Medical Update: Midwifery In Alabama

What is a midwife? According to the definition given by the American College of Nurse-Midwives (ACNM), a midwife is a healthcare provider offering services to women of all ages in all stages of life. They have advanced education and focus on partnering with women, making them among the most modern, forward-thinking health professionals in the U.S. today (midwife.org, ACNM). Many midwives do not only focus on maternity care, but attend to all the healthcare needs specifically related to a woman’s health such as annual exams, family planning, care and treatment of infections, menopause care, and the care of teenage girls in addition to care during pregnancy. There are also different kinds of midwives, including Certified Nurse-Midwives (CNMs), Certified Midwives (CMs), Certified Professional Midwives (CPMs), and non-certified midwives (who may or may not have proper training to assist with pregnancy and delivery).

A CNM is a nurse who has gone for a master’s degree (in addition to their RN,) and graduated from an accredited program. They must also pass a national examination. A CM is a midwife with a non-nursing bachelor’s degree and goes for a graduate degree in midwifery. Their scope of practice is the same as that of a CNM and training is comparable. A CPM is trained either through the apprenticeship model or an accredited program, but their scope of practice isn’t as broad as that of a CNM or CM, and can only provide pre- and post-natal care and delivery care. Midwives practice in a variety of settings including hospitals, free-standing birth clinics, and homes.

In the state of Alabama, midwives are only allowed to practice in hospitals in conjunction with OB-GYNs, making the law the strictest in the nation. This has not always been the case. In 1975, the state began granting licensure only to CNMs. Initially independent midwives with a valid permit issued by the Alabama Department of Health were still allowed to practice. Over the next few years, permits were not renewed and midwives were informed that they must cease to practice. Midwives continued to practice during the 1980s and 1990s, (though it was illegal,) and some still do. In the early 1990s, a court of appeals set a precedent in the state of Alabama by overturning the dismissal of 5 misdemeanor charges against a Certified Professional Midwife for practicing midwifery without a license. A similar circumstance occurred in 2002 in Cullman, AL. Some midwives in Alabama have traveled across state lines in order to safely and legally care for women.

As grim as this all sounds, there are organizations in Alabama working to overturn these extremely restrictive laws in order to give women more options regarding prenatal care and childbirth. Both the Alabama Birth Coalition and the Alabama Midwives Alliance have been hard at work on this issue. They lobby for trained midwives to be able to safely practice in this state, thus ensuring that women will have choices open to them that currently are not available. For more information, please visit www.alabamamidwivesalliance.org.
By: Rachel Clark