On June 26, 2023, Connecticut Governor Ned Lamont signed Public Act No. 23-147, “An Act Protecting Maternal Health.” The Act makes various changes aimed at bolstering health care access and services for maternal and infant health. Key elements of the Act are summarized below.
Section 1 of the Act, effective January 1, 2024, implements a new licensure category for freestanding birth centers in Connecticut. The Act defines a birth center in pertinent part as “a freestanding facility that is licensed by the department to provide perinatal, labor, delivery and postpartum care during and immediately after delivery to persons presenting with a low-risk pregnancy and healthy newborns for a period typically less than twenty-four hours” and which is not a licensed hospital. The Act defines “low-risk pregnancy” to refer to an “uncomplicated, singleton pregnancy that has vertex presentation and is at low risk for developing complications during labor and birth” as determined by a qualified provider’s professional judgment. This new licensure category for freestanding birth centers is intended to replace the current maternity hospital licensure category, which the Act formally repeals as of July 1, 2025 (as well as providing that no maternity hospital licenses shall be granted or renewed after January 1, 2024). Starting January 1, 2024, entities must obtain a license in order to operate a freestanding birth center. Notably, the Act makes a corresponding change to state Certificate of Need laws to exempt birth centers that enroll as providers in the Connecticut Medical Assistance (Medicaid) Program from Certificate of Need requirements until June 30, 2028.
In connection with the recognition of freestanding birth centers as a standalone licensure category, the Act revises the current certified nurse-midwife (CNM) practice act to newly allow a CNM to practice within a birth center, in addition to the allowance under current law for a CNM to practice within a health system. The Act also requires the Department of Public Health (DPH) to establish a midwifery working group that studies and provides recommendations on community birthing and the potential role of “direct entry midwives” (individuals other than CNMs trained in planned out-of-hospital births) in “addressing maternal and infant health disparities.”
The Act also establishes new laws governing certificate and practice of doulas in support of childbirth services. Section 13 of the Act, effective July 1, 2023, charges DPH with establishing a Doula Advisory Committee to develop recommendations for doula certification and standards of doula training. Section 14 of the Act, also effective July 1, 2023, obligates the Doula Advisory Committee to support DPH in the creation of a certification program for doulas. Doulas, defined as trained nonmedical professionals who provide support to pregnant persons and their family in connection with childbirth, can seek certification upon completion of an approved doula training program or after a combination of training and practice.
In further efforts to increase support for new parents, Section 16 of the Act requires the Office of Early Childhood to develop a universal nurse home visiting program for all families with newborns living in Connecticut. Under this voluntary program, families will be able to receive home visits from registered nurses who will provide information, assessment, and referrals as needed.
The Act also creates various programs within DPH to review and document the landscape of maternal health in the state, including an Infant Mortality Relief Program, Infant Mortality Review Committee, Doula Advisory Committee, and the Midwifery Working Group referenced above. These programs seek to identify disparities in maternal and infant health, review and report on cases of maternal and infant mortality and improve training and resources for the labor and delivery workforce across the state.