Birth right: Alabama Birth Coalition goes the distance for mothers’ right to midwives
by Benjamin Nunnally
Special to The Star
Nov 10, 2013 | 2099 views |  0 comments | 23 23 recommendations | email to a friend | print
Illustration by Jessica Stephens/The Anniston Star
Illustration by Jessica Stephens/The Anniston Star
It’s a Monday at the Northeast Alabama Baby Cafe at McClellan Medical Mall, and it’s filled with moms and babies for a lactation class provided by the staff of Cheaha Women’s Health and Wellness. A privacy screen divides the large coffee shop in half, blocking the view into a world of babies and young children. Some of the kids are running and playing; others are still so new and tiny that they’re attached to mom by baby slings.

Some of the new mothers have only been out of the hospital for a week or two — but others haven’t been there at all. Several of these mothers enlisted the services of a midwife and gave birth outside a hospital.

Thanks to the high cost of having a baby — nearly $4,000 on average, according to the government’s Healthcare Cost and Utilization Project — and the sometimes impersonal nature of hospital health care, mothers are becoming more interested in home options.

According to a 2009 report by the National Center for Health Statistics, home births increased by 29 percent from 2004 to 2009, from 0.56 percent of births to 0.72 percent, a total of 29,650 births in 2009.

“Our state motto is, ‘We dare defend our rights,’” said Nicki Arnold Swindle, an active doula, or birth counselor, in the Anniston area. “What’s more natural than a right to choose where and how to give birth?”

She and other mothers who support midwifery are preparing for “Miles for Midwives,” a local 5k event sponsored by the Alabama Birth Coalition, a statewide midwife advocacy group battling for midwives to become regulated, certified and active in Alabama.

The American system of midwifery has two major categories of midwife: the certified nurse midwife and the certified professional midwife. In Alabama, nurse midwives can operate alongside obstetricians with whom they’ve made official arrangements.

Professional midwives train specifically to meet the needs of mothers who want to give birth in homes or other non-hospital environments, where they will give guidance before the birth, medical assistance during the birth and neonatal care after the birth. The only problem? Professional midwives, under Alabama law, can be prosecuted for assisting a home birth.

According to the American College of Nurse-Midwives, a nurse midwife is a registered nurse who has passed a national certification examination after successfully completing a graduate level degree in midwifery — essentially, a master’s-degree carrying, trained midwife.

Professional midwives are a bit different. They participate in practical experience, receiving training over three to five years, including 1,350 hours of supervised clinical contact. Translation: they attend births to learn.

“It’s a credential that’s nationally recognized,” said Hannah Ellis, president of Alabama Birth Coalition. “Which is important, because you’ve got to know how to handle things without all the resources of a hospital before there are any emergencies.”

Should a pregnancy have red flags that usually indicate a high-risk delivery, midwives will send those mothers on to hospitals, where they will have access an obstetrician’s specialized training in serious issues such as heart problems, high blood pressure or even happy complications like giving birth to twins.

“There’s no way we can 100 percent eliminate risk,” said Ellis, “but we can make home birth as safe as it can be.”

Professional midwives are trained to handle unpredictable issues such as hemorrhaging and tearing or breathing troubles for mother and child, which are problems that will come up even during routine births in a hospital. If a situation gets truly out of hand, transfers to hospitals are a last resort.

Groups such as the American College of Obstetricians and Gynecologists cite a 2010 study by Dr. Joseph Wax, a maternal specialist at Maine Medical Center, which states that planned home births result in more than twice as many neonatal deaths — deaths in the month after birth — than planned births in a hospital.

Alabama Birth Coalition refutes these results, saying that the statistics are actually skewed by a wide definition of what can be counted as “planned home birth.” According to Ellis, the study includes all out-of-hospital births, not only home births with an attending midwife — deliveries by firemen, paramedics and taxi drivers would all be included.

A 2009 study by Dr. Patricia Janssen at the University of British Columbia’s School of Population and Health studied the same two categories — planned home birth and planned hospital births — but specified that the home births were attended by midwives, and the hospital births would have qualified as low-risk, midwife-qualified births if performed out of hospital.

The study showed a perinatal death rate — deaths in the period from five months before birth to one month after — of 0.39 percent per 1,000 planned home births. Planned hospital births attended by midwives had a rate of 0.57, compared to a rate of 0.64 deaths per 1,000 in planned hospital births attended by physicians.

Dr. Joshua Johannson, obstetrician at Cheaha Women’s Health and Wellness, makes the point that rather than arguing about research methods, doctors and midwives should plainly explain the risks for both in and out of hospital birth and then give parents the freedom to make their own choice.

“You’ve got to give them a balanced picture,” says Johannson. “You’re a big girl, you can make this call — but that’s treating them like an adult.”

Johannson previously worked at a Philadelphia, Penn., hospital with 10 nurse midwives. They referred high-risk cases to him while he sent low-risk cases their way. He found that he had more time for “doctor-only stuff,” Johannson said, which helped him form a positive view of midwives.

“The thing about being a midwife is you have the whole life of a child and mother in your hands,” said Nancy Makransky, an ex-midwife who spent 16 years delivering babies in Guatemala. “It takes a lot of knowledge and adrenaline when a baby is going to be born and you’re responsible.”

Ellis points out that relationships with midwives can be very different than those with obstetricians. Due to lighter client loads, midwives can spend more time with mothers, which often leads to something closer to a family bond.

“They strive to empower you,” said mother Megan Brightwell of her experiences with midwives. “That’s not typical training for obstetricians.”

Those ties are what will drive midwives and mothers to gather at McClellan Medical Mall to walk, run or stroll in support of health care providers that they truly care about, all in the hope that one day, Alabama will support their decision to leave the hospitals and head home for their births.

“It’s really a different kind of experience,” said Swindle. “I’m not forcing anyone to have a home birth, but don’t force us to not have one.”

Miles for Midwives takes place Nov. 16, with registration opening at 7:30 a.m. and the 5k starting at 8:30 a.m. A kids’ race will start at 9:30 a.m. Live music by Kings of Swing, Peter Boyle and Sunset Rizing, with DJ Danny Santiago providing music throughout the event. Kids can get their faces painted or take a leap in a bouncy house, and there will also be a stroller/carrier decoration contest with prizes from sponsor companies. Individual registration is $5, family is $10 and $2 for kids. If you’d like to purchase a shirt, add $20 to the registration cost. Call 256-782-8822 for more information.

Benjamin Nunnally is a freelance writer in Jacksonville. Contact him at

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