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FROM STAFF REPORTS

Consumers have joined together from across the state to speak out against amended language added to Senate Bill 87, which was designed as a housekeeping bill to clarify language to the state’s licensed midwifery laws.

Sponsored by Sen. Arthur Orr, R-Decatur, the original bill cleaned up language from the 2017 Childbirth Freedom Act that decriminalized and regulated the practice of certified professional midwives in the state of Alabama. In its housekeeping was the addition of words “and administer” to language about the state’s required newborn screenings. This was to resolve a seven-year debate between licensed midwives and consumers with the state health and medical agencies as to whether or not licensed midwives had the legal authority to administer newborn screenings.

On March 20, during a called special Senate Health Committee meeting, the bill was amended with a substitute bill introduced the previous day by Sen. Larry Stutts, R-Tuscambia. The sub bill allows only the right to “administer a heel lance” and allows the Alabama State Board of Health to continue to restrict midwives from its rule passed in 2018 that requires licensed midwives to refer newborns to a physician for newborn screenings. The sub bill also added language that “a licensed midwife is prohibited from providing any care to newborns” that is not specifically granted within the bill.

A new video from consumers and midwives—produced by Crema Video in Cullman and posted by Alabama Midwives Alliance, urges the legislature to take action to fix the bill.

“Midwives play a critical role in keeping newborns safe by providing essential care, vitals, weight checks, breastfeeding support and timely newborn screenings. Without this care risk can go unnoticed until it’s too late,” said participants in the video. “Every family, no matter where they give birth, deserves safe, timely care. So why should homebirth families face delays or miss screenings? This sub bill does not solve the problem. It makes it worse. The solution is simple. In 2017, the legislature ensured Alabama midwives met national certified professional midwife standards. SB87 should stick to those standards and protect evidence-based care. Not restrict it. This would also bring Alabama in line with the rest of our nation in certified professional midwifery care. Alabama families deserve the best start possible. Let’s get SB87 back on track.”

Prior to the passage of the sub bill on March 20, the Alabama Midwives Alliance worked with Orr and Sen. Linda Coleman-Madison, D-Birmingham, to offer a different sub bill that attempted to meet in the middle with the Medical Association of the State of Alabama that read licensed midwives may “order and administer” newborn screenings but also that “test results shall be referred to a licensed physician or nurse practitioner for interpretation and follow-up care.”

The negotiated language was removed for the version that was pushed through.

Why is the entire newborn screening program important?

These screenings exist to prevent life-threatening complications and lifelong disabilities:

• CCHD screening detects critical congenital heart defects with a handheld pulse oximetry. Newborns can seem perfectly healthy but deteriorate rapidly without immediate medical intervention.
• Hearing screening identifies hearing loss early, ensuring timely intervention to prevent developmental delays. Most pediatricians don’t have the equipment, forcing families to scramble for a specialist, yet performed by ancillary staff at the hospitals.
• Blood spot testing, similar to a glucose blood drop, detects metabolic and genetic disorders, where delayed treatment can result in severe disability or death.

Right now, Alabama forces midwives to refer newborns to a physician within 24 hours and those families who choose home birth to secure a physician appointment 24-48 hours for the newborn screening program timeframe.

“One rumor floated through the halls of the State House by MASA is that licensed midwives do not have the training or qualifications to administer newborn screenings or provide well-baby care. However, licensed midwives are required by Alabama law to obtain a Certified Professional Midwife credential from the North American Registry of Midwives,” read an official press release from the Alabama Midwives Alliance Post. “All three newborn screenings are required for training and completion of the national credential required by Alabama Law. Midwives are more trained at the time of obtaining licensure than a medical assistant or nurse. Registered nurses and medical assistants usually receive their first newborn screening training as on-the-floor training when hired on their unit, not in school or to obtain their certification. No training is required by their license like it is for CPMs.”

The CPM credential from NARM requires all certified midwives to be able to do the following, from the NARM Job Analysis document, the Alabama Law’s definition of scope of practice:

• Well-baby care, up to 6 weeks, such as assessment of vital signs, including temperature, heart rate/rhythm/regulatory, respirations, etc., appropriate weight loss and gain, length, head circumference, neuro-muscular response, level of alertness, wake/sleep cycles, feeding patterns, urination and stool—frequency, quantity, color—appearance of skin, condition of cord stump, newborn dried blood spot, metabolic, screening, newborn hearing screening, pulse oximetry newborn screening for critical congenital heart disease, care for circumcised or intact penis.
• Issues associated with breastfeeding, such as: adverse factors affecting breastfeeding or breast milk, including environmental, biological, occupational, pharmacological, etc, baby’s ability to breastfeed, including sucking method, position of lips and tongue, if ties are present, etc.
• Assess elements of newborn transition to extrauterine life, such as: physiological changes in cardiopulmonary system, basic needs, including breathing, warmth, nutrition, bonding, etc., normal/abnormal activity—inducing responses, vital signs, appearances, behavior, etc.—normal growth and development.