Urgent Action Needed: AL Birth Center Regulations

URGENT ACTION REQUIRED: Contact the Alabama Legislative Council

The AL Legislative Council is meeting in Montgomery this week. They have the power to reject or amend the harmful regulations that have been approved by the Alabama Department of Health (ADPH). The Legislative Council needs to hear from midwives, physicians, RNs, consumers and others to understand the importance of holding a hearing. We have until October 15th to it's critical that we act now. 

Anyone can call--you do not need to live in Alabama. We are targeting the following members of the legislative council. It's especially important to contact the chair, Senator Sam Givhan. 

If you do live in Alabama, your voice is even more important. In addition to calling some or all of the below legislators, please call your legislator. View the full Legislative Council here. 

Call Script

• Hello, I'm calling about the proposed birth center regulations. Can I speak with Senator/Representative ____________. My name is_________, I'm a __________ (parent, midwife, physician, advocate, RN, etc.) and I support birth centers in Alabama. 
  • The Alabama Department of Public Health has proposed birth center regulations that will prevent nearly any birth center from operating in the state. We’re asking the legislative council to hold a hearing on these regs.
  • March of Dimes research shows that freestanding birth centers can help alleviate perinatal care shortages.
  • Birth center care saves an average of $2010 per mother/baby pair by reducing rates of unnecessary cesareans and fewer NICU admissions due to lower rates of prematurity with birth center care (CMS, 2018).
  • The American Association of Birth Centers publishes evidence-based model birth center regulations that protect public health and safety. We're asking you to reject ADPH's proposed regulations and replace them with AABC's model regulations. 
• Will you (/your boss) commit to calling for a hearing? Thank you and have a great day. 

Email Template

Dear Senator/Representative ____________,

I'm writing to express my concern about the Alabama Department of Public Health's (ADPH) proposed birth center regulations. I'm a ________________(midwife, physician, nurse, parent, doula, advocate, etc) and I support birth centers in Alabama. [Tell a little bit of your story]. 34% of Alabama counties are perinatal care deserts (March of Dimes). Lack of access is evident in the health outcomes--AL has the highest rate of pregnancy related mortality in the nation (CDC 2018-2021) and the third highest rate of infant mortality (CDC 2021). These devastating figures disproportionately impact Black and Indigenous families (March of Dimes). Research demonstrates that midwifery led freestanding birth centers are a proven solution to the perinatal mortality crisis, however ADPH approved birth center regulations that will prevent nearly any birth center from opening. Now the Legislative Council has the authority to amend or reject them. 

We’re asking the Legislative Council to hold a hearing on these regs. Research shows that freestanding birth centers can help alleviate perinatal care shortages. Providing access to pregnancy care leads to fewer complications and lower costs. Birth centers save healthcare dollars by reducing rates of unnecessary cesarean births and fewer NICU admissions due to lower rates of prematurity with birth center care (CMS, 2018).

A recent federally funded study showed average savings to Medicaid was $2010 for each mother/baby pair with birth center prenatal care (CMS, 2018) compared to people from the same areas and similar risks receiving typical care.

The ACLU has sued Alabama over restricted birth center access. On September 30th, the judge filed an injunction allowing birth centers to operate as long as they can demonstrate compliance with American Association of Birth Center Standards. This injunction, which cited "irreparable harm" to birth center owners and patients, will be in effect while the case makes its way through the courts. Four expert witnesses testified to the safety of birth centers, including ADPH's own Chief Medical Officer. ADPH is arguing that the injunction should become invalid on October 15th if the Legislative Council allows the regulations to go into effect. 

We want to make it very clear: childbearing families will continue to experience irreparable harm if these regs go into effect. It will be nearly impossible for birth center owners to satisfy these regs because the regs are not in line with the evidence or with industry standards.

We have a clear, evidence-based alternative. The American Association of Birth Centers publishes model regulations that are in line with the nationally recognized Standards for Birth Centers. We recommend that you reject these rules and replace them with AABC's model birth center regulations. 

Birth centers are a proven solution to the perinatal mortality crisis. We need immediate regulatory overhaul so Alabama physicians and midwives can expand access to care by opening birth centers in our state. We're asking you to stand with midwives, physicians, and childbearing families by calling a hearing on these regulations before October 15th. 

Sincerely,

Context 

Proposal of regulations

In June 2023, the Alabama Department of Public Health (ADPH) proposed regulations that would severely restrict the ability of birth centers to open and operate in the state. 

These regulations were written without the input of experts and stakeholders such as AABC, Alabama birth center owners, Alabama consumer groups, or the Alabama State Board of Midwifery.

37% of Alabama's counties are Maternity Care Deserts and Alabama has one of the highest rates of pregnancy related/associated deaths nationally. These regulations are restrictive in many ways but we are especially concerned about the following areas:

• Certified Professional Midwives are not allowed to practice to their full scope despite the fact that Alabama licenses CPMs and the AL Attorney General explicitly confirmed that CPMs may practice in birth centers. 
• The RN staffing model is unnecessary and financially unsustainable.
• A staff or consultant physician is required to be on call and able to arrive at the birth center within 30 minutes at all times (this is not the standard of care, if advanced intervention is needed, the client should be transferred to the hospital). 
• Written transfer agreements are required, however there is no requirement for hospitals to enter into such agreements. 
• Eligibility criteria exclude clients over 40, people who've had cesareans, and remarkably, people with a history of miscarriage or abortion. 

Approval of regulations

After extensive public outcry and expert testimony in opposition to the proposed regulations, ADPH approved them in August and they are set to go into effect on October 15th, 2023. While this is a disappointing development, advocates continue to fight for fair and evidence-based regulations using a variety of tactics. AABC and the Alabama Midwifery Alliance are engaged in outreach to legislators who have the power to reject or amend the regs. At the same time, the ACLU filed a lawsuit against the state on behalf of the birth center owners. 

ACLU Lawsuit

On August 8th, the ACLU filed a lawsuit stating that ADPH is enacting a "de facto ban on birth centers" by refusing to provide a viable path to licensure. On September 30th, the judge in the case ruled that while the case moves through the courts, ADPH may not refuse licenses to birth centers that "can demonstrate substantial compliance to the standards set out by the American Association of Birth Centers". This decision was reached based on several factors including "reasonable chance of success on the merits". 

Notably, in testimony, the Chief Medical Officer of ADPH "conceded that she could not identify a single piece of evidence showing that freestanding birth centers that comply with the national AABC standards are less safe than licensed hospitals". 

In theory, this decision means that birth centers who are compliant with the Standards should be able to obtain licenses and open quickly. In practice there are a lot of unknowns--stay tuned for updates. 

Donate

The following organizations are all working diligently for birth center access in Alabama. Please consider giving.

To contribute toward the legal fight, donate to the ACLU

ACLU

To support a birth center working to come into compliance with AABC Standards, donate to the Alabama Birth Center

Alabama Birth Center

To support a developing birth center in rural west Alabama, donate to Birth Sanctuary Gainesville. 

Birth Sanctuary Gainesville

To support the local consumer groups donate to Alabama Birth Coalition and Safer Birth in Bama

Alabama Birth Coalition Safer Birth in Bama

We expect that there will be more opportunities for public engagement in the near future--keep an eye out for updates!