Colorado’s birth equity package aims to improve maternal mortality rates

By Anna Sutterer

May 7, 2021 | Health, News | 0 comments

//Janelle Jenkins, community advocate and mother of two, stands outside the State Capitol on May 1. She sits on three councils within Colorado’s Department of Health Care Policy and Financing. Photo by Anna Sutterer | asutt99@gmail.com

In 2005, Janelle Jenkins had her first child. She was young and didn’t know what to expect or what to ask for, but her health providers didn’t offer much guidance.

“Thank God I didn’t have any complications,” she said, knowing the risks Black women face. And although her first birth went fine, in retrospect the lack of communication and a birth plan sticks out in her mind.

“Do I even want to have another child when I know I’m not going to receive quality care?” Jenkins said. She is a mother of two and community wellness advocate. 

With her second child’s birth in 2015, she was fortunate to be in a program where a group of women received regular check-ups and comprehensive information about their maternal health journey. 

This level of professional attention and public education, plus cultural competency, is what Jenkins believes could save lives and families.

Jenkins sits on three Member Experience Advisory Councils within Colorado’s Department of Health Care Policy and Financing, where she’s heard stories from community members, doctors and nurses who’ve witnessed inequitable care.

“It all has the same type of themes—racism, not feeling heard, not being taken seriously,” she said.

Nationally, about 700 women in the U.S. die annually from pregnancy, delivery and postpartum complications, according to the Centers for Disease Control and Prevention. Black birthers are nearly four times more likely to die from pregnancy-related issues than their white peers, regardless of education or income level. Indigenous birthers’ risk of death in Colorado, according to a CDPHE Maternal Mortality Review Committee report, increases close to five times as compared to white birthers.

A trio of bills, SB21-193 Protection Of Pregnant People In Perinatal Period, SB21-194 Maternal Health Providers and SB21-101 Sunset Direct-entry Midwives, propose malpractice accountability, data collection, an expansion of Medicaid coverage, and increased midwife access respectively as a path to equity for birthers.


Expanding Coverage 

Midwifery care improves maternal and infant health outcomes, reports the World Health Organization. Eighty-seven percent of services needed can be delivered by certified midwives, and their work can reduce maternal mortality by 82%. Midwifery is also associated with reduced labor interventions such as cesarean sections.

SB21-101 is a renewal and expansion of a standing midwife regulation. This iteration brings Colorado up to speed with other states by allowing midwives to practice at licensed birth centers, according to Indra Lusero, director of the Elephant Circle birth justice organization and legal expert who helped draft the bill package. Expanding Certified Professional Midwife work in this way is cost-effective, according to a study by the Centers for Medicare & Medicaid Services.

“Currently the [midwives] in community settings are not majority BIPOC,” Lusero said. “That’s a result of systematically eliminating both Black and Indigenous midwives.”

As medicine became increasingly institutionalized, midwives who were embedded in these communities were discredited, said Demtra Seriki, CPM and owner of A Mother’s Choice Midwifery in Colorado Springs. In Colorado, new midwifery licenses were barred from 1941 to 1993.

Seriki testified before the Colorado Senate on April 14 in support of SB21-194. In her testimony, she spoke about a client, a mother of color who was showing signs of preeclampsia—elevated blood pressure and rapid weight gain. The mother was discharged from the hospital twice before a late preeclampsia diagnosis and eventual C-section.

“I had to be extremely persistent in sending her back to the hospital for evaluation and management,” Seriki said. “If she had been received and my notes had been reviewed we could have probably prevented that urgent situation.” 

This happens more often than not with the community she serves, Seriki added. 

SB21-194 requires health facilities to implement best practices for transfers of pregnant persons from homes or birthing centers. Dr. Lee Morgan representing the American College of Obstetricians and Gynecologists (ACOG) at the April 14 hearing, clarified that past direct-entry midwife legislation requires a transport plan in case of emergency. 

SB21-194 also expands Medicaid coverage to provide one year of postpartum benefits for those who qualify for the program while pregnant, which would be a sizable expansion of the current 60 days. However, on March 11 the federal American Rescue Plan Act passed, allowing states to expand to 12 months. Advocates of the bill urged the state to take up the new opportunity, noting high rates of pregnancy-related deaths between six weeks and one year. Drop-offs in coverage can mean disrupted physical and mental health care when folks need it the most.

“It’s really hard to think about applying for coverage in the exchange in that moment because life is so full when you have a 61-day-old baby,” said Erin Miller, VP of Health Initiatives at Colorado Children’s Campaign.


Tracking Outcomes

Official reports on racial disparities in health outcomes, trainings on racism and discrimination and incidents of disrespect or mistreatment of a pregnant person are hard to come by in Colorado. 

That’s why the Maternal Mortality Review Committee was established and funded in 2019. They’re catching up with what data is available, but could get a boost with SB21-194, which empowers the group to recommend improved data collection practices and public reporting from health providers. 

The committee would also incorporate in its reports input and experiences from marginalized groups.

Years down the line, with clearer data and a better understanding of the situation, more policy changes can be made. Miller hopes reports from health practices become widely available so the public can make informed decisions while shopping for their providers.

Childbirth is a bellwether of the strengths and weaknesses in medical and social supports, including insurance coverage, birth control access, medical setting choice and childcare. 

“It’s a defining moment that can set families up to get bonding,” Miller said. “Or you can get a situation with traumatic birth experiences, racist experiences before, during and after. And the family formation period becomes additionally stressful.”

SB21-193 steps in where malpractice or uninformed care occurs. The bill allows a birthing person who was harmed or felt they had an unnecessary procedure three years to bring their case to court. This change from two to three years accounts for the unique exhaustion of the postpartum period. 

This legislation would also establish the right for pregnant people to make medical decisions for themselves in advance in case they become incapacitated, just like all other adults. It would also ensure incarcerated people the power to consent or deny immediate medical examination of their babies, meaning the birthing person and child could bond and breastfeed right away. 

In essence, SB21-193 is about human rights, Lusero said.

For Janelle Jenkins, her focus is about putting control in peoples’ hands. Detailed, customizable birth plans and advocates in the room—Jenkins says her parents didn’t have all this and weren’t able to pass down knowledge. 

“They didn’t even have a seat at the table,” she said. “I’m gonna be the first in my family to be able to educate my daughter on things like this, or show her advocacy and policy.”

Legislation updates:

The reporting above applies to the bills’ contents as of May 7.

SB21-101 Sunset Direct-entry Midwives moved to the House Committee on Appropriations on May 4.

SB21-193 Protection Of Pregnant People In Perinatal Period passed to the Senate Committee of the Whole on May 7.

SB21-194 Maternal Health Providers referred to the Senate Committee of the Whole on May 7.



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