Dr. Heather Skanes’ team at the Oasis Family Birthing Center in Birmingham, Alabama, started turning away patients this spring as state officials cracked down on alternative childbirth options.
The center had offered patients with low-risk pregnancies a place to deliver their babies outside of a hospital, where cesarean sections weren’t performed, epidurals weren’t administered and midwives took the lead. Some women labored in an inflatable aqua birthing pool, in what Skanes saw as a more supportive environment in which Black women in particular would feel more comfortable and heard.
But in March, officials with the Alabama Department of Public Health told Skanes that they considered the previously unregulated facility to be a hospital that didn’t have proper permission to be open, according to her attorneys.
The American Civil Liberties Union is suing the state Public Health Department on behalf of Skanes over what it has called a “de facto ban” on freestanding birth centers. The court battle is unfolding as the agency is weeks away from implementing licensing regulations for the facilities.
Alabama has an alarming record on keeping expectant and new mothers alive, with a higher share of residents dying in pregnancy and during or shortly after childbirth than almost any other state. More than a third of counties in Alabama lack hospitals with labor and delivery units or practicing obstetric providers, according to a report last year from the March of Dimes.
There is a lot more to this article that you left out that provides very important context. The state health department is imposing really quite reasonable regulations on the birthing centers for the health and safety of the mothers. Some of the requirements include formal nursing education for midwives (who can otherwise calls themselves midwives after taking barely-regulated online courses), proximity to a hospital that has obstetrics and pediatrics in case of emergency (must be within 30 minutes by ambulance), and building requirements that allow for things like ADA compliance and appropriate medical facilities at the birthing center.
The article does also address the significant systemic problems that mothers, particularly black mothers, face in many hospital settings, as well as the black maternal fatality rates. While these issues are important to discuss and address, inadequately staffed and equipped birthing centers 45 minutes away from the nearest hospital by ambulance are not the answer here. In my professional medical experience working in such a hospital, I’ve seen transfers from birthing centers like the ones discussed in the article that were unable to address maternal uterine hemorrhage and neonatal hypoxia. Luckily, they were close enough to proper hospitals that could care for the mother and newborn, but if they were 45 minutes away by ambulance, the mother and newborn very likely would have died.
I agree with much you have said, but the problem still exists that 30% of counties don’t have hospitals … so expecting that all birthing centers should be within a reasonable range is in the state’s lap, not expectant mothers.
This is setting aside the prohibitive cost for those hundreds of thousands of Americans who don’t have insurance.
Not to oversimplify, but they could build these birthing centers 20 minutes away from the town and 25 minutes away from the hospital rather than in town and 45 minutes away from the hospital. They could also pivot to offer assistance to mothers in the form of facilitating transportation, doulas, and help setting up pre- and peri-natal Medicaid.
The problem is lack of rural hospitals. Without the birthing centers, some people will drive the extra distance, some will opt for home birth.
This policy won’t help Alabama’s maternal mortality rate, especially among it’s poorest.
I can speak a little on this. I am a resident of Alabama in one of the poorer counties, Pickens. Median household income per Wikipedia is $26,254. I’d say that ranks pretty low. 20% of families, and 24% of people here live below the poverty line. I have lived here all my life. Prior to COVID in the US, our only local hospital closed in 2020. It is now a 30-40 minute drive to Tuscaloosa or Columbus MS for emergency care on a good day. There are local clinics, but nothing for OBGYN care or emergency treatment. There was a doctor who came to the local hospital weekly for local appointments prior to the closure.
During my wife’s first pregnancy, care was pretty good even having to drive the 40 minutes to each appointment and waiting in the car. (During COVID, the OB offices would only allow the patient inside).
The second pregnancy my wife miscarried towards the end of the 1st trimester, and we had to wait until the following day to come back for her D&C procedure. She collapsed the following morning at the hospital due to blood loss. Or what I’d call lack of care from Alabama hospitals. Thankfully, this was prior to Alabama’s new silly abortion and pregnancy laws. I can’t imagine how this would’ve been handled then.
Her third (and hopefully final from both of our standpoints) pregnancy went fairly well, but it sure seemed the doctors and quality of care and ability to do things changed between the 1st and 3rd pregnancy. The only thing I can think of is Alabama’s new stupid laws around pregnancy. I’m glad we are both done with having kids.
We aren’t well off, but compared to many here, we are. I can’t imagine it working out well for many of our fellow citizens in Alabama.
And now onto the rural hospitals part. As mentioned above, our local hospital closed just prior to COVID. I am a first responder as a volunteer fireman for the community. With the closure of the local hospital, our local ambulance company (which is coincidentally managed by a company from Tuscaloosa county) has been hard pressed to keep up with emergency demand. They may have 2 trucks on a good day to cover a population of 20,000 people spread over 900 square miles. (2300 km2). It is not unusual for us to wait 40 minutes or longer for an ambulance. Our situation is also not helped by frequent flyers or people that could get there on their own but think going by ambulance gets them in and out faster. (it’s a really common misconception.)
Prior to the local hospital closure, we’d work a code all the way to the hospital in the back of an ambulance with the paramedics. Nowadays, the ambulance arrives, we state how long we’ve been doing CPR, the ambulance crew observes, sometimes assists, and watches, gets an ECG reading, calls the doctor on duty at one of the ERs, and if there’s no good news, we stop there and tell the family we’ve done all we can. It FUCKING SUCKS. At least prior to the closure, they had that hope as we loaded them into the ambulance and left with them that maybe they’d make it. Nowadays, you’re there for all of it. The initial hope, the shock, the crushing realization. It takes a toll on all of us. Volunteers are down, and I can’t help but think the stresses of all this are a major part of it.
And the final kick in the dick for all of this is remember where I said our local ambulance service is managed out of Tuscaloosa? Tuscaloosa fines them if they don’t have an ambulance available. Our county has no such stipulation. So if their county’s ambulances are tied up, ours get pulled over there, and we are left with nothing and no local care.
There has been a major push by local mayors to get funding to open the hospital ER back up and use the hospital part as a mental health unit for teens from across the state. We thought a good deal had been reached, but our own state senator out of Tuscaloosa shot it down and spent the money elsewhere. I’ll remember that next time I vote, and I’ve been telling everyone that I see in the community to remember it also. The mayors even got a group together to go to the state capital and make their case only to be told that they thought they were speaking to the wrong committee about it. So we were told to wait until 2024 and see what happens. I suspect nothing will change in this dump, and people will continue to suffer. That’s what I expect.
Sorry for the long rant, this is something I’m directly involved with, and rather passionate about. Thanks for reading this far if you have.
It’s honestly heartbreaking to hear how bad things have gotten. I’ve been part of plenty of failed codes in the hospital and I don’t think I could deal with your situation day in and day out.
My hope for these birthing centers is that they either get things up to code and really, truly provide a necessary service, or they don’t give women a false sense of security. Labor usually tends to take a while, particularly in low risk pregnancies, and it really sounds like mothers would be in better hands driving 40 minutes to the nearest hospital than ending up in the worst case scenario with almost an hour and a half or more to get them to the hospital from an inadequate birthing center.
These birthing centers are just a small step above home births in the grander scheme of things. The regulations being imposed are absolutely necessary for the centers to actually be better options. Even if the pregnancy has had no complications and is very low risk, things like uterine hemorrhage, neonatal hypoxia, or other unpredictable complications can occur. When those things happen, being an hour away from proper emergency care is very likely to be lethal. The 30 minutes away from the hospital by ambulance rule isn’t even taking into account the time it takes to recognize the problem and the time for the ambulance to arrive in the first place.
If these centers are going to exist and claim to be a safe option, they need to have adequately trained staff, appropriate facilities, and viable access to emergency care in case of unpredictable complications.
So, if a facility that’s 20 minutes away doesn’t quite meet all the regulations, let’s close it down and make people have to drive over an hour to a facility that does meet all the regulations?
I guess that leaves three options then, deliver at home, just hold it in, or break out the chainsaw…
Actual medical training and appropriate facilities are not high bars to clear if they want to actually do things right. The education requirements for being a midwife as opposed to a nurse midwife are appallingly lax. It’s like saying that a class taught by a high school graduate is equivalent to one taught by someone with an education degree. The person interviewed in the article is an OB/Gyn, but it doesn’t sound like her staff has any qualifications. Hell, EMTs get more education on how to actually deliver a baby and care for the mother than some midwives.
Agreed. Yet still, once upon a time the solution was ‘hey, let’s invent a hand crank chainsaw’…
Just because a facility might not technically meet every single regulation doesn’t mean that a woman can just hold her hoo-hoo shut for an hour or more to get to a proper facility.
Might want to avoid living in an area where you are over an hour away from a hospital.
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I am so freaken grateful that my wife wanted a normal hospital birth, the way skydaddy intended. Doctors, nurses, and machines. Especially given what almost happened.
Medicine > rain goddess chanting
Why are people so upset? The conservatives are benevolent leaders. They allow women to drive, to speak out of turn and to even get their very own jobs if they want a little spending money for makeup and hair-do’s. Maybe women are just getting a little uppity and need to be reminded who’s really in charge around here.
Careful friendo, some people actually believe this
I agree. I live in the south (U.S.).
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Pro baby
In my 3rd world cuntry, my wife gave birth and I was charged zero dollars.
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Thanks, but that doesn’t help those of us who are trying to make the state better.
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