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Rep. Mike Ball from Madison
has sponsored HB 67. |
by Anna Bertone, MPH Guest Blogger
The
Senate Judiciary Committee held a hearing yesterday for House Bill 67, and Senate Bill
99, "The Home Birth Safety Act." The bill, sponsored by Rep. Mike Ball, R-Madison, and Sen.
Paul Bussman, R-Cullman would have decriminalized the practice of Certified
Professional Midwives (CPMs) in an effort to improve out-of-hospital maternity
care in Alabama.
Supporters
from across the state filled the room and waited through hours of less popular
bills to the last on the agenda – the midwifery bill. The committee allowed
three testimonies from the opposition and two from the proponents. Legislators
were preparing to vote as planned when Sen. Bryan Taylor, R-Prattville made a
late arrival and halted the legislative process by calling for the bill to be
tabled. The "no" votes on tabling the bill were
Sen. Orr, Sen. Ward and Sen. Williams.
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Sen. Bryan Taylor arrived late and
called for SB 99 to be tabled. |
The disappointing end to the public hearing came
after passionate testimony from both sides of the issue. The opposition cited a
not yet published study on national birth certificate data that found
an elevated relative risk of neonatal death for home births. They gave no
discussion of absolute risks or the limitations of using administrative records
for research purposes. They recounted examples of tragic outcomes from Alabama home
births in such detail that many in the audience could identify the cases being
described.
Supporters referenced favorable results from a
recent observational study that used “intention to treat” methodology.
This study design avoids many of the limitations in using birth records.
It involves enrolling
women who are planning a home birth early in prenatal care and then following
them to document the outcome. They also explained to legislators that
credentialed midwives should not be blamed for poor outcomes occurring at
unattended home births or births attended by lay midwives (as were the
anecdotal scare stories). On the contrary, this legislation seeks to address
unsafe out-of-hospital birth practices.
"Although the Committee on Obstetric Practice believes that hospitals and birthing centers are the safest setting for birth, it respects the right of a woman to make a medically informed decision about delivery." ACOG 2011 Statement
The Medical Association of the State of
Alabama uses powerful political leverage to oppose home birth safety
legislation year after year. They acknowledge that parents are choosing home
birth in increasing numbers, that it
is within their legal right to do so, and that birth carries risk of injury and
death to mother and child. Nevertheless, they refuse to come to the table with
parents and midwives to discuss safety measures. Medical opponents agree in
principal but not practice with the official American College of Obstetricians
and Gynecologists
2011 statement on planned home birth, to “respect the right of a woman to make a medically informed decision about delivery.” We are not respecting
women’s choices in childbirth if we strive for standards and quality
improvement in the hospital setting but refuse to implement safety measures for
alternative choices.
According to an Alabama pediatrician:
"I have studied this issue in
detail and have learned that the CPM certification process is rigorous and appropriate.
With well-trained attendants, planned home birth can be a safe option
for low risk pregnancies. Even for higher risk cases, women who
decide to give birth at home have significantly better outcomes if
they are able to have a well-trained midwife present than if they are
not. Home births without such help, happening now in our state, are
dangerous to both mother and newborn. I support the licensure or at
least the decriminalization of CPM practice, to improve the safety of mothers
and newborns." -- Pippa
Abston, MD, PhD
Women choose to birth outside of the hospital for a variety
of cultural, spiritual, economic and personal reasons. For some, a previous
negative hospital experience has left them seeking alternative care in a state
with no freestanding birth centers. Others hope to avoid the risks associated
with routine hospital interventions or hospital-acquired infections. The rising
cesarean rate (now 1 in 3 in AL) may be contributing to women choosing a
setting more conducive to physiologic birth. Some women who have experienced
sexual trauma or forms of discrimination prefer to birth in a familiar setting.
There are individuals and communities (Amish, Mennonites) that hold pregnancy
and birth to be normal but private life events belonging to the family. Costly
hospital services are enough to deter some uninsured or underinsured
individuals from utilization.
The 28 states
already authorizing the practice of CPMs have come to the common sense
conclusion that it’s absurd to allow home births but outlaw qualified care
providers to attend them. The safest possible course is to license and regulate
credentialed midwives while collecting publicly available data on maternal and
child outcomes.
Families choosing home birth are fed up with bullying tactics from
powerful special interest groups and want to let the legislative process work
to come up with real solutions to real problems. We at the Alabama Birth Coalition agree with the American
Public Health Association’s resolution to increase access to trained
out-of-hospital maternity care providers as an important step in improving
public health and safety. We support the
safest possible care for all Alabama families, regardless of chosen birth
setting.
For more information, visit
www.alabamabirthcoalition.org or find the organization on Facebook.
The Alabama Birth Coalition (ABC) is a 501c4
non-profit, grassroots organization.
