A circuit judge on Thursday permanently blocked the Alabama Department of Public Health (ADPH) from licensing freestanding birth centers like hospitals after years of litigation and protests from midwives and other birthing advocates.
Since 2023, ADPH has courted a series of rules designed to regulate birth centers, drawing ubiquitous protest from birthing advocates nationwide.
Alabama previously had regulations for birthing centers, which it repealed in 2010 due to the lack of centers in the state.
The ADPH rules attempted to regulate birthing centers, requiring them to meet the same criteria as hospitals.
Opponents of the rules claimed they acted as a de facto ban on birthing centers, which placed undue burdens on those with diminished access to birthing care and those wishing to pursue alternative birthing care.
In August 2023, the American Civil Liberties Union (ACLU) of Alabama filed a lawsuit on behalf of several doctors and midwives to combat the proposed rules.
The lawsuit brought several statutory and constitutional claims against ADPH, including:
- ADPH lacks the authority to require birth centers to obtain a hospital license because midwife-led birth centers do not constitute "hospitals" under Alabama law.
- Even if ADPH has licensing authority, it does not have the authority to ban birth centers altogether, and by failing to provide any path to licensure, the Department is imposing a de facto birth center ban throughout Alabama.
One week after the lawsuit was filed, ADPH passed the rules, despite the ongoing lawsuit. However, Montgomery Circuit Judge Greg Griffin filed an injunction, blocking the rules from going into effect.
On Thursday, Griffin issued another ruling, this time permanently blocking the rules.
Griffin's ruling states that "freestanding birth centers operating in the midwifery model of care are not 'hospitals' under section 22-21-20(1) of the Alabama Code and, therefore, ADPH and Scott Harris, in his official capacity as the State Health Officer for ADPH, have no authority to require such freestanding birth centers to obtain a license"
The ruling states 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 care in their communities, by evidence-based standards set by the American Association of Birth Centers.
"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," said ACLU staff attorney Whitney White. "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."
The lawsuit 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.
"This ruling is a powerful affirmation of what birth workers, families, and communities across Alabama have long known: midwife-led care is essential," said JaTaune Bosby Gilchrist, executive director of the ACLU of Alabama. "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."
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