Preventing Home-Birth VBACs Attended by Non-Nurse Midwives

For the third installment of an in-depth look into each of the Association’s “Top 10 Highlights” from the 2022 Legislative Session, we will look at the Medical Association’s opposition to home-birth VBACs and support for high national standards that ensure the safety of pregnant woman and their children.

In 2017 Lawmakers passed legislation that allows a non-nurse midwife to legally deliver babies in Alabama.  The Association fought against this legislation for over a decade because the practice of non-nurse midwifery has led to more home births that can put the mother and her child in a dangerous situation if a medical emergency does occur.  Nonetheless, the Association was able to remove language from the legislation that would have allowed non-nurse midwives to perform a VBAC (Vaginal Birth After Cesarean Delivery) outside of a hospital setting.

Fast forward to the 2022 legislative session, a bill was filed that would do what the Medical Association negotiated to have removed from the 2017 law—allow non-nurse midwives to be able to perform a VBAC in a home setting. In response to the bill being filed, the Association partnered with physicians from the Alabama Chapter of the American College of Obstetricians and Gynecologists to educate lawmakers on what a VBAC is and the dangers it poses to both the mother and child. 

The Association and its partners voiced concern to lawmakers that although a VBAC is commonly performed, it is always done in a hospital setting with a medical team readily available because there are only minutes to spare if an emergency occurs. Due to the risks associated with VBACs, and specifically considering that uterine rupture and other complications may be unpredictable, the Association maintained that a VBAC be undertaken only by a physician-led healthcare team in a hospital, where an emergency cesarean delivery is possible within a time interval that best incorporates maternal and fetal risks and benefits with the provision of emergency care. Lawmakers agreed with these realities and chose to maintain current law that appropriately prevents non-nurse midwives from assisting a mother’s delivery of a baby in the home setting if the mother has had a previous C-section. 

The Association would like to thank the physicians who volunteered their time through zoom calls or gave their expert opinion to lawmakers at public hearings in order to maintain the critical patient-safety protection present in the existing law that was negotiated into the non-nurse midwife licensing bill before it became law in 2017.  The Medical Association fully expects to see this bill filed again in future legislative sessions and will continue to educate lawmakers on the dangers that this legislation presents to both the mother and child during birth. 

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