The Alabama Department of Public Health (ADPH) is considering a resolution to place restrictions on birthing centers in the state.
The proposal has drawn objections from many midwives and birthing advocates.
Alabama previously had regulations for birthing centers, which were repealed in 2010 due to the lack of centers in the state.
Alabama currently has no operating birthing centers, but several are in the works in various areas across the state.
Due to the current plans for these birthing centers, the ADPH is proposing reinstating the previous rules that existed before midwives were permitted to deliver babies in the state.
Women across the nation are switching to alternative methods of birthing children other than in the hospital, often choosing to have a midwife attend their birth.
The reasons for choosing midwifery care over hospital care are many. Some have had previous negative experiences with hospital birth; others simply prefer a less medical approach to what they consider to be a natural bodily function that requires no medical intervention outside of emergencies.
While there are various levels of certification for different kinds of midwives, they all require extensive training, and licensed midwives have stringent regulations dictated by the state.
Alabama has only allowed Certified Professional Midwives (CPM) to perform births for five years, although they are still excluded from participating in hospital births.
The proposed rules would exclude CPMs from delivering babies in birthing centers, which is not the practice for other birthing centers across the nation. Opponents also say that the ambiguity of the rules could also disallow midwives from delivering a baby in a location other than the birth mother's home.
The ADPH held a public meeting on Thursday for opposition and supporters to make public comments on the proposed regulations.
The Alabama State Board of Midwifery (ASBM) was present at the meeting to oppose the suggested rules.
"If adopted, these rules would effectively prohibit any licensed midwives from starting or even working in any birthing center in Alabama," said Noel Leithart, chair of the ASBM. "This proposal drastically reduces the ability of licensed midwives to care safely for women and babies in Alabama, especially in rural areas."
Opponents of the regulations also state that they will negatively impact more rural areas of the state by requiring birthing centers to only operate within 25 miles of a hospital with an operating obstetric (OB) unit.
Only 17 out of Alabama's 54 rural counties have a hospital with an OB unit.
"Passing this proposed rule will increase the risk of significant harm if this rule does not allow a mother to choose her setting of birth with a licensed midwife, as women in rural Alabama and other settings will see their birth options decrease," Leithart said.
While nearly everyone who spoke supported some form of standards and regulations for birthing centers, the speakers mostly opposed the proposed rules, which they deem antiquated and in conflict with current birthing evidence.
Jessica Smith, the president of the Alabama Birth Coalition, has consistently spoken against the proposed rules, claiming the ADPH did not consult with supporters of midwifery or pregnancy centers.
"I ask today that the rules be revoked and all stakeholders, including the consumers, be given a seat at the table in making these decisions," Smith said.
Steve McCormick, general counsel with the Alabama Hospital Association, said he did not fully agree with the proposal. However, McCormick also claimed that failing to pass the rules would result in significant harm.
"Although there are a lot of success stories outside of the hospital, there are a lot of success stories inside the hospital," McCormick said. "…So if they are going to operate overnight stays, then there should be checks, there should be everything that a facility hospital now has, we need to make sure that those regulations are followed in these facilities."
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