Alabama women cross state lines to give birth with midwives

HUNTSVILLE, Ala. (AP) – When Brianna Barker spots the big blue “Tennessee welcomes you” sign about an hour into her car trip, she breathes a little easier. Barker crosses the state line from Alabama to Tennessee every time she goes for a prenatal appointment.

It’s the same welcome sign she’ll see in about a month, when she makes the now-familiar two-and-a-half hour journey while in labor.

More than 30 states allow certified professional midwives to deliver babies, but Alabama is not one of them.

For Barker, that isn’t acceptable.

For Alabama women like her who have low-risk pregnancies and don’t want to give birth in a hospital with a doctor, or at home unassisted, there’s one other option: cross the state line into Tennessee, Georgia, Mississippi or Florida where it’s legal.

Those states have options: in-hospital births attended by midwives; freestanding birth centers staffed with midwives or nurse-midwives; and home births attended by midwives.

“We have women in Alabama who give birth unassisted because they may not have the means to go elsewhere, and for them, that may be a choice they feel backed into,” said Barker, who traveled to a midwife in Tennessee the last time she gave birth.

“That is not what we want. We want people to make educated and informed decisions for their family.”

The number of American women choosing midwife-attended births is small, but growing.

Certified midwives and Certified Nurse-Midwives (CNMs) attended 8.4 percent of births in 2014, an 11 percent increase from 2005, according to data from the National Center for Vital Statistics. The vast majority (94 percent) of those births occurred in hospitals. Just 2.7 percent were home births.

Organizations like the Alabama Birth Coalition and other birth-choice advocacy groups have been lobbying the state legislature for at least a decade to get midwifery legalized.

This year’s bill, which did not make it out of committee, was the most detailed and stringent yet. It would have required midwives to receive the national Certified Professional Midwife accreditation and would have established a regulatory board to oversee licenses granted to midwives.

Cavender, vice president of the Alabama Birth Coalition, said a hearing on the bill held back in April was “one of the most positive experiences we’ve had” in the fight to make midwives legal. Mark Jackson, the executive director of the Medical Association of Alabama, which has traditionally been opposed to legalized midwifery, agreed.

“The education requirements in this bill have come a long way from previous pieces of legislation, so we were encouraged by that,” he said at the time.

Thompson believes midwifery care, if it were legal in Alabama, could provide better outcomes for mothers and babies especially in rural areas where doctors are scarce and hospitals often don’t have labor & delivery departments.

“What hurts is that I know there are women driving two and a half hours just to get prenatal care,” said Cavender. “There are women showing up with no prenatal care at the nearest ER two hours away (to give birth). It’s awful.”

One in fourth births in Alabama happen to women who have had less than adequate prenatal care. Alabama’s infant mortality rate is one of the highest in the nation, at 8.7 deaths before age 1 per 1,000 live births. The U.S. rate is 5.8.

“One thing my husband and I talk in circles about is why this is not more accepted in the medical community,” she said. “We hear both sides because we’re medical people. But the day this becomes a healthcare team effort and less ‘us versus them,’ our birth outcomes might look more like Oregon, Idaho, Vermont.”