Summary

Georgia–like the rest of the U.S.–is facing a maternal health crisis. Labor and delivery units are closing left and right, leaving many pregnant people without options. Expanding access to midwives can help fix this crisis, but many states have laws in place that restrict midwifery—and Georgia’s are some of the strictest.

Georgia law prohibits midwives with expertise in home and birth center births from practicing at all, and prevents certified nurse midwives (CNMs) from practicing independently to the full extent of their training. These restrictions and others like them are exacerbating the state’s maternal health crisis, leaving pregnant Georgians without options for care.

The Center is taking the state to court over these restrictions, so that pregnant Georgians can choose the care and provider that’s right for them.

Background

Background

The U.S. maternal mortality rate is higher than all other high-income countries, and rates for Black women are even worse. As more labor and delivery units and birth centers shutter, a dire shortage of maternity care providers leaves many people without options for care during pregnancy. More than 1/3 of counties in the U.S. are considered maternity care deserts, without a single birthing facility or obstetric clinician.

Evidence shows that more access to midwives leads to better health outcomes for pregnant people and babies–especially for people of color and lower-income people. People cared for by midwives are less likely to have pregnancy interventions like C-sections, episiotomies, epidurals, and drug-induced labor–costly procedures that can lead to health complications.

Despite this, states like Georgia continue to restrict access to midwifery care. Georgia has some of the most restrictive midwifery laws in the country and some of the worst maternal health outcomes. In February, Georgia’s oldest freestanding birth center closed–leaving just three birth centers in the entire state. As of August 2025, only 36% of Georgia’s rural hospitals provided labor and delivery services.

Restricting access to maternity care providers doesn’t make pregnant people safer. Instead, it leads to more deaths. To meaningfully improve maternal health, pregnant people need more support–including access to midwives.

Restrictions on midwifery are increasingly facing challenges nationwide. Recent lawsuits in Mississippi, Nebraska, and Alabama have sought to strike down laws that limit midwives and birth centers from serving their communities. In October, certified nurse midwives in North Carolina will no longer have to enter agreements with physicians.

Following a 2024 lawsuit filed by the Center to challenge Hawaii’s restrictions on traditional and apprenticeship-trained midwives, the state successfully expanded access to midwifery.

About midwifery in Georgia

About midwifery in Georgia

There is a long and rich tradition of midwifery in the U.S., especially in the South. Women of all backgrounds have relied on midwives for generations—particularly those from Black and other marginalized communities, whose access to care may otherwise be limited or nonexistent.

The U.S. also has a long legacy of midwifery restriction and exclusion. In the South, this began with overt efforts to eliminate Black midwives from practice—an effort driven by racism, sexism, and doctors’ desire to undermine their competition. Between the 1890s and 1920s, doctors and public health workers promoted the idea of “the midwife problem,” which blamed midwives for poor maternal and infant health outcomes.

Georgia’s first crackdown on midwifery came in the early 1900s, when a law was passed requiring certification by the state. By the middle of the century, Georgia had drawn a distinction between certified nurse midwives (CNMs), who are licensed nurses and typically work in hospitals, and direct entry midwives, midwifery professionals whose training takes place outside of formal nursing school.

Georgia’s laws and practices grew increasingly hostile, and the number of midwives dwindled. In 1955, the state enacted a statute requiring the Department of Public Health (DPH) to issue certificates to midwives based on qualifications set out by the Department.

At the same time, Jim Crow segregation reigned. Hospitals barred Black doctors and patients, or segregated them within hospitals. As midwives were pushed out of practice, Black pregnant people were left with few options.

In 1979, the DPH announced that it would not certify any new midwives. In 1991, Georgia decreed that only CNMs could practice midwifery, despite the fact that direct entry midwives were—and are—crucial to maternal health within the state.

For the next three decades, Georgia escalated its attacks on midwifery, again codifying the nursing license requirement in 2015, which continued to bar direct-entry midwives from practicing. Even certified nurse midwives face serious restrictions to their work—they’re banned from prescribing medication unless they enter an unnecessary oversight contract with a doctor.

About the case

About the case

This case is challenging two restrictions on midwifery in Georgia:

1. A law that threatens jail time and financial penalties for any midwife who practices without a nursing license–regardless of their training.
2. A law that prevents Certified Nurse Midwives (CNMs) from practicing independently. In order to provide the full scope of care they are trained in, including delivering babies and prescribing medications, CNMs must work under physician oversight, which in practice often means paying hundreds of dollars to a physician–a cost that many CNMs cannot afford.

It makes the following claims under the Georgia Constitution:

• Due process right to practice a profession: The current laws create arbitrary barriers that prevent skilled midwives from practicing.
• Equal protection: The laws draw irrational distinctions between midwives and doctors, who, although they receive different training, are similarly equipped to provide maternal care consistent with their respective training.
• Nondelegation: the General Assembly delegated authority to the Department of Public Health (DPH) to regulate midwives without adequate standards to guide them. DPH then unlawfully transferred that authority to the Board of Nursing.
• Ultra vires: DPH exceeded its authority by transferring its authority to regulate midwives to the Board of Nursing.
• Private nondelegation: The laws delegate regulatory control to private physicians–midwives’ market competitors—by requiring written agreements for certified-nurse midwife practice, effectively giving private actors veto power over whether midwives may practice or on what terms.
• Anti-competition clause: The Georgia Constitution prohibits the State from authorizing agreements that lessen competition or encourage monopoly. Mandatory written agreements between certified nurse-midwives and physicians that allow physicians to restrict competition, violating this prohibition on anticompetitive arrangements.
• Vagueness: The laws fail to provide clear standards, inviting arbitrary enforcement against midwives.

The case was filed on behalf of three plaintiffs—two direct entry midwives and one nurse midwife—on April 2, 2026 in Georgia state court.  

Case and plaintiff details Related stories Timeline Legal documents