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We should look at how midwives are underutilized

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Dear Editor,

Having recently retired from the Military after a 20 plus year career, I am and have been a Certified Nurse Midwife (CNM) practicing independently in the U.S. Army for over 10 years.  There is much focus in our legislation currently regarding Midwives and the right to a Home Birth.  I am concerned that there is a lack of understanding surrounding the definition of Midwifery (CNM vs. CM vs. CPM).  It can be very confusing and misleading.  I am a CNM, an Advanced Practice Nurse, who chose to do obstetric and gynecologic care for women from “womb to tomb,” to include adolescent care; contraceptives; pregnancy (prenatal, antenatal, intrapartum and postpartum care); lactation consultation; care of the infant for the first 29 days; and menopausal issues.  A CNM does NOT typically do in-home births, this requires additional training and a collaborative agreement with a licensed MD.  I have always done in-hospital deliveries affording women an alternative to Obstetrician and/or Family Practice physician medical model.

A Certified Nurse-Midwife (CNM) is an individual Masters level educated in the two disciplines of Nursing and Midwifery, who possesses evidence of certification according to the requirements of the requirements of the American College of Nurse-Midwives (ACNM).  A Certified Midwife (CM) is an individual educated in the discipline of midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives.  A Certified Professional Midwife (CPM) is a knowledgeable, skilled and independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM).  CPMs are currently working with Alabama State Legislators to have the right to do home births.  As a whole, midwives reduce medical costs; litigation rates are much lower, our patient satisfaction exceeds traditional benchmarks of patient satisfaction.  Our clients/patients are more autonomous, well-informed, often higher levels of education, and more participative in their care.

I feel that if we are going to focus on this issue in the State of Alabama, we should look at how Midwives are underutilized.  I understand UAB used to have CNMs and eliminated them reportedly under the pretense that residents were not getting adequate opportunity for deliveries.  In many military facilities, the CNMs supervise the residents affording them the opportunity to learn the value of labor sitting/coaching, the hallmark of midwifery practice.  Once a Physician understands the value in midwifery there is a much better understanding and mutual respect.  Brookwood Women and Infant Center advertises “have the birth of your choice” but is still an ALL MD staff.  Having been a labor and delivery nurse, I know who manages labor.  I think the group of young women that I met supporting the Alabama Birth Coalition are bright, professional women and should be given the right to choose.  As a group of professionals, we do have to be very careful the floodgates are not opened for all that want to deliver a baby at home.  There has to be STRICT adherence to guidelines much like the ACNM practice guidelines.  Adhering to clearly defined risk factors, the patient would have to be counseled given her risks when she does not meet criteria for a home birth and informed she cannot deliver at home for her and her infant’s well being.

This State needs to look at the value of Midwives as a whole and consider the evidence to give CNMs the right to practice independently in underserved, as well as, populated communities that would prefer to have Obstetric/Gynecologic care done by a CNM (APN).  The CNM can function independently which is not currently considered in Alabama.  Midwives want to care for the underserved communities, these are the resources that need to be looked at and are basically untapped!  While preparing to retire, many of my CNM/Advanced Practice nursing colleagues in the Army would say “DON’T go to Alabama you can’t get a job”.  I admit it is VERY difficult to find one in my specialty.

If the Alabama Board of Nursing isn’t comfortable with new ideas, maybe it is time to get some new board members.  There needs to a support systems for Advanced practice nurses, some programs taught in this States universities, rather than suppress the value of Advanced Practice Nursing. There is a need for fresh ideas and schools of thought.  Change is inevitable in the medical community.  Thinking outside the box, wanting to be a scholarly community and support our women’s request should be valued not oppressed.

Do we want to remain in the minority of states that do not have independent nurse practitioners and/or midwives?  Did you know that in-home birth is considered a felony in Alabama?  Should we not afford that RIGHT and the CHOICE for a healthy mother?   Much like lotto, women cross the state line to have the right to have the birth of their choice.

LTC (r) EuLynne Harrison, MSN, CNM, CLC

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Crime

Seven inmates, seven workers test positive for COVID-19

Eddie Burkhalter

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The Alabama Department of Corrections on Tuesday said in a statement that seven more prison workers and seven additional inmates have tested positive for COVID-19. 

Four workers and one woman serving at the Julia Tutwiler Prison for Women all tested positive for coronavirus, according to an ADOC press release. There are 16 confirmed cases among staff at the facility. 

The woman serving at Tutwiler prison continues to be asymptomatic and was tested pre-operation for a scheduled surgery, according to the release, which states she has been moved to “medical isolation” and the dormitory where she was housed has been placed on on level-one quarantine, meaning inmates will be monitored for symptoms and have temperature checks twice daily. 

Other positive test results came back for a worker at Ventress Correctional Facility, another at the Alex City Community Based Facility and Community Work Center and one at the Birmingham Community Based Facility and Community Work Center, according to ADOC. 

Four inmates at the St. Clair Correctional Facility who also tested positive for COVID-19 were living in the same small area within the prison’s infirmary as an inmate who previously tested positive for the virus, according to the release. That living area remains on level-two quarantine, meaning inmates remain there for all daily activities, and the entire infirmary at St. Clair remains on level-one quarantine.

One inmate at the Kilby Correctional Facility and another at the Frank Lee Community Based Facility/Community Work Center also tested positive for  COVID-19. 

The man serving at Kilby prison was housed in the facility’s infirmary, and was transferred to a local hospital after showing symptoms of the virus, where he tested positive, according to ADOC. Kilby’s infirmary has been placed on level-one quarantine.

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The inmate at Frank Lee developed symptoms of COVID-19 and was taken to the Staton Correctional Facility to an area under level-two quarantine, where he subsequently tested positive, according to the department. He was then taken to medical isolation at Kilby prison,  and the facility was placed on level-one quarantine. 

There have been 68 confirmed cases among prison workers in the state, while 17 have since been cleared to return to work. 

Ten of the 19 confirmed COVID-19 cases among inmates remain active, according to ADOC. As of Monday the state has tested 176 of Alabama’s approximately 22,000 inmates, according to the department.

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News

State files lawsuit against Birmingham for removing Confederate monument

Chip Brownlee

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Alabama Attorney General Steve Marshall filed a new lawsuit against the city of Birmingham Tuesday for removing a Confederate monument in Linn Park.

Local officials in Alabama’s largest city, which has a majority black population, removed a 115-year-old Confederate Soldiers and Sailors monument in the city’s Linn Park after protestors and demonstrators vandalized it Sunday.

Birmingham Mayor Randall Woodfin ordered the monument removed during the waning hours of Jefferson Davis day Monday, a state holiday honoring the Confederate leader.

“This action is a very, very powerful symbol of our city’s desire to move beyond the pain of the past and uniting into the future,” Woodfin said Tuesday, adding that the city would not disclose the monument’s new location due to security concerns and to protect it from further vandalism.

The city paid $1 to remove the monument, Woodfin said, adding that the city council would need to vote on whether to accept public donations to pay off any fines imposed by the state for removing the monument.

One public fundraiser has raised more than $60,000 in a day to support the city in removing the monument.

The monument has been at the center of a years-long legal battle between Alabama’s majority-white, GOP-led Legislature and predominately black local officials in Birmingham.

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Marshall filing the lawsuit seeking the $25,000 fine, if imposed, would effectively end the legal showdown over the monument.

“In balancing between the costs of civil unrest versus the costs of a civil fine, I think most would agree with me: the city should pay the cost of that civil fine to make sure that there is not any more unrest in our city,” Woodfin said.

Marshall filed the lawsuit against Birmingham for violating the state’s Memorial Preservation Act, which prohibits the removal of historic monuments including Confederate monuments.

This is the second lawsuit filed by the Alabama attorney general against the city of Birmingham over the Linn Park monument.

The lawsuit seeks additional penalties after the city lost a similar lawsuit filed by the state in 2017.

The Memorial Preservation Act was passed in 2017 by the Alabama Legislature to protect architecturally significant buildings, memorial buildings, memorial streets and monuments located on public property for 40 or more years.

The law effectively prohibited municipalities from removing Confederate monuments.

“The State of Alabama first filed suit against the City of Birmingham in 2017 after the City erected barriers around the monument in Linn Park. In November 2019, the Alabama Supreme Court sided with the State and determined that the City of Birmingham had violated the law and was subject to the Act’s penalties. However, the Court held that any violation of the Act was punishable only by a one-time fine of $25,000 per violation,” Marshall said in a statement.

Woodfin, amid nationwide protests, demonstrations and unrest over the killing of George Floyd by a Minneapolis police officer, said he was willing to pay the fine to remove the monument, directing city workers to remove it Monday evening.

Legislation was filed in the 2020 session that would have amended the penalties provision of the act in response to the court’s ruling, but that legislation failed to become law.

“On Monday, I advised Mayor Woodfin that the removal of the 115-year-old Confederate Soldiers and Sailors monument in Birmingham’s Linn Park would violate the law and that I would fulfill my duty to enforce it,” Marshall said.

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Health

Third patient at state’s Mary Starke Harper Geriatric Psychiatric Center dies from COVID-19

Eddie Burkhalter

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A third patient at the state’s Mary Starke Harper Geriatric Psychiatric Center has died from COVID-19, the Alabama Department of Mental Health confirmed to APR on Tuesday. 

There remained 16 active coronavirus cases among patients at the state-run facility, said ADMH spokeswoman Malissa Valdes-Hubert in a message Tuesday.

Those patients are in various states of recovery, she said. 

Valdes-Hubert also confirmed that the members of the Alabama National Guard are to clean the facility on Thursday. 

Under the direction of Gov. Kay Ivey, the Alabama Department of Public Health and the Alabama Emergency Management Agency, members of the Alabama National Guard have since early April decontaminated and sanitized state nursing homes. Guard members also cleaned the Bill Nichols State Veterans Home, which had a serious outbreak of coronavirus, killing more than 20 residents and infecting more than 100. 

Valdes-Hubert said the department is in the process of planning for recovering patients and will release more information when available. 

There were no confirmed cases at ADMH’s two other facilities in Tuscaloosa, Bryce Hospital and the Taylor Hardin Secure Medical Facility as of Tuesday, Valdes-Hubert said.

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National

Sewell implores Alabamians “to speak out and demand change without violence”

Brandon Moseley

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Alabama U.S. Rep.Terri Sewell said that her heart aches for George Floyd and that anger should be directed not to violence but to action.

“The heroes of the Civil Rights Movement showed us it is possible to change history without damaging property and torching businesses that our community members depend on, so I implore all Alabamians to speak out and demand change without violence,” Sewell said. “We cannot let violence distract from the legitimate anger and frustration that we must channel toward action. I pray for both peace and justice.”

Sewell posted a video message Monday in response to protests across the country, which have at some points, turned violent and chaotic. On Sunday, several reporters were attacked in Birmingham, and some businesses were vandalized.

The representative’s video message comes after Birmingham Mayor Randall Woodfin and Montgomery Mayor Steven Reed also called peaceful demonstration. Birmingham implemented a curfew in response to the riotous demonstrations Sunday evening, but the city also removed a Confederate monument from Linn Park.

“To all those who feel marginalized because of the color of your skin: I see you and I hear you,” Sewell said. “Your pain and hopelessness is legitimate — since the founding of our nation, our criminal justice system has failed our black and brown communities. My heart aches for George Floyd, Ahmaud Arbery, Breonna Taylor and the countless others whose senseless deaths have not made the national news cycle.”

Sewell represents Alabama’s 7th Congressional District and is the only black member of Alabama’s congressional delegation.

“As a daughter of Selma, I myself have struggled to reconcile with the moment in which we continue to find ourselves, over and over,” Sewell said in the video statement. “The Foot Soldiers who came before us fought to create a better future, but every day we are reminded that that fight is far from over. They sacrificed their lives in pursuit of an America that lives up to its ideals – an America that we have not yet reached more than 55 years later.”

Sewell said the racism that causes pain can be seen plainly in police brutality and in the staggering health disparities black communities have endured before and during the COVID-19 pandemic.

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“It can be seen in thinly-veiled attempts to put African Americans in our place, holding on to and idolizing a time when our bodies were not our own,” she said. “And it can be seen in the state-sanctioned holidays and monuments that honor the leaders of the Confederacy, including today, ‘Jefferson Davis Day.’”

Sewell said she also knows that the vast majority of Americans across the country and in Birmingham are peacefully protesting for social justice.

“I wish I had all the answers and I could give us all the solutions we need,” Sewell concluded. “For now, I promise that I will work tirelessly to do absolutely everything within my power to bring peace and justice to our communities.”

“My Administration is fully committed that for George and his family, justice will be served,” President Donald Trump said on Monday. “He will not have died in vain. But we cannot allow the righteous cries of peaceful protesters to be drowned out by an angry mob.”

Floyd was killed while being arrested by the Minneapolis Police Department on suspicion of counterfeiting. The police officer who killed Floyd has been arrested and charged with third-degree murder and manslaughter. Activists say more widespread reform of policing and the criminal justice system needs to happen, and the other officers involved in Floyd’s homicide should also be charged.

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