Local nurse midwife: Bill raises apprentice questions

As a midwife, it has long bothered local resident Kathleen Burditt that an Alabama woman may lawfully choose to have a baby at home unattended, but cannot legally be attended by a midwife at home.

A bill to change that cleared the Alabama House of Representatives Tuesday on an 84 to 11 vote, and will now move to the Senate. HB 315 makes it legal for two categories of midwives to attend at-home births.

Certified nurse midwives are nurses who have completed a national, certified education program, completing master’s degrees with a concentration in midwifery, Burditt explained. They sit for an exam with the American Midwifery certification board.

“Technically, we are on the same level as a nurse practitioner,” she said. “We come under the Board of Nursing and the Board of Medicine.”

But HB315 also allows certified professional midwives the same privileges.

“Certified professional midwives are not nurses,” she explained. “They don’t have any kind of set degree. Most are apprenticed trained. The don’t have the same skill sets and skill levels.”

And that’s what bothers her about this legislation.

“If it passes and is made into law, a bunch of women can practice midwifery without regulation,” Burditt said.

A companion bill, HB316, sets up a state board of midwifery.

Like nurse practitioners, certified nurse midwives must work under a collaborative agreement with a physician.

“You can’t even get a license without having a doctor sign for you,” she said, adding that the physician must review a certain percentage of a midwife’s charts.

“In other (states), with this degree, you can put your sign out and be an independent practitioner.”

Much of her training she completed in Mobile, alongside medical students, she said.

“That’s my problem with it,” she said.

Certified professional midwives – those who basically are educated through an apprenticeship – can only conduct home births or assist in birthing centers, while certified nurse midwives may practice in an office setting or in a hospital.

“The problem I see is this. Covington County has an OB-GYN, and a hospital that delivers babies,” she said. “But there are four or five nearby counties that don’t.

“Their rationale is that rural Alabama does not have enough (health care) providers. The problem is that the professional (apprenticed) midwives are not trained in emergency procedures. If they get into trouble in a rural area, by the time they get that baby to the hospital, it’s going to be too late.”

Only 16 or 18 of Alabama’s 67 counties have practicing OB doctors, she said.

Overall, she believes allowing midwives to attend births can increase the levels of prenatal care in rural areas, and reduce the costs of health care.

“We’ve got to do something in Alabama,” she said. “But I’m not sure this is it.”

Burditt said the bill gained grassroot support, but many in the medical field oppose it.

Under the act, lay midwifery is still a criminal offense.