Fourteen years after Karen Brock pled guilty to the misdemeanor of practicing as a midwife without a license, the Alabama law that convicted her still stands, despite efforts to change it, which could be renewed in 2017.
Brock was sentenced in 2002 to 18 months of unsupervised probation under a 1975 Alabama law prohibiting the practice of midwifery except by registered nurses who have received advanced training as midwives. Although the law also allows “lay midwives” with valid state health department permits to practice, the Alabama Department of Public Health stopped renewing and issuing such permits soon after the 1975 law was passed, according to the Alabama Midwives Alliance (ALMA) website.
Current law permits certified nurse midwives, who do not typically deliver outside of hospital settings in Alabama, to practice under the supervision of an obstetrician-gynecologist.
The law effectively prohibits certified professional midwives (CPMs), who are not nurses but have met certification standards set by the North American Registry of Midwives, from being present at home births or delivering at non-hospital birthing centers.
Underground Birth Network
Brock now helps pregnant women find CPMs willing to help them give birth outside of a hospital setting illegally in Alabama or legally across state lines. ALMA’s website displays a map dividing Alabama into five regions and provides contact information for six CPMs whose “coverage area will typically extend about an hour in all directions from either her residence or the location where she attends births.”
Two of the six midwives list contact information in Tennessee, which borders Alabama. ALMA’s list of CPMs is “not exhaustive as some midwives prefer not to be publicly listed,” the site states.
Lawmakers adjourned the 2016 session without approving a bill introduced by state Rep. Ken Johnson (R-Moulton) that would have established a Board of Midwifery to regulate the profession independently of the State Board of Nursing and the Board of Medical Examiners.
Laboring While Driving
Brock says Alabama’s restriction of midwifery prompts pregnant women to travel to border states to deliver with the help of midwives outside hospital settings.
“All four states connected to Alabama have families travelling from Alabama to their state in order to birth legally with licensed midwives,” Brock said. “Tennessee and Florida license midwives specifically for out-of-hospital or home births. Georgia and Mississippi do not license midwives but also do not prosecute them.”
ALMA President Chloe Raum says the Alabama law forces pregnant women to choose between driving across state lines during labor or hiring a midwife operating illegally.
“Under the law, parents may give birth at home with anyone but a midwife in attendance,” Raum said. “Women who are able to cross state lines are forced to drive hours in labor instead of having their midwives come to their homes. Women who live too far to cross state lines must find a midwife willing to risk prosecution to attend them.”
Some midwives are willing to break the law to provide services, at the request of their patients, Brock says.
“We have had midwives who practiced openly in the state, fully aware that they risked prosecution for doing so,” Brock said. “They made a choice to stand with Alabama mothers who desire the services of skilled midwives but cannot cross state lines to access that care.”
Lack of Alabama licensure for CPMs increases risks for pregnant women and their babies, Raum says.
“The vast majority of midwives are excellent care providers, but the law creates an underground market of midwives in which people with no certification and oversight can practice and consumers have no recourse if they are unhappy with their care,” Raum said.
Pregnant mothers would prefer lawmakers legalize their choice of care, Brock says.
“Consumers are grateful for the sacrifices their midwives make in order to offer care to women in a state that criminalizes their practice,” Brock said. “These mothers are asking legislators for a law that addresses the needs of their families.”
One Size Doesn’t Fit
Raum says the law ignores the preferences of pregnant mothers who prefer not to give birth in a hospital.
“Instead of dismissing these mothers as reckless and selfish, we should investigate the reasons some mothers are so afraid of giving birth in a hospital,” Raum said. “While we adamantly do not endorse unassisted birth, we understand the motivations that drive women away from one-size-fits-all birth, which is the standard of care in Alabama hospitals.”
The care CPMs provide is at least as safe as hospital care, Raum says.
“The CPM is the only midwifery credential that requires out-of-hospital training,” Raum said. “Numerous quality studies have shown over and over again that CPMs have similar infant and maternal mortality rates—compared to low-risk hospital births attended by doctors—and much lower morbidity rates, as well as higher patient satisfaction and lower costs.“
Alabama’s 2015 infant mortality rate was 8.7 deaths per 1,000 births, the second-highest among all states and Washington, DC, according to the statistics aggregator Statista.
Willing to Be Regulated
Brock said ALMA midwives “want to see a law passed which authorizes CPMs to serve Alabama mothers in their own homes and in birth centers and which meets the [International Confederation of Midwives] standard of midwives being self-regulated primary care providers.”
Thirty states either issue or recognize CPM licenses, according to the Alabama Birth Coalition’s website.
“If there was a problem of safety with CPMs, that would have been exposed in these states,” Raum said.
Dustin Siggins ([email protected]) writes from Washington, DC.
Image via Thinkstock