Courtney Sirmon wants to give birth to her baby at home — and that is something, she says, that will not change. “I want to be where I feel the safest and most comfortable, and for me, that’s my house,” said Sirmon. “I would love for my children to wake up and be like, ‘There’s a baby here!’ and for us to carry on as a family.”
Sirmon’s thoughts on home births are not as uncommon as some may believe. More and more women are choosing to give birth to their children in the comfort of their own homes. According to a published report by the Center for Disease Control, in 2012 there were 53,635 births out-of-hospital, including 35,184 home births. However, choosing to give birth at home in Alabama runs into trouble with the law; it is illegal for midwives to operate in the state, even if trained and certified elsewhere.
Parents are legally allowed to have their children at home unassisted, but Sirmon believes that it is “common sense” to have a professionally trained midwife there to help. Some parents won’t let the law prevent that, she said. “There are families that are going to do this [have a home birth],” she said. “It could be religious, it could be cultural, it could be a researched decision, but they’re going to give birth at home in Alabama. And the question is, do we want to provide a care provider for them that’s safe, or do we want to let them give birth unassisted?”
A bill before the Alabama legislature when it resumed this week would decriminalize midwifery in Alabama, allowing professionals to practice in the state. A companion bill would set up a board to license midwives in the state. The decriminalization bill, HB 315, is currently sponsored by Rep. Ken Johnson and Rep. Phillip Pettus, while the licensure bill, HB 316, also sponsored by Johnson, has 36 cosponsors.
Alabama legislators came back from their spring break April 4, and Sirmon remains hopeful that the bills will pass. Before the legislature reconvened on Tuesday, Sirmon stated that the specific voting date for the bill won’t be known until “we see the bill on the agenda. [We are] hoping for Thursday but won’t know until maybe [Tuesday] sometime.”
Jennifer Crook has been a certified professional midwife for 13 years and is one of several fighting for the bill to be passed. “If the decriminalization bill is passed then that is a great first step,” she said. “If they could graciously give us the reprieve of not having to worry about going to jail for doing our job, that would be a great step forward for moms and midwives alike.”
While optimistic that the decriminalization bill will pass, Sirmon believes that people often misunderstand what midwifery advocates want. “I think… [people] think we’re asking for midwives with no training or education or skills to be doing this, but that’s not what we’re asking for at all,” she said. “We’re asking for certified professional midwives. And they’re licensed and regulated in 32 states now. It’s pretty clear that their education, skills, and training… would benefit the state of Alabama,” said Sirmon.
There are certified nurse midwives, who first become registered nurses and are legally allowed to practice in Alabama under a physician’s supervision. And there are certified professional midwives, who are trained to assist in home birth situations. Becoming a certified professional midwife is a long process, which includes but is not limited to a three- to five-year course of study, an internship component with a senior midwife, and a daylong written exam. Crook describes modern midwifery as “evidence-based practices” that have been around for years.
For instance, she said, “Doctors are saying now that not immediately clamping the [umbilical] cord after the birth is a great idea for babies. Well, midwives have been doing that forever! And women have had to fight in hospitals to keep physicians from clamping the cord, because that’s how [the physicians] were trained. That’s what they do. Not because there’s any research that backs up what they’re doing, but because that’s how they’ve always done it. So, it always cracks me up when these policy position papers come out saying things that midwives have been doing in practice for quite some time.”
Crook added that giving birth to a child at home is not for everyone, but ideally for low-risk pregnancies. However, in the instance of a high-risk situation, Crook said that modern midwives are highly trained to make quick and appropriate decisions. “When you’re dealing with normal, low-risk pregnancies 99.9 percent of the time, when something comes up outside of that experience, we’re very quick to pick up on it,” she said. “Part of our training is how, what, and when we need to make an appropriate transfer of care… And gosh, wouldn’t it be great if we weren’t worried about being arrested when we get to the hospital?”
Crook argued that few birth transports are true emergencies. “We are trained to recognize those situations and stabilize mom and baby until that transfer of care can happen,” she said. “We don’t want to be at home in a situation that we’re not trained to deal with. We, too, want healthy moms and healthy babies.”
Crook said that many of the misconceptions surrounding midwives are the result of the greed of medical institutions. “The opposition to legalize midwives in Alabama will say it’s about safety but…we know it’s not an issue of safety,” she said. “They like to tell dead baby stories, but the Medical Association of the State of Alabama (MASA) is not a public health organization. It’s a trade organization that’s responsible for protecting interests of its members. And those interests in this case are financial. It’s a turf war. They don’t want to give up their piece of the pie.”
Recently, the executive director of MASA, Mark Jackson, expressed his opinion on the decriminalization of midwives in an interview with the Alabama Political Reporter. “There should be no midwives in Alabama without a regulating authority in the state. Rep. Johnson’s HB 316 would set up a regulating authority, but the Medical Association has problems with that bill as well,” he said. “It is unfair and wrong for the hospitals in this state, the physicians in the state, the nurses in the state, to assume the liability when something goes wrong.”
Weld made several attempts to contact Jackson but he could not be reached for comment.
Weld also reached out to the most well-known doctor in the state: Gov. Robert Bentley. Bentley’s communications director Yasamie August responded in an email, “Once the Governor’s Office receive the final bill it will undergo a legal review, at that time we will make it known if the Governor supports the bill or not. This is a standard procedure for all bills.”(sic)
The ‘Birth Monopoly’
While the ultimate goal of the decriminalization bill is to allow midwives to practice legally, advocates for the bill, like Sirmon, believe the overall goal is to simply give women more choices. “They [the mothers] have very few options. They can basically decide to give birth at home unassisted, they can try to drive as fast as they can [to another state] and maybe give birth in their car on the side of the road, or they can schedule their birth, and that comes with its own risks,” Sirmon explained.
Sirmon, who is also the vice president of the Alabama Birth Coalition, called the lack of maternity care choices a “monopoly on birth.”
“There really aren’t any other choices,” she said. “There are no birth centers. There’s not any certified nurse midwives delivering outside the hospital. There’s not any certified professional midwives delivering in Alabama. So you basically have developed what we refer to as a monopoly on birth.
“When there’s not that competition or that ability for families to make any other choices, there’s not a real reason to want to change,” Sirmon said.
Cristen Pascucci, founder of an organization called Birth Monopoly, says that Alabama is typical among states that don’t allow midwife assistance.
“Alabama is a really great example of the birth monopoly,” Pascucci said. “In Alabama you’ll have hundreds of families fighting for out-of-hospital options like birth centers [and] midwives, and then you’ll have this really well-funded medical lobby doing everything in their power, making sure that people don’t have options other than hospitals and physicians. So you just get all these families caught in this horrible conundrum asking, ‘How do you beat organizations that are spending hundreds of thousands of dollars making sure they have exclusive rights to your business?’”
Pascucci attributes the rising popularity of out-of-hospital birthing options to the “bullying” and disrespecting of women’s rights in hospitals.
“Alabama is a particularly bad example of when women’s rights are disrespected,” she said. “So you get women looking for other options outside of hospitals because they can’t be treated with dignity and respect when they do go to a hospital. The Alabama hospital situation is pretty bad in a lot of parts of the state so these women are desperately trying to find other options and it’s a whole other battle to try and get midwives able to practice legally.”
Pascucci said hospitals are focusing on their financial drives instead of what is best for the mother and baby. As a result families are being forced into practices they otherwise would avoid, she said. “I’ve talked to women who absolutely have been threatened with child protective services or, ’If you don’t induce [labor] by the end of this week we will drop your care and we will not see you anymore.’ Really paternalistic, punitive practices on women that are really not about their health. It’s about controlling how they give birth.”
Pascucci denied “hating on hospitals,” adding that “We need hospitals! We need C-sections,” she said. “We need medical interventions, and I feel that’s an important point that needs to be made. We aren’t saying people don’t need these things. We just don’t need them jammed down our throats.”
Sirmon agreed that there’s nothing wrong with choosing to give birth in a hospital and that Birmingham is “very blessed” with in-hospital options willing to work with mothers without interventions. But at the end of the day, it’s all about choices, she said. “We need to recognize that if we’re saying we agree a woman should have the choice of where she gives birth, then it only makes sense that we make sure we’re making it safe by providing a care provider for her.”
On March 2, Health Committee Chairman April Weaver issued her own midwifery bill titled HB 344, which would, according to the bill, “authorize lay midwives who are registered with the State Board of Registration for Lay Midwifery to assist with deliveries at birthing centers in certain circumstances.”
This bill, said Crook, would cause a “myriad of issues.”
“It’s really hard to believe that things could be made worse,” she said, “but if HB 344 were to pass, that’s exactly what would happen.”
Crook continued that due to the certain requirements issued in the bill, “there is literally not a single midwife on the planet, from any educational background, who would qualify to practice under this proposed legislation.”
The bill would also increase the criminal charge of practicing midwifery from a misdemeanor to a felony and, according to Crook, would outlaw home births. “So, in an attempt to address Alabama’s maternity care crisis, they’re proposing that the government mandate where women can give birth, restricting access to birth options in all 67 Alabama counties, and essentially forcing women to birth in hospital with [OB-GYNs],” she said. “It does nothing but muddy the water and make an already miserable situation even more unbearable for Alabama’s babies, mamas, and midwives.”
Weld was unable to reach Weaver for comment, but her bill is currently awaiting committee action, according to the Alabama Legislature website.
Addressing the Issue
Crook, who expressed hope that HB 315 and HB 316 would get priority treatment during the legislative session, said that changing state law would benefit mothers even more than midwives. “We want as many options for our mamas as possible,” she said. “We just feel like the more options that Alabama moms have the better off they’ll be.”
Progress will require trust, Pascucci said. “We need to trust women and families that they know what’s best for them. Midwifery has been proven to be safer than obstetric care. Women and families must have the right to choose it. It doesn’t make any sense that a cab driver or a police officer or a bus driver could catch a baby and be considered a hero, but we would put in jail a woman who is professionally trained to catch babies in the safest way possible,” she said.
She added that people should research what modern midwifery entails so they can be properly informed on the subject. “I think there’s a lot of misinformation about what midwifery is and what midwives do and people who don’t support midwifery benefit from those prejudices,” she said. “I’d really like to see people get a clear true picture of what midwifery is and what midwives are instead of buying into these false narratives that they are these untrained, backwoods old ladies.
“These are trained professionals that are recognized in most of the other states in the nation. They are smart, they’re caring, they are compassionate. They know what they’re doing. They care so much about women and babies, that’s their calling…and it’s unconscionable to me that the state would prevent women from caring for other women and babies. And in the end that’s what this is all about: women helping women,” Pascucci added.
Sirmon is choosing to stay “cautiously optimistic” that HB 315 and HB 316 will be passed, she said. “I haven’t talked to a single Alabamian that does not agree with me that this needs to happen,” she said. “And I think that’s so great. It isn’t an issue that’s polarizing…everybody’s saying, ‘Of course.’”
Making home births safer should be the priority, not questioning the value of midwifery, Sirmon said. “We really should not be asking whether or not home births are safe. What we should be asking is how we make it safer. And in Alabama, the way we make it safer, is by licensing and regulating certified professional midwives.”
For more information on modern midwifery in the United States, visit www.mana.org.