Alabama is cracking down on birth centers, leaving pregnant women with fewer options

The team of Dr. Heather Skanes at the Oasis Family Birthing Center in Birmingham, Alabama, began turning away patients this spring as state authorities cracked down on alternative birth options.

The center offered patients with high-risk pregnancies a place to deliver their babies outside of a hospital, where cesarean sections were not performed, epidurals were not performed, and midwives took the lead. Some women labored in an inflatable aqua birthing pool, which Skanes saw as a more supportive environment in which black women in particular would feel more comfortable and heard.

But in March, Alabama Department of Public Health officials told Skanes that they believed the previously unregulated facility was a hospital that did not have the proper permission to open, according to its lawyers.

Only patients who were in their third trimester at the time of the crackdown were still able to have their babies at Oasis.

Everyone else would have to go somewhere else.

“Many of them felt like their voice was taken away from them when they voted,” Skanes said.

The American Civil Liberties Union is Sue the state health department on behalf of Skanes over a so-called “de facto ban” on freestanding birth centers. The court battle continues as the agency is just weeks away from implementing licensing requirements for the facilities.

Alabama has one alarming In the United States, the proportion of residents who die during pregnancy and during or shortly after birth is higher than almost any other state. More than a third of the counties in Alabama Shortage Hospitals with labor and delivery departments or practicing obstetric care providers, according to a report last year from the March of Dimes.

The new rules could drastically change how some birthing centers, including Oasis, are staffed and whether they can operate at all. Midwives trained to assist in out-of-hospital births would not be able to take the lead if they do not also have certain nursing qualifications.

The rules would also require birthing centers to make arrangements with local hospitals to transfer patients if necessary. And the centers would only be allowed to open within a 30-minute drive of hospitals with obstetricians — a significant hurdle in a state where many communities lack nearby options.

Along with Skanes, the ACLU represents Stephanie Mitchell, a Gainesville midwife, and Dr.

The state Department of Health declined to comment, citing the litigation, instead citing its previous defense of the new requirements as important safety measures.

After several groups, including the American Association of Birth Centers, objected to the regulations, state officials wrote in August that “the inclusion of each requirement is deemed necessary to ensure the health and safety of families seeking the services of a birth center.” in this state.” .”

The agency also defended its requirement for transfer agreements with hospitals, writing that at least 13 states have such requirements.

However, not all of the state’s new measures are so widespread.

According to Kate Bauer, executive director of the American Association of Birth Centers, Alabama’s rules are stricter than other states because midwives at birth centers are limited to “a supportive role.”

“Birth centers have the ability to empower people in their health care,” she said, “and they come from birth feeling empowered, feeling like, ‘Yes, I can do this.’

A spokesman for the Alabama State Medical Association said the medical group had no position on the rules.

Although there is limited research on birth centers, a several years of study An Urban Institute study found that Medicaid patients who used birthing centers for prenatal care had lower rates of preterm births and cesarean sections than patients who did not.

Alabama isn’t the only state where people interested in opening birth centers are encountering difficulties. In Georgia, a facility was planned in Augusta clogged from opening if none of the city’s three hospitals agreed to a transfer agreement. In New York, New rules can help give midwives the opportunity to take charge of their own birth centers after previous restrictions made this a challenge.

Critics of Alabama’s new rules have argued they could cut off a potential path to addressing gaps in maternal health care.

“The Department of Health and Human Services has taken steps over the past year to make it more difficult for pregnant women to access out-of-hospital pregnancy care,” said Whitney White, an ACLU attorney in the case. “They are blocking access and preventing qualified providers from providing this care to their communities at a time when it is so desperately needed.”

Advocates say the need for such care goes beyond ensuring pregnant women have access to doctors and transportation to appointments; It’s also about ensuring that vulnerable patients like black women have access to spaces where they feel respected.

Black women of all economic backgrounds, including such well-known figures as Serena Williams, have done this shared experiences They had to fight to be heard by medical staff, sometimes in life-threatening conditions. Nationally, the maternal mortality rate for black women is almost three times the rate for white women, according to the Centers for Disease Control and Prevention. And Alabama’s Maternal Mortality Review Committee found that more than half of the deaths assessed by the group occurred in 2016 and 2017 avoidable.

Skanes envisioned her birthing center, which opened in September 2022, as a place where patients, particularly women of color, would feel like “they’re not just serving me; They serve me with joy” and see, “I couldn’t have just one black midwife; I have a black obstetrician who supports me if something happens.”

But the midwifery team she has at Oasis doesn’t meet the state’s new staffing requirements, according to the ACLU; The birthing center would have to hire certified midwives and registered nurses. Skanes will also likely face “costly renovations” to meet some of the facility’s new requirements, her attorneys wrote in a court filing.

One reason Mitchell, the Gainesville midwife, wanted to open a birthing center is the urgent need for maternal health care she sees in Alabama’s Black Belt — it’s 37 miles from her town to the nearest hospital with a maternity ward.

The need is particularly urgent in a post-Roe era, when some Alabama residents may have no choice but to continue their pregnancies in a state that has banned almost all abortions.

“It’s very narrow-minded to simply force pregnancy on individuals but then offer nothing about how to optimize a person’s long-term health and outcomes afterward,” Mitchell said.

But it is precisely Gainesville’s distance to the nearest hospital that meets state regulations that could prevent Mitchell from completing the birthing center she planned to open in January.

“There are things that are insurmountable and that we cannot change,” she said.

Under the new rules, an ambulance would have to be able to reach a hospital with an obstetrician and a pediatrician within 30 minutes. The closest provider to Mitchell is estimated to be 44 minutes away.

The new regulations are expected takes effect Oct. 15 unless a group of state lawmakers raise objections as part of a final review. At a court hearing on September 28, the ACLU will ask a judge to stop the health department from blocking the operation of birth centers.

Montgomery, where the case is being heard, has its own chapter in the state’s long, troubled history of reproductive rights, particularly for black women. 1973 two black sisters – 12 and 14 years old – were sterilized without their consent. A lawsuit on behalf of the children led to a ban on the use of federal funds for forced sterilizations.

Just a half-mile from the county courthouse is Mothers of Gynecology, a memorial honoring three enslaved black people Women those of Dr. James Marion Sims underwent surgery. Sims, a white doctor sometimes called the “father of gynecology,” did not provide anesthesia during surgeries and only had to obtain consent from the women’s owners.

Michelle Browder, who gives civil rights tours of the city, is the one sculptor behind the installation.

A self-described “artivist,” she also founded a group that sends doulas and certified professional midwives to communities where there is no robust access to maternal health care.

The Mothers of Gynecology group does not deliver babies, but provides basic services such as weighing newborns and educating pregnant women about how to stay healthy.

On some trips, Browder met girls and women who were afraid of giving birth in hospitals because of poor treatment by staff, she said. During a home visit, a young woman with a newborn shared that she ended up giving birth alone at home because she was afraid to go to the hospital after a previous negative experience there.

Browder is interested in opening a birth center to provide space for women seeking options other than hospitals or home births, but she doesn’t see a way to do that right now.

“I would love to have a birthing center one day — not until this is all sorted out,” she said.