Midwives say Georgia restrictions causing maternal health crisis

ATLANTA (CN) — A group of midwives challenged Georgia’s restrictive laws on the profession in a Thursday lawsuit, arguing the state limits access to maternity care and denies families meaningful choices about pregnancy and birth.

In the complaint filed in Fulton County, midwives Jamarah Amani, Tamara Taitt and Sarah Stokely claim they face criminal and civil penalties for providing care to pregnant women in the state.

Midwives specialize in the care of pregnancy and childbirth for people considered low-risk, providing skilled and individualized care during pregnancy, birth and postpartum.

“Instead of integrating midwives into the state’s maternity care system, Georgia maintains some of the most restrictive midwifery laws in the nation,” the plaintiffs write in the suit.

They say the laws prohibit direct entry midwives — who received training outside of nursing school and include certified professional midwives, state-licensed midwives and traditional midwives — from practicing altogether.

Their training focuses on caring for low-risk pregnancies and supporting births outside hospital settings, particularly in homes or freestanding birth centers, thus limiting those options for pregnant Georgians, the midwives say.

At least some direct entry midwives practice legally in more than 40 states, including most states that border Georgia, according to the Center for Reproductive Rights.

The state also bars certified nurse-midwives — advanced practice nurses that must pass a national certification exam — from practicing independently. It requires a formal, written agreement with a physician that often entails paying physicians hundreds of dollars a month.

Locating a physician willing to enter a formal, written agreement is itself an obstacle, the midwives argue, as physicians have no obligation or incentive to enter into such agreements that raise concerns about malpractice liability or compliance with state law.

As a result, some certified nurse-midwives do not practice in Georgia at all and instead seek employment out of state, such as Stokely, who travels more than four hours to work as a staff nurse-midwife at an out-of-hospital birth practice in Tennessee that offers a home-like environment.

Thirty-seven states license certified professional midwives, who also pass a national certification exam but do not attend nursing school, including the surrounding states of Alabama, Arkansas, Florida, Kentucky, Louisiana, South Carolina, andTennessee.

Yet, regardless of their training, experience, or skills, only midwives who are certified by the Board of Nursing as nurse-midwives may practice midwifery in Georgia, the plaintiffs say.

Amani says she obtained her license to practice midwifery in Florida, but has been unable to operate her own practice in Georgia, despite pursuing graduate studies at Clark Atlanta University, where she researched the state’s disproportionately high Black maternal mortality rates.

Georgia has one of the worst maternal mortality rates in the country, which itself has a higher rate of maternal mortality than any other high-income country. The state’s infant mortality rate is also among the highest in the nation.

During her second pregnancy in Georgia, Amani said she was unable to obtain midwifery care covered by Medicaid and instead received care from an obstetrician, where she experienced a “distressing and traumatic” labor.

“These restrictions and others like them are exacerbating the state’s maternal health crisis, leaving pregnant Georgians without options for care,” the midwives write.

Taitt says in the suit she is a direct-entry midwife, who became licensed to practice in Florida after graduating from the Miami Dade College Midwifery Program. Although she lives in Georgia now as the executive director of the Atlanta Birth Center, one of only three birth centers in the state, she is barred by Georgia law from practicing midwifery.

Over half of Georgia counties have insufficient maternity care providers, according the Center for Reproductive Health. More than one-third of counties are considered “maternity care deserts,” because they have no obstetric providers, birth centers or hospitals offering obstetric care.

In their suit, the midwives argue expanding access for their practice could help fix this crisis, especially through freestanding birth centers that are designed to provide individualized maternal care. They point to evidence that shows that more access to midwives leads to better health outcomes for pregnant people and babies — especially for people of color and lower-income people.

They claim people cared for by midwives are less likely to have pregnancy interventions that can lead to health complications, like C-sections, episiotomies, epidurals and drug-induced labor.

“We are suing the state because pregnant people should have the autonomy to decide who they give birth with, and taking away options while there is a glaring lack of providers is senseless. We must break down these legal barriers to improve maternal health care in this country,” Nancy Northup, president of the Center for Reproductive Rights, said in a statement.

According to the center, Georgia’s restrictions also reflect and perpetuate a history of excluding midwives from practice.

For generations, midwives, most of whom were Black across the South — were central to supporting pregnant people through pregnancy and birth. Over time, however, Georgia imposed increasingly restrictive laws as part of a broader campaign that pushed midwives out of practice, narrowed options for families and left care geographically and financially inaccessible for many.

The Georgia attorney general’s office did not immediately respond to a request for comment.

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