Alabama judge blocks state from regulating birth centers as hospitals
Dr. Heather Skanes, OB-GYN and owner of Oasis Family Birth Center in Birmingham, discusses ACLU's lawsuit against the Alabama Public Health Department on Aug. 8, 2023 in front of the Mothers of Gynecology Monument in Montgomery. (Alander Rocha/Alabama Reflector)
An Alabama judge Thursday blocked the Alabama Department of Public Health (ADPH) from regulating freestanding birth centers as hospitals, delivering a victory to midwives in the state.
Montgomery Circuit Court Judge Greg Griffin's ruling concluded that the Alabama Legislature did not authorize the ADPH to regulate midwifery care in birth centers as 'hospitals,' saying that ADPH's attempt to impose hospital regulations on Freestanding Birth Centers (FSBCs), which offer an out-of-hospital birth option, was unlawful.
'Because both legal rules of statutory construction and undisputed record evidence make clear that FSBCs do not provide 'obstetrical care,' and do not provide care 'to the public generally,' ADPH's attempt to regulate them as 'hospitals' exceeds its statutory authority and violates the AAPA,' Griffin wrote in the ruling.
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Messages seeking comment was left with ADPH and the Alabama Attorney General's office.
Birth centers are health care facilities dedicated to childbirth and are centered around the midwifery model of care. They are often looked at as an in-between option for mothers not completely comfortable with home births or the medical setting of a hospital. Supporters also say that it provides another option for people with low-risk pregnancies in a state where about 34% of counties are considered maternity care deserts.
Dr. Heather Skanes, OB-GYN and owner of Oasis Family Birth Center in Birmingham, one of the plaintiffs in the lawsuit, said in an interview Friday that the ruling allows her to keep operating without 'the burdensome regulations that ADPH was planning to impose' on them. Since reopening after the preliminary injunction, Skanes said that her birth center has been 'able to start caring for birthing people again.'
'We've been doing births without any issues, and we've continued to provide safe and effective prenatal, labor, delivery, postpartum care in an underserved area here in Birmingham,' Skanes said.
New rules approved by the ADPH in 2023 required Alabama birth centers to be overseen by a physician; be located within 30 minutes of an OB-GYN hospital and seek hospital licenses. Birth center advocates feared these regulations, especially the hospital licensing requirement, would make it challenging to serve low-risk pregnancies, particularly in rural areas of the state with poor maternal health outcomes that may lack health care providers..
The plaintiffs, including the birth centers, midwives, and the Alabama affiliate of the American College of Nurse-Midwives, filed a lawsuit in August 2023. The plaintiffs argued that these rules would make it nearly impossible for them to provide midwifery care. The following month, Griffin blocked ADPH from enforcing hospital licensing requirements on birth centers.
In a statement, the American Civil Liberties Union (ACLU), which represents the plaintiffs, said the rule would ensure access to equitable pregnancy care in Alabama, a state facing a maternal and infant health crisis. This crisis disproportionately affects Black women, low-income communities, and those living in rural areas with limited access to hospitals.
'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 Whitney White, staff attorney with the ACLU Reproductive Freedom Project. '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.'
JaTaune Bosby Gilchrist, executive director of the ACLU of Alabama, said the ruling affirms the essentiality of midwife-led care.
'This ruling is a powerful affirmation of what birth workers, families, and communities across Alabama have long known: midwife-led care is essential,' Gilchrist said in a statement. '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.'
Skanes said that she hopes the ruling 'allows Alabama to really reconsider the way that we provide maternal care.' She said that birthing centers could be a solution to providing maternal care by placing them 'in strategic areas around the state.' She said that Alabamians would benefit from an integrative approach to maternal care that utilizes both birth centers and hospitals.
'I think that we really have to change our mindset as physicians and as Alabamians, that this care can really be integrated into the medical system,' Skanes said. 'That it doesn't have to be something that's stigmatized, it doesn't have to be something that is talked down upon, but it's just another option for women and for birthing people, and it works in conjunction with the hospital.'
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