SHIP - Maternal Morbidity and Mortality

Maternal Morbidity and Mortality is one of the four priority areas under the State Health Improvement Plan (SHIP).

Overview

In 2023, the Massachusetts Department of Public Health (DPH) published the Review of Maternal Health Services, 2023, a report which featured  25 action-oriented recommendations (Review of 2023 Maternal Health Services). Six of them were identified as priority goals by the Advancing Health Equity in Massachusetts (AHEM) - Maternal & Perinatal Health Workgroup. 

Review of 2023 Maternal Health Services (PDF) | (DOC)

Goals

1. Update DPH hospital and clinic regulations regarding birth centers to better align with national standards, including updates to staffing and supervision requirements (such as expanding the scope of Certified Nurse Midwives) 
2. Develop a pathway for a voluntary doula certification 
3. Integrate Levels of Maternal Care (LOMC) into DPH licensure regulations   
4. Update guidance for healthcare providers to share best practices and document the establishment of a dual reporting system whereby substance-exposed newborns with no indication of neglect or abuse can be identified for support but not investigated for neglect or abuse 
5. MassHealth will explore opportunities to reimburse midwives equitably as physicians for the same service; private insurers would be encouraged to follow 
6. Develop and reimburse remote blood pressure monitoring programs 

Data

Source: Data Brief | An Assessment of Severe Maternal Morbidity in Massachusetts: 2011-2020¹.

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Nationally, the risk of pregnancy-related deaths for black birthing people is three to four times higher than that of white birthing people. Pregnancy-related death is defined as a death during or within one year of pregnancy, from a pregnancy complication, a chain of events initiated by pregnancy or the aggravation of unrelated conditions by the physiological effects of pregnancy. Additionally, in Massachusetts Severe Maternal Morbidity (SMM) nearly doubled from 2011 to 2020. Severe Maternal Mortality is defined as the unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health.  In the United States, birthing people are more likely to die from childbirth or pregnancy complications than birthing people in other high-income countries. Research shows that more than 80% of these deaths, from mental health disorders, hemorrhage, cardiovascular disease and preeclampsia may be preventable². Moreover, racial and ethnic inequities in maternal health outcomes exist and have persisted for decades.  

The Maternal Mortality and Morbidity Review Committee (MMMRC) reviews maternal deaths, studies the incidence of pregnancy complications, and makes recommendations to improve maternal outcomes and prevent mortality. 

Visit the Maternal Mortality and Morbidity Initiative to learn more about SMM and related issues around maternal mortality.  

Community Engagement

The 2023 Review of Maternal Health Services report built upon the recommendations of the 2022 Report of the Special Commission on Racial Inequities in Maternal Health. The goals and strategies in the Report were developed collaboratively through a review of access to all maternal health services in the Commonwealth. This involved listening sessions, legislatively mandated Commissions, and data collection and analysis.

The Advancing Health Equity in Massachusetts (AHEM) Maternal and Perinatal Health, Data and Action, and Community Engagement workgroups includes representatives from DPH, MassHealth and other agencies within the Executive Office of Health and Human Service (EOHHS). The maternal health team will look at how to best support moms and infants before, during and after birth. AHEM will pilot innovative strategies in ten areas of the state with the most extreme health disparities. These priority geographies will serve as a starting point for greater change, allowing EOHHS to conduct a thorough, thoughtful, and focused review of its approach and investments. At the end of year one, EOHHS will review lessons learned in those communities and move forward accordingly. 

List of Partners

• MassHealth
• Maternal Health Task Force
• Title V Advisory Group
• Maternal Mortality and Morbidity Review Committee
• Advancing Health Equity in Massachusetts - Maternal & Perinatal Health Workgroup
• Perinatal Neonatal Quality Improvement Network (PNQIN)
• The Levels of Maternal Care Implementation Steering Committee
• The Betsy Lehman Center for Patients Safety

Additional Resources

Report of the Special Commission on Racial Inequities in Maternal Health

1. (2023). (rep.). Data Brief: An Assessment of Severe Maternal Morbidity in Massachusetts: 2011-2020. Boston, MA.

2. Trost SL, Beauregard J, Njie F, et al. Pregnancy-Related Deaths: Data from Maternal Mortality Review Committees in 36 US States, 2017–2019. Atlanta, GA: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2022.