‘Lay midwifery’ bill not good for Alabama
by Michael Flanagan, MD
Jan 31, 2014 | 495 views | 0 0 comments | 38 38 recommendations | email to a friend | print
Next week, a bill will be presented before the Alabama Senate Judiciary Committee to legalize the dangerous practice of “lay midwifery.” This bill would allow non-nurses and non-physicians to oversee planned home births. These unlicensed practitioners have little or no formal training apart from attending births with another lay midwife. Although this practice may seem benign, unexpected emergencies can arise during labor that requires immediate intervention to save the life of the mother or baby.

Physicians and nurses acknowledge the absolute safest place to give birth is a facility with the latest lifesaving equipment and properly trained personnel. This environment allows professional health care providers to deliver immediate and appropriate care should something go wrong. Hence, excluding emergency situations, neither physicians nor nurses participate in the delivery of babies outside a hospital setting.

Complications of labor can include, but are not limited to, a baby getting stuck in the birth canal, tangling of the umbilical cord around the baby’s neck, bleeding, infection, or even unexpected immaturity of the newborn’s lungs. These dangers are possible even in the most state-of-the-art facility, but at least the infant and mother have the best possible chance of survival. I have personally participated in urgent and emergent care that required quick decisions by the physicians and nurses to save the life of the unborn child and mother. The same cannot be said for a birth that is planned for the home and attended by a lay midwife. Instead, you will have a well-meaning, but woefully undertrained and underprepared individual and a false sense of security for the parents. When a planned home birth takes a turn for the worse, the time spent in an ambulance ride to the ER can mean the difference between life and death.

There will always be babies born spontaneously in elevators, taxi cabs and parking lots. Most of these deliveries will likely be fine, given the law of averages. However, if the State of Alabama passes a law legalizing lay midwifery, it sends a message to the public that this practice is safe. This idea could not be farther from the truth.

I cannot speak for other states that have unfortunately legalized this dangerous practice. Perhaps no one spoke up against it. This issue is not about access to care, but it is a safety issue. Often crises can arise in minutes, are unexpected and can have devastating complications if not treated immediately. It is unacceptable to put even one baby or mother’s life at risk through this legislation.

 Though this debate continues, for physicians, the only position we can take is one that provides our patients the best opportunities for health and safety. The Medical Association of the State of Alabama stands firmly with the Alabama Chapter of the American Academy of Pediatrics, the Alabama State Society of Anesthesiologists, the Alabama Chapter of the American College of Obstetricians and Gynecologists, the Alabama Chapter of the American College of Emergency Physicians, the Alabama Academy of Radiology and the Alabama Academy of Family Physicians in opposing any legislation authorizing lay midwifery in Alabama.



Michael Flanagan, MD,


Anesthesiologist,

President, Medical Association

of the State of Alabama