I 
111TH CONGRESS 
2D SESSION 
H. R. 5807 
To promote optimal maternity outcomes by making evidence-based maternity 
care a national priority, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JULY 21, 2010 
Ms. ROYBAL-ALLARD (for herself, Ms. BALDWIN, Mrs. CAPPS, Ms. CASTOR 
of Florida, Mrs. CHRISTENSEN, Mr. COHEN, Mr. CONYERS, Mrs. DAVIS 
of California, Ms. DEGETTE, Ms. DELAURO, Mr. ENGEL, Mr. HINOJOSA, 
Ms. LEE of California, Ms. ZOE LOFGREN of California, Mrs. LOWEY, 
Mr. MCGOVERN, Mrs. MALONEY, Mr. MICHAUD, Ms. MOORE of Wis-
consin, Mrs. NAPOLITANO, Ms. NORTON, Mr. REYES, Ms. VELA´ZQUEZ, 
Ms. WASSERMAN SCHULTZ, Ms. WOOLSEY, and Ms. SCHAKOWSKY) intro-
duced the following bill; which was referred to the Committee on Energy 
and Commerce, and in addition to the Committee on Ways and Means, 
for a period to be subsequently determined by the Speaker, in each case 
for consideration of such provisions as fall within the jurisdiction of the 
committee concerned 
A BILL 
To promote optimal maternity outcomes by making evidence- 
based maternity care a national priority, and for other 
purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Maximizing Optimal Maternity Services for the 21st 
Century’’ or the ‘‘MOMS for the 21st Century Act’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Findings. 
TITLE I—HHS FOCUS ON THE PROMOTION OF OPTIMAL 
MATERNITY CARE 
Sec. 101. Additional focus area for the Office on Women’s Health. 
Sec. 102. Interagency Coordinating Committee on the Promotion of Optimal 
Maternity Outcomes. 
‘‘Sec. 229A. Interagency Coordinating Committee on the Promotion of Op-
timal Maternity Outcomes. 
Sec. 103. Consumer education campaign. 
Sec. 104. Bibliographic database of systematic reviews for care of childbearing 
women and newborns. 
TITLE II—RESEARCH AND DATA COLLECTION ON MATERNITY 
CARE 
Sec. 201. Maternity care health professional shortage areas. 
Sec. 202. Expansion of CDC Prevention Research Centers program to include 
Centers on Optimal Maternity Outcomes. 
Sec. 203. Expanding models to be tested by Center for Medicare and Medicaid 
Innovation to include maternity care models. 
TITLE III—ENHANCEMENT OF A GEOGRAPHICALLY, RACIALLY, 
AND ETHNICALLY DIVERSE INTERDISCIPLINARY MATERNITY 
WORKFORCE 
Sec. 301. Development of interdisciplinary maternity care provider core cur-
ricula. 
Sec. 302. Interdisciplinary training of medical students, residents, and student 
midwives in academic health centers. 
Sec. 303. Loan repayments for maternal care professionals. 
Sec. 304. Grants to professional organizations to increase diversity in maternity 
care professionals. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) The United States spends more than double 
per capita on health care than other industrialized 
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countries, but ranks far behind almost all developed 
countries in important perinatal outcomes. In the 
World Health Report 2005— 
(A) the World Health Organization identi-
fied 29 nations with lower estimated maternal 
mortality ratios than the United States (14/ 
100,000 live births); 
(B) the World Health Organization identi-
fied 35 nations with lower early neonatal mor-
tality rates (5/1,000 live births) and 33 with 
lower neonatal mortality rates (5/1,000 live 
births) than the United States; 
(C) 23 countries (out of 30 reporting) had 
superior low birth weight rates than the United 
States; and 
(D) 19 member countries (out of 23 re-
porting) had lower cesarean section rates than 
the United States. 
(2) Despite maternity expenditures in the 
United States, childbirth continues to carry signifi-
cant risks for mothers in this country, as dem-
onstrated by the following: 
(A) More than two women die every day in 
the United States from pregnancy-related 
causes. 
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(B) More than one-third of all women who 
give birth in the United States (1,700,000 
women each year) experience some type of com-
plication that has an adverse effect on their 
health. 
(C) African-American women having nearly 
a four times greater risk of dying from preg-
nancy-related complications than White women, 
and these disparities have not improved in 20 
years. 
(3) In spite of the Nation’s considerable invest-
ment in maternity care, the United States is failing 
to ensure that all infants have a healthy start in life, 
as demonstrated by the following: 
(A) The national rate of pre-term birth in-
creased by 36 percent in the quarter-century 
from 1981 to 2006. 
(B) The proportion of low birth weight ba-
bies increased by 22 percent between 1981 and 
2006. 
(C) Non-Hispanic Black infants continue 
to experience significantly higher rates of both 
pre-term birth and low birth weight, two of the 
leading causes of infant mortality in this coun-
try. 
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(4) Maternity Care is a major component of the 
escalating health care costs in this country, as dem-
onstrated by the following: 
(A) Maternity care for mothers and their 
newborns is the number one reason for hos-
pitalization in the United States, exceeding 
such prevalent conditions as pneumonia, cancer, 
fracture, and heart disease. Of those discharged 
from hospitals in the United States in 2007, 25 
percent were childbearing women and newborns. 
(B) Combined mother and baby charges 
for hospitalization, which was $86,000,000,000 
in 2006, far exceeded charges for any other 
hospital condition in the United States. 
(5) Maternity care also accounts for a signifi-
cant proportion of expenditures under the Medicaid 
program, as demonstrated by the following: 
(A) In 2006, 29 percent of all hospital 
charges under Medicaid ($39,000,000,000) 
were for birthing women and children. 
(B) Six of the 10 most common procedures 
reimbursed under the Medicaid program were 
maternity related, making ‘‘mother’s pregnancy 
and delivery’’ the most costly Medicaid expendi-
ture. 
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(6) Maternity care charges vary significantly by 
setting and type of birth. In 2005— 
(A) the average charge for a hospital ce-
sarean birth with complications was $15,900, 
and without complications was $12,500; 
(B) the average charge for a hospital vag-
inal birth with complications was $8,960, and 
without complications was $6,970; and 
(C) the average charge for a birth center 
vaginal birth was $1,600. 
(7) The procedure-intensity of birth-related hos-
pital stays helps to explain their high costs. In 2005, 
6 of the 15 most commonly performed hospital pro-
cedures for all patients with all diagnoses involved 
childbirth. Cesarean section was the most common 
operating room procedure for Medicaid, for private 
payers, and for all payers combined. 
(8) There is a vast body of knowledge regarding 
best evidence-based practices in maternity care, but 
current practice is not following the research, as 
demonstrated by the following: 
(A) A recent analysis of American College 
of Obstetrics and Gynecology obstetrical prac-
tice bulletins 1998 through 2004 found that 
only 23 percent of their practice recommenda-
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tions were based on good, consistent scientific 
evidence, while 42 percent of recommendations 
were based on consensus and opinion. 
(B) There is widespread overuse of mater-
nity practices that have been shown to have 
benefit only in limited situations, which can ex-
pose women, infants, or both to risk of harm if 
used routinely and indiscriminately, including 
continuous fetal monitoring, labor induction, 
epidural anesthesia, elective primary cesarean 
section, and repeat cesarean delivery. 
(C) There are multiple non-invasive mater-
nity practices that have been associated with 
considerable improvement in outcomes with no 
detrimental side effects, and are significantly 
underused in this country, including smoking 
cessation programs in pregnancy, group model 
prenatal care, continuous labor support, non-su-
pine positions for birth, and external version to 
turn breech babies at term. 
(9) The growing shortage of maternity health 
care professionals and childbirth facilities is creating 
a serious obstacle to timely and adequate maternity 
health care for women, particularly in rural areas 
and the inner cities. 
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(10) There are significant racial and ethnic dis-
parities across the maternity care workforce creating 
additional access barriers to culturally and linguis-
tically competent maternity services. 
(11) Although most women in the United 
States are healthy and at low risk for complications, 
Obstetrician-Gynecologist Surgeons are the lead 
caregivers for about 79 percent of women during 
pregnancy and labor, as compared to midwives who 
care for 8 percent to 9 percent of women, and Fam-
ily Practice Physicians who care for 6 percent to 7 
percent of women. Among developed nations, only 
the United States and Canada rely to this degree on 
specialists rather than midwives or family physicians 
to provide care to healthy birthing women. 
(12) There is a growing shortage of Obstetri-
cian-Gynecologists in the United States who provide 
maternity services. Data from the 2006 American 
College of Obstetricians and Gynecologists (ACOG) 
Survey on Professional Liability showed a negative 
trend in length of obstetrical practice, with the aver-
age age at which physicians stopped practicing ob-
stetrics being 48 years. At one point this was the 
near midpoint of an Obstetrician-Gynecologist’s pro-
fessional career. 
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