State Laws Force Pregnant Mothers to Rely on Black Market to Find Midwives

Published October 13, 2016

Pregnant mothers in Alabama and other states may need to turn to the black market or drive across state lines if they want to give birth under the direction of a midwife outside of a hospital setting. Alabama lawmakers should heed the calls of mothers and midwives to update a 1975 law effectively outlawing some mothers’ choice of health care for their labor and delivery, and other states should follow suit.

Many mothers prefer to seek the care of midwives operating without licenses approved by the state, instead of obtaining legal care at hospitals from obstetrician-gynecologists (OB-GYNs) or even certified nurse midwives (CNMs), who in Alabama primarily work in hospitals.

Mothers have their reasons for hiring illicit out-of-hospital health care providers instead of seeking care from legal providers at hospitals. Some mothers even choose to give birth unassisted at home when they are unable to find a midwife to provide care, Chloe Raum, president of the Alabama Midwives Alliance (ALMA), told Health Care News in September.

“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.”

A 1975 Alabama law prohibits persons not licensed by the state from practicing “nurse midwifery.” In 1995, a criminal appellate court ruling reversed the acquittal of non-licensed midwife Toni Kimpel, with the effect of criminalizing midwifery practiced by anyone other than CNMs.

CNMs are registered nurses (RNs) who undergo advanced training above and beyond regular RN education. Raum says Alabama lawmakers should also license certified professional midwives (CPMs), who are not nurses but who have been credentialed by the Institute for Credentialing Excellence (formerly the National Organization for Competency Assurance).

All CPMs meet the certification standards of the North American Registry of Midwives (NARM), according to NARM’s website, which also states, “The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings.”

Twenty-eight states authorize CPMs to practice, according to the Midwives Alliance of North America’s website, and 30 states either issue or recognize CPM licenses, according to the Alabama Birth Coalition’s (ABC) website.

Alabama mothers who want midwives to help with their out-of-hospital births have been known to drive to border states during or just prior to labor. Florida and Tennessee license midwives to perform out-of-hospital births, and although Georgia and Mississippi do not, those states do not prosecute midwives for doing so, Karen Brock told Health Care News.

Brock pled guilty in 2002 to breaking the 1975 Alabama law. She is one of five Tennessee-certified CPMs listed on ALMA’s website as willing to travel up to an hour from their homes or the sites where they attend patients during labor.

The most recent attempt to update the disco-era law proved stillborn. State Rep. Ken Johnson (R-Moulton) introduced House Bill 248 in the 2016 session. The bill was read once in February and referred to the House Health Committee, where it lay until lawmakers adjourned in May.

The bill would create an Alabama Board of Midwifery. Currently, CNMs – the only midwives licensed in the state – are regulated by the state Board of Nursing and the Board of Medical Examiners.

The midwifery board Johnson has proposed would be appointed by the governor and consist of four CPMs approved by ALMA, one physician approved by the Medical Association of the State of Alabama, and two mothers approved by ABC who have used midwifery services in the state.

Alabama lawmakers won’t convene again until February 7, 2017, but the evidence they need on this issue is already in.

Laws notwithstanding, mothers are determined to call the midwife. Lawmakers should hear them out.

— Michael T. Hamilton ([email protected]) is a Heartland Institute research fellow and managing editor of Health Care News, author of the weekly Consumer Power Report, and host of the Health Care News Podcast.



Minnesota Gov. Mark Dayton says the Affordable Care Act is “no longer affordable.”

Dayton, a Democrat who signed the state law allowing Obamacare to go forward in his state, reversed course Wednesday, telling the Twin Cities Pioneer Press, “Ultimately … the reality is the Affordable Care Act is no longer affordable for an increasing number of people.”

The damning admission comes just one month after the Pioneer Press reported that the state’s individual insurance market was “in danger of collapse,” as insurance companies on the individual market announced they would hike premiums anywhere from 50 to 67 percent.

“These rising insurance rates are unsustainable and unfair. This is a real emergency situation,” Minnesota Commerce Commissioner Mike Rothman said at the time.

“These are middle-class Minnesotans. They are getting squeezed — crushed — by these health insurance costs,” Rothman added.

Dayton called the soaring costs a “very serious problem” and said there are “a number of things that need to be done,” perhaps including the federal government giving bigger tax credits. He also suggested the state legislature should meet for a special session to address the problem, but not until after the November election. …

SOURCE: Jon Street, The Blaze


In Sunday night’s debate, Republican nominee Donald Trump once again vowed to repeal the Affordable Care Act, an Obama administration and Hillary Clinton-supported idea.

“It was [a] big lie,” Trump said. “President Obama said ‘you keep your plan,’ the whole thing was a fraud and it doesn’t work.” He vowed to replace it with “something that works.”

But what exactly is that something?

One of the main facets of what he’s proposing to put in place of Obamacare is letting insurers offer health coverage across state lines. Currently insurers may offer policies in states where they are licensed to do business.

“We have to get rid of the lines around the states,” he said. “Artificial lines, where we stop insurance companies from coming in and competing because they want and President Obama and whoever was working on it, they want to leave those lines because that gives the insurance companies essentially monopolies. We want competition,” he said.

“Once we break out [of] the lines and allow the competition to come,” Trump predicted, “You’re going to have plans that are so good because we’re going to have some competition.”

As with other instances where Trump forays from personal attack into actual policy, it would be hard for any voter not already familiar with the topic to have much of a sense of what’s talking about. But his plan to let insurers sell products across state lines is an actual thing in Republican circles. …

The thinking behind the idea is that insurers could offer the same health plan across a national market, thus saving boatloads of money that they would otherwise spend complying with different regulations in states where they operate.

Critics of the idea say that the GOP has placed too much faith in the notion that a national market for health insurance market will drive billions of dollars in costs out of health insurance premiums. The primary driver is simply the cost of entering a new health insurance market, which obligates new entrants to build networks of health care providers. …

SOURCE: William McConnell, The Street


The days of driving hours for a medical appointment may be coming to an end for some people in Eastern Kentucky.

The recent broadband expansion has opened the region to advances in telemedicine – the diagnosis and treatment of patients by medical professionals from a distance – and one college is trying to capitalize.

Starting in January, Hazard Community and Technical College will offer a telemedicine technician assistant program.

“Telemedicine isn’t a new concept, but it’s fairly new to our area,” said program director Shaun Neace, who worked as a registered nurse for 13 years before helping start the telemedicine course at HCTC.

Telemedicine technology allows healthcare professionals to see their patients from miles away, but often assistants are needed to help examine the patients, relay their health information and operate the equipment. That’s where HCTC comes in with a 16-week course preparing students for telemedicine jobs.

“We’re breaking down distance barriers, as far as healthcare,” Neace said. “We’re cutting down on that distance and that gap and we’re getting patients treated sooner, which is cutting down on re-admissions back into hospitals, prolonged hospital stays and overall just making for a healthier community.” …

HCTC is accepting 20 telemedicine students for the 2017 spring semester, which begins in January.

The program is funded by a grant through the Shaping Our Appalachian Region (SOAR) initiative. …

SOURCE: Tanner Hesterberg, Mountain News WYMT


To the editor: Michael Hiltzik is correct that “California’s ballot initiative process traditionally has been a laboratory for new methods of campaign deceit,” excoriating the opponents’ campaign against Proposition 56, which would increase the state cigarette tax by $2 a pack. (“The tobacco industry’s deceitful Prop 56 campaign takes a page from its old playbook,” Oct. 7)

However, reading the state’s official voter information guide, it’s obvious the proponents are just as deceptive by saying the tax will help pay for tobacco-related healthcare costs and prevention measures. According to the state’s legislative analyst, funds from the increased cigarette tax “would be allocated to a variety of purposes, with most of the monies used to augment spending on healthcare for low-income Californians.”

Since one-third of all Californians are now enrolled in Medi-Cal, perhaps all of the state’s taxpayers should share some responsibility in support of this vastly expanding program, especially considering that the cigarette tax has become such an unreliable source of income because of the diminishing number of smokers.

SOURCE: Jim Redhead Los Angeles Times

This article has been updated to convey “Institution for Credentialing Excellence” as the current name of the former “National Organization for Competency Assurance.”