A group of midwives, doctors and health care activists are working to provide a path for freestanding birth centers in Alabama to keep their doors open.
The Alabama Department of Public Health (ADPH) is requiring the facilities to be licensed as hospitals in the Yellowhammer State, but the American Civil Liberties Union (ACLU) said this move has imposed a “de facto ban” on freestanding birth centers throughout Alabama.
A lawsuit filed earlier this month brings 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.
Also at issue is the department allegedly has not provided any path for the birthing centers to obtain the required licenses. Oasis Family Birthing Center in Birmingham shut its doors in early 2023 after ADPH sent notice it needed a hospital license to remain open.
The lawsuit, Oasis Family Birthing Center et. al. v. Alabama Department of Public Health, was filed on August 8 in the Fifteenth Judicial Circuit Court in Montgomery by the American Civil Liberties Union, the ACLU of Alabama, and Bobby Segall of Copeland Franco on behalf of Oasis Family Birthing Center in Birmingham, Heather Skanes, M.D., Alabama Birth Center in Huntsville, Yashica Robinson, M.D., Birth Sanctuary in Gainesville, Stephanie Mitchell DNP, CNM, CPM, and the Alabama affiliate of the American College of Nurse-Midwives.
Whitney White a staff attorney with the ACLU and lead litigator on the case. She said there is a lack of access to high quality care for many patients in Alabama that birth centers address, and access to that care would stop if the facilities were shut down.
“That is an important context for why the care that birth centers are providing could be so critical,” White explained. “Birth centers specifically serve low-risk patients. There is ample evidence showing that for these patients, not only are birth centers as safe as hospitals, but on many measures, they do better than hospital settings.”
The National Institute of Health reports childbearing people who participate in birth center care, even if they have only birth center prenatal care, experience better outcomes including lower rates of preterm birth, low birth weight births, and cesarean birth, and higher rates of breastfeeding when compared to people with similar risk profiles who receive typical perinatal care.
“These and other reasons are why organizations including the American College of Obstetricians and Gynecologists agree that alongside hospitals, birth centers operating in compliance with national standards are among the safest places for pregnant folks to give birth,” explained White. She went on to say birth centers are ideally complementary to hospital-based care.
“With birth centers caring for low-risk patients who prefer out of hospital care, and who, because they're low risk, do not need access to the acute care facilities that hospitals can provide,” White explained. “That frees up capacity in the hospitals, for physicians to focus on higher risk patients who do need that level of care.”
According to the ACLU’s website, the “de facto ban” comes at a critical time for pregnant Alabamians or those seeking to become pregnant. Alabama has one of the highest maternal mortality rate in the nation, with Black women making up a disproportionate share of maternal deaths.
Alabama consistently has one of the highest infant mortality rates in the nation with 7.6 deaths per 1,000 live births in 2022. The mortality rate for Black babies in the state — 12.1 deaths per 1,000 live births — is twice that of white babies, according to statistics from the Alabama Department of Public Health. And according to a 2020 ADPH report that reviewed 80 maternal deaths in Alabama, more than 55% of the deaths were preventable.
The ACLU reports one factor playing into infant mortality rates and maternal deaths is the growing number of maternal health deserts in the state.
“Health care deserts are prevalent in Alabama,” explained White. “More than a third of counties are classified as maternity care deserts, meaning that they have no providers of pregnancy-related care locally.”
White explained more than two-thirds counties in Alabama have little to no access to maternity care: “There are no hospitals providing labor and delivery services. There are no obstetricians,” she said. “Hospitals, especially in rural areas, are also closing at alarming rates, and the remaining hospitals are stretched thin. They simply don't have the staff resources or the capacity to meet this need for care. This is a crisis that is disproportionately harming Black women and their babies.”
According to data collected by the Center for Healthcare Quality and Payment Reform, 25 of Alabama's 52 rural hospitals are in danger closing. 16 of those are in immediate danger of closing. This comes as state health leaders reported facilities lost more than $700 million in 2022.
The ACLU says to address this disparity, midwives and providers are working to open birth centers to provide safe and welcoming environments for low-risk patients to access much-needed prenatal care and birthing services, especially for those who have decided that giving birth at home or in a hospital is not the right place for them to deliver, or impossible due to the lack of maternal care available in their area.
While lay midwifes attended births for centuries, Alabama has only made midwifery legal in recent years. Alabama lawmakers voted in 2017 to legalize midwifery, and the state began issuing licenses in 2019.
“The primary goal in the lawsuit is to provide a path for these birth centers to provide high quality evidence-based care to their communities as soon as possible,” said White. “We're seeking a preliminary injunction that would prevent the department from continuing to block birth centers from operating in the state so that our plaintiffs can resume providing this critically needed care to their patients and communities as soon as possible.”
A hearing on the ACLU’s request for a preliminary injunction has been scheduled for September 28.
