A group of Alabama birth center operators is asking the Alabama Supreme Court to review a January decision that allowed birth centers to be regulated as hospitals.
The lawsuit, Oasis Family Birthing Center et. al. v. Alabama Department of Health, was launched in the Fifteenth Judicial Circuit Court in Montgomery in 2023.
Birth center plaintiffs are represented by the American Civil Liberties Union of Alabama, Covington and Burlap LLP and Bobby Segall of Copeland Franco. The Alabama Attorney General’s Office is representing defendants ADPH and State Health Officer Scott Harris.
The January ruling by the Alabama Court of Civil Appeals would allow ADPH to begin requiring birth centers to obtain hospital licenses in order to operate in the state, which the case plaintiffs have described as a de facto ban on the facilities. Birth centers will be able to continue operating without receiving a hospital license while the case is on appeal.
Plaintiffs have argued that the proposed rules, which would require a physician or medical director to be present for facility oversight and that a facility must be within 30 minutes of a hospital with OB-GYN services, will impose burdensome, unnecessary regulations on birth centers by requiring the facilities to obtain hospital licenses.
Meanwhile, ADPH has argued its proposed regulations are necessary to ensure the safety of birth center facilities and the services they provide.
Oasis Family Birthing Center, Alabama’s first freestanding birth center, began operations in 2022 and sued ADPH, alongside Huntsville’s Alabama Birth Center, when the department adopted its birth center regulations.
Since the proposed ADPH regulations were first blocked by a state trial court in 2023, additional birth centers, Alabama Birth Center and Birth Sanctuary Gainesville, both run by case plaintiffs, have begun operations in the state.
The Montgomery Circuit Court also ruled that ADPH was not given the authority to regulate birth centers last May, a decision reversed by the January ruling.
The plaintiffs on Friday requested that the high court hears oral arguments in the case in hopes of reversing the ruling.
“The resolution of this question is of public importance because it impacts access to much-needed health care. The Plaintiff birth centers have been safely providing midwifery care to their communities continuously since 2024,” the plaintiffs’ filing reads. “But if permitted to seize unauthorized licensing authority, Defendant intends to enforce burdensome and unnecessary regulations4 that would make it difficult, if not impossible, for the birth centers to keep operating, thus depriving their current patients and communities of access to essential care.”
Alongside their request for Alabama’s high court to hear their appeal in the case, made on Monday, birth center plaintiffs shared statements arguing the importance of providing patient-centric care and improving maternal health outcomes across the state.
Whitney White, a staff attorney with the ACLU Reproductive Freedom Project, who delivered oral arguments before the appeals court in December, said her organization will “remain steadfast” in fighting for birth centers in Alabama, describing the facilities as “essential for Alabama women and families.”
“Birth isn’t one-size-fits-all. Alabamians deserve to be able to access the model of care that serves their needs and their families best. We hope that the Alabama Supreme Court will recognize how crucial birth centers are and protect Alabamians’ ability to continue receiving this essential care in their communities,” White said.
In an interview on Tuesday, White told APR that birth centers are a “common sense solution” for improving maternal health access and outcomes in Alabama and described the proposed ADPH regulations as unnecessary government overreach.
“The midwifery care that birth centers provide is a modern, evidence-based care. Evidence and research has shown that it is safe for low-risk pregnancies, and that it can, in fact, improve outcomes for many folks,” White said.
“Essentially, the department is attempting to require these facilities to be set up like mini hospitals,” she continued. “And that level of regulation is simply unnecessary for birth centers.”
White also highlighted that the Alabama Board of Midwifery already regulates birth center care alongside home births facilitated by licensed midwives.
“There’s been, you know, a certain amount of fear mongering about, you know, well, what will happen if the Department of Health isn’t involved here?” White said. “But this case is not about whether or not birth centers and the midwifery care they provide is going to be regulated.”
“It is already regulated by agencies like the Board of Midwifery. Those agencies are responsible for ensuring that licensed midwives are providing safe care in accordance with the prevailing, you know, standards of care for midwifery, no matter where they’re practicing in the state,” she continued. “That’s the same model of oversight that exists for other kinds of care, including home births, and home births involve the same licensed midwives, the same low-risk patients, and the same evidence-based midwifery care as in birth centers.”
ACLU of Alabama Executive Director JaTaune Bosby Gilchrist expressed hope the state’s Supreme Court will ensure access to birth center care by overturning the appeals court decision.
“Alabama’s maternity care desert is growing larger every year, and no family should have to worry about whether they can find the care they need during pregnancy and through birth in the manner in which they desire,” she said.
Dr. Yashica Robinson, founder of the Alabama Birth Center, argued that birth centers are a valuable resource in improving maternal health disparities among Black Alabamians.
“The care we provide at birth centers not only improves pregnant Alabamians’ outcomes—it changes their lives,” Robinson said.
“Being able to get pregnancy care in their own communities, in a home-like setting, makes a world of difference—especially for Black Alabamians, who are more likely to experience complications and be disempowered as the result of medical racism,” she continued. “With Alabama facing a serious maternal and infant health crisis that is disproportionately affecting Black Alabamians, those with low incomes, and rural communities, the support birth centers provide our communities is more important than ever.”
Jo Crawford, a certified professional midwife on staff at Oasis Family Birthing Center, similarly emphasized the potential of freestanding birth centers to provide personalized care to mothers who wish to deliver their pregnancies outside of a hospital or home birth setting.
“My patients choose midwifery care because of the comprehensive support we provide throughout pregnancy,” said Crawford. “I have seen first-hand how midwife-led care empowers birthing mothers, giving them control over their care and ensuring that they can deliver safely. It is essential that we continue to be able to provide this care to pregnant Alabamians.”
According to an annual report released in November by March of Dimes, Alabama ranked among the worst states for maternal and infant health.
Despite improvements in the state’s infant mortality, which, according to ADPH, declined from 7.8 deaths per 1,000 births in 2023 to 7.1 in 2024, infant mortality among Black Alabamians remains disproportionately high.
The state’s infant mortality rate for Black mothers on the March of Dimes report card came in at roughly 12 deaths per 1,000 live births, or 1.6 times the state’s overall rate.
Nine rural hospitals have closed in Alabama since 2009, according to the University of North Carolina’s Sheps Center. Only 30 percent of the state’s rural hospitals have labor and delivery units.
ADPH also reports that Alabama faces higher infant mortality rates in rural Wilcox, Butler, Conecuh, Hale and Cherokee counties, all of which are home to hospitals without delivery units.
Messages were left requesting comments on the appeal from the Alabama Attorney General’s Office.
The Alabama Supreme Court has not acted on the certiorari request as of Monday evening.
