Changes to Maternal Health Policy in Michigan Could Save Lives

Michigan Live covers this topic here.

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• Alyssa Burr|aburr@mlive.com

Elon Geffrard was five years old when she saw her mother give birth with the support of a midwife. She said from then on, she wanted to make a career in “catching babies.”

After years of caring for Black and brown women in metro-Detroit as a doula and co-founder of Birth Detroit, she has a deeper understanding of how the health of a community can be reflected in the women and children in it.

If you were to look at the women and children here in Michigan, “Michigan is not doing well,” she said.

Birth justice advocates like Geffrard say racial disparities in Michigan’s maternal health system are creating a crisis for Black mothers and birthing people. These advocates, as part of a coalition called MI State of Birth Justice, intend to present the issue to the state legislature in the form of a comprehensive package of bills.

Aptly named the “Momnibus”— a combination of the terms “mom” and “omnibus”— the package would increase access to alternative birthing care throughout the state, such as birthing centers and midwives, while addressing systemic racism to improve outcomes for Black mothers.

Nationwide, Black women die from pregnancy-related causes at a higher rate compared to white women. In Michigan specifically, those odds are three times more likely, according to the latest data from Michigan’s Maternal Mortality Surveillance Program.

Racism is embedded in the history of women’s health, Geffrard said. She pointed to Dr. J. Marion Sims, “the father of gynecology” who used unethical experiments to study on enslaved Black women in the 19th century.

“Racism is an ideology. It is a belief that individuals who belong to certain groups are less or that devalue, dehumanize,” Geffrard said. “We see that show up very easily in institutions like health systems and hospitals, because that is how medical education was shaped.”

Nicole White, a certified midwife and co-founder of Birth Detroit, said racism is why some women still don’t have a safe option for birth care, and eradicating this harmful factor is one of the important messages of the Momnibus.

“I think we’re going to look back on this time in history with embarrassment and shame,” White said.

The proposal would require the use of the PREM-OB Scale, a tool to help measure the experience of Black mothers in hospitals across the state. It also suggests the creation of a formal complaint system with the state’s health equity commission specifically for obstetric racism.

Tatiana Omolo, government and policy affairs director with Mothering Justice, a Detroit policy advocacy organization, said supporters looked to ensure the Momnibus was as extensive as possible to cover many multifaceted inequities in maternal health.

“We wanted to be really careful about who to include, how to include them and to make sure that we are not forgetting who this bill really is for, and it’s for communities of color,” Omolo said.

The Michigan Momnibus builds on similar legislation federally and in other states. The Black Maternal Health Momnibus Act was introduced in the U.S. House in 2021, and Colorado also passed its own Birth Equity Bill Package that same year.

A key component of the Michigan Momnibus proposal is the licensing of birth centers and the reimbursement of midwifes to better the access of care throughout the state.

Michigan is one of 10 states that does not license freestanding birth centers– a health care facility for childbirth that is not a hospital and where midwives provide care. Without birth center licensure, midwives working in these settings are not reimbursed by Medicaid.

Birth Detroit has campaigned to open Detroit’s first free-standing birth center since its inception, White said, but the coverage that would improve workforce development and retention of midwives is not yet available.

“We were going to do a birth center and then when we recognized we can’t get paid for the care that we give in the birth center, then that’s just the sustainability,” White said. “We have to rip those legislative barriers down so that we can give this quality care for years and years and years.”

Possible birth center expansions would also positively benefit low-income families by lowering the cost of birth down to about $4,000, a significant difference when compared to hospital births, Geffrard said. “Obstetric deserts” like in the Upper Peninsula or in rural areas where families have to travel long distances to receive care, may also benefit.

The package focuses on several other areas like diversifying data collection to include LGBTQ people and people with disabilities, and integrating health systems so patients could be better transferred from birth centers to hospitals.

Currently, advocates are working on finalizing the details before the bills are ready to be presented to the legislature.

Some Democrat lawmakers, Omolo said, are hesitant to support the package in fear of it coming across as too radical or unappealing for their base.

Shanayl Bennett, a doula and black maternal health and reproductive justice organizer for Mothering Justice, said some of those feelings may stem from a lack of understanding about alternative birth practices.

A doula is a person who provides emotional and physical support before, during and after childbirth. Doulas are not medical professionals, but offer services such as developing a birth plan, breastfeeding education and help the family as a whole navigate life with a newborn.

Like doulas, midwives offer childbirth education to families, but they also have the needed medical training to assist during labor and delivery.

“I think the thought of midwifery care is still kind of out there to some people,” Bennett said. “They just can’t wrap their minds around why people won’t just go to a hospital.”

Sen. Erika Geiss, D-Taylor, who Omolo identified as being an essential partner in the legislature, said it may be a matter of time for legislators to learn about these issues as the new term has just begun and Democrats get acquainted with their role as the new majority. She’s hopeful her fellow lawmakers will begin to look at affording people the type of maternal care they want and need in Michigan.

“I am hopeful and cautiously optimistic that now we can have these very real conversations about how to advance some of these policies,” Geiss said.