DAVID GREENE, HOST:
For more than 30 years, it has been illegal for certified professional midwives to deliver babies in the state of Alabama. But that is now changing. As Julia Simon with our Planet Money team reports, the state is about to start licensing midwives, and this is likely to change the economics of giving birth in Alabama.
JULIA SIMON, BYLINE: A few months ago in Birmingham, Ala., I met Whitney Jones. She told me what happened five years ago when she was in labor.
WHITNEY JONES: They was telling me that if I didn't have my daughter within the hour, that they was going to have to have a caesarean. And then the doctor literally told me, don't push.
SIMON: This confused Jones. The baby wasn't in distress. She wasn't in distress.
JONES: And I was like, that sound the opposite of what you do when you're giving birth. So soon as he left, guess what I started doing. I started pushing. And next thing you know, she just popped out. He came in, what did you do? I said, nothing.
SIMON: Jones' daughter Brooke (ph) was born. And when I met Jones, she was eight months pregnant with her second daughter. This time, she didn't want to feel pressured to have a C-section she didn't need. She wanted a midwife, but she wasn't sure she could find one.
JONES: I was being told there wasn't any midwives. I was very close to going across the state line just to give birth to my child.
SIMON: Wow. Where would you go?
JONES: I was going to go to Tennessee.
SIMON: In the '70s, Alabama stopped licensing midwives. The argument was they were uneducated, unsafe, which, was often very coded racial language because many Alabama midwives were black. But last year, the Childbirth Freedom Act passed the Alabama Legislature with a wide margin, and Alabama joined more than 30 other states legalizing certified professional midwives.
Sheila Lopez welcomed the change. She's one of a handful of certified nurses in the state who provides midwifery care but has to collaborate with a physician. Lopez says more midwives will mean mothers have more childbirth options. And...
SHEILA LOPEZ: We also do decrease C-section rates.
SIMON: A five-year study published earlier this year found midwifery use was associated with lower C-section rates. And while C-sections can be critical for high-risk situations, for women like Jones - low-risk with a low-risk baby - they might not need them. Plus, compared to vaginal births, there's a cost.
DAVID LANSKY: It turns out a C-section is about $10,000 per case more expensive.
SIMON: David Lansky is the CEO of the Pacific Business Group on Health, a nonprofit helping big companies around the country make sure their employees get high-quality, affordable health care. A lot of the money they deal with is maternity care. And those costs were going up, and Lansky wanted to know why.
LANSKY: We discovered there were an awful lot of unnecessary surgeries taking place, causing harm to moms and causing a lot of unnecessary expense.
SIMON: And when you say surgeries, you're talking about C-sections?
LANSKY: Yeah. C-sections in particular.
SIMON: And so Lansky's group turned to midwifery. He's helping obstetricians integrate midwives, helping health insurance companies include them in provider directories. And they're trying something called bundled payments - giving hospitals the same set fee for both C-sections and vaginal births, so the hospital's incentive is to do what's right for the patient. They have an incentive to call the midwives.
LANSKY: Call the midwives.
SIMON: Alabama recently established a regulatory board to license midwives. And for Jones and her midwife search, she went online and found Sheila Lopez, so she didn't have to cross state lines. And on June 25, baby Raya was born. This time, no one pressured her to have a C-section. They just told her to keep on pushing. Julia Simon, NPR News.
(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.
