Imagine you (or a woman that you deeply care about) have recently moved to Alabama and discovered that you are pregnant. You’ve already decided that you want an experience that involves a care provider who promotes low interventions, a healthy pregnancy, and continuity of care throughout the entire process. Your last birth was at home with a Certified Professional Midwife (CPM), and you want to go that route again. You begin to do your research, only to find that CPMs are illegal in Alabama. Your only option is to go over the state line to Tennessee, Mississippi, Georgia, or Florida. So you begin to look for birth centers, only to find there aren’t any of those in Alabama either. Then you expand your research options, looking a Certified Nurse Midwife in the hospital setting. You find that there are only 3 full-scope midwifery practices in the state, and none of them are close to you. What do you do? Drive across the state line to birth with a CPM, or drive hours to Anniston, Montgomery, or Mobile to one of the full-scope CNMs?
For well over a decade, organizations such as the Alabama Birth Coalition (ABC), Alabama Midwives’ Alliance (ALMA), and Safer Birth in ‘Bama have been working hard to educate consumers, healthcare providers, and legislators about the safety and necessity of the Midwifery Model of Care. The hope is to also repeal a law passed in 1975 that makes the practice of midwifery by a Certified Professional Midwife illegal and a class C misdemeanor.
Why is this so important, you ask? And what does it have to do with cornbread and shrimp? In 2014, a bill passed the Alabama House of Representatives to make cornbread the state bread. In 2015, legislation making the brown shrimp the “State Crustacean” of Alabama passed. And yet, issues like the decriminalization of Certified Professional Midwives (CPMs) were ignored. This year, legislators will have a midwifery bill on their desks again. Consumers like Hannah Ellis (who came up with the terms “choking on cornbread” and “strangled by shrimp”) have begged legislators to consider this bill, and stop wasting time and money voting on frivolous bills like the two mentioned above, and instead focus on bills that really make a difference to people in our state.
The word “midwife” means “with woman,” and there are different types of midwives. Currently, Certified Nurse Midwives (CNMs) are legal in all 50 states of the U.S., but in Alabama, there are only 3 state-wide who have the opportunity to practice to the full extent of their training, meaning that they can deliver babies in the hospital setting, as well as practice primary care for women. Among them is a new graduate from Frontier Nursing University, Sara Hellwege, who works with Dr. Joshua Johannson in Anniston, AL. The other two are located in Montgomery and Mobile.
Certified Nurse Midwives are nurses with an advanced practice degree from an accredited institution, who have completed degree requirements and passed certifying examinations by the American Midwifery Certification Board. Their expertise includes all aspects of women’s health, from puberty to menopause, and beyond.
Certified Professional Midwives (CPMs) are legal in 28 states, and are educated via accredited midwifery programs or an educational pathway that meets national certification standards. They are trained specifically in what is called “out of hospital birth,” and provide care specifically during the childbearing cycle. They must pass the certifying examination through the North American Registry of Midwives.
So, why seek out a midwife? Midwives can bridge a gap that currently exists. There are approximately 2.2 million women in our state, and only 470 OBGYNs. Of the 67 counties in Alabama, 37 don’t have obstetrical services in their local hospitals. For low-risk mothers, midwives are an option to improve the outcomes of birth in this state. Currently, we receive an “F” rating by the March of Dimes on prematurity. We are in the top 4 for infant mortality in the country, which only 3 other states have worse records than we do. Despite the fact that the March of Dimes recommends breastfeeding for the first year, only 60% of infants in Alabama are ever breastfed, and only 14% continue to be by 12 months of age. Midwives are able to spend more time with clients, educating them about lifestyle, breastfeeding and nutrition, health screenings, and other issues pertaining to women and babies.
Please contact your senators and representatives, and tell them you want midwives to be able to practice in this state again. Consider joining organizations such as ABC and Safer Birth in ‘Bama. Also get involved with events like “Miles for Midwives,” a walk in various towns across the state which demonstrates solidarity with the midwifery profession, educates communities, and raises money for grassroots campaigns.
By: Rachel Clark, RN, BSN
