03/23/2025
Alabama politics at its finest. It's honestly exhausting to be a midwife in this state and have to fight to be able to do our job safely. The days when I just want to pack it all up I remind myself that that is exactly what they want, and how they win. They don't want midwives and babies being born at home in this state, and they will continue to make it hard for all of us. This sub-bill would make it so that I and other midwives cannot provide any newborn care, which includes even weighing a baby. But we will find a way to make it work. Alabama midwives and home birth families aren't going anywhere.
POLITICAL MANEUVERING DERAILS SB87, THREATENING MATERNITY CARE ACCESS IN ALABAMA
Secret Sub-Bill, Last-Minute Meetings, and a Hostile Overhaul of Midwifery Regulations
Montgomery, AL ā Despite tabling SB87 during its regularly scheduled meeting on Wednesday, March 19, the Alabama Senate Health Committee called a surprise meeting without a designated time on Thursday morning, March 20 to push through a substitute bill that highlighted backroom politics in a coordinated effort between Senator Larry Stutts and Niko Corley of the Medical Association of the State of Alabama (MASA).
During the March 19 committee meeting, Sen. Linda Coleman-Madison presented a substitute bill of SB87 on behalf of bill sponsor Sen. Arthur Orr and the Alabama Midwives Alliance (ALMA). The substitute agreed to remove language about birth centers and keep language related to insurance. It focused on midwives being able to administer the tests within the Alabama newborn screening program and added language that ātest results shall be referred to a licensed physician or certified registered nurse practitioner for interpretation and follow-up care.ā A second bill was also submitted during the March 19 committee by Sen. Stutts at the urging of MASA that allowed only for the newborn blood spot screening and banned any other newborn care by midwives, who have a national certification to attend to newborns for well-baby care up to six weeks. The bill specifically removed blood glucose tests for newborns and excluded the newborn screenings for critical congenital heart defects (CCHD) and hearing. The bill also removed ALMAās suggestion of including nurse practitioners as providers midwives could refer care to.
Sen. Stuttsā sub bill was passed in the March 20 meeting without reasonable notification for ALMA to attend. Stutts himself was also absent, similar to the Childbirth Freedom Act vote, legalizing midwifery in 2017.
āWhile removing the birth center language was not what we wanted, we knew conceding on anything except the screenings was a win for the babies, and we had to keep their health and safety at the highest priority, so we accepted Mr. Corleyās verbal offer in negotiations. We later learned that the offer occurred after Sen. Stuttās sub bill had already left LSA on March 4, making Mr. Corleyās offer not even valid, only lip service. This process has been full of deception, secrecy, and political maneuvering at the expense of Alabama mothers and babies,ā said Nancy Megginson, Chairperson of the Alabama Midwives Alliance (ALMA) Legislative Committee. āA bill that could have improved access to care was deliberately sabotaged to prioritize physician-led preferences over real solutions. In Alabama we do a good job of that; promoting physicians. Alabama families deserve better. They deserve physician leadership that looks beyond the paper and into what's actually happening in the community.ā
ALMA says the sub-bill severely restricts midwifery practiceāposing a direct and dangerous threat to maternal and newborn care in Alabama.
āThe word ānewbornā is in the bill, but itās not about them anymore, MASA has made the substitution about power,ā Megginson said. āItās about the clear picture we presented at the public hearing that homeborn babies are being delayed and missed due to physician logistics, so MASA āgave usā heel lances to look like they care, but then tied our hands tighter in other areas, thus increasing risks to the newborns.ā
Alabama continues to suffer from one of the highest maternal and infant mortality rates in the nation. In Alabama, 43 counties lack a hospital providing obstetric care, and 23 counties do not have a single pediatrician. Licensed Midwives have served 61 of Alabamaās 67 counties.
A Direct Attack on Midwifery and Newborn Care
The newly approved sub-bill is highly restrictive midwifery regulations. Key provisions include:
āā¢āSevere limitations on newborn care: The bill states midwives may perform no newborn care except in an emergency. So midwives cannot weigh, measure, take vital signs or assess a baby, restricting them from the most basic support, even a lactation consultant or unlicensed medical assistant could offer.
āā¢āSplit newborn screenings: Instead of allowing midwives to conduct the routine 24-48 hour newborn screenings needed to detect life-threatening conditions early, the bill only allows them to perform a heel lanceāwithout explicitly permitting them to conduct the actual blood spot screening. MASA oddly extend the time to 72 hours, outside the national and ADPH standard of 24-48 hours.
āā¢āDelays in critical newborn testing: The dangers of delaying newborn screenings for hearing loss and Critical Congenital Heart Defects (CCHD) remain restricted in the sub-bill, putting newborns at unnecessary risk for conditions that require early intervention, and likely death for some.
Right now, Alabama forces families who choose homebirth to be referred to a physician within 24 hours and secure that appointment within 48 hours to attain these screeningsāsomething pediatricians simply canāt accommodate, especially on weekends or holidays.
This sub-bill is not about safetyāit is about control. By stripping midwives of their ability to provide even the most fundamental newborn care, this bill is a direct attack on community birth options in Alabama. It is a blatant attempt to force families back into a broken maternity system, one that already fails Alabama mothers and babies at alarming rates.
Why is the entire newborn screening program important for Midwives?
These screenings exist to prevent life-threatening complications and lifelong disabilities:
ā CCHD screening detects critical congenital heart defects with a handheld pulse oximetry. Newborns can seem perfectly healthy but deteriorate rapidly without immediate medical intervention. Unscreened, suddenly critical babies will drive past multiple hospital closures, and infant loss will increase. All because they were denied a simple pulse oximetry screening after birth.
ā Hearing screening identifies hearing loss early, ensuring timely intervention to prevent developmental delays. Most pediatricians donāt have the equipment, forcing families to scramble for a specialist, yet performed by ancillary staff at the hospitals.
ā Blood spot testing, similar to a glucose blood drop, detects metabolic and genetic disorders, where delayed treatment can result in severe disability or death.
Photo: Bill sponsor Sen. Arthur Orr (right) and Senate Health Committee Chair Sen. Tim Melson (center) talk with Nancy Megginson, LM, prior to the scheduled Senate Health Committee meeting on March 19.
