MONTGOMERY — Women, doulas, doctors, midwives and other birthing advocates from around the country, many with children in tow, showed up in Montgomery on Thursday to protest proposed regulatory rules from the Alabama Department of Public Health (ADPH) on birthing centers.

The meeting was held at 2:00 at the Montgomery County Public Health Department, where ADPH officials heard public comments.

Every person who spoke at the meeting opposed the rules, saying the proposed regulations constitute a de facto ban on the existence of all birthing centers in the state. Opponents of the rules offered varying critiques, ranging from lack of accessible birthing care in rural areas, restrictions on those who do not want to labor in a hospital but cannot access a home birth, unrealistic and cost-prohibitive measures placed on birthing centers and more.

Representatives from the Alabama State Board of Midwifery, The American Association of Birth Centers,  the American College of Nurse-Midwives, and other similar organizations attended the meeting to speak in opposition.

ADPH leadership had one woman removed from the meeting due to her repeated outbursts and vulgar hand gestures. The woman did not appear or claim to be associated with any of the present organizations, and no one that spoke to 1819 News knew her identity.

The meeting was filled with passionate objections to the proposed rules, with calls to allow professional midwives to have some say in formulating regulations, which all agreed were necessary. Nearly 20 spoke against the rules, and no one spoke in favor.

Last year, ADPH also introduced similar regulations on birthing centers that were opposed by those within the birthing community. After saying it would address opponents' concerns, ADPH suggested the current rules, which are equally unacceptable to those assisting in out-of-hospital births.

Alabama previously had regulations for birthing centers, which it repealed in 2010 due to the lack of centers in the state.

Opponents said ADPH is proposing to essentially reinstate the previous rules that existed before midwives were permitted to deliver babies in Alabama, evidenced by the rules' antiquated language and terminology.

Many women nationwide have been switching to alternative methods of birthing children other than in the hospital, often choosing to have a midwife, doula or both attend their birth.

RELATED: Alabama advocates continue struggle for birthing rights.

The reasons for choosing midwifery care over hospital care are many. Some have had previous negative experiences with hospital birth. Others simply prefer a less medical approach to what they consider a natural bodily function that requires no medical intervention outside of emergencies. 

Birthing centers offer a middle ground between a hospital birth and home birth. According to one speaker, birth centers allow a "home-like environment" for mothers to give birth while still having access to certain medicines and interventions in the case of an emergency. Otherwise, the mothers can give birth as they see fit, in line with their preferences.

While there are various levels of certification for different kinds of midwives, they all require extensive training, and licensed midwives have stringent regulations dictated by the state.

Alabama has only allowed certified professional midwives (CPM) to perform births for five years, although they are still excluded from participating in hospital births.

Among other things, the proposed rules would exclude CPMs from delivering babies in birthing centers, which is not the practice for other birthing centers nationwide.

Noel Leithart, who chairs the Alabama State Board of Midwifery, took the microphone to criticize ADPH for not including anyone from the state midwifery board or anyone who provides birthing care outside of a hospital in formulating the rules.

"I have personally birthed 10 children unmedicated in normal, physiological births," Leithart said. "As a midwife, I have witnessed over 300 unmedicated, normal, physiological births. So yes. I do feel a little bit like an expert in this field."

She continued, "When it became apparent last December that ADPH was not pushing through their original set of rules for free-standing birth centers, I asked for a seat at the table discussion in order to represent the licensed midwives. I was told that I would be kept informed. But again, when I heard in March that new rules were coming, I asked for a seat at the table. I was effectively denied. This is appalling considering that free-standing birth centers are historically the place where [the] midwifery model of care occurs, and midwives oversee births."

Leithart further described rules used by Texas to regulate birth centers as an acceptable alternative to the restrictive rules suggested by ADPH. She also said the rules would essentially make birth centers into "birthing hospitals," an unacceptable proposition for birthing advocates since most choose out-of-hospital births to avoid the hospital environment for its perceived intrusive policies and interventions.

Several mothers also spoke, many of whom became doulas or midwives after experiencing maltreatment while giving birth in a hospital. The mothers described many instances of traumatic experiences due to excessive intervention on behalf of OB-GYNs and hospital staff during labor.

Dr. Heather Skanes works at a midwifery-led, physician-owned birthing center in Birmingham called Oasis Women's Health, where she operates as the center's obstetrician and gynecologist. According to Skanes, ADPH has already forced Oasis from accepting new patients until the regulations are finalized, which places the center in a perilous state of affairs.

"[ADPH] have asked us to basically stop operating because of these regulations, and they are wanting us to wait until regulations are passed before we can actually resume operations," Skanes said.

Skanes says there is a disconnect with the medicalized view of birth as a medical condition needing intervention, an idea she and other birthing advocates reject.

"I think there is a perception from people who don't work in women's healthcare that birth is inherently dangerous, and I think that's not true, especially for low-risk women. I think that we have so much evidence that helps us to really re-stratify, and I think that if you didn't work in a birthing space, you wouldn't know that. You would just assume, 'Oh my god. Someone's pregnant. They're going to die.'"

Skanes further said the proposed rules would "essentially be compelling" hospital births since home births are not an option for most women.

"I think hospitals, one, don't want any competition," Skanes continued. But that's just like if I sold Coke, I don't want Pepsi, right? That's just a business strategy. But then two, I think that hospitals and providers assume that they are going to get the worst-case scenario from the midwives and they are going to be held liable for decisions or clinical care that was provided outside of the hospital. And I can tell you, as someone who accepts home birth transfers from people who are not necessarily my patients, these are not emergencies."

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