What you can do to help get midwives licensed in Alabama even if you don't live anywhere near it

September 7 2011 | offbeatbride
This is from the 2010 Walk for Midwives in Huntsville, AL. Photos by Heather Ellis.

As some of you MIGHT know, I live in northern Alabama. This state is known for a whole bunch of things (Wikipedia is great for examples of both the good and the bad), and one of the weaker aspects of living here is that the state does not currently grant licensure to Certified Professional Midwives. As I mentioned in March, this means women who want to have a midwife present at their home birth either have to travel out of state or keep it on the downlow.

The Alabama Birth Coalition is an organization that's working hard to change this. It's completely volunteer-based, totally grassroots-driven, and one of the coolest collectives of people I've ever had the pleasure of being around. I recently interviewed Hannah Ellis about her work as the North Director with the Alabama Birth Coalition and what you can do to help — even if you don't live anywhere near Alabama.

What is the Alabama Birth Coalition?
Alabama Birth Coalition is an all-volunteer, grassroots, non-profit organization, working for healthier moms and babies. We hope to achieve this goal through increased access to midwives and by empowering citizens across the state to make informed maternity care decisions based on the best evidence available. We were founded in 2003 by a group of families who wanted access to Certified Professional Midwives without having to cross state lines.

What is the goal of the Alabama Birth Coalition?
The Alabama Birth Coalition is working to change state law to license Certified Professional Midwives to attend out-of-hospital births in Alabama. We want all Alabama families will have access to the safe, proven, cost-effective care provided by Certified Professional Midwives.

How is the Alabama Birth Coalition impacting the lives of women and children in Alabama?
First, we are educating Alabama families on maternity care options and the benefits of the midwife's model of care. As the National Association of Certified Professional Midwives (NARM) states, the application of the midwives model of care "has been proven to reduce the incidence of birth injury, trauma and Cesarean section." Second, we provide a much needed support network for families in Alabama who are choosing out-of-hospital birth. We are somewhat of a family for those who choose out-of-hospital birth in this state.

Why is an organization like the Alabama Birth Coalition necessary?
With Alabama home birth rates increasing, public safety demands access to a certified care provider licensed to practice out-of-hospital maternity care. While Certified Nurse Midwives are licensed in our state, very few actually attend births in hospitals and none provide out-of-hospital care. There are no freestanding birth centers in the state. The state has failed to authorize Certified Professional Midwives, who are specially trained to provide out-of-hospital maternity care, to practice legally.

As a result, Alabama families who wish to deliver out-of-hospital with a midwife are often surprised and distressed to learn that any midwife they hire to attend them risks prosecution. Families are forced to choose among difficult and limited options. Some find a midwife who is willing to risk prosecution to attend the birth. Some choose to birth in the hospital although they would prefer a midwife-attended birth. Some travel to birth in states that license midwives. Some give birth unassisted. Alabama families deserve better options.

What is your involvement in the organization?
I became involved with Alabama Birth Coalition after becoming pregnant and experiencing care with a local OBGYN. I became distressed at how long I had to wait for rushed, impersonal prenatals, the lack of proper nutritional information I was given (I was told to "eat well" — but what does that mean?), and the way the doctor dismissed my interest in an unmedicated birth. I switched care to a Certified Professional Midwife located in Tennessee. WOW! What a difference!

Instead of a two hour wait, I had a two hour prenatal. Instead of "eat well" I was given a nutrition plan and was held accountable for following it. My Certified Professional Midwife listened to my thoughts around my birth, and provided helpful, evidence-based information so that we could work on a birth plan that was safe and natural. My birth plan included OBGYN backup, in case I needed to transfer to a hospital should unexpected and rare complications arise. I ended up with an amazing, natural water birth out-of-hospital. My baby was just born in someone else's home, instead of my own, because Certified Professional Midwives are not licensed in Alabama. I drove 1 1/2 hours in labor to get to my Certified Professional Midwife, and it was worth every painful mile.

After my experience with a Certified Professional Midwife, I became passionate that all women be legally allowed the option to have a Certified Professional Midwife in Alabama, if they wanted one. I am NOT anti-doctor and anti-hospital — there will always be women who prefer that option or who need that option due to risk factors that do not make them good candidates for out-of-hospital birth. I just feel all families have the right to easily access a Certified Professional Midwife's services if they choose to do so. So I became the North Director for Alabama Birth Coalition. I organize Alabama Birth Coalition's north community events and also help northern Alabama folks get in touch with their senators and representatives so they can educate them on their desire to have Certified Professional Midwives licensed in Alabama. Right now, I am proud to be working with a dedicated set of volunteers to organize Huntsville's Walk For Midwives.

Why aren't midwives licensed in Alabama?
That is a great question! Here is my opinion: Alabama is quite behind more progressive states in our nation, and places extremely tight restrictions on health care professionals other than MDs, including physicians assistants, chiropractors, physical therapists, and Certified Nurse Midwives. It appears to have a very strong "good ol' boys' club of Alabama MDs" who very much care about protecting their financial interests. They may say they are concerned about safety; however, this concern does not seem to be valid in light of the studies which support Certified Professional Midwives, as well as the numerous states that safely and successfully license Certified Professional Midwives.

Unfortunately, The Medical Association of the State of Alabama (MASA) vehemently opposes our legislation to license Certified Professional Midwives to attend out-of-hospital birth. They feel that a hospital birth is the only acceptable way to have a baby, and so far, have been unwilling to compromise at all with the Alabama Birth Coalition. They are financially and legislatively powerful and actively lobby against our cause. Many legislators are understandably reluctant to vote against MASA's agenda. However, in the end, whether MASA or other physicians groups like it or not, home birth is on the rise in Alabama. Public need will demand an out-of-hospital care provider, and the state of Alabama will need to issue licenses to Certified Professional Midwives.

If you're near the area, the Alabama Birth Coalition will be hosting a fund-raising Walk for Midwives in Huntsville on Saturday, September 17, from 11:30am until 12:30pm. You can snag tickets (they're $10 per household) at the site, and if you don't live close enough to make it, you're always more than welcome to donate to the organization.

  1. Represent!!!!

    OK, actually, I moved out of Alabama last year (we're in Jersey now), but I was involved with ABC during most of the time I lived there! (My son was conceived and born in AL.)

    I've been keeping up with them via FB and email and I am hoping, hoping, hoping that this year is the year, for CPMs!!!

    Even though I no longer live there, my heart is with ya, Alabama!

  2. Go Alabama!!! Do you know of anything like this going on in Georgia? I just found out that unfortunately, it's illegal for midwives to attend home births in GA too. I'd love to get involved! It seems like there is next to no information about "alternative" (as some would call it) birthing options in GA. I'm thinking of becoming a doula and can't find anyone here to meet and talk to about it!

    • The legal situation is a little different in GA, but the practical situation is similar. There are CPMs who attend homebirths in the state, though. The Mothering.com forums have a fair bit of information about how to contact these midwives. Many of them can also be Googled. But, no, I don't know of any groups really organizing for change. There is a campaign to build a birth center in Atlanta, though.

      • GA law allows for licensure of CPMs, but the license hasn't been offered in many years. As a result, there are no currently licensed CPMs in the state. CPMs who practice here are often licensed in another state but are practicing in a legal gray area. Also, because they are not licensed in the state, insurance generally doesn't pay for CPM services. A disjointed but informative overview of the current state of CPMs in GA here: http://gamidwife.com/pdf/MTF102308.pdf

        • Oh, okay! I've been having such a hard time finding any information about it, which is such a testament to how far Georgia needs to come.

          What I've been finding in regards to insurance, though, is that most insurance companies, if they cover midwives at all, cover only CNMs.

          To be completely honest, my comment above about Georgia was based on this wikipedia article, which (not completely surprising) is apparently incorrect. http://en.wikipedia.org/wiki/Home_birth#United_States

      • I had a home birth in Georgia last year and had a tough time finding a midwife. I ended up using a wonderful midwife out of Chattanooga, TN, who traveled to my home. One Georgia midwife I interviewed called it "alegal" and said that while it is not technically illegal, the state would not hesitate to prosecute a midwife if her patient ended up transfering to the hospital! They all asked us never to mention their names-how awful is that?!

  3. I've been following (and supporting!) your progress for a couple of years now. I cannot tell you how thrilled I was to hear such a movement is going again. I was one of the earliest to spearhead the Alabama Midwifery Council in the 80s, and many women worked tirelessly to educate lawmakers of the benefits of having midwives licensed in Alabama. Sadly, that "good ole boys network" won out. My involvement with the group ended in the late 80s, and I believe it folded a few years later, primarily from an inability to form a cohesive goal without getting distracted by other topics. It gladdens my heart to see this movement happening again, and I feel this organization has chosen the best path toward certifying midwives in this state.
    I was fortunate to give birth 30 years ago in Douglasville, Georgia's birthing center, assisted by a wonderful certified nurse midwife. Imagine my horror to come back to Alabama a month later, to become acquainted with women whose birth stories were rampant with episiotomies and epidurals, and many more interventions. It is sad that 3 decades later, much is unchanged. I'm so thrilled by what you are doing. Keep up the great work!

  4. Glad to see this going on in Alabama. There aren't any certified midwives in Kentucky either, and unfortunately I don't know of any still active midwifery-activists in the bluegrass state.

  5. I'm reading Birth Matters, Ina May's new book, and I'm inclined to send a copy to every friend who's having a baby, every OB/GYN I encounter, and every member of the legislature of any state in which midwifery practice is illegal. Ina May lays out clearly the history of midwifery v. obstetrics in the US, where in many other countries–with lower maternal and infant morbidity and mortality rates–it's a case of obstetrics + midwifery.

  6. Illinois could learn from this too. We do not allow CPM's in my state either. I want to become a CPM although I'm fearful I'll not make enough to keep at least my student loans paid. I'm not in it to get rich, just give women a choice. I'd rather not leave IL as the grandparents of my children are here but if necessary I will. CHOICE FOR FAMILIES!!

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