To the members of the Alabama State Legislature,

I am an OBGYN physician practicing in Birmingham at Princeton hospital and in Andalusia and Andalusia
Health. I have dedicated my career to improving the health of Alabama women and infants and am
painfully aware of how our system fails mothers and children. I welcome any efforts on the part of the
Alabama legislature to address this crisis and am saddened by bills that undercut (our less than
adequate) available maternity care in the name of addressing this crisis. I am writing today, specifically
because of concerns I have with proposed HB 491. Not only does this bill fail to improve infant survival
in Alabama, but it intrudes on nuanced medical practices in ways that may cause harm to the very
infants you wish to protect.

Firstly, abortion of fetuses beyond the point of viability does not occur in Alabama. Even therapeutic
abortion for fetal anomalies incompatible with life do not occur in this state. These procedures are not
performed at hospitals or at free standing women’s clinics. Women seeking these interventions
currently travel out of state.

Procedures affected by this bill that most OBGYN physicians in Alabama perform include removal of
ectopic pregnancy (tubal, cornual, ovarian, or abdominal) and the delivery of “inevitable abortion/
miscarriage” that occurs prior to 22 weeks. In these cases, the fetus may have a heartbeat or even an
umbilical cord that pulses, but the technology for fetal resuscitation in the first and early second
trimester does not exist. Perhaps in the future, these fetuses may be placed in artificial uteruses and
nurtured to viability, but, currently, that is the stuff of science fiction. In this bill, “born alive” includes
removal of fetus and product of conception with a heartbeat or pulse in the umbilical cord. Would
OBGYNs be prosecuted for removing ectopic pregnancies and saving a woman’s life? Would an OBGYN
or Emergency Room physician be prosecuted for allowing a mother to hold her nonviable infant while
it’s heart stops beating rather than attempting painful procedures that cannot work at early gestational
ages? If so, our existing OBGYN shortages will be exacerbated as we will be unable to perform our jobs
according to our training and ethics.

My second concern with this bill regards its infringement on the decision for palliative care. For both
children and adults, disease exists for which medicine has no cure. In these cases, individuals, parents
and caregivers are given the option of palliative care rather than aggressive resuscitation. Women who
choose to carry fetuses with lethal anomalies to term (as most Alabama women in this situation do)
should have the option of palliative care for those newborns. Rather than intubation, rib cracking CPR,
numerous sticks and lines, parents may choose to have their baby made comfortable with oxygen, warm
blankets, pain medicine, to be held and protected by those who love them, allowing them to “die with
dignity.” There is no reason why these infants should not have the right to a peaceful death just as
other Alabama citizens do.
Finally, I would like to address the subject of infant mortality due to prematurity. Prematurity is the
leading cause of infant mortality in this state but not because physicians are acting as “executioners.” It
is because our current maternity care system cannot adequately meet the needs of Alabama mothers
and babies.

Evidence based interventions to decrease premature birth include group based prenatal care and
progesterone shots for women with a history of preterm delivery. Bills that support and encourage
reimbursement for these practices are needed.

Premature babies that are born in a setting without the resources for neonatal care are at increased risk
of death. Interventions to support rural hospitals, physicians and nurse midwives that offer maternity
care, and reimbursement of services that integrate consultation with maternal fetal medicine specialists
via telemedicine with timely transfer of women at risk for early delivery are needed. Current
reimbursement models de-incentivize these measures and have led to the loss of maternity service lines
all over the state.

There are many ways to improve Alabama’s criminally high infant and maternal mortality rates. HB 491
is not one of them.

Thank you for your attention,

Jesanna Cooper, MD