Alabama midwives and home-birth advocates who pushed early in the session for a bill to allow them to administer state-required newborn screenings on Wednesday called a substitute version a “gut punch.”
Now, they’d like to see it amended before its last needed vote on the House floor. Or die without a vote.
“It can’t pass as it is, it’s a hostile bill,” Nancy Megginson, legislative chair of the Alabama Midwives Alliance, told Alabama Daily News Wednesday. “It will drastically affect midwifery in Alabama.”
The author of the substitute bill said it does what midwives requested; the sponsor of the original bill said he’ll keep it from a final vote if needed.
As originally filed, Senate Bill 87 by Sen. Arthur Orr, R-Decatur, changed current law regarding midwives, who gained the ability to assist with home births in Alabama in 2017 after years of lobbying lawmakers. The change allowed licensed midwives to administer newborn screening tests, including what’s commonly referred to as a “heel stick” that detects metabolic and genetic disorders.
Currently, home birth families must visit a physician within 24 to 48 hours for the newborn screenings. That’s not always logistically possible, Megginson said, meaning newborns are delayed in receiving the critical tests.
In March, the bill was substituted in the Senate Health Committee by Sen. Larry Stutts, R-Florence. It said midwives can order and administer a heel lance within 72 hours after birth but are prohibited from interpreting any tests and will refer results to a licensed physician.
It does not allow midwives to perform other tests that are required for newborns in Alabama, including to detect congenital heart defects and a hearing screening.
Stutts on Wednesday told Alabama Daily News he filed the substitute bill after a Senate Health Committee meeting where midwives discussed wanting to do the heel stick screening.
“That’s what they said at the public hearing, how important that was, and that was what they wanted to be able to do,” Stutts said. “So I rewrote the bill and gave them the authority to do that, but I did not give them the authority to do all the other things they were trying to sneak into the bill.
“… (They’re) not qualified to do all that. Yeah, they can probably collect a blood sample on a heel stick, but they’re not qualified to assess the baby for congenital heart defects.”
Stutts, a practicing obstetrician, opposed the 2017 bill that decriminalized midwifery in the state.
Orr’s original bill would have allowed midwives to practice in birthing centers. That language has been removed too.
Midwifery advocates are calling the new bill a step back. The new bill also says “a licensed midwife is prohibited from providing any care to newborns” that is not specifically granted within the bill. That means midwives cannot weigh, measure, take vital signs or assess a baby, restricting them from the most basic support, Megginson has said.
Several groups had concerns with the original SB87, including the Medical Association of the State of Alabama, Blue Cross and Blue Shield of Alabama, Alabama Hospital Association and the American Academy of Pediatrics.
The medical association worked on Stutts’ substitute with him, he said.
“The medical association’s long-standing opposition is based on the belief that this bill overlooks the fundamental issues undermining maternity care in Alabama: insufficient reimbursement, the failure to expand Medicaid, and an unfavorable practice environment caused by high medical malpractice insurance rates,” a statement from MASA said.
Aaron Crawford, president of Alabama Birth Coalition, said in a public hearing Wednesday SB87 had been “hijacked.”
“Shame on those who would rather see a midwife fail than a newborn be saved,” Crawford told the House Health Committee.
The committee unanimously approved the bill, sending it next to a House floor vote. If it is unchanged there, it will go to the governor.
Orr told ADN Wednesday evening that he sponsored the bill brought to him by the alliance because he believes in midwives’ cause, though the issue isn’t in his policy wheelhouse.
With about two weeks remaining in this legislative session, Orr said if midwives don’t want the bill to pass as is, he will work to stop it.
“I did it for them,” Orr said. “If they don’t want it, then I will do my best to make sure it doesn’t advance.”
Alabama Midwives Alliance said it had worked on a substitute bill that would have allowed midwives to order and administer the tests, but also required “results shall be referred to a licensed physician or nurse practitioner for interpretation and follow-up care.” The Alliance said that change was an effort to compromise with MASA.