The Alabama Midwives Alliance (ALMA) is crying foul after the Senate Healthcare Committee called a surprise meeting to vote on amending legislation related to midwifery that ALMA and other advocates fiercely opposed.
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.
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. SB87 sought to allow midwives to conduct three at-home tests that advocates believe are crucial to obtain as soon as possible.
Despite compromising on multiple aspects of the bill, ALMA claims it was blindsided by a committee vote on Thursday.
The Senate Healthcare Committee met on Wednesday to vote on the bill. State Sen. Linda Coleman-Madison (D-Birmingham) offered a substitute to the bill, which Orr and ALMA agreed upon. However, State Sen. Larry Stutts (R-Tuscumbia) offered his substitute, which ALAMA fiercely opposed.
Coleman-Madison's amendment removed initial language related to midwives working in birth centers, focusing mainly on approving the rights of midwives to administer the three at-home tests: CCHD screening, hearing screening, and blood spot testing. It also clarified that a patient must be referred to a licensed physician or certified registered nurse practitioner for interpretation and follow-up.
Stutts' version, on the other hand, only allowed midwives to conduct the blood spot testing, leaving the other two tests outside the scope of practice.
State Sen. April Weaver (R-Brierfield) asked for additional time to examine the two proposed substitute bills more in-depth. The committee was also confused about whether Coleman-Madison's substitute had been agreed upon by all parties, including some healthcare regulatory agencies.
The committee adjourned on Wednesday without a vote. However, on Thursday morning, it was announced that it would meet again to vote on the substitute later that day. The committee met and approved Stutts' version of the bill.
Prior to the vote, ALMA had accused regulatory agencies of interfering in the bill, trying to stifle midwives' ability to practice in the state. After the vote, ALMA wasted no words in placing all the blame at the foot of the Medical Association of Alabama (MASA).
In a release, ALMA accused Stutts and Niko Corley, MASA's Director of Legislative and Public Affairs, of "backroom politics" by secretly working on a substitute while claiming to agree on Coleman-Madison's substitute.
"While removing the birth center language was not what we wanted, we knew conceding on anything except the screenings was a win for the babies, and we had to keep their health and safety at the highest priority, so we accepted Mr. Corley's verbal offer in negotiations," ALMA Legislative chairwoman Nancy Megginson said. "We later learned that the offer occurred after Sen. Stutt's sub bill had already left LSA [Legislative Services Agency] on March 4, making Mr. Corley's offer not even valid, only lip service. This process has been full of deception, secrecy, and political maneuvering at the expense of Alabama mothers and babies.
"A bill that could have improved access to care was deliberately sabotaged to prioritize physician-led preferences over real solutions. In Alabama we do a good job of that; promoting physicians. Alabama families deserve better. They deserve physician leadership that looks beyond the paper and into what's actually happening in the community."
ALMA claims the Stutts substitute severely limits midwives' ability to detect diseases swiftly after birth, enumerating the perceived unrealistic expectation for newborn parents to schedule testing within 48 hours following childbirth.
"The word 'newborn' is in the bill, but it's not about them anymore, MASA has made the substitution about power," Megginson continued. "It's about the clear picture we presented at the public hearing that homeborn babies are being delayed and missed due to physician logistics, so MASA 'gave us' heel lances to look like they care, but then tied our hands tighter in other areas, thus increasing risks to the newborns."
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.
ALMA contends that not allowing midwives to perform the health screenings would delay parents receiving results as quickly as possible, thereby wasting valuable time for newborns.
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