Credit: (AP Photo/LM Otero, File)

State lawmakers are considering a measure to make home birth more accessible, something birthing advocates say is needed as New Jersey works to improve maternal health outcomes and reduce related racial disparities.

The Senate Health, Human Services and Senior Citizens Committee is scheduled to vote Monday on a bill (S-1097) that would require health insurance companies to cover the full cost of home births The legislation will be amended to include Medicaid plans, which pay for some 40% of births in the state, a spokesman for the sponsor, Sen. Britnee Timberlake (D-Essex) said. Insurance coverage for these services is limited in New Jersey.

Monday’s hearing on the home birth proposal, first introduced in May 2020, comes a few weeks after midwives, doulas and policy experts testified before an Assembly panel, outlining barriers in New Jersey that make it hard for women to deliver at home or in a community birthing clinic. They urged lawmakers to consider regulatory reforms that would enable more freestanding birthing centers unaffiliated with hospital systems to open and sustain their operations.

Advocates also used that Assembly hearing to call for changes that would allow midwives, the licensed clinical professionals who oversee the vast majority of non-hospital births, to operate more independently and be better paid. Midwives also deliver babies in hospitals – although not when surgery is involved – and provide pre-natal, postpartum and other primary care.

Sheila Reynertson, a senior program officer with the Robert Wood Johnson Foundation who is focused on health equity, said New Jersey has made important investments in improving maternal health outcomes in recent years. But she said more work is needed to support midwives and non-hospital birth.

“Current state regulations and insurance payment policies prevent many New Jersey families from choosing anything but a hospital setting for childbirth,” Reynertson told the Assembly Aging and Human Services Committee in mid-September. “That’s a feature, not a bug. And it’s contributing to New Jersey’s egregiously high C-section rates and episiotomy rates and dismal racial disparities in maternal health outcomes.”

New Jersey has made changes over the past decade that have driven down unnecessary cesarian-section births – which involve additional health risks for the mother and baby, when compared to a vaginal birth – but many hospitals remain above the national target for these surgical births. Black women are also 25% more likely to receive an unplanned C-section when compared to white women, according to new research.

The Murphy administration has focused on addressing New Jersey’s dismal maternal mortality rate, launching a program that sends nurses to the homes of new mothers, training culturally competent doulas – who serve as non-clinical birth coaches – and creating a quasi-independent government authority to continue this work in the years to come. It has also promoted efforts to strengthen hospital birth protocols, address racial bias among providers and extend insurance coverage for low-income pregnant women.

Roughly two dozen women die each year in New Jersey while pregnant, in labor or in the weeks following delivery, according to state and national data, in a state where nearly 100,000 babies are born annually. Black women are nearly seven times — and Hispanic women three times — more likely to die during pregnancy, childbirth or the postpartum period, when compared with white women, according to a state analysis.“The demand for midwifery care and for childbirth outside the hospital setting is only growing in New Jersey, particularly among Black and brown families. Yet New Jersey maintains an environment where the profession of midwifery and birthing centers is undervalued,” Reynertson said.

Michelle Gabriel-Caldwell, a doula and birth educator who operates several birthing centers, shared data that illustrated the diversity among families interested in a community delivery option. In 2023 half her clients were Black, 1 in 4 was Hispanic, 15% were white and 5% were Asian, she told the committee, while nationwide 77% of birthing centers clients are white.

Still, non-hospital birth options for women of color are limited, Gabriel-Caldwell said, for insurance and other reasons.

“Birthing centers are scarce in urban areas, forcing families to travel long distances or rely on local hospitals where they will see higher (surgical or pharmaceutical) intervention rates and cultural bias,” she said.

Among low-risk women nationwide, 27% of those who deliver at a hospital will end up with a surgical birth, Gabriel-Caldwell said, in part the result of a culture that favors medical intervention over patience and trusting women. At birth centers, just 6% of low-risk women end up being transferred to a hospital for a C-section, she said, while the rate for home births is 5%.

There’s been an increase in non-hospital births recently, according to data compiled by the state Department of Health, which regulates health care facilities, although the vast majority of mothers deliver at one of New Jersey’s 43 hospital birthing centers. While the number of babies born statewide appears to have declined between 2022 and 2023, preliminary data shows the number of deliveries at the state’s five freestanding birthing-clinics grew from 516 to 613. The number of home births reported dropped slightly over those years however, from 590 to 540, the state data shows.

To strengthen the midwifery workforce, the state needs to reimburse midwives at the same rate as physicians for low-risk deliveries, according to Armonie Pierre-Jacques, a program officer with the New Jersey Health Care Quality Institute, which has produced several reports on maternal health reforms including a paper on the midwifery workforce. She said the state also needs to reduce regulatory restrictions on their work and make it easier for patients to be transferred from birthing centers to hospitals, or between hospitals, if something goes wrong.

There are more than 400 midwives working in New Jersey, a workforce that attends about 1 in 10 births, according to Julie Blumenfeld, director of the nurse-midwifery program at Rutgers School of Nursing. Blumenfeld is among those who urged Timberlake to amend the home birth bill to include Medicaid. She is also advocating for language that would ensure the insurance coverage is for planned births attended by a licensed midwife, obstetrician or family physician.

As drafted, Timberlake’s bill does not specify exactly what services would be paid for under home birth health insurance coverage.

Editor’s note: The Robert Wood Johnson Foundation is a supporter of NJ Spotlight News.