Midwives, doulas, and birthing advocates have struggled to draw attention to the cause of prenatal care and childbirth rights in Alabama.

House Bill 164 (HB164), sponsored by Rep. Debbie Wood (R–Valley), would allow licensed midwives to attend Vaginal Births After Caesarians (VBAC) and provide birthing care in an out-of-hospital setting. The bill would apply only to midwives who have received state licensing and not traditional midwives. Traditional midwives choose not to obtain certification or licensure due to religious, philosophical, or personal reasons.

On Wednesday, March 16, a public hearing was held in a House committee in which mothers, midwives, and doulas were able to advocate for the bill and detail their experiences.

The bill has drawn attention to the fight of many mothers and birth-care providers to seek alternative forms of prenatal, birthing, and postpartum care due to negative experiences with birthing in a hospital.

While the practice of vaginal births after caesarians (VBAC) has become more common with fewer complications, according to the May Clinic the concerns of doing so not in a hospital environment center around the possibility of complications, including uterine ruptures, that may occur after a failed trial of labor after a C-section. According to the Mayo Clinic, this happens in less than 1% of women who attempt a trial of labor after cesarean. However, uterine rupture is life-threatening for the mother and baby, requiring an emergency C-section to prevent life-threatening complications.

A 2019 peer-reviewed, published, and registered meta-analysis of twenty years’ worth of studies published in The Lancet (a weekly peer-reviewed general medical journal) on home birth containing roughly 500,000 parents. The analysis also showed that parents birthing at home have fewer medical interventions and fewer Cesareans. But the study also said there are no current, conclusive VBAC homebirth studies to date. There is not enough data to compile showing how those risks compare specifically for VBAC parents.

Mothers from around the state have detailed to 1819 News allegations of poor or insufficient prenatal treatment combined with forceful or manipulative hospital staff, including allegations of doctors or nurses who manipulate or compel their patients into their preferred method of care.

One such allegation of medical trauma comes from a student midwife Charity Howard, who also sits on the board of the Alabama Birthing Coalition.

Howard detailed to 1819 News the trauma she allegedly suffered during the delivery of her first child. Now that she is expecting her second child, her desire for passage of the bill comes from her desire to have an assisted VBAC at home. Howard is on her way to becoming a fully licensed midwife, a decision she made after the trauma experienced from her experience with a hospital birth.

She alleges that the day before her planned delivery at a Birmingham area hospital, Howard waited for hours in the hospital with blood pressure at stroke levels before her doctor was available.

The following day, after her water broke, she claims she was allowed to labor for six hours before she felt pushed to undergo a C-section due to what she said her doctors called "failure to progress." Although she did not desire to have a C-section, she felt pressured to do so and allowed the operation to go forward.

"They were talking about their plans for the weekend during the section," Howard alleges.

Howard also detailed one alleged event of advocating for a mother with whom she was working. Howard was on the phone with the mother while in labor because hospital restrictions would not let her be physically present. The mother did not want a C-section, but claims the healthcare staff urged the mother to comply. While on the phone with hospital staff, Howard attempted to inquire why the mother was being pushed to have the operation, and Howard says the hospital staff hung up the phone. The mother yielded to undergoing the C–section during the labor process.

Howard alleges that trauma from hospital birth is so common among mothers that most who desire to have an out-of-hospital birth would rather have an unassisted home birth than deliver in a hospital again, a sentiment shared by the mothers who spoke with 1819 News. Howard stated that legislation such as HB164 is pivotal for allowing mothers to give birth in the manner they deem most safe.

"We have so many that now, Alabama's Health Department has had to develop a way to record unassisted home births," Howard said.

Many mothers have related stories of traveling to neighboring states with less restrictive laws on midwives, which is the only legal option for mothers in Alabama who wish to have a midwife attend their VBAC.

A majority of mothers who advocate for VBACs claim that C-sections are often overused and are very traumatic. According to Jessica Barker, Alabama chapter president of the International Cesarean Awareness Network, the prohibition against VBACs is due to a massive misunderstanding of the process. Despite the risk, which studies show is consistently less than 0.1%, , many mothers have stated that the risk is acceptable for them to give birth in their preferred manner and environment. Barker further emphasized that hospital policies that don’t allow for VBACs essentially mandate surgery for pregnant mothers who have had a previous caesarian.

“A lot of hospitals will have a policy that says they don’t ‘do’ VBACs,” Barker said. “The important thing to remember here is that VBAC is not an operation; it’s a vaginal birth.”

Kate Petty of Auburn detailed her experience with her first birth in the hospital in which she lost her daughter three hours after the grueling birth. The painful experience was filled with what she considered attempts by medical staff to coerce her into decisions that she did not desire and on which she alleges she was not given informed consent.

“I didn’t want the medical intervention, but I felt it was pushed on me.”

After her negative experience with the first hospital birth, she sought alternative birthing care and delivered her next child in a camper that was driven to Georgia. She has gone on to be a home-birth advocate.

She also stated that most C-section mothers with whom she works have lingering trauma from the experience.

One mother, Erin Inman from Phenix City, detailed her first birth in a hospital where she was allegedly compelled to receive a litany of medical interventions without appropriate informed consent. She has gone on to be a student midwife because of the experience she had with her first C-section.

“I was a first-time mom,” Inman said. “I didn’t put enough research into it. You just think you go to the hospital because that’s what everybody does.

"They wheeled me into the ER and had me cut open before I knew what was happening. I was bawling and crying because I was scared to death. I thought I was going to die. This whole time, they aren’t telling me anything that they’re doing."

After the C-section, her baby was taken out of the room while they waited to sew her up, a wait that Inman says took over an hour, a time during which she was unable to see her baby.

“I would rather have a baby, alone, by myself, in a closet, then go to the hospital again,” Inman said.

Amber, another mother who became a doula after her negative hospital experience with her first two children, detailed to 1819 News the trauma of her first delivery. Amber told similar stories involving an alleged lack of informed consent and forceful and manipulative hospital staff.

According to Amber, her first birth was a planned C-section filled with undignifying and cold processes.

“As they’re doing the surgery, they have me tied down to the table, completely naked, with just me and my husband,” Amber said.

“I asked the nurse if I can hold my baby, and she said, ‘well you just got your dose of morphine,’ and literally seconds later, I was asleep,” Amber claims. “I didn’t ask for it, and they didn’t tell me they were doing it.”

Amber stated that it was multiple hours after the procedure before she was allowed to hold her baby.

Amber’s second birth was a hospital VBAC, yet still allegedly involved an uncaring staff, less-than-dignifying procedures, and lackluster postpartum care.

11819 News reached out to members of the Medical Association of the State of Alabama but received no response. 

To connect with the author of this story, or to comment, email craig.monger@1819news.com