Alabama Steps Up Regulation of Birthing Centers

The Alabama Department of Public Health (ADPH) has approved a new set of rules to regulate birthing centers in the state even as advocates have filed suit against the state alleging its actions amount to a de facto ban on such facilities. 

Issued by the ADPH during a meeting last week, the new regulations require that birthing centers, which the American Association of Birth Centers defines as a “health care facility for childbirth where care is provided in the midwifery and wellness model,” be located within 30 minutes of a hospital with OB-GYN care. The ADPH also approved a rule that requires a physician or medical director to oversee these centers, which are freestanding and operate independently from hospitals. Thursday’s regulations do allow midwives to work in birthing centers as long as they have oversight from a physician.

But midwives and midwifery advocates say that these new regulations make it harder to provide midwifery services. This is of particular concern in places in the state where maternal healthcare is already limited, according to reporting from the Alabama Reflector. 

The new regulations come against the backdrop of an ongoing legal challenge against the state’s earlier proposed rules against these centers. Scott Harris, Alabama state health officer, claimed that on Thursday, ADPH did not make changes that were “more restrictive,” the Alabama Reflector reported. 

Earlier this month, the ACLU filed a lawsuit against ADPH in Montgomery Circuit Court on behalf of three birth centers and the Alabama affiliate of the American College of Nurse-Midwives, claiming that the department’s “ongoing actions” have “imposed a de facto ban on freestanding birth centers through Alabama, preventing three such birth centers from providing much-needed pregnancy care to their patients. One center was forced to abruptly shut down operations earlier this year, despite a perfect safety record.” 

The legal challenge, according to the ACLU, was mounted after the ADPH required that birthing centers be required to have a hospital license, creating a “significant uncertainty around the legal status of birth centers.” The lawsuit alleges that ADPH does not have the authority to require birthing centers to get hospital licenses because, under Alabama law, they are not considered hospitals. 

The lawsuit also asserts that even if ADPH did have this authority, “it does not have the authority to ban birth centers altogether, and by failing to provide any path to licensure, the Department is imposing a de facto birth center ban throughout Alabama.”

“The regulations approved last week are not yet final. But, as our lawsuit demonstrates, the Alabama Department of Public Health does not have legal authority to issue licensing regulations on birth centers, and, even if it did, it cannot exercise that authority in a way that bans birth centers from operating," a spokesperson from the ACLU told The Messenger. "We hope the court recognizes this overreach from the Department and enjoins the state from continuing to block birth centers from operating."