Natural Birthing in Alabama Presents Challenges by Bexley McLennan
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here is an abundance of decisions to be made during the nine months of pregnancy, and determining the best birth setting for a mother necessitates sound planning, especially in Alabama. “Childbirth is a life-altering event, and a woman wanting a natural experience must be informed,” says Gulf Coast Birth Partners facilitator Colleen Tullis. Kristi Lanford, a Mobile marriage counselor, became interested in natural birth because she believes that God designed women’s bodies to birth, and states, “I wanted to be a partner with that and an active participant in my birth.” Lanford has had one hospital birth and three out-ofhospital births. In most places, a woman can have a non-medicated birth experience attended by a qualified care provider in a hospital, birthing center or the comfort of her own home. A home birth experience is suitable for a healthy woman with a low-risk pregnancy. In this setting, the mom-to-be is able to wear her own clothing and eat as she pleases. Because monitoring of mom and baby is done intermittently, she is also free to move around. Typically, a certified 22
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professional midwife (CPM) attends a home birth, but Alabama is one of eight states that actively prosecutes midwives. While it is legal for parents to choose the home birth option, it is illegal for a CPM to attend an out-of-hospital birth. Midwives are traditional care providers for mothers and infants, and the CPM is a competency-based national credential developed by the North American Registry of Midwives. It is awarded to midwives that have demonstrated the knowledge and hands-on skills required to attend childbirth in out-of-hospital settings, but CPMs are not sanctioned to practice in any Alabama setting. According to the Alabama Birth Coalition (ABC), Alabama law protects almost anyone that attends a birth at home from prosecution. An untrained neighbor or a stranger could assist with an out-of-hospital birth with no repercussions, yet a midwife that is nationally certified in natural childbirth would be prosecuted for the same assistance for practicing without a nurse-midwifery license. Certified nurse-midwives (board certified nurses with a master’s level degree in midwifery) can legally assist in prenatal
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and maternity care, but only under the direct supervision of a physician. Because physicians typically don’t attend home births, local mothers that choose to birth out-of-hospital have three difficult options: drive out of state, birth in-state with an unregulated midwife that risks prosecution, or birth without a qualified caregiver. “Many Alabama families are not aware of the positive culture with midwives around our nation and the world,” says Lanford. “In many other states, it’s easy to find midwives, doulas and Bradley Birth classes in the Yellow Pages, as well as support networks for babywearing and breastfeeding.” In much of the U.S., birth centers offer a middle ground option between home and hospital settings by providing the comforts and freedoms of a home-like environment with a collaborative team that includes midwives, obstetricians, pediatricians and other specialists. But because there are no birth centers in Alabama, a hospital birth is the only option for women wanting to have an in-state childbirth, legally attended by a qualified professional. With proper preparations, a nonmedicated birth is possible in the traditional hospital setting, but Tullis warns, “Striving for a natural childbirth in a hospital feels like you’re swimming upstream. It’s like going to KFC and ordering a Big Mac. It can often be a foreign concept for most physicians and nurses.” She emphasizes that she is not anti-doctor and values a physician’s expertise, particularly in highrisk situations. “But you must be prepared and have an agenda, because they do if you don’t, and what’s normal protocol to them may not be what you want,” she advises moms that desire a natural experience. To allow for an active labor, request intermittent fetal monitoring, avoid intravenous fluids and ask about the availability of birthing props. Become familiar with hospital policies such as who can be in the delivery room and whether the baby will stay with Mom after the birth. Even if the hospital has a nurse midwife on staff, there’s no way to guarantee that her work schedule will mirror a patient’s labor timeline. Tullis encourages women to hire a doula to assist in preparing for and carrying out the family’s birth plan. “A doula doesn’t write your plan, she just helps you stay the course. Particularly with long labors, exhaustion makes it easy to throw in the towel to hospital staff that are