Alabama’s insane midwifery regulations are costly and inhumane

Ina Mae Gaskin shows students how to feel for the position of a baby as she teaches a class in midwifery at The Farm in Summertown, Tenn., Tuesday, June 26, 2007. Gaskin, 69, a midwife who never formally studied nursing, has helped to bring back home birth and lay midwifery from the brink of extinction in America. (AP Photo/Mark Humphrey)

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Here’s a crazy thing: In the state of Alabama, you can have your baby in a hospital with medical care. And you can have your baby in your home. But you can’t have your baby in your home with the medical care of a trained midwife.

Seriously, there’s a law on the books banning home and birthing center births with a midwife on hand even though an unattended birth — obviously riskier by comparison — is perfectly legal. Elizabeth BeShears reports at, which “means women with healthy, low-risk pregnancies are forced into a narrow set of choices that may not suit their needs or desires.”

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Now, if you’ll permit me to trade in gross stereotypes, this is an issue that those on the right and the left should be able to agree on: women who choose to give birth with the help of a midwife should be allowed to do so, and their decision is none of Alabama’s business.

If that’s not enough reason for Alabamans to support fully legal midwifery, BeShears has another salient point:

Home births with a midwife are significantly less expensive than hospital births. In 2014 (the most recent year for which the statistics are available) 52 percent of births in Alabama were covered under Medicaid. That means more than half of the births in the state that year were paid for with taxpayer funds.

For a state government that isn’t exactly rolling in the dough, that should count for something.

Still, even if we set aside arguments about personal liberty and fiscal responsibility, the practical consequences BeShears recounts are galling:

Thirty-four rural Alabama counties don’t have a hospital that provides obstetrical services, and according to the non-profit Safer Birth in Bama, there are 7 rural Alabama counties without a single obstetrician. That means for thousands of Alabama women, they must travel a significant distance to receive care from an OB/GYN whether they are pregnant or not. […]

And tragically, this means many women simply do not pursue or receive prenatal care at all. Which leads to the most heartbreaking number.

Alabama’s infant mortality rate is one of the worst in the country, and lags significantly behind most first world countries. At 8.7 infant deaths per 1000 live births, we’re number 49 after, you guessed it, Mississippi.

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In other words, it is no stretch to say Alabama’s midwife regulations are likely contributing to the avoidable deaths of babies and women alike. This is awful, an example of government at its clumsiest and most inhumane, and Alabama legislators should make it their first priority.

What do you think?

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