A much-contested bill allowing midwives to expand care for patients has failed in a House committee. 

The midwife and doula community in Alabama has long been fighting to expand the scope of birthing care practices currently limited by the state. Midwives are trained and certified by the state of Alabama to provide birthing care in several capacities. Midwives are the preferred alternative for those who do not desire to have a baby in a hospital due to past hospital trauma, personal or religious convictions, or simply choosing more freedom in labor and delivery. Doulas assist in birthing care before, during, and after delivery. They do not deliver babies, nor are they trained medical professionals; their main focus is the emotional and physical care of mother and baby. Doulas are relatively common in hospital births as they can advocate for the mother's rights and often act as a coach to attend to the mother's needs and assist her through the labor process.

Under Alabama law, midwives are restricted from various practices in delivering babies outside of hospitals. Those opposed to the bill have repeatedly expressed that the risk of uterine rupture is the primary reason for opposing the bill. When a woman delivers a baby via cesarean section, the likelihood that she will be permitted to have a subsequent vaginal birth is very low. Vaginal birth after cesarean (VBAC) is considered high-risk by many in the medical community due to the concern of uterine ruptures, which occur in .5% of VBACs, according to the National Library of Medicine.

Nothing legally restricts a mother from having a VBAC in a hospital, but many hospital policies state they will not perform them. Therefore, many mothers desiring a VBAC have minimal options. 

House Bill 164 (HB164) by Rep. Debbie Wood (R – Valley) addresses this issue by attempting to allow certified midwives to perform VBACs in the state. The bill was presented by the Alabama Birthing Coalition (ABC) board. 

Wood previously said that she would be removing her name from sponsorship after an unaffiliated group distributed fliers at the church of State Rep. Paul Lee (R–Dothan), the leader of the House Health Committee which HB164 was in. After the flier incident, Lee asked Wood to kill the bill, which she initially said she would do. Wood later reversed her decision and moved the bill to the Committee on Boards, Agencies, and Commissions.

The bill had a public hearing exactly two weeks ago where advocates for the bill gave personal testimony of their experiences with VBACs and traumatic incidents in hospital births. Representatives of the Alabama Birthing Coalition (ABC) were present, as were many midwives and doulas who pleaded their cases. When the vote failed, they were collectively distraught, and some were in tears. 

Jessica Smith, president of ABC, told 1819 News that the team is upset at the result of the vote, but they will continue to fight for birthing rights for midwives across the state. 

Due to trauma experienced in previous hospital C-sections, some mothers travel out of state with their midwife to have a VBAC to avoid legal complications. Many mothers have told 1819 News that they would rather take the increased risk of having an unassisted home birth than have another hospital birth. Tennessee is one of the preferred states for traveling VBAC mothers. 

"When our ladies go out of state… they don't go there and look for someone that's a midwife in Tennessee," Wood said. "They take our midwives from Alabama with them because they trust our people." 

Wood drew attention to the rapidly increasing rate of C-section births in the state, which Wood believes indicates a less natural approach to the delivery process. 

"Cesarean birth has risen in most all of our hospitals," Wood said. "It's unbelievable. Some have over 50% of every woman that walks through the door having a cesarean birth. Why is that? Is it because we don't wait and allow a natural birth anymore? Because we have to be worried about time, worried about money, worried about insurance, worried about all of these factors?"

Since nearly all insurance will not cover an out-of-hospital delivery with a midwife, mothers desiring such births are forced to pay their medical costs out-of-pocket.

State Rep. Ben Robbins (R–Talladega)  opposed the bill, stating that he would not be voting for it because his wife had a positive C-section experience. He also said that he would be in favor of limiting midwife VBACs to a birthing center where they would have access to doctors and anesthesia. 

State Rep. Mike Holmes (R-Wetumpka), who voted in favor of the bill, asked if data demonstrated any deaths from similar procedures in the state. Supporters of the bill claim none had been reported by the Alabama State Board of Midwifery. 

State Rep. Napoleon Bracy (D-Mobile) voted against the bill but said he had discomfort with the bill being put on a committee that has no women.

The committee requested a roll call vote on the bill. The bill failed with a vote of 5-4 and no abstentions. 

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