Thursday, February 6, 2014

Political Tactics Deprive “Home Birth Safety Act” of Promised Vote

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.
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.

After studying the issue, Dr. Pippa Abston
supports the licensure of CPM's.
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
The Alabama Birth Coalition will
keep fighting for the birthing
rights of Alabama mothers.
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 or find the organization on Facebook.
The Alabama Birth Coalition (ABC) is a 501c4 non-profit, grassroots organization.

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