Midwifery Legislation Takes a New Approach

Lisa Clark

For the eighth time, legislation pertaining to midwifery stood before the state legislature this year. "This bill doesn't touch whether we should have home births or hospital births. It doesn't touch how midwives should be licensed, how they should be regulated. It only addresses whether they should be criminals,” announced Representative Joe Hubbard during the March 19 public hearing for his House bill, HR 601.

In years past, legislation on midwifery sought certification and regulation of the practice. Medical professionals, including the Medical Association of the State of Alabama, did not support the need, and the bills failed.

This year’s legislation focused only on decriminalizing midwifery. With judicial precedent sitting on Alabama’s books, supporters said they needed to create protection before pursuing certification.

“Alabama is one of only nine states which prosecute certified professional midwives who attend out-of-hospital births,” says Lisa Clark, advocate with the Alabama Birth Coalition, a group of families supporting the right of mothers to choose home births.

Two women have been prosecuted in Alabama for practicing midwifery, Clark says. The last was in 2002, when the midwife paid a fine and was prohibited from practicing for 18 months. “She was not about to go through that again,” Clark says. “Before it was even settled, she was licensed in Tennessee and practicing there.”

This latest bill, HB 601, mimics one presented earlier this year in the Senate. Senator Paul Bussman introduced SB 99, the Home Birth Safety Act of 2014, in January. Though it made it through the public hearing, it stalled in committee in March.

“Rep. Hubbard took that original bill and listened to the concerns of the committee and made amendments to address those and simplify it,” Clark says.

Hubbard’s House bill adds wording to Section 34-19-11 of the Code of Alabama 1975 to provide women with the right to choose where and with whom to provide physiologic childbirth. It also creates immunity from criminal prosecution to midwives and civil immunity to certain healthcare providers, such as EMTs, who provide care related to a physiologic childbirth.

The bill only covers midwives who hold a current midwifery certification from an organization accredited by the Institute for Credentialing Excellence. It defines care as “physical or emotional support, education, advice, or assistance, in good faith, to a woman choosing physiologic childbirth at the conclusion of her pregnancy outside of a hospital or medical facility.”

“Alabama law currently allows families to choose home birth as long as their home births are not attended by any professional care provider. Any midwife who attends an Alabama home birth risks prosecution,” Clark says.

This includes Certified Nurse Midwives (CNM). The Board of Nursing supports women having the right to choose home births, but code prohibits CNMs from planning for home deliveries, according N. Genell Lee, MSN, RN, JD, and executive officer with the Alabama Board of Nursing.

Because of liability concerns, Lee says, not all CNMs can even attend deliveries in hospitals. “The focus of most CNM practice is prenatal and postnatal care but not delivery. There are active practices where CNMs are allowed to participate in hospital deliveries in the Athens and Dothan areas but not in most areas of the State of Alabama,” she says.

Currently, anyone caught assisting with or attending a home birth in Alabama is subject to a class-C misdemeanor. Penalties could mean up to three months in jail and fines of up to $500.

Clark says the fear of prosecution and cost of legal fees forces pregnant women and their midwives to travel to neighboring states, such as Florida, to give birth where midwifery is legal. Not an optimal choice but their actions show how strongly the families feel about avoiding a hospital setting.

Should the legislature change the code to allow CNMs — who currently must be in collaboration with a physician — to attend and plan for home deliveries, “the Board of Nursing would support allowing Certified Nurse Midwives practicing at the scope of their education and practice,” Lee says.

Governor Robert Bentley was quoted In the Florence Times Daily in February as saying he’s not opposed to legalizing midwifery. “I feel that midwives that at least have the proper training, that have backup so that if there are any problems they could get the mother — in one or two percent of births — to the hospital quickly, then I have no problems with that,” Bentley said.

HB 601 was introduced only a few weeks before the slated end of the session on April 7. Though it quickly received its first reading, assignment to committee, and public hearing, it lay dormant in committee at the time of press, just like the earlier Senate bill, SB 99.

“There’s only a few weeks left in the session, so it has to happen pretty quick,” Clark says. “I once watched a bill go from a first reading through the House process and the Senate on the last day of the session. We can’t foresee any miracles, but stranger things have happened.”


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