Midwife Rally

Kaycee Cavender, president of the Alabama Birth Coalition, speaks during a rally for midwives Wednesday, Feb. 15, 2017, on the steps of the Alabama State House in Montgomery, Ala. (Julie Bennett/jbennett@al.com)

(Julie Bennett)

Legislation that would pave the way for midwife-assisted home birth is headed for a vote in the Alabama House of Representatives for the first time since midwifery proponents began working to change the law more than a decade ago.

"We're very excited," said Kaycee Cavender, president of the Alabama Birth Coalition, a lobbying group that has been pushing to decriminalize midwifery in Alabama. Currently, it is illegal in Alabama for most midwives to practice. Home birth is only legal if it is unassisted by a professional, such as a midwife.

"It's the first time that we have ever gotten a bill out of House committee."

The pair of bills, HB 315 and HB 316, were given a favorable report yesterday in committee. They're headed to the floor of the House after the legislature returns from a two-week break.

"Legislators are seeing how hard we have worked for many years for this," said Cavender, "and they've acknowledged we deserve to be heard."

HB 315, a decriminalization bill, would exempt midwives who hold certain certifications from being prosecuted for practicing midwifery. The Childbirth Freedom Act, HB 316, would establish a State Board of Midwifery and require midwives to earn the Certified Professional Midwife (CPM) certification through a nationally-accredited program in order to get a license to practice in Alabama.

Alabama is one of a five states that does not allow midwives to practice and actively prosecutes non-nurse midwives.

Cavender credits the bills' success to a more concentrated effort by midwife supporters and improved support from legislators this year.

Midwife advocates say the bills are necessary because Alabama has a shortage of maternity care providers and many women have to drive long distances to reach a hospital that offers labor and delivery services. There are no birth centers in Alabama.

Alabama also has one of the lowest rates of OBGYNs per 10,000 women in the country, according to the American Congress of Obstetricians and Gynecologists. Thirty-two of Alabama's 67 counties do not have a practicing OBGYN.

The midwife bills face opposition from the Medical Association of the State of Alabama, the Alabama Hospital Association and the Alabama State Nurses Association. The American College of Nurse-Midwives and its Alabama affiliate have lent their support to HB 316 after certain amendments were made. Certified Nurse-Midwives, which have credentials on par with nurse practitioners, can legally practice in Alabama if they work in collaboration with an obstetrician.

"Several other states have passed similar legislation and we look forward to Alabama being a leader in improving women's access to care by increasing the accessibility of care providers," said the Alabama Affiliate of ACNM in a statement.

The Medical Association of the State of Alabama remains firm in its opposition of HB 315 and 316.

"We're still very much opposed to these bills, despite the few amendments that were adopted," said Mark Jackson, executive director of the Medical Association of the State of Alabama. "The main thing is that we still have tremendous concern about home birth, regardless of who provides the care."

Opponents of the bill met with the bills' sponsor, Rep. Ken Johnson, R-Moulton, co-sponsor and House Speaker Mac McCutcheon, R-Monrovia, and Rep. April Weaver, R-Brierfield, who has proposed a more limited midwifery bill which would allow some midwives to work in birth centers, but not attend home births. The Alabama Birth Coalition and other supporters of HB 315 and 316 do not support Weaver's bill, which was created by the Medical Association "as a conversation piece to put on the table for discussion," said Mark Jackson, the association's executive director.

Out of that meeting came multiple amendment requests to HB 316, said Cavender. Around half of the amendments were accepted by the bill's supporters, most of them dealing with governmental reporting requirements for midwives and providing paperwork similar to what maternity patients are given at the hospital.

"These were all standard things that in no way inhibit a midwife's practice," said Cavender. Other amendments, including requiring CPMs to sit for a nurse-midwife's exam, were rejected.

The amendments that were accepted were "far too few in order for us to be comfortable," said Jackson. He said the Medical Association has changed its position slightly on out-of-hospital births.

"As we started this conversation we weren't sure birthing centers were the right thing to do," said Jackson. While the Medical Association would support the opening of birth centers staffed by Certified Nurse-Midwives and overseen by obstetricians, "We feel strongly in our hearts that home birth is clearly not the right thing to do."

While the state legislature is on a two-week Spring Break, Cavender said the bills' supporters are going to "reorganize and strategize" in preparation for the House vote and beyond.

"The Senate is where most of our work is," she said. "Our opposition is working really hard on those senators, so we have to come back and work harder."