Summer McCreless describes the birth of her daughter as an amazing and peaceful experience.
Her second child, Lavender, was born two years ago at her home in Lawrence County. Between contractions, McCreless was able to walk around her property, breath fresh air and look at the sky.
“It was extremely empowering and completely different from a hospital birth,” McCreless said.
Under Alabama law, women can give birth at home. But they can’t do it with assistance from midwives. Alabama is one of nine states that can prosecute midwives who assist in home births.
For that reason, McCreless won’t reveal the name of the midwife who helped deliver Lavender.
“She risked her career to give me a home birth in Alabama,” McCreless said.
One Alabama lawmaker is hoping to change the law with a bill to license and regulate certified professional midwives.
“If we are going to allow at-home births, if they can have someone there with some experience, that is always going to be a better situation than doing it at home by themselves,” Sen. Paul Bussman, R-Cullman, said.
Bussman said he favors certifying midwives, in part, because 27 other states that have done it haven’t seen an increase in infant mortality or any other reason to repeal their laws.
His bill prohibits midwives from administering epidurals and anesthetics, inducing abortions or performing cesarean sections.
There are proponents and opponents of the Bussman’s Senate Bill 314, but they agree on one thing — more women are giving birth at home.
“In my district, we have a high number of constituents who are interested in (home births with midwives),” Bussman said. “I just felt it was important that we have this discussion.”
That discussion included a public hearing before the Senate Health Committee last month and a subcommittee formed to study the issue. Approval from the Senate Health Committee is the first step toward creation of a state midwifery certification board and making it legal for women like McCreless to have a certified professional midwife assist in deliveries.
“If it is legal to have (babies) at home, which it is, it should be legal to have someone trained to attend to them,” said Jennifer Crook, a Birmingham resident and Tennessee-licensed certified professional midwife. She’s also a registered lobbyist arguing for professional midwives.
She describes a certified professional midwife’s care as including pre-natal care, delivery and up to six weeks of postpartum consultations.
Crook, who has a master’s degree in public health, said home births with certified profession midwives are no more risky for low-risk mothers than hospital births.
But “low-risk” is the key, supporters said.
McCreless said she wanted to have her first child at home five years ago, but said she “risked out” of that option because she had toxemia, also known as pregnancy-induced hypertension.
“It was not safe for me to deliver outside of a hospital,” she said.
With Lavender, McCreless consulted both her midwife and a physician during her pregnancy.
“We made the educated decision to have our second child at home,” she said. “I am not one of these people who wants a home birth no matter what. The first time, I realized I needed to be in a hospital.”
Opponents said Bussman’s bill could put mothers and babies at risk.
“For the state to approve certified professional midwives could make the public think delivering a baby at home is safer than it is,” said Dr. Thomas Miller, deputy director for medical affairs for the Alabama Department of Public Health. “When you’re doing a delivery, there is the potential for it to go bad. Anyone has the right to deliver their baby at home, but to license these (certified professional midwives) gives a false sense of security.”
Department officials voice concern that since midwives don’t handle as many births as doctors, they aren’t experienced enough to recognize an emergency. They also said a professional midwife’s training is inadequate.
“You can get that training out of high school,” Miller said. “For a lot of reasons, we don’t think the training and education is sufficient.”
Crook argues her profession’s nationally-recognized accreditation, which includes years of training, an internship and an eight-hour exam, is the “gold standard for out-of-hospital births.” She agrees that midwives don’t deliver as many babies as doctors do, but that’s by design for a different model of care. She said six babies a month would be a busy practice for a midwife.
But state medical and nursing associations said certified professional midwives don’t have enough formal education. Aside from their national certification, they don’t need any education after high school.
The Alabama State Nurses Association opposes Bussman’s bill, insisting that anyone who delivers babies should have credentials equal to certified nurse midwives, said Marilyn Rhodes, who has represented the association on the committee studying the bill. She also is a certified nurse-midwife and assistant professor of nursing at Auburn University Montgomery.
Certified nurse-midwives are allowed in Alabama. They are registered nurses and have master’s degrees in nursing or another health-related field of study. And they work in conjunction with physicians and are prohibited from assisting with home births.
By contrast, the certified professional midwives that Bussman’s bill would allow operate separately from doctors and hospitals.
Rhodes disagrees with Crook on the education a midwife should have; the two women agree midwives should be working outside of hospital walls. Rhodes said she’d like to see certified nurse-midwives working in group practices with collaborative medical backup.
“We need to do better than what we’re doing now,” Rhodes said.
McCreless said her first delivery, in a hospital, cost about $20,000. Part of that price was because of complications she had. Her home birth, by comparison, cost about $3,000.
Crook said on average, care with a midwife, including pre-natal care and six weeks of postpartum care, costs between $3,000 and $5,000. Meanwhile, a non-complicated, vaginal hospital birth costs on average about $10,000, according to the Childbirth Connection.
A 2008 cost-benefit analysis for the state of Washington, which has one of the largest networks of certified midwives, said midwife care results in cost savings to Medicaid of nearly half a million dollars every two years.
“I have facts that say this is a safe, economic option for low-risk moms,” Crook said.
Supporters of the bill said it is not just about being able to choose home births. It’s also about access to medical care.
Thirty-six of Alabama’s 67 counties do not have birthing hospitals, including Lawrence and Franklin counties, according to the Alabama Department of Health.
Rebecca Swinney, of Phil Campbell in Franklin County, said she wanted to have her fifth child in a birthing house in Tennessee. But the baby’s birth progressed so rapidly, she didn’t have time to make the hour drive. And she wouldn’t have had time to get to the nearest hospital in the Shoals.
Baby Jameson was born in the Swinney family’s bathtub.
“There are women in first or second pregnancies that can go very fast,” Swinney said. “What if we had been all alone and hadn’t known what to do?
Swinney supports Bussman’s bill because it could create a network of community midwives in rural areas.
“We have these women that are certified and experienced,” Swinney said. “We need to be utilizing them in our communities.”
But Miller said just because a county doesn’t have a birthing hospital within its boundaries doesn’t mean residents aren’t close to one.
He lives in Autauga County, which doesn’t have one, but said he’s about 11 miles from two Montgomery hospitals with maternity wards.
Two of Swinney’s children were born in hospitals, but she wanted the other three born at home or at birthing houses because it felt more natural to her.
“I like that there are fewer interventions when you birth with a midwife,” she said “(In a hospital) you’re kind of put on a time schedule. There is an idea of how a birth is supposed to progress.”
She also likes the idea of “my house, my germs.”
“In a hospital, you don’t know what you and your baby are going to be exposed to,” she said.
For McCreless, to give birth at home with her family nearby, to rest in her own bed, wear her own clothes and to never have her baby taken away from her at any point after the delivery, is something she wouldn’t trade. But she wouldn’t have done it without a midwife.
“To have that option, if you are able to, is amazing,” she said.
Mary Sell is the TimesDaily Montgomery bureau chief. She can be reached at mary.sell@TimesDaily.com.
Home births in the U.S. increased by 29 percent from 2004-09, but are only a small fraction of overall births (.72 percent in 2009).
During the same period in Alabama, home births rose from .23 percent to .26 percent of all births. That means about 162 of the 62,474 babies born in Alabama in 2009 were delivered at home.
In 2009, 62 percent of home births nationwide were attended by midwives.
Source: Centers for Disease Control