Midwives say Georgia is sidelining them in maternal mortality fight
As Georgia continues to grapple with one of the highest maternal mortality rates in the nation, a new lawsuit claims lawmakers are sidelining a vital resource: midwives.
Three midwives who face financial barriers or outright bans on practicing in Georgia are suing the state, hoping to overturn the state’s restrictive midwifery laws.
“We have a maternity care workforce trained, ready and willing to provide care to their communities — and the state is telling them no,” said Breana Lipscomb, with the advocacy organization Center for Reproductive Rights, which filed the lawsuit on behalf of the plaintiffs.
Given the state’s troubled history with maternal healthcare, Lipscomb said Georgia’s laws don’t make sense.
Certified nurse midwives are trained as registered nurses, but under Georgia law they cannot practice unless supervised by a physician. And direct entry midwives, who train through programs seperate from nursing and specialize in out-of-hospital births are barred from serving patients in Georgia altogether.
Those who violate these rules risk thousands of dollars in fines and, in some cases, felony charges punishable by up to five years in prison.
Sarah Stokely, a certified nurse midwife licensed in Georgia and one of the plaintiffs in the lawsuit, said physician oversight can cost hundreds of dollars per month making it financially impossible for her to work in Georgia.
Instead, she drives more than four hours from her home in Rome to work at a birth center in Tennessee.
“I trained and practiced for years to be a midwife,” she said. “There is no good reason why my hands should be tied this way.”
The two other plaintiffs, Jamarah Amani and Tamara Taitt, are direct entry midwives licensed in Florida and leaders in maternal healthcare but are barred from serving patients in Georgia. Midwives like them get their accreditation through a national certification process after completing programs through midwifery schools, participating in apprenticeships or taking university-based courses other than the nursing track.
The three women argue Georgia’s laws limit birth options and push midwives to leave the state, operate in secret or get out of the profession.
“Every pregnant person should have the right to choose where they give birth and with whom,” Amani said. “I am bringing this lawsuit for every Georgian who has called asking me to be their midwife and who I’ve had to turn down because I cannot get a license in this state.”
Debate under the Gold Dome
Midwives have spent years pushing for lawmakers to change Georgia’s rules and decided to take legal action after legislation that would have eased midwifery restrictions died under the Gold Dome this session.
Georgia Rep. Park Cannon, an Atlanta Democrat, stood with the midwives on the last day of legislative session and slammed her colleagues for failing to take up the issue.
“Your constituents birth at home too,” she said. “Your constituents want birth center care too. Your constituents want to be met with midwives when they reach the hospitals.”
Since the late 1970s, Georgia’s Department of Public Health has slowly backed away from certifying midwives unless they were nursing graduates.
But a more drastic change came in 2015, when DPH revised its existing licensing rules to considered midwives without a nursing background to be practicing medicine without a license.
Marietta Republican state Rep. Sharon Cooper, chair of the House Public and Community Health Committee, agrees with the restrictions and argued that all mothers should be treated by medical providers with the highest level of schooling.
“Why would we want to license people that are not as qualified to deliver babies — and to do it at home,” Cooper said, “where, if there is an emergency, there is less time to get the mother and that baby to a facility to take care of them.”
While certified nurse midwives have the additional training on top of their nursing certification, Cooper said she still believes a physician should be monitoring their work.
“I still think we need to have the most qualified person at least overlooking the care that the patient is getting, having input and being informed about what’s going on with that mother as they go through the process.”
But plaintiffs allege in the lawsuit filed in Fulton County Superior Court that Georgia is violating their right to practice their chosen profession and equal protection laws and that the Legislature and state health department are overstepping their authority.
Desireé Clement, a certified nurse midwife and associate professor at Emory University’s Nell Hodgson Woodruff School of Nursing, said the Georgia’s midwifery laws go further than most other states with its physician oversight requirements.
“Over half of the country recognizes certified nurse midwives and they don’t have these same restrictions,” Clement, who is also the assistant dean of academic operations, said. “There’s years of data that supports that we have low intervention and that this is a safe, viable option for care.”
Kaprice Welsh, also a certified nurse midwife and instructor at Emory, argued that part of midwifery training is to know when a patient needs a physician’s care.
“Does that mean they need physician oversight? No, it does not,” she said. “That means that they need to practice within the scope of what they can do.”
Dwindling options
In their lawsuit, the midwives say Georgia’s legal barriers create a fragmented healthcare system where midwives and traditional hospital providers operate in silos, despite the benefits of working together.
“Georgia’s laws don’t just limit care, they treat midwives like criminals,” said Hillary Schneller, a lawyer with the Center for Reproductive Rights. “The result is fewer providers, fewer choices and a broken maternal health system that is failing too many families.”
Reona Porter spent much of the birth of her first child crying alone in the hospital bathroom. She had hoped for a natural delivery but ultimately received an epidural after pressure from staff.
“But they rushed me into a decision I knew I didn’t want to make,” Porter said.
Porter is a patient at the Atlanta Birth Center and about to give birth to her fifth child.
“The support here is unlimited,” she said sitting in the center’s waiting room ahead of a checkup. “Some moms are timid and don’t feel safe sharing. The center allows that barrier to be broken, so you feel safe and confident in the help and services you’re getting.”
Her experience reflects a broader pattern described by many Black mothers, including plaintiffs in the recent lawsuit, who report negative treatment in hospital settings and prefer nontraditional births. In Georgia, Black women are three times more likely to die from childbirth-related causes than white women.
“Everybody’s situation is not the same — don’t put me in a bubble because of the color of my skin,” Porter said.
Mothers like Porter have few options. Birth centers nationwide are struggling to remain open, squeezed by hospitals that can offer higher salaries to certified nurse midwives and by low Medicaid reimbursement rates for maternity care.
The financial crunch has contributed to a startling trend of closures across the country.
Earlier this year, the Savannah Birth & Wellness Center — the state’s oldest free-standing birth center — closed after nearly 40 years of serving the coastal community. Decades-old centers in Pennsylvania and New Mexico suffered the similar fates. In Rio Grande, Texas, a longtime birthing facility is trying to fill a $600,000 gap after its federal funding was slashed.
Leaders of the Atlanta Birth Center have also been forced to make tough decisions. Starting in September, the facility will pause deliveries as it looks for a new, cheaper location.
High operational costs coupled with low insurance reimbursement rates and a staffing shortage have forced the center to rethink its future, said Taitt, who is the executive director at the Atlanta Birth Center.
“Birth centers that are essential pillars of their communities have been constrained under our healthcare climate,” she said, citing data that the Atlanta Birth Center’s outcomes for patients tops state and national averages.
The center’s C-section rate for clients hovers at 12%, according to the data from the facility, while the state’s rate tops 35%, according to the Centers for Disease Control and Prevention.
And its pre-term birth rate is 2% compared to Georgia’s more than 11%, according to the National Center for Health Statistics.
“And our outcomes don’t have any statistically significant difference between Black and white patients — that does not exist anywhere else in healthcare,” Taitt said.
Advocates of overturning Georgia’s midwifery restrictions also point to the state’s controversial abortion law that bans most abortions after about six weeks. Taitt said if growing families is important to legislators, their policies should support expanding maternal care options, not limit them.
“And we shouldn’t be squandering a workforce that’s available to us address that issue,” she said.
About the Author
Riley Bunch is a politics reporter at The Atlanta Journal-Constitution who covers the impacts of policy on everday Georgians.
