Black midwives are suing southern states, claiming laws make it harder to help patients

Black midwives in the South, a region rife with racial disparities in access to maternal health care and maternal mortality, are filing lawsuits over state laws they say limit their ability to provide care.

The women behind the litigation say midwives can help improve birth outcomes in Southern states, where maternal mortality rates are higher than the overall U.S. rate, and treat low-risk pregnancies in rural and underserved areas. They say they turned to the courts after legislative efforts to expand their scope of practice stalled.

Lawsuits have been filed against Alabama, Georgia and Mississippi, where state laws and regulations require midwives to have collaborative agreements with doctors – some of which can bristle with working with midwives. These states also have regulations for birthing centers where midwives assist with labor and delivery for low-risk pregnancies, similar to those in hospitals.

The U.S. maternal mortality rate in 2024 was 17.9 deaths per 100,000 births, according to the latest data from the federal Bureau of Investigation. Centers for Disease Control and Preventionbut the rate for black women was 44.8, meaning they were two and a half times more likely to die from pregnancy-related complications than the national average.

Research shows this culturally compatible care — patients who operate providers who look like them — can improve maternal health outcomes. However, according to the American Midwifery Certification Board’s 2025 demographic data, 82% of the nation’s nearly 15,000 certified midwives are white. report.

“It is also true that when you focus your lens and attention on the group that is most impacted by the situation — in this case, Black women — everyone in the system benefits,” said Tamara Taitt, a direct-entry midwife, executive director of the Atlanta Birth Center and a plaintiff in an April lawsuit against the state of Georgia.

Banning certain midwives

Even though Taitt runs a birthing center, she hasn’t been able to exercise.

This is because Georgia prohibits direct entry midwives, also known as certified professional midwives, from practicing in the state. Such midwives learn through certificates and professional internships. Georgia requires certified nurse practitioners and midwives – advanced practice clinicians with advanced degrees – to enter into collaborative agreements with physicians.

These contracts can cost up to $1,000 a month, which is too much for Sarah Stokely, a registered nurse and midwife living in Rome, Georgia, who regularly travels to Tennessee for more than four hours to instead practice midwifery at a birthing center in that state, according to complaint against the State of Georgia.

Along with Jamarah Amani, co-founder of the National Black Midwives Alliance, Stokely and Taitt are asking Fulton County Superior Court for an injunction against the state’s midwifery restrictions. They claim the restrictions violate the Due Process and Equal Protection Clauses of Georgia’s Constitution.

Taitt said restrictions on midwifery in Georgia mean there are fewer job applicants at birthing centers like hers. According to Hillary Schneller, an attorney with the Center for Reproductive Rights who represents the plaintiffs, there are only three such individuals in the state, all in the Atlanta area.

AND Bill which would have relaxed midwifery regulations was not introduced in parliament this spring. A spokesman for the Georgia Attorney General’s office, a defendant in the lawsuit, declined to comment on the pending litigation.

There are 350 certified nurse-midwives and certified vocational midwives in Georgia, but even fewer in Alabama, where there are 22, and in Mississippi, where 11 are certified. American Board of Midwifery Certification.

Taitt said it is particularly essential that black midwives strive to expand the scope of their work, given that until the early 20th century most midwives in the South were black.

Dr. Yashica Robinson, an obstetrician-gynecologist who owns a practice in Huntsville, Alabama, staffed by certified midwives, nurses and doulas, said she opened the center to expand childbirth options for women who don’t want to give birth in hospitals.

“We know that outcomes are better for people who have access to providers that they feel comfortable with, that they trust and that they can actually reach in a timely manner,” she said. “Every community – especially communities of color, rural communities and those where maternity wards are closing – everyone benefits.”

Robinson said other healthcare providers may be skeptical about working with midwives because they don’t understand the value they bring to the care of pregnant women. Other concerns include liability and costs, she added.

In Alabama, the state Supreme Court rejected last month to review a January is appealing against the court’s decision this established that the Alabama Department of Public Health had the authority to regulate birthing centers as well as hospitals. Birth centers initially filed the lawsuit in 2023, saying the restrictions made it tough to operate.

The case will return to the district court level, where judges will assess what specific provisions will apply. Oasis Family Birthing Center in Birmingham and Alabama Birth Center in Huntsville, the plaintiffs in the lawsuit, remain open.

Push for legislation

The American College of Nurse-Midwives filed a federal lawsuit in January against the Mississippi Board of Licensure and other state health officials, arguing that the cooperative agreement is irrational and violates federal and state antitrust laws. The state attorney general’s office in March rejected the charges and asked the court to dismiss the case.

Getty Israel is the founder of Sisters in Birth, a Mississippi women’s health clinic that provides community health services and referrals. She’s not a midwife, but she tried to open one freestanding birthing center in its condition for five years.

“Like the written transfer agreement, the main obstacle is the collaborative practice agreement,” she said. States typically require birthing centers to have a contract with the hospital that allows them to transfer patients if complications occur.

Israel said that few doctors want to sign cooperation agreements with certified nurse-midwives, and hospital associations see midwives as competition.

The Mississippi State Medical Association told Stateline it is monitoring the lawsuit, and the American College of Obstetricians and Gynecologists declined to comment on either lawsuit.

Rob McDuff, an attorney with the Mississippi Center for Justice who represents the plaintiffs, said the group would drop the lawsuit if the Legislature passed a law this spring that would eliminate the cooperation requirement.

Mississippi Republican Rep. Dan Eubanks has repeatedly introduced this measure Billbut it did not make it out of the health committee in either house.

Eubanks said getting rid of requirements for collaborative agreements is a “fiscally responsible solution at our fingertips. All we need to do is give our nurses and midwives a little more authority in their scope of practice, and they won’t be able to operate outside their scope of practice.”

He said the change would boost access to maternity care in Mississippi, where more than half of the state’s counties are maternity care deserts. March of Tens.

Mississippi State Sen. Hob Bryan, a Democrat who chairs the Senate Public Health and Human Services Committee, said obstetrics laws are complicated. He said the Legislature should examine these issues in detail before eliminating the collaborative practice requirement.

“I’m a big believer in going slowly, and I think my first thought is: do no harm. Whatever we do, I think we have to think through all the ramifications of it,” Bryan said.

Eubanks admitted that making it easier for midwives to practice in the state would not solve all of the state’s problems maternal AND baby’s health discrepancies, but he said it would help.

“Part of the reason for the high infant mortality rate in our state is the lack of access to care, and many mothers don’t even receive much prenatal care,” Eubanks said. “We talk about the problem, but we don’t really want to do anything that will solve the problem, and the beautiful thing is that it is a solution… that doesn’t cost the state any money.”

-What’s the problem?

Dr. Wanda Wilburn, an obstetrician-gynecologist in southern California and historian with the Association of Black Women’s Physicians, pointed out that midwives are not prepared to handle high-risk pregnancies.

Wilburn supports giving midwives more opportunities to expand prenatal care for black women, but said midwives should call doctors when a patient’s condition worsens.

“There is no way their level of training is sufficiently in-depth to be able to make decisions about the various serious problems that can arise in obstetrics and gynecology,” said Wilburn, who trained at Emory School of Medicine in Atlanta.

But she added that midwives can help create closer relationships with patients that doctors simply don’t have time to develop, and working together would improve obstetric outcomes for black women.

“What’s the problem?” he asked Wilburn. “Open a birthing center and let us work together to make sure the patient gets all the care, rather than missing out on a piece that could have been that critical piece that caused maternal morbidity and mortality.”

Stateline reporter Elisha Brown can be reached at: ebrown@stateline.org.