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

This is a guest opinion.

What happens when a small, home-like setting staffed by midwives is forced to operate under the same rules as a massive medical facility? If you ask the Alabama Department of Public Health, that cozy environment for low-intervention, cost-effective maternity care is simply a hospital. This bureaucratic contradiction is at the core of Oasis Family Birthing Center v. Alabama Department of Public Health, a case that recently hit a wall when the Alabama Supreme Court declined to review its appeal.

For the midwives and centers behind the challenge, the logic is straightforward: birth centers are not hospitals. By imposing hospital-level licensing on these facilities, the state is effectively handing out a death sentence to a care model that many Alabama women desperately need.

A Growing Maternity Crisis

Alabama is staring down a major maternal health crisis. According to March of Dimes data, maternity care deserts—areas lacking obstetricians, nurse-midwives, or delivery facilities—are expanding. In Alabama, 37.3% of counties are classified as maternity care deserts, while another 31.3% offer only limited access to care.

A Pacific Legal Foundation survey reveals that these regulatory roadblocks have real-world consequences. Across all 50 states, there is a clear link between heavy-handed regulations and a lack of birth centers. In states that mandate a certificate of need for new centers, 60 percent have either one or no facilities available, whereas that number drops to 20 percent in states without such barriers.

Evidence-Based Care Under Fire

Freestanding birth centers serve as a community-focused alternative to the sterile environment of a hospital, providing prenatal, labor, and postpartum care. As of 2022, about 400 such centers operated across 40 states, backed by a wealth of positive data. Research like the federal Strong Start for Mothers and Newborns Initiative has highlighted that the birth center model consistently yields favorable outcomes, such as reduced rates of cesarean and preterm births, along with higher rates of breastfeeding. Furthermore, the National Birth Center Study II, which observed over 15,000 women, found high success rates for natural birth with zero maternal deaths.

Despite this, the Alabama Department of Public Health shuttered a local birth center in 2023, even with its perfect safety record, and pushed for regulations that treat birth centers like full-scale hospitals. These mandates—which include complex construction and staffing requirements—ignore the reality of the birth center model. It is the equivalent of requiring a local family doctor to maintain the infrastructure of an emergency trauma center.

Fighting for Access

While a state trial court initially ruled in favor of the plaintiffs in May 2025, that decision was reversed in early 2026. Represented by the ACLU, the midwives asked the state Supreme Court to intervene, arguing that these regulations serve no clinical purpose. Given that 35 other states already allow certified nurse-midwives to practice independently, Alabama is clearly out of step with the national trend toward improved maternal outcomes and expanded access.

Ultimately, this isn’t about protecting patients; it is a regulatory move to eliminate competition for traditional hospital systems. The Alabama Supreme Court had the chance to preserve a proven model of care, but as it stands, the future of these centers remains in jeopardy. Alabama's families deserve better than a system that prioritizes bureaucratic fiction over healthy, evidence-based maternity outcomes.

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