The need for midwives in Alabama is a big issue which, for the most part, falls on deaf ears. Although the Alabama Birth Coalition (ABC) introduces and argues for midwifery legislation each year; many times the bill never makes it out of committee debates. Each legislative session ABC’s bills for the Senate and House of Representatives (The Home Birth Safety Act) are “tabled” over and over, without discussion. Women are forced to cohere to the standard of OB care offered, or find other inconvenient alternatives for birth options.
The current midwifery situation in Alabama:
I am constantly told Alabama has “midwives”. To which I reply, “No, Alabama has Certified Nurse Midwives (CNMs), who are not allowed to practice with their full scope of capabilities.” Alabama allows CNMs to practice under the direct supervision of an OB. (The OB is called into the hospital for the CNM to work.) That means, ultimately, the OB has the last word on your birth options. Also, there are not many CNMs practicing due to the legal restraint and cost to work under an OB. Alabama does not allow Certified Professional Midwives (CPM), who would most likely collaborate with OBs in the case of any issue that may arise; but not a necessity. Along with CPMs, the option of birth centers (free standing or hospital attached) would be created. Alabama also allows doulas. Doulas are birthing coaches, essentially. They provide encouragement, pain management options, and stick to your birth plan. Yet, many hospitals have changed their policies to only allow doulas that sign an agreement to work with the hospitals’ “labor policies”. Example: You do not want an IV. Hospital policy is for every patient to have an IV. What is the doula to do? It creates a conflict of interest for the doulas. Many women who want more control in their birth either drive out-of-state to have midwifery care, illegally deliver at home with assistance from a midwife, or legally deliver at home without any medical assistance. The infant mortality rate for Alabama is 8.73 deaths per 100,000 live births. (CDC, 2010) The infant mortality rate is double the rate for African-American babies than Caucasian babies. The maternal mortality rate is 11.6 deaths per 100,000 live births. (2010) 29 of the 67 counties have a hospital with OB care, 16 of those 29 are considered “rural” and are without OB care within hospitals. The cesarean rate is 35.5%; that is the 6th highest rate in the US. The vaginal birth after cesarean (VBAC) rate is 3.3%.
How could CPMs change maternity care in Alabama?
CPMs work with pregnant women, who are considered low risk and normal. Any women that show signs of abnormalities are referred to a collaborative OB and hospital. Women looking for more of a holistic approach to birth, not the standard medical condition from OBs could choose CPMs. CPMs lower the cesarean rate. Midwifery care lowers your overall cost for prenatal care, labor and delivery, and post delivery care. Not pregnant? That’s fine! Midwives often provide general gynecology care too. All of those Alabama women residing in counties without hospital OB care, (especially the rural counties), would have access to proper, affordable maternity care; because the midwives make house calls. Women do not have to take off of work, find childcare, travel over an hour for prenatal care or to deliver. The OB system within Alabama would be relieved from mundane, low risk pregnancies to focus on high risk pregnancies, as it was meant to. Wow, that offers major improvement! To top it off, the American Public Health Association and the World Health Organization, both approve the use of midwives for low risk pregnancies.
So, why is Alabama so resistant?
The Medical Association of the State of Alabama (MASA) argues the reasoning behind not allowing CPMs in Alabama is because any labor (low or high risk) is a medical condition, which requires the expertise of an OB and hospital setting. It is for the women’s and babies’ best interest. Uh, really? So, why does the state allow medically unassisted home births?! That is not looking out for Alabama women. The above mentioned statistics prove MASA isn’t for women’s best interest. The REAL reason is because CPMs offer exceptional care with lower costs. MASA, OBs, and legislators would lose a lot of money from women with low risk pregnancies and gynecology care. Follow the money trail! MASA has several prominent OBs on the Board of Directors, along with sponsors for legislators. Conveniently, they have major Alabama insurance companies under their influence too. Making the usage of midwives and doulas an out-of-pocket cost for most women. The resistance is all about greed. Lawmakers would rather endanger women and children to pad their pockets. Evidence has shown time and time again, that OBs perform unwanted medical procedures on women; driving up the medical bill. (Just look at my birth story! My OB was in such a hurry to perform a more expensive C-section, that he forcibly pulled my placenta out (instead of allowing me to naturally birth it) and making me hemorrhage. My mundane, low risk labor and delivery turning deadly within seconds. And you better bet we were charged for that shot of Pitocin and extra IV bag.)
In closing, Alabama has a NEED for midwifery/CPMs. The current OB model of care is stretched to the ends, expensive, and dangerous. The demand far out weighs the supply. Alabama women and babies are dying because of this. Women are waking up to this and demand better maternal health care, only to be denied for greedy reasons. Please Alabama women, continue to SPEAK UP and EDUCATE yourselves on proper maternal care. Do not wait until you have already experienced a traumatic birth or loss of a child, friend, or family member. Do not hide in the shadows! Let your voices and stories be heard!