Midwife rally 2017
Supporters of legislation that would legalize certified midwives gathered at the Alabama Statehouse for a rally in February 2017. (Photo credit: Corinne Rollan, Elise Photography)
A pair of bills in the Alabama legislature would allow certain types of midwives to legally work in the state and could open the door to out-of-hospital births.
"We are confident this is our year," said Kaycee Cavender, president of the Alabama Birth Coalition, an advocacy group that has been working with state legislators to introduce midwifery reform bills for more than a decade.
"For us, it's been a 13-year gestation for this long-overdue baby," she said.
Currently, most midwives can't legally deliver babies in Alabama, and home birth is only legal if a midwife or other professional is not attending.
The Childbirth Freedom Act, HB 316, is similar to the bill proposed last year, which would require midwives to receive the Certified Professional Midwife (CPM) accreditation through a nationally-accredited program in order to get a license to practice in Alabama. The bill would also establish a State Board of Midwifery to regulate education standards and practice guidelines.
This year's bill removes twin and breech births from the types of births that CPMs would be allowed to attend.
Cavender said that was a concession to organizations including the Medical Association of the State of Alabama and the Alabama Department of Public Health, whose leadership did not feel comfortable supporting a bill that included twin and breech births in the scope of a midwife's duties.
Despite concessions, the Medical Association still opposes the bill.
"We still have concerns," said Mark Jackson, the association's executive director. "The concept of home birth, which is really what this is all about - allowing midwives to do home birth - we have serious reservations and concerns about that. Nothing has changed in that regard.
"It's not about who can deliver and where they can deliver when everything goes right. From our point of view, we're debating where that mother and child needs to be when things don't go right, and how rapidly things can go wrong."
Jackson said MASA is working on its own bill, which could be introduced as early as the 2017 legislative session.
"It's not going to allow home birth, but it would have some parameters in place that might allow a midwife who is properly trained, educated to do some deliveries in a birthing center. It would have to be reasonably located in proximity to a hospital in case there were complications or emergencies where a mom or baby would need to be transferred to a hospital."
The Alabama Birth Coalition and other midwifery supporters held a rally on the steps of the Statehouse last week in support of the Childbirth Freedom Act.
"We want the same rights and the same choices and the same access to Certified Professional Midwives here in Alabama that women in 31 other states have," said Erin Mize, director of strategic initiatives for the Alabama Birth Coalition, during the rally.
Mize and others pointed to the savings to Alabama's healthcare system and Medicaid that could be had by utilizing midwives for prenatal care and births, and providing maternity care in areas where women must drive long distances to hospitals or obstetricians' offices.
"By integrating CPMs into Alabama's maternity care system as a safe option for healthy women we could, conservatively, save Medicaid and private insurance millions of dollars," said Mize.
"The (Childbirth Freedom Act) belongs to the nearly 25 percent of women in our state who do not get adequate prenatal care, some even going their entire pregnancies without it."
The Childbirth Freedom Act has 37 sponsors and co-sponsors in the Alabama House.
"We really do have overwhelming support in both chambers," said Cavender. She said ABC spent the summer meeting with representatives from the Department of Public Health, MASA, Alabama Medicaid and the state's Certified Nurse-Midwife association, as well as convening an advisory council of Alabama midwives who practice over the state line in Tennessee, Mississippi and Georgia.
"I think everyone has realized that after 13 yearsw we all have to come to the table," she said. "There is no such thing as a perfect bill, and no one is going to leave fully satisfied they got everything they wanted. Let's figure out where we can meet in the middle so the professional and consumer concerns are equally met and we can get midwives to consumers who desperately need them, and savings for Medicaid. It's a win-win-win."
Rep. Ken Johnson (R-Moulton), sponsor of the Childbirth Freedom Act, also filed HB 315, which would simply decriminalize Certified Professional midwives. Currently, state law says it's a misdemeanor offense to practice midwifery without a license issued by the State Board of Nursing and the Board of Medical examiners. HB 315 would let midwives legally practice if they are certified by an accredited organization, but would make the practice of lay midwifery a criminal offense.