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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.

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

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Education

Alabama’s First Class Pre-K program gets more national attention

The article analyzed a recent study that found that students who attended the program were “statistically significantly more likely” to be proficient in both math and reading than those who did not.

Micah Danney

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(STOCK PHOTO)

The state’s First Class Pre-K program gives children advantages in math and reading that last into middle school, far longer than the gains studied in other high-quality pre-K programs, according to an article published in the International Journal of Child Care and Education Policy.

The article analyzed a recent study that found that students who attended the program were “statistically significantly more likely” to be proficient in both math and reading than those who did not.

While programs like Head Start and Tennessee’s pre-K program have been shown to lead to significant educational improvements when children enter kindergarten, those benefits appear to experience a “fadeout” within a year. 

The new research followed students through the 7th grade. Further research should examine the persistence of benefits through high school, according to the article, which was published by researchers from the University of Alabama at Birmingham, the Public Affairs Research Council of Alabama, ThinkData and the Alabama Department of Early Childhood Education.

The research “is reassuring and supports accountability for continued investments and expansion,” the article concluded.

The journal that featured the article is a publication of the National Institute of Early Education Research at Rutgers University.

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Congress

U.S. Rep. Bradley Byrne announces new chief of staff

Eddie Burkhalter

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U.S. Rep. Bradley Byrne

Congressman Bradley Byrne, R-Alabama, on Friday announced that Seth Morrow will serve as his chief of staff.

“As we enter the last half of 2020, my office remains busy assisting constituents and advancing our legislative priorities. I know Seth shares my focus on finishing out my term in Congress strong, and he is well prepared to move into the Chief of Staff role,” Byrne said in a statement. “My staff and I will continue working hard every day to fight for the people of Southwest Alabama and advance our conservative agenda.”

Morrow is a native of Guntersville and has worked for Byrne since June 2014, serving as deputy chief of staff and communications director. 

“I am grateful for this opportunity, and I’m committed to ensuring our office maintains our first class service to the people of Southwest Alabama. Congressman Byrne has always had the hardest working team on Capitol Hill, and I know we will keep that tradition going,” Morrow said in a statement.

Morrow replaces Chad Carlough, who has held the position of Byrne’s chief of staff since March 2017. 

“Chad has very ably led our Congressional team over the last few years, and I join the people of Southwest Alabama in thanking him for his dedicated service to our state and our country,” Byrne said. 

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Crime

Alabama Department of Corrections investigating inmate death

Robert Earl Adams, 40, died on Aug. 5 and although no foul play is suspected, a department spokeswoman in a message to APR said the exact cause of death is pending an autopsy.

Eddie Burkhalter

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The Alabama Department of Corrections is investigating the death of an inmate at the Donaldson Correctional Facility.

Robert Earl Adams, 40, died on Aug. 5 and although no foul play is suspected, a department spokeswoman in a message to APR said the exact cause of death is pending an autopsy.

“While Adams’ exact cause of death is pending the results of a full autopsy, at the time of his passing inmate Adams was not exhibiting symptoms of COVID-19, was not under quarantine following direct exposure to an inmate or staff member who previously had tested positive, and was not in medical isolation as a result of a positive COVID-19 test,” said ADOC spokeswoman Samantha Rose in the message.

Because Adams was not exhibiting symptoms of COVID-19, he had not been tested, Rose said.

An ADOC worker who contacted APR Friday morning about the death, who asked not to be identified for fear of repercussions from ADOC administrators, said it’s suspected that Adams may have overdosed after being given a cigarette laced with a drug.

Adams is at least the sixteenth state inmate to die this year from either homicide, suspected drug overdose or suicide. Additionally, fifteen inmates and two prison workers have died after testing positive for COVID-19.

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Alabama GOP chair: “We expect our elected officials to follow the law” after Dismukes arrest

“Will Dismukes matter: We expect our elected officials, regardless of Party, to follow the laws of our state and nation,” Alabama GOP chair Terry Lathan said on Twitter.

Brandon Moseley

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State Rep. Will Dismukes, R-Prattville, has been arrested on the charge of felony theft.

Alabama Republican Party Chair Terry Lathan said Thursday that Alabamians expect their leaders to follow the law. Her comments came in response to news that an arrest warrant had been issued for State Rep. Will Dismukes, R-Prattville, on the charge of felony theft.

“Will Dismukes matter: We expect our elected officials, regardless of Party, to follow the laws of our state and nation,” Lathan said on Twitter. “No one is immune to these standards. It is very disappointing to hear of these allegations. This is now a legal matter and it must run its course.”

Speaker of the House Mac McCutcheon, R-Monrovia, said Friday in a statement that Dismukes will get his day in court.

“As a former law enforcement officer, I have faith in the criminal justice process and trust that he will receive a full and fair hearing,” McCutcheon said. “Both Democrats and Republicans have been accused of similar crimes in the past, and we cannot tolerate such behavior whether the lawmaker involved has a D or an R beside their name.”

Dismukes has been charged by his former employer, a custom flooring company, of felony theft charges. Dismukes left that employer and started his own custom flooring company.

Dismukes, who is serving in his first term and is one of the youngest members of the Alabama Legislature, has been heavily criticized for his participation in a birthday party for Confederate Lt. General Nathan Bedford Forrest in Selma. Forrest was also the first grand wizard of the Ku Klux Klan.

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The party in Selma occurred the same week that Congressman John Lewis’s funeral events were happening in Selma. Dismukes resigned his position at Valley Baptist Church when the Southern Baptists threatened to disassociate the Prattville Church if they retained Dismukes. He has defiantly refused to step down from the Legislature, but if convicted of a felony, he would be automatically removed from office.

Both Democrats and Republicans have called for Dismukes to resign from the Alabama House of Representatives over his being the chaplain of the Prattville Sons of Confederate Veterans and his Facebook post lauding Forrest. The investigation into the theft predates the controversies surrounding Dismukes’s glorification of the Confederacy and Forrest.

Republican State Sen. Clyde Chambliss, who also represents Prattville, has called on Dismukes to resign.

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“Since first being elected in 1996, I’ve had a policy of not publicly criticizing other elected officials, but at this time I am making an exception since Rep. Dismukes is MY state representative. He does not represent my views or the views of the vast majority of people of District 88,” Chambliss said. “The post is bad enough, the timing is even worse, but the real problem is that an elected official in 2020 would attend a celebration of the life of someone that led a group that terrorized and killed other human beings. He has had 24 hours to understand why people are so upset, but his interview on WSFA a few moments ago confirms that he is lacking in understanding and judgment — he should resign immediately.”

Alabama Democratic Party Chairman State Rep. Chris England, D-Tuscaloosa, has repeatedly called for Dismukes to resign from the Alabama House of Representatives.

The Alabama Democratic Party recently said in a statement, “Will Dismukes is morally unfit for office. Republicans and Democrats statewide seem to agree. Unfortunately, despite the mounting calls for his immediate resignation, Will intends to stay in office and seek re-election without penalty from the Republican Party.”

“While Alabama Republicans hope this will be a distant memory when Dismukes runs for re-election in 2022, we are not going to let him off the hook,” the ADP wrote. “The Alabama Democratic Party is going to leverage every tool we have to send Will packing when he comes up for re-election in two years.”

“In our darkest hours in life there is still light in Christ!” Dismukes wrote on social media Wednesday. “As the storm continues to blow with heavy force, there is yet a peace that this too shall pass. I guess sometimes we find out if we have built our house on sand or the solid rock of Christ. Psalm 23.”

When Speaker of the House Mike Hubbard, R-Auburn, was indicted on 21 charges of felony ethics violations, he did not resign and actually remained speaker until a jury of his peers in Lee County convicted him on 12 counts.

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