The Alabama Midwives Alliance (ALMA) claims it is getting pushback from state regulatory agencies as it tries to advance legislation allowing midwives to collect newborn screenings for babies born outside of hospitals.
Like many years before, Alabama midwives are asking the legislature to expand their ability to perform birthing care in non-hospital settings.
SEE: Alabama advocates continue struggle for birthing rights
SEE ALSO: Midwifery bill fails committee
This year's bill is Senate Bill 87 (SB87) by State Sen. Arthur Orr (R-Decatur). In addition to revising technical language, the bill would allow Midwives to perform newborn screenings for specific diseases.
The bill initially allowed midwives to provide care in freestanding birthing centers. However, ALMA says an amendment is coming to remove that provision at the request of several regulatory agencies. Midwives are currently not permitted to assist in hospital births.
Alabama previously had regulations for birthing centers, which were repealed in 2010 due to the state's lack of centers. Once plans began to open several centers, the Alabama Department of Public Health (ADPH) implemented new rules barring Certified Professional Midwives (CPMs) from working in birth centers.
RELATED: Midwives and birthing advocates come out swinging against proposed birthing center rules from ADPH
Despite protests, ADPH passed the rules, which a circuit judge swiftly blocked.
Currently, parents have to secure testing within 48 hours at a pediatrician, which birthing advocates such as ALMA claim is unrealistic and often leads to parents not doing the screenings early enough, especially in cases of home birth.
Despite compromises on the bill, ALMA says state regulatory agencies are still trying to restrict CPMs' ability to perform screenings ahead of a proposed March 19 vote. According to ALMA Legislative chairwoman Nancy Megginson, midwives are trained and licensed to provide screenings.
"Alabama lawmakers have a choice to make on March 19: Stand for newborn safety or allow unnecessary bureaucracy to put babies at risk," ALMA said in a statement. "SB87, set for a Senate Healthcare Committee vote, would ensure that newborns born at home receive the same lifesaving screenings—CCHD, hearing, and blood spot—as those born in hospitals. Yet, despite years of negotiations and repeated compromises from midwives, Alabama's regulatory boards continue blocking midwives from administering these essential tests."
It continued, "In 2023, key definitions were removed from the bill to ease opposition. It was never called for a vote. This year, regulatory boards proposed a compromise allowing midwives to administer newborn screenings while requiring results to be sent to a physician. Midwives agreed—prioritizing newborn safety over everything else. Then, without warning, regulators backtracked, falsely claiming they had only ever considered allowing midwives to perform the blood spot test.
"This isn't a misunderstanding," Megginson said. "The bill has always referred to 'newborn screenings'—plural. The goalposts keep moving because the opposition isn't about safety. It's about restricting midwifery."
The screenings in question are:
- CCHD screening detects critical congenital heart defects with a handheld pulse oximetry. Newborns can seem perfectly healthy but deteriorate rapidly without immediate medical intervention.
- Hearing screening identifies hearing loss early, ensuring timely intervention to prevent developmental delays. Most pediatricians don't have the equipment, forcing families to scramble for a specialist, yet performed by ancillary staff at the hospitals.
- Blood spot testing, similar to a glucose blood drop, detects metabolic and genetic disorders, where delayed treatment can result in severe disability or death.
Dr. Jeremy Thompson, co-founder of Safer Birth Bama, expressed concern about not allowing midwives to perform the tests.
"As a physician, I cannot accept that Alabama is making it harder—not easier—for midwives to provide these screenings," Thompson said. "This isn't about regulation. This is about newborn safety. No other state forces families to secure a physician appointment within 48 hours postpartum just to access tests that midwives are fully trained to administer."
Thompson's wife, Jessica, another co-founder of Safer Birth Bama, detailed the "maddening" process of procuring a newborn screening with a physician after having a baby at home.
"When our fifth baby was born at home in early 2020, just before the pandemic, we assumed accessing newborn screenings would be simple," she said. "We were wrong. Despite being a medical family, we had to fight to get the blood spot screening card—something that should have been immediately available through our midwife. It was maddening to navigate this red tape, knowing full well these screenings are critical and time-sensitive. This was never an issue for our Tennessee midwife and it's appalling."
Megginson reiterated that state law does not prohibit midwives from performing newborn screenings. Instead, she said it was a rule imposed by ADPH requiring midwives to refer newborns to a licensed physician. State law permits midwives to order screenings, and, according to Megginson, state law does not differentiate between "order" and "administer," but ADPH does.
"There is no other statute with language saying who can administer these screenings only who can order, and the existing statute already says 'order' and uncredentialed, ancillary, hospital staff are administering these tests," Megginson added. "Legislators need to ask themselves: Can a state truly be pro-life and anti-midwife? Are we witnessing a modern-day Exodus 1:15-21? Will opposing regulatory bodies become the new Pharaoh, ordering midwives to withhold lifesaving screenings so that newborns perish?"
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