MONTGOMERY, Ala. — An Alabama trial court issued a ruling yesterday permanently blocking the Alabama Department of Public Health (ADPH) from regulating freestanding birth centers like hospitals and imposing onerous licensing rules that would have made it effectively impossible for these centers to provide evidence-based midwifery care in the state. The ruling ensures that plaintiffs Oasis Family Birthing Center in Birmingham and Alabama Birth Center in Huntsville, which have been safely operating for the past year, may continue providing midwifery care to pregnant Alabamians.
The decision from the Fifteenth Judicial Circuit Court holds that the Alabama Legislature never authorized ADPH to regulate midwifery care in birth centers, leaving that responsibility to the Board of Midwifery and other professional licensing boards in the state. Under the terms of a preliminary injunction issued in 2023, two birth centers — Oasis Family Birthing Center and Alabama Birth Center — are now open and providing much-needed care in their communities, in accordance with evidence-based standards set by the American Association of Birth Centers.
Birth centers play a critical role in providing care for low-risk pregnant Alabamians. Expanding access to this care is especially important in light of Alabama’s ongoing maternal and infant health crisis, which disproportionately harms Black women and families, low-income communities, and people living in the state’s rural areas. More than a quarter of all Alabamians — and nearly 90 percent in rural areas — have no birthing hospital within 30 minutes’ drive. Today’s decision will allow even more Alabamians to access this essential care, and pave the way for more birth centers to open in the state.
Statement from Whitney White, staff attorney with the ACLU Reproductive Freedom Project:
“We are elated that the dedicated midwives at Alabama’s birth centers can continue to provide crucial care to pregnant Alabamians across the state without undue interference. Midwifery care in birth centers is safe, can improve patient outcomes, and can play a critical role in expanding access to equitable pregnancy care in Alabama. This ruling ensures that these essential health care providers will be able to continue serving their communities.”
Statement from JaTaune Bosby Gilchrist, executive director of the ACLU of Alabama:
"This ruling is a powerful affirmation of what birth workers, families, and communities across Alabama have long known: midwife-led care is essential. As hospitals and obstetric services close across the state—particularly in rural areas—birth centers and midwives are stepping in to fill a dangerous gap in access. In a state facing a maternal health crisis, we need more options, not fewer. This decision brings us one step closer to ensuring that safe, accessible, and community-based birthing care is available to everyone who needs it."
The birth centers’ lawsuit was filed after ADPH created significant uncertainty around the legal status of birth centers that provide midwife-led care by asserting that all such birth centers require a “hospital” license, even though they exclusively provide midwifery care to low-risk patients using a model of care that is safely provided in out-of-hospital settings across the country. ADPH’s actions abruptly shut down operations for the one birth center then-operating in Alabama, despite a perfect safety record.
The de facto ban on this essential care was especially harmful in Alabama, which has some of the highest maternal and infant health rates in the country, with Black women and infants making up a disproportionate share of deaths. One factor playing into this concerning trend is inadequate access to pregnancy-related care, including the growing number of maternal health deserts in the state and closures of hospital labor and delivery units.
The lawsuit, Oasis Family Birthing Center et. al. v. Alabama Department of Public Health, was filed in the Fifteenth Judicial Circuit Court in Montgomery in August 2023. The plaintiffs – Oasis Family Birthing Center in Birmingham, Heather Skanes, M.D., Alabama Birth Center in Huntsville, Yashica Robinson, M.D., the Alabama affiliate of the American College of Nurse-Midwives, Jo Crawford, CPM, and Tracie Stone, CPM – are represented by the American Civil Liberties Union, the ACLU of Alabama, Covington & Burling LLP, and Bobby Segall of Copeland Franco.
A copy of the ruling can be found here.
An overview of the case can be found here.
