Midwives Challenge Georgia’s Restrictive Laws Amidst Escalating Maternal Health Crisis

In a significant legal challenge aimed at reshaping maternal healthcare access in Georgia, several midwives, represented by the Center for Reproductive Rights, have filed a lawsuit against the state, contesting laws that severely restrict their ability to practice. Announced on the final day of Georgia’s legislative session, the suit targets some of the nation’s most stringent midwifery regulations, which plaintiffs argue exacerbate the ongoing maternal health crisis and limit options for pregnant individuals, particularly those in underserved communities.

The Legal Challenge and its Genesis

The lawsuit, officially filed as Amani v. State of Georgia, directly confronts Georgia’s legal framework governing midwifery. These regulations, described by advocates as among the strictest in the United States, effectively prohibit midwives with extensive experience in home and birth center births from practicing independently. Furthermore, certified nurse midwives (CNMs) are prevented from practicing to the full scope of their advanced training, a situation that plaintiffs contend is a direct impediment to addressing the state’s dire maternal health outcomes.

The timing of the announcement was strategic, coinciding with the close of the Georgia legislative session. This occurred shortly after the failure to pass House Bill 520 (HB 520), a bill that, had it been enacted, would have significantly decriminalized and expanded the practice of midwifery in the state. The bill’s demise in the legislature underscored the urgency of the legal action, as legislative avenues for reform appeared to be closed for the session.

The plaintiffs in the case are Jamarah Amani, a Florida-licensed midwife and co-founder of the National Black Midwives Alliance; Tamara Taitt, a Florida-licensed midwife and executive director of Atlanta Birth Center; and Sarah Stokely, a certified nurse midwife who resides in Georgia but currently practices in Tennessee due to state restrictions. They are represented by the Center for Reproductive Rights, Covington & Burling LLP, and Mitchell Shapiro Greenamyre & Funt LLP.

The Scope of Georgia’s Restrictions

The core of the lawsuit lies in several key restrictions imposed by Georgia law:

• Prohibition of Unlicensed Midwives: The state largely prohibits individuals who have not obtained a specific Georgia license from practicing midwifery. This often excludes traditional, apprenticeship-trained midwives who possess extensive experience and have served communities for generations, particularly in the Black community where such traditions are deeply rooted.
• Scope of Practice Limitations for Certified Nurse Midwives (CNMs): While Georgia does license CNMs, their practice is often constrained by requirements that necessitate burdensome and often financially prohibitive physician supervision or collaborative agreements. These agreements, sometimes referred to as "physician babysitting" by critics, can limit CNMs’ autonomy and prevent them from offering a full range of evidence-based care that aligns with their training.
• Barriers to Home and Birth Center Births: The legal framework creates an environment where planned home births and births at freestanding birth centers are effectively discouraged or made impossible for many qualified midwives to attend, pushing pregnant individuals towards hospital-based births, which may not align with their preferences or needs.

The National Maternal Health Crisis and Georgia’s Role

The legal challenge in Georgia is situated within a broader national context of a deepening maternal health crisis. The United States continues to have significantly higher maternal mortality rates compared to other high-income nations. This crisis disproportionately affects Black women, who face mortality rates several times higher than their white counterparts.

Georgia, in particular, has been identified as a state with some of the worst maternal health outcomes. This grim reality is compounded by a shrinking landscape of maternity care providers and facilities. In February of the current year, Georgia’s oldest freestanding birth center announced its closure, leaving only three such centers operational across the entire state. This mirrors a nationwide trend of labor and delivery units and freestanding birth centers closing, creating vast "maternity care deserts." As of August 2025, more than one-third of U.S. counties are designated as such, meaning they lack any birthing facility or obstetric clinician.

The closure of these facilities and the scarcity of providers leave many pregnant individuals with limited or no options for receiving care during pregnancy, labor, and delivery. This situation is particularly acute in rural areas and for low-income communities and communities of color.

The Evidence for Midwifery’s Impact

Extensive research underscores the critical role midwives play in improving maternal and infant health outcomes. Studies consistently show that midwifery-led care is associated with lower rates of interventions such as Cesarean sections, episiotomies, and the use of epidurals and drug-induced labor. These interventions, while sometimes necessary, can carry risks of complications and contribute to the escalating costs of healthcare.

For marginalized populations, the benefits of midwifery care are even more pronounced. Evidence suggests that people of color and lower-income individuals experience improved health outcomes when they receive care from midwives. This is attributed to a more personalized, patient-centered approach that emphasizes informed consent, shared decision-making, and a deeper understanding of individual needs and cultural contexts.

A Wave of Legal Challenges Against Midwifery Restrictions

Georgia is not an isolated case in facing legal scrutiny over its midwifery laws. A growing number of states are witnessing similar challenges, reflecting a national movement to expand access to midwifery care. Recent lawsuits have been filed in Mississippi, Nebraska, and Alabama, all seeking to dismantle restrictive laws that limit the practice of midwives and birth centers.

In a significant development for North Carolina, as of October of this year, certified nurse midwives will no longer be mandated to enter into restrictive agreements with physicians. This change signifies a move towards greater professional autonomy for CNMs in that state. Furthermore, a lawsuit filed by the Center for Reproductive Rights in Hawaii in 2024 successfully led to the expansion of access to traditional and apprenticeship-trained midwives in the state, demonstrating the efficacy of legal advocacy in this area.

Voices from the Front Lines

The plaintiffs and their legal representatives have voiced their deep concerns and motivations behind the lawsuit:

Jamarah Amani, a Florida-licensed midwife, expressed her personal connection to the issue: "It should not be illegal to give birth at home with a midwife. Every pregnant person should be able to choose where they give birth and with whom. I was inspired to become a midwife after my own distressing birth experience in Georgia, where hospital staff would not let me give birth in the way I wanted – an all-too-common experience, especially for Black women. I trained in the tradition of legendary grand midwives who have helped Georgians give birth for generations. But because of Georgia law, I had to move to Florida to get my midwifery license and build my career. We’re bringing this case to get rid of these oppressive laws so I can serve families in Georgia, too."

Tamara Taitt, executive director of Atlanta Birth Center and a Florida-licensed midwife, highlighted the systemic failure: "Georgia has a maternity care crisis and the state continues to squander a workforce that could help change that. Currently, there are not enough maternal health care providers in Georgia. The solution is more midwives, and lawmakers need to let us practice. As the US continues to fall behind in maternal mortality and morbidity, the rest of the world employs the solution: more midwives. As a country and as a state, we are visibly failing pregnant people – especially Black women, rural families and communities of color."

Sarah Stokely, a certified nurse midwife who currently practices in Tennessee, shared her experience of being unable to serve her home state: "As a Georgia native, I want to use my midwifery license and skills to help families in my own state. But because of Georgia laws, I have to drive to Tennessee to practice my profession. In Georgia, I would need to pay a physician an insurmountable fee to babysit me. Many clients come to me because they’ve had traumatic hospital births, with procedures forced upon them. Our current medical system is not meeting the needs of pregnant people, and they deserve options. Midwives prioritize providing more personalized care and listening to the needs of our clients. We also know when to pull in a physician if certain risks arise."

Nancy Northup, president of the Center for Reproductive Rights, articulated the broader implications: "We cannot solve the maternal health crisis without midwives – they are a key part of the solution in Georgia and nationwide. Yet under Georgia law, midwives are treated like criminals. These extreme restrictions are exacerbating the maternity care crisis and infringing on the rights of pregnant women who want to give birth with midwives. 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."

Broader Implications and Future Outlook

The lawsuit filed in Georgia represents a critical inflection point in the ongoing struggle to expand access to comprehensive and equitable maternal healthcare. By challenging restrictive laws that limit the practice of midwives, the plaintiffs and their legal counsel aim to achieve several key objectives:

1. Improve Maternal Health Outcomes: By allowing qualified midwives to practice to the full extent of their training and experience, the lawsuit seeks to increase the availability of evidence-based, patient-centered maternity care, potentially leading to a reduction in maternal and infant mortality and morbidity.
2. Address Health Disparities: The lawsuit directly confronts the disproportionate impact of the maternal health crisis on Black women and other marginalized communities, aiming to provide more culturally sensitive and accessible care options.
3. Restore Autonomy and Choice: The case champions the reproductive autonomy of pregnant individuals, advocating for their right to choose where and with whom they give birth.
4. Economic and Professional Viability for Midwives: The restrictions not only limit patient access but also create significant barriers for midwives, forcing them to practice in other states or face unsustainable financial burdens. The lawsuit seeks to create a viable professional landscape for midwives in Georgia.

The outcome of Amani v. State of Georgia could have far-reaching implications, not only for the state of Georgia but also as a precedent for other states grappling with similar restrictive midwifery laws. As the legal battle unfolds, it highlights the urgent need for policy reforms that recognize and integrate the essential role of midwives in building a more just and effective maternal healthcare system.

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