Alabama wants to license birth centers as hospitals. That’s absurd: op-ed

This is a guest opinion.

Imagine a small, home-like setting staffed by professional midwives, created to provide affordable, low-intervention maternity care for healthy, low-risk pregnancies. According to the Alabama Department of Public Health, this facility is apparently just a hospital. This bureaucratic misclassification is the crux of Oasis Family Birthing Center v. Alabama Department of Public Health, a legal battle that recently saw the Alabama Supreme Court decline to review an appeal.

A State in Crisis

Alabama faces a severe maternity health crisis. The March of Dimes identifies many regions as maternity care deserts—areas lacking obstetricians, midwives, or birthing facilities. Currently, 37.3% of Alabama’s counties qualify as such deserts, while another 31.3% offer only minimal access to care.

Research from a Pacific Legal Foundation survey reveals that regulatory burdens directly impact accessibility. Among states requiring a certificate of need for birth centers, 60 percent have one or zero facilities. States without such mandates see that number drop significantly to 20 percent. Essentially, extreme regulation does not just add red tape; it eliminates viable healthcare options.

Proven Outcomes

Freestanding birth centers serve as a community-based alternative to the sterile hospital environment. As of 2022, nearly 400 centers operated across 40 states. Evidence regarding their efficacy is robust. The federally funded Strong Start for Mothers and Newborns Initiative demonstrated that the birth center model yielded highly favorable outcomes, including reduced rates of preterm and cesarean births. Additionally, the National Birth Center Study II, tracking over 15,000 women, showed high rates of natural births with zero maternal deaths.

An Absurd Regulatory Sledgehammer

Despite this success, the Alabama Department of Public Health has pushed to force these facilities to obtain hospital licenses. Requiring a birth center to adhere to hospital infrastructure, construction, and staffing mandates is akin to requiring a private family practice to operate like an emergency trauma center—it is an impractical, costly, and impossible hurdle.

Following a May 2025 trial court ruling that favored the birth centers, an appeals court reversed the decision in January 2026. The midwives, backed by the American Civil Liberties Union (ACLU), challenged the ruling before the state Supreme Court. With thirty-five states already allowing certified nurse midwives to practice independently, Alabama’s restrictive approach defies national clinical trends.

It is time to look past this regulatory fiction. Alabama needs to stop classifying birth centers as something they are not and allow them to fill the critical gap in maternity care, helping mothers achieve healthy outcomes.

Donna G. Matias is an attorney in Pacific Legal Foundation’s economic liberty practice.