MONTGOMERY — The Alabama House Health Committee advanced on Wednesday legislation changing the scope of practice for the state’s midwives, despite opposition from midwives and other supporters of non-hospital births.
Senate Bill 87 (SB87), sponsored by State Sen. Arthur Orr (R-Decatur), was initially supported by the state’s midwives and midwife organizations, such as the Alabama Midwives Alliance (ALMA).
In addition to revising technical language, the bill initially allowed midwives to perform newborn screenings for specific diseases.
The bill initially allowed midwives to provide care in freestanding birthing centers. However, that provision was removed at the request of several regulatory agencies, according to ALMA. Midwives are currently not permitted to assist in hospital births.
Despite removing the birth center language, ALMA and others continued to support the bill. Support waned only after the Senate Health Committee approved another amendment.
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.
The bill was intended to allow midwives to perform and submit newborn screenings.
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. The three at-home tests are: CCHD screening, hearing screening and blood spot testing. Midwives would not be permitted to interpret the tests, only to administer and submit them to a pediatrician, removing the need for a days-postpartum mother to take the newborn to a screening.
Advocates argue that midwives performing these simple tests drastically aid in catching potentially life-threatening issues early, pointing out that nurse practitioners, not pediatricians, frequently administer the tests in the office.
In the Senate committee, State Sen. Larry Stutts (R-Tuscumbia) offered a substitute, allowing midwives to conduct the blood spot testing, leaving the other two tests outside the scope of practice.
Despite the opposition, the Senate Health Committee passed the bill as substituted.
In a non-traditional move, the House Health Committee voted to approve the bill on the same day it held a public hearing.
At the hearing, advocates for midwives opposed the bill as amended, asking for it to revert back to allowing the three initial at-home tests. Conversely, the state’s healthcare organizations and special interests advocated limiting midwives' practice scope.
State Rep. Ben Harrison (R-Elkmont) presented the bill before the committee, seemingly taking a dim view of the Senate amendment himself, pointing out that there has not been an infant or mother who has died in a homebirth setting in the state.
“We’ve had a total, over six years, 200 [hospital] transfers out of 1,902 births, and that’s 11%; that’s good, with no deaths of the mother or child, and I don’t understand why we can’t get the screenings that would help protect the infants,” Harrison said.
First to speak in opposition was Alabama Birth Coalition president Arron Crawford, who lambasted the Senate’s actions for denigrating midwifery care and placing mothers and babies in danger, especially in rural areas without easy access to neonatal care.
“Today, I’m calling out a disgrace,” Crawford said. “The Senate leaders, pockets buzzing with lobbyists’ texts, gutted work by [ALMA]. SB87 has been hijacked. As is, it denigrates the sanctity of motherhood, the safety of newborns, and, above all, it’s a wolf in sheep’s clothing.”
“SB87 is currently a gut punch. It bans midwives from providing the full battery of screenings our babies need, forcing moms to find a far-off hospital or take a chance. This is restricting access to care," Crawford added.
Linda Lee, with the Alabama Chapter of the American Academy of Pediatrics (ALAAP), read a letter from ALAAP legislative chair Nola Jean Ernest. Ernest argued that midwives do not have sufficient training to conduct the tests and that they should be done in a clinical setting.
“While it is legal in Alabama for families to choose homebirth under the care of a certified lay midwife, there is no evidence that this practice improves infant mortality rates,” Ernest’s letter read. “In fact, in Alabama, the leading risk factor for infant mortality is poverty: a very complex issue that remains largely unaddressed.”
“At a time when we are striving to reduce infant mortality, we must not compromise the quality of care provided to newborns. Lay midwives attending homebirths do not have the equivalent training or clinical experience as pediatricians or neonatologists," it added.
In an untypical move, State Rep. Ernie Yarbrough (R-Trinity) was next to speak against the bill at the public hearing. He advocated for the bill to be reverted to its original form and relayed his personal experience with midwives with three of his children.
“As amended, the rights to practice, options, and freedoms of Alabama citizens, I believe, are being abridged and taken away,” Yarbrough said. “Choices and options are being removed or denied from Alabama mothers are being removed or denied from Alabama mothers because, it would seem, special interests and a general attitude that our mothers and their midwives can’t possibly make good decisions and should ‘trust the experts.’”
“It’s not only un-American, it’s a violation of Alabama’s State Constitution, Article I, Section 35," he added.
A licensed midwife also spoke against the amended bill, while a representative from the Alabama Hospital Association joined ALAAP in claiming that midwives’ practice should not include newborn screenings.
Lawmakers did not ask Harrison questions before voting to advance the bill, sending it to the House floor for a vote. There were no audible votes against the bill.
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