Will Alabama Actually Make Home Birth Safer?

By Glenni Lorick, IBCLC

For the last several years, the Alabama Birth Coalition has worked tirelessly to pass legislation providing for the licensing and regulation of Certified Professional Midwives. Each year, their efforts have fallen short, as the bill has either not made it out of committee or been terribly altered by unfriendly ammendments. There is good reason to hope that this year will be different!

A New Committee

Instead of presenting a bill to the Health Committee like they have in past years, this year they have taken a different approach: they have provided a bill to the Judiciary committee! The focus of the bill is the decriminalization of home birth. House Bill 67 and Senate Bill 99, "The Home Birth Safety Act," would decriminalize the practice of Certified Professional Midwives (CPM's).  According to the Alabama Department of Public Health, 1,448 women gave birth outside of the hospital from 2005-2012. Many of those mothers had no medical assistance, increasing the risk dramatically. 

While it is not illegal for a mother to give birth in the comfort of her home, it IS illegal for anybody with any medical training to provide assistance to her. This bill provides immunity to midwives and certain healthcare providers who assist in "physiologic childbirth." In other words, specially trained professionals will not be prosecuted for helping a mother give birth at home.

The Debate

Opponents argue that home birth is inherently unsafe. They insist that a woman should only give birth in the safe confines of a hospital. In fact the president of the Medical Association of the State of Alabama weighed in heavily against this bill. Nevertheless, even Governor Bentley recognizes that Alabama mothers ARE having babies at home, and the wisest thing to do is make it as safe as possible for them by allowing trained professionals to attend those births. 

Proponents of the Home Birth Safety Act recognize that the bill on the table actually helps to ensure the safety of mothers by authorizing only "midwives who hold a current midwifery certification from an organization accredited by the Institute for Credentialing Excellence." Certified Professional Midwives are specifically trained in dealing with out-of-hospital births. They are experienced professionals who have undergone thorough testing of their knowledge base.

You Can Help

Tomorrow at 1:00 pm a public hearing is scheduled before the Senate Judiciary Committee followed by a committee vote. Many members of the Alabama Birth Coalition will travel to Montgomery to show their support. Assuming this bill passes the committee tomorrow, you need to contact your state senator, asking him or her to vote in favor of this bill when it comes to a full vote of the senate. Hopefully, the same process will take place in the House.

Eventually the Alabama Birth Coalition would like to see the practice of midwifery licensed and regulated by the state. This would confer even greater protection on childbearing families. Nevertheless, decriminalization is a very important first step!

Whether you personally would be comfortable with a home birth or not, it is time to recognize that every mother has the right to choose how she wants to give birth. Some women just want their epidural in the hospital, and that is their right. Others want a natural birth in a hospital setting. Some even want a Certified Nurse Midwife.  If a woman has the right to choose to end the life of her child, then she should certainly have the right to choose where and under what birthing circumstances her child's life outside of the womb will begin.

A Long-Term Vision

If you've been around A Nurturing Moment very much, you know that I often say I have the best job in the world. I love getting to help mothers breastfeed their babies. I love holding sweet newborns on a daily basis! I love encouraging moms and seeing their excitement when baby latches on and nurses well!

You may have also noticed the cross with Jeremiah 29:11 sitting in front of the desktop computer on  our counter. It is there as a constant reminder to me that A Nurturing Moment doesn't belong to me. It belongs to my Lord.  Therefore, as I make plans for the future of this business, I want to make sure that I am simply following His leading. I want to reflect Him in my interactions with customers, vendors, creditors, my landlord...everyone I meet. I know I don't always do as good a job of that as I should...I'm definitely still a work in progress!! But I AM in progress...He is guiding my steps daily! In fact, He often uses you, the mothers I work with, to help me gain wisdom and direction.

A Corner Of Our Own 
I don't remember the exact day when I first felt drawn to consider the piece of property at the corner of Airport Rd. and Memorial Parkway. But I do remember getting chills of confirmation the first time I pulled in the parking lot and actually drove around it. I believe that is supposed to be the ultimate location for A Nurturing Moment! I've told a lot of you that in person, but this is the first time I have actually written it down for the whole world to see! It's one thing to talk about a vision for the future, but quite another to step out in faith and record it for all posterity. After all, what if it doesn't happen?  I guess that's just a risk I will have to take.

So here is the vision that I believe God has placed in my heart for A Nurturing Moment - I will bullet the various parts of it to make it easier to read (and digest!)

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• Purchase the piece of property on the northwest corner of Airport Rd. and Memorial Parkway.
• Tear down the abandoned and dilapidated restaurant that currently occupies that corner, and build a two story building there.
• The first floor will house A Nurturing Moment. Our actual storefront doesn't really need to be much bigger than what we have now. However, we will have a MUCH larger classroom area that will also serve as a Mom Internet Cafe and hangout spot. I also want a small separate classroom for prenatal yoga and infant massage. There will be a couple of offices for lactation consultation and a place for doulas to meet with their clients. The Mom Foundation office will be there as well.
• The second floor will be home to a Birthing Center owned and operated by an Ob/Gyn who employs midwives! It will offer a homelike environment with the security of knowing you are just minutes from the hospital in case of an emergency. Although they are very common in other parts of the country, there is not a single birthing center in Alabama. About 17 years ago, Crestwood actually did open a birthing center with a Certified Nurse Midwife as the administrator. It was phenomenal, as any mother who delivered there will tell you. It was, however, also very short lived. It just wasn't the right time! I also hope to have a chiropracter who specializes in working with mothers and babies in the office space there. 

Getting From Here to There

A dream is a wonderful thing to have. All too often, however, we look at our dreams and think they are impossible to attain, so we just give up. If I didn't feel so certain that this is the direction the Lord wants us to go, I certainly wouldn't think there is any way we can ever get there. But I am absolutely convinced that this IS the path we're supposed to be on. So I am taking the necessary steps to move in that direction.

We are in a 5 year lease that began last October. So we have 4 years to purchase our corner and build A Nurturing Moment there. The asking price for that corner was somewhere in the neighborhood of 1.6 million dollars the last time I checked. Then we have to demolish the building that is there and rebuild. And I really don't think that I am supposed to incur any more debt. In fact, the more I learn about business, the more I really hate debt.

That sounds like a pretty impossible order. Actually from a purely human standpoint it sounds just plain foolish. So how in the world are we going to get there? 

As I pray about it, several action steps stand out in my mind:

1. Be the very best at what we do. We provide education, information, support and encouragement for hopeful, expectant and new parents. We need to be the #1 resource in North Alabama for new parents. We need to make every mother who walks through our door know how special she is and how glad we are that she came to see us. If we don't have what she needs, we need to figure out who does and help her get it as quickly as possible.
2. Seek partners for The Mom Foundation. We are the only non-profit that I know of in North Alabama dedicated to providing professional breastfeeding support to low-income and teen moms. We have attempted to write several grant proposals, but don't really know what we're doing. We need someone experienced in non-profit fundraising to come alongside us and guide us as we grow the non-profit arm of A Nurturing Moment. On average we provide about $250 worth of lactation services a month right now to mothers who would not otherwise be able to get the help. We also give out numerous nursing bras each month to moms in the WIC progam.
3. Publish The Creator's Guide to Infant Feeding. Although many outstanding books have been written about breastfeeding, not a single one that I've ever read approaches it from a Christian perspective. So several years ago, I wrote this book. I have looked at several publishing options and even had a literary agent working with me for a while. Unfortunately the one deal we were able to get with a major publisher fell through. However, with renewed interest in breastfeeding in this country, I think it is time to publish.
4. Talk openly about our vision any time I have the opportunity. It is amazing how God puts the right people in your path at the right time. I have no idea who all will be involved in the project, but I do know that I certainly won't achieve it by myself! I've already met an amazing commercial interior architectural designer who I know will be instrumental in the design of our new facility.
5. Build a team of families who will become an integral part of this vision. We are already doing this
   
   through Team National, an innovative purchasing co-op concept that allows members to save money on the things they buy every day for their families. It also allows them to create a Plan B income that they can use as a college fund, retirement plan or to pay off debt. Many families actually find that the income will allow them to gain more time freedom to actually spend quality time with their children. I am convinced that without Team National, this dream would be nothing more than a pipe dream for me. However, Team National is giving me a way to earn the capitol I will need to make this vision a reality by October of 2017!

Get Involved 

The one thing of which I'm certain is that it will be impossible to achieve this dream by myself. Our Nurturing Moment family will accomplish this together! I need your input. I need to know what we're doing right and where we need to improve. As we get closer, I will put together a focus group of moms to help us design the ideal space. Your suggestions are our lifeblood!

As you read through the action steps, maybe one of them struck you. Maybe you have a specific talent that you would like to offer. It has been so exciting to see various ANM moms take leadership in different local outreaches to other moms that have come out of our store. Maybe you have professional abilities or a relationship with a foundation or corporation that would align well with our goals. Maybe you just like the idea of saving money or making money.

 Perhaps you don't feel like you have much to offer aside from your prayers; that is definitely our greatest need! Please pray for wisdom for me and for clear direction. Pray for God's provision, and pray that we would be a tremendous blessing to moms all over North Alabama.

I have really bared my heart  tonight. But I believe that this is the right time to do so. I'm excited about what the future holds for us and can't wait to see it unfold! Thanks for coming along for the ride!!

Childbirth and Infant Mortality Abroad: The Netherlands

By: Marley Phillips, ANM Intern

Okay folks, let’s talk about the Netherlands. The Netherlands has the 20^th lowest infant mortality rate in the world. Not as impressive as the other countries featured, but I digress. This country has had worldwide recognition for its maternal healthcare, and I wanted to know why. The Netherlands is home to possible the most risqué city in the world, Amsterdam. The country as a whole is known for its sexual promiscuity and frequent visits to the “coffee shop”. With this knowledge, I did not expect the Netherlands to be a very family-friendly place. However, the government strives to take care of expectant mothers and ensure parents and babies are happy and healthy.

The Netherlands requires all citizens to buy approved private insurance plans. Insurance must cover anyone who asks for insurance. Citizens pay flat-rate premiums for all ages and incomes. If people use less than a preset amount of care in a given year, they get a refund. All insurances cover birth, but all insurances may not cover a hospital birth. Insurance also covers the cost of a kraamzorg service, but more about that later.

Holland is known for having the highest rates of homebirth in Europe for decades. We’ve always heard the amazing fairytales of a magical place where women get to choose where they birth. And midwives; oh, midwives for miles and miles! Despite the stories, the Netherlands’ home birth rates have been steadily declining for quite some time, and are now at an all time low of 24%.  Now, 24% may not seem very low to you or I here in America where the home birth rate is less than one percent and absolutely, completely taboo. But, for Holland, this is a staggering drop in numbers. 25 years ago, over 2/3 of women gave birth at home and now less than 1/3 are opting for the same birth experience. So why are so many women running for the hospital these days? According to this news story, some doctors are saying women now want a variety or pain relief and speedy deliveries. Seems like Holland is catching up to the rest of the world’s need for luxury and promptness.

After confirming the pregnancy with a general doctor, doctors can refer a midwife or women can choose their own midwife. The first appointment with a midwife won’t be until around week 12, where the midwife obtains medical history and does screening to assess if a woman would qualify for home birth, or if she should be referred to an obstetrician. The midwife will continue to monitor a patient’s condition to ensure she is the perfect candidate for home birth.

In the first 12 weeks of pregnancy, women should also arrange for a kraamzorg service. What’s a kraamzorg service, you ask? A kraamzorg is a wonderful service offered to new families that provides in-home postnatal care. Along with showing the new parents how to bathe and dress and basic breastfeeding support, the kraamzorg will also do some light cooking and cleaning around the house. The kraamzorg stays for about a week for 4-8 hours per day, depending on the need. Since this is such an amazing service, women are encouraged to find a kraamzorg service by the12^th week of pregnancy because it could be difficult to find an availability.

If a woman opts for homebirth, there’s not much procedure. Labor starts, midwife comes, out pops baby. The only thing is that each bed will require a metal riser to meet safety regulations for delivering a baby. Obviously, there is no type of pain medication when giving birth at home, so if a woman wants that she needs to go to a hospital. Although, I should mention only about 10% of women actually get the pain medication in Holland, and doctors are not too willing to administer it. When pain relief is given, it is usually in the form of an opiate-based liquid on a push-button basis. A midwife will deliver the baby, unless there is some type of abnormality, and most women are released within 24 hours of delivery.

Another option for expectant mothers in the Netherlands is a maternity hotel, or kraamzorghotels. These hotels offer a home birth for women whose home can’t accommodate a birth, or who simply don’t want to stay home. In these hotels, the woman and her husband (or other guest) can stay in luxury and she delivers her baby, and will have a kraamzorg immediately available to help when the baby arrives. Prices weren’t available, but some insurance will cover this. There are also maternity clinics for these women who can’t have or don’t want a home birth. Women may choose this option as a way to be close to hospital amenities in case of emergency, but not actually have to birth in the hospital.

Breastfeeding is heavily encouraged in the Netherlands, although the numbers may not necessarily reflect that. 80% of women initially begin breastfeeding and by 6 months that rate has dropped to 20%. Many women attribute this to feeling unwelcome while feeding in public, as well as returning to work, even though the Dutch have great legislation for breastfeeding moms. The Netherlands has also started putting in breastfeeding cafes around the country. These cafes serve as a place for mothers to meet up and nurse, share stories, give advice, etc. The country is also working on setting up public destinations specifically for nursing moms, so that they may not feel shunned or be asked to leave any establishment while feeding, which has been a hot button issue in recent years.

So, here’s the Netherlands: nothing overly spectacular or groundbreaking happening here. Midwives handle nearly all the deliveries, whether at home or in the hospital, and there is a harmonious system between midwife and obstetrician that is clearly working for this country. Holland maintains a fairly hands-off approach to pregnancy and childbirth, and I am really hoping this country doesn’t follow in the footsteps of the rest of the industrialized world and begin over-medicalizing the natural art of childbirth. Yet, based on these new statistics, the  Netherlands reputation as home birth capital of the world may be quickly fading.

Women's Rights, Alabama Law and Midwives

For the last several years, an amazing group called the Alabama Birth Coalition has been working

Photo from SoulVegMama

tirelessly to bring about legislative change which will allow Certified Professional Midwives (CPM's) to practice in Alabama. This legislation is important because in many rural counties, women have to drive an hour or more to the nearest hospital with a maternity unit. Families who don't want medical community involvement may end up giving birth at home without any attendant at all. Legalizing CPM's and home birth would offer these women another option. Furthermore, creating legislation that sets forth licensing requirements and regulates the practice of CPM's actually helps to ensure that women choosing home birth receive a high standard of care.

The Opposition 

Opponents of the bill, however, are many and powerful. Unfortunately even within the midwife community, there is sharp disagreement about this legislation. Certified Nurse Midwives (CNM's) sometimes cite the lack of medical training received by CPM's as a reason not to support the bill. Are their concerns legitimate? Certainly the kind of training that CPM's receive is different in nature than that received by CNM's. It is definitely more focused on out-of-the-hospital births. In fact, a candidate cannot even become a CPM without experience in at least 10 births in a non-hospital setting.

While it is true that we do currently have 17 CNM's in the state of Alabama, only a very small handful of them are actually catching babies! Some work in doctor's offices, others teach, but only 3 or 4 hospitals in the state have a CNM delivering babies. Why is that?  Why isn't there a single freestanding birth center in this state? In one word, the answer is MONEY.  Blue Cross, Blue Shield of Alabama, the largest insurance provider in the state, doesn't reimburse for midwife delivery the way they do for a physician delivery...not even close! Plus, the Alabama law is written in such a way that a midwife may only practice under direct supervision of a physician. Essentially, her supervising doctor is supposed to be on the premises when a midwife is delivering. Few doctors are willing to have midwives deliver under those conditions.

The Reality

Dr. Pippa Abston 

Within the medical community here in Alabama, it is common to hear how unsafe home birth is. But is it really? Dr. Pippa Abston, a pediatrician and instructor in the UAB family residency program used to agree with those who opposed home birth. In fact, she was a rather outspoken opponent. However, she began to thoroughly examine this issue, to actually see what a CPM does, and to understand just how badly we need the quality of care in many Alabama communities that a CPM would provide. In fact, Dr. Abston wrote a 5 part series about the importance of CPM's for Alabama women. It will take some time, but if you really care about this issue, you need to read Dr. Abston's excellent series. She has covered everything from the training of  a CPM to the safety issue to the desperate need in our rural counties.

The Root Issue

This is, at it's most fundamental point, a human rights issue. Last Friday evening The Alabama Birth Coalition sponsored a presentation of the film, Freedom For Birth. Take 15 minutes to watch the abbreviated web-version of this film. It details the cases of Hungarian midwife, Agnes Gereb and Hungarian mother, Anna Ternovsky. In 2010, The European Court of Human Rights affirmed that a woman has the right to give birth in the place and manner of her choosing.

Hungarian midwife Agnes Gereb

The United States Supreme Court in the infamous Roe v. Wade decision in 1973 stated that a woman has the right to abort her unborn baby - a decision I don't personally support. However, based on that precedent, it is utterly illogical to say that she doesn't have the right to choose how and where her baby (whom she has chosen not to kill) can be born.  Even in the highly unlikely event that Roe v. Wade were ever reversed, it should be a common-sense decision to view a woman's right to give birth as she pleases as her decision to make. Whether a physician or a competent midwife  performs her prenatal care should be up to her. If a mother has chosen the midwifery model of care, and her midwife realizes that something is amiss, then her midwife should be able to have a collaborative professional relationship with a physician and should be able to stay with the mother throughout  whatever kind of birth the mother needs at that point. Opponents may say that this endangers mothers and babies. However, in the Netherlands where this is the model, the maternal and infant death rate is lower than that of the United States.

A Call to Action

There are many states in this country where women have absolute freedom to give birth in the manner that is most comfortable for them.  Alabama, however, is definitely not one of those states. We would do well to look at the maternity care models in states like Texas, Tennessee,  and New York. Two separate and very important things need to happen legislatively in Alabama:

Hungarian mother Anna Ternovsky

1. CNM's need to be authorized by law to work without direct physician supervision in any birth setting, and insurance reimbursement for their services needs to be mandated.
2. CPM's need to licensed and regulated by the state to ensure that mothers desiring their services are getting the highest possible standard of care. This will stop the mass exodus of birthing mothers to surrounding friendlier states, and allow mothers in the poorest Alabama counties access to local well-trained professional birth support.

Anna Ternovsky was willing to take her fight to the highest court that held jurisdiction over her country.  Will it actually take a mother here beginning that judicial fight to create the changes that must occur? I would hope that our legislators, midwives and physicians will find a way to come together in respectful support of mothers and babies before that happens. However, the Alabama Birth Coalition has been struggling for twelve years to bring about legislative change. Maybe now is the time to seek the kind of judicial ruling that will ensure all mothers have their basic right to give birth as they choose protected.

Someday I would love to see a Free-standing birthing center here in Huntsville where both CNM's and CPM's work together and have healthy collaborative relationships with local physicians. There is absolutely no valid reason why this can't happen. And I believe it will. If all those who are concerned about birth in this state would simply work together, we could lower our infant mortality rate, provide high-quality care to the poorest among us, and make certain that every Alabama mother receives her basic human right to the birth of her choosing.

My Natural Hospital Midwife Birth in Alabama!

Roberta Ress, CNM is the only Certified Nurse Midwife
delivering babies in a hospital setting in North Alabama.

by Anna Bertone, Guest Blogger

When I became pregnant with my first child in May 2012, I was living in Chicago and finishing graduate school. I selected a midwifery practice with privileges to deliver at an “Alternative Birthing Center” within a local hospital. In my view, this was the ideal arrangement because I had support for a natural birth, all of the comfort amenities (tub, ball, peaceful setting), and, if I were to need an emergency procedure, I could be wheeled out the door and down the hall in a matter of seconds.

When work required that my husband and I move to Huntsville in my 8^th month of pregnancy, I was scared and confused by the apparent lack of birthing options in AL. Where were the midwives? The Birthing Centers? The natural birth classes? After days of web searching and phone calls, I spoke with a former CNM (Certified Nurse Midwife) who put me in touch with Roberta Ress, CNM at Carlota OB/GYN practice in Athens. We met for the first time when I was already well into my pregnancy. With that meeting, my hope was restored that a natural birth in a hospital setting is indeed possible in Alabama.

Roberta delivers at Athens-Limestone hospital. She is supported by her OB/GYN practice and the wonderful hospital nurses. My Birth Plan was well received and respected by everyone I came in contact with during and after delivery. 

I won’t pretend that my birth was easy or “ecstatic”, as some women claim. It was eight hours of HARD WORK following a day and a half of sleepless pre-labor. I’m not sure I could have done it without Roberta and the nurses. Some of the nurses had experienced their own natural births. I think this made them even better at encouraging me and knowing what to do (or not to do). For example, no one pushed drugs, or made me feel as though I was up against the clock, or was being too loud. No one complained about how I was chugging coconut water like a shipwrecked sailor the entire time. They brought me mats when I was laboring on the floor, demonstrated the many ways a hospital bed can change to support different positions, attached a bar to the bed, and pointed a fan on me. Roberta coached my breathing when I started to “drown” during transition, and my husband and doula held my hands and assisted me throughout. Carina was born Jan. 14^th at 7:33 AM.

Ladies, I highly recommend hiring a doula. A doula is a friend, an educator, a masseuse, and an experienced mother. Even if you have a husband, partner, or family member present, a doula can show them how to help you best. I worked with Aleah Charney. You can visit her website www.birthingbeautiful.net/.

Thanks to A Nurturing Moment for creating a space for women to connect on issues such as these. I love your services and products!

Anna Bertone

(919)-428-6918        annacbertone@gmail.com

Feel free to call/email me with any questions about Carina’s birth!

Huntsville Walk for Midwives

Yesterday morning more than 100 proponents of a woman's right to choose how and where she gives birth gathered at Big Spring Park for the Walk for Midwives. They raised money for the Alabama Birth Coalition, but more importantly, they were hoping to raise awareness about the importance of changing the Alabama law.

The majority of states allow women to give birth as they choose. Alabama, however, does not. In Alabama, women who would prefer to give birth in the comfort of their own home with a trained professional midwife are denied that option. There is much debate about the safety of women giving birth at home, and this isn't the forum to debate that.

However, if we had greater availability of midwives routinely offering services in Alabama hospitals and birth centers, perhaps fewer mothers would opt for home birth. Women who want to avoid interventions, who want to labor in the water and who want to give birth in non-traditional positions often feel they don't have those options with an Ob/Gyn in a traditional hospital setting. Although we do have some doctors in our area who are very open to a woman's preferences, the presence of midwives working alongside them would go a long way toward helping this group of mothers feel comfortable.

The Alabama Birth Coalition is working to change the law in Alabama. If Blue Cross Blue Shield would change the way they cover midwife deliveries in the hospital setting, that would be a terrific first step. Another important step is the legalization and regulation of Certified Professional Midwives. Many rural Alabama counties have no prenatal care or hospital at all. That's one of the primary reasons that Alabama has such a high infant mortality rate. Women in these rural counties would be well-served by the changes in legislation that the Alabama Birth Coalition is seeking.