January 1, 2024. However, states requiring legislative approval to adapt their plans will have until the end of the first calendar quarter after their next legislative session to comply. For states with biennial legislative sessions, each year counts as a separate regular session.
The financial aspects of the proposed changes hinge on the Medicaid program, which is jointly funded by the federal government and individual states. The bill doesn’t detail specific funding mechanisms but implies an adjustment within existing Medicaid budgets to cover the newly included services.
If passed, the Mamas First Act could significantly reshape maternal healthcare in the United States, particularly for women of color and underserved communities. By incorporating doula and midwife services into Medicaid, the legislation aims to provide more equitable, culturally sensitive care that addresses and reduces preventable maternal deaths. The measure is now set for review by the Senate Committee on Finance before possibly advancing to the House and, eventually, to the President for approval.
On the larger scale, this proposed legislation ties into broader discussions about healthcare reform, especially initiatives focused on reducing racial disparities and improving maternal and child health outcomes. Supporters argue that this holistic approach not only addresses immediate health needs but also brings long-term benefits such as decreased healthcare costs due to fewer complications and better early-life health indicators for newborns.
As the bill progresses through legislative machinery, various healthcare organizations, advocates for maternal health, and professional groups representing doulas and midwives eagerly watch, hopeful for reforms that might just save lives and lead to healthier families across the nation.
