After Auburn business owner Sarah Gill became pregnant, she decided to pursue delivery options outside of a typical hospital birthing experience. She called a midwife, which, if you live in Alabama, isn't so easy.
"It's almost like you have to know a guy that knows a guy who knows a guy, because they can be prosecuted," she said. "I had to call someone three or four times before I could get a call back because they had to ask about me ... It's like a drug deal or something, trying to find a midwife, which is ridiculous to me."
It is illegal for certified, non-nurse midwives to practice in Alabama, but a bill moving through the Legislature could change that.
The bill — which would allow midwives holding certification from an "organization accredited by the Institute for Credentialing Excellence" to practice midwifery — passed out of the House with an 84-11 vote, with three abstentions, and today, the bill, HB315, passed out of the Senate Judiciary Committee. The bill would also make the practice of lay midwifery a criminal offense.
Despite the current legal issues surrounding midwife services in the state, Gill gave birth to her son at home in her bed last year, with her husband, a doula — or birth companion — and a certified midwife assisting her.
After meeting with her midwife for the first time, Gill was certain she wanted the midwife's services for her son's delivery, especially since she made the decision to also seek prenatal medical treatment at a local OBGYN.
She remembers telling the staff she was planning to have a home birth, but wanted to do the standard prenatal check-ups, complete with sonograms, anatomy checks and blood work. This would also allow Gill to be on file in case she ended up at the emergency room during childbirth.
"(The OBGYN staff) was like, 'Well, I'm glad you're helping us rather than showing up at the ER with us knowing nothing about you or your pregnancy,'" she said.
But Gill did not end up at the hospital despite going through 25 hours of labor that ended in Samson being born "sunny side up."
"Usually, the ... head is down and tucked in, so they kind of roll out," she said. "(Samson) was born up, with his hand on his face and the cord wrapped around his neck three times."
Her midwife monitored the baby's heart while Gill pushed for two hours. Gill said her midwife was prepared to take the two to the hospital — which was a couple of miles away — should either of them ever become distressed.
"She said if there were any heart situations we were going to the ER, and that was comforting to know; she wasn't like, 'We're home birth or nothing,' " Gill said. "She had concern for me and my baby."
Gill said she will do a home birth again if she has a second kid and if the pregnancy is as low-risk as her first. She attributed her comfort-level and the encouraging people surrounding her to the birth being a "beautiful experience."
"I think it's important that women have a choice," she said. "If someone says, 'I don't want to go through that pain; please numb me up,' they should be able to do that. But I think it's very silly that as much research, time and money that I put into educating myself about my (son's) birth, that the process I took is illegal."
Gill said she knows several other women who have chosen to have home births. Auburn resident and business owner Katy Hortenstine did not have a home birth, but she did go to Columbus, Georgia, to be cared for by certified nurse midwives, who delivered all three of her children.
Certified nurse midwives (CNM) are registered nurses who have graduated from a nurse-midwifery education program. According to Dr. Lee Sharma, a local obstetrician, CNMs are legally allowed to deliver babies in Alabama under the guidance of a physician.
Hortenstine said she chose a CNM over a doctor because the experience was more personal and her CNMs understood her desires for her birthing experiences.
"I love my midwives because they took time with me, and they knew me and what my fears were about birthing and about what kind of experience I wanted," she said. "When it came time for me to be in the delivery room, I wasn't just getting a nurse I'd met five minutes before. I was getting my nurse midwife that had been taking care of me my whole pregnancy. She held my hand through the whole delivery and just encouraged me because she was my friend."
Hortenstine said she still has a relationship with her midwives and continues to visit them for her annual check-up, where they listen to any problems she is having and talk her through them, giving advice that isn't always medicinal.
Both Hortenstine and Gill said they would encourage women to be open-minded about the experience of birth, to do research on what options are out there as well as research about what a woman's body goes through during labor.
"It's such a huge part of your life, and it's a great story to be able to tell your kids," Hortenstine said.
While CNMs are legally allowed to practice in Alabama, they must do so under the guidance of a physician and are usually affiliated with a hospital or doctor's office. Dr. Sharma said more can be done to increase their scope of practice in the state — a route she prefers over legalizing certified, non-nurse midwives and allowing them to legally perform home births.
Sharma voiced concerns about certified midwives' lack of formal education and about the safety of home births.
"What scares the daylight out of me is that I know ... how quickly that situation can change from a perfectly normal delivery to something that becomes a complete emergency," she said. "To be in a situation and have no way to help that mom and that baby, we're going to say that's OK in the state of Alabama? ... I've been doing obstetrics for 20 years. I don't even know how many babies I've delivered; I couldn't tell you, but it would still scare me to be doing a delivery at home."
HB315 passed out of the Senate Judiciary Committee today with two amendments that include insurance requirements for the certified midwives and a mandatory contract between the midwife and patient, outlining the responsibilities of each and what the plan is in case of complications or an emergency, according to Sen. Tom Whatley.