The Alabama Midwives Alliance (ALMA) is advocating for the passage of a bill that would clarify and allow licensed midwives to conduct newborn screenings for out-of-hospital births.
As the law is currently written, a licensed midwife in Alabama has the ability to order required newborn tests. However, the Alabama Department of Public Health has a rule within Alabama’s Administrative Code that licensed midwives have to refer newborns to a licensed physician within 24 hours to perform the newborn screening tests. The screenings include bloodspot specimen tests, newborn hearing screening tests, and pulse oximetry screening tests.
“We have statute law to ‘order.’ ADPH later created a rule, not in statute, to refer. That’s where they direct us. It is very confusing,” Nancy Megginson, LM, CPM said. “There’s confusion across the board about what can and can’t happen. The babies are the ones that are suffering from it.”
Megginson is a licensed midwife (LM) and a certified professional midwife (CPM). She is the legislative chairperson for ALMA, which represents midwives who work in out-of-hospital settings.
Senate Bill 87 would alter the law to allow licensed midwives to not only “order,” but also “administer” newborn screenings.
For births at hospitals, the initial screenings are typically done before a mother and baby are discharged. Megginson explained that babies born in a non-hospital setting can be delayed in getting their newborn screening when parents have to set up appointments with physicians.
“It is a very simple process that we are nationally trained for already,” she said.
“There are 23 of the 67 Alabama counties that do not have a licensed pediatrician in them at all. There are only three counties that midwives are not able to serve. We are willing to go much further and have been serving much further for a while,” Megginson said.
In 2024, Megginson said there were more than 400 babies delivered at home with licensed midwives.
While the screenings are simple to administer, Megginson said the tests are important to ensuring the health of a child.
- CCHD screening detects critical congenital heart defects with a handheld pulse oximetry.
- Hearing screening identifies hearing loss early, ensuring timely intervention to prevent developmental delays.
- Blood spot testing, similar to a glucose blood drop, detects metabolic and genetic disorders, where delayed treatment can result in severe disability or death.
Megginson added the bill in its current form, alters some of the language in the law that stemmed from a bill passed in 2017 that allowed midwives to practice in Alabama legally. Megginson said an amendment is being prepared to take out some of the proposed changes, including language related to birthing centers and insurance.
“We’ve changed gears a little bit and conceded on the birthing centers language and insurance language for this year, and we are really pushing strong on the newborn screenings because the safety of our babies is the utmost importance,” Megginson said.
In August 2023, a lawsuit was filed against ADPH by midwives and doctors who challenged rules adopted by ADPH related to requirements for birthing centers. Plaintiffs described the rules as a de facto ban on freestanding birth centers. A judge issued a preliminary injunction in October 2023 preventing the rules from being used as the lawsuit moved forward.
A public hearing was held for SB87, but no vote was taken in committee. Megginson anticipated a vote next Wednesday, March 19.
SB87 is sponsored by Sen. Arthur Orr, R-Decatur.
