Alabama House committee passes contested midwife practice bill after public hearing
An Alabama House committee Wednesday passed a bill changing the scope of practice for midwives in Alabama after a packed public hearing over the measure.
As originally filed, SB 87, sponsored by Sen. Arthur Orr, R-Decatur, would have allowed midwives to administer three parts of newborn screenings: heel stick, hearing screening and Critical Congenital Heart Disease (CCHD) screening, which can provide early detection of genetic or metabolic conditions.
But in the Senate, the bill was amended to only allow midwives to conduct a heel stick and adds language prohibiting midwives from providing 'any care' that is not in law or in an emergency to newborns.
'This bill started out with those three newborn screening tests included, but two of them were removed when the substitute was submitted over in the Senate. It passed the Senate, and so that's where the bill stands today,' said Rep. Ben Harrison, R-Elkmont, who is carrying the bill in the House.
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Midwives in Alabama were only allowed to practice after the state in 2017 started regulating midwifery and lifted a four-decade ban on the practice. Midwives have since then been fighting to provide more comprehensive care. The medical community has historically pushed back against such efforts, saying midwives don't have sufficient training, especially in cases of emergency.
State health guidelines in Alabama require newborn screenings within 24-48 hours postpartum. Midwives must refer newborns to pediatricians, often delaying these critical tests. While midwives can administer screenings if a doctor is absent, they are not allowed to order these tests.
Alabama midwives pull support from bill after addition of 'hostile language'
The new version also states that while a licensed midwife 'may order and administer a heel lance within 72 hours after birth,' they are 'prohibited from interpreting any tests or screens under this subsection and shall cause any results to be referred to a physician of the mother's choosing who is licensed to practice medicine.'
'Today, I'm calling out a disgrace … SB 87 has been hijacked. As is, it denigrates the sanctity of motherhood, the safety of newborns, and above all, is a wolf in sheep's clothing,' said Aaron Crawford, president of the Alabama Birth Coalition, who blamed lobbyists for changes in the bill.
Rep. Ernie Yarbrough, R-Trinity, said he opposed the bill as amended but supported its original intent.
'Choices and options are being removed or denied from Alabama mothers because it would seem special interest and a general attitude that our mothers and their midwives can't possibly make good decisions and should trust the experts. I would humbly submit that 6,000 years plus of evidence would be different to that,' he said.
Maria Cranford, a midwife in north Alabama, said that national standards provide midwives are trained and educated in the care of mothers and newborns through the first six weeks after birth.
'This includes performing newborn exams, administering newborn screens, critical congenital heart screenings with referral… and newborn screenings,' she said. 'All of which I'm taught students to do in clinical settings — not here in Alabama, because I'm legally not allowed to.'
Support for the amended bill came from the medical community, who said it would preserve medical standards.
Linda Lee, executive director of the American Academy of Pediatrics Alabama chapter, read a statement from Dr. Nola Jean Ernest, a pediatrician in Enterprise. Claiming there's no evidence that midwifery improves infant mortality rates, Ernest said that 'all further medical evaluation and care' should be performed by a medical provider.
'Lay midwives attending home births do not have the equivalent training or clinical experience as pediatricians or neonatologists,' Ernest wrote in the letter.
Danne Howard, deputy director of the Alabama Hospital Association, also supported the bill as it passed the Senate and defended notions that 'hospitals across the state have not abandoned labor and delivery.' Rural hospitals have faced financial struggle for years, which had led to some delivery units being closed around the state.
'Alabama Hospital [Association] supported the bill as it was passed by the Senate and look forward to additional work in years to come to see what other avenues that we can make great strides in improving access to care,' Howard said.
The committee approved the bill on a voice vote. The legislation moves to the full House.
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