A group of Georgia midwives filed a lawsuit against the state on Thursday, calling for it to loosen stringent regulations governing the industry.
The plaintiffs argue their services are necessary in large swaths of areas described as maternity care deserts, where obstetric providers or birthing facilities are lacking. Physician agreement requirements and other state regulations have placed an unlawful barrier to residents’ access to healthcare services from midwives, they argued in the lawsuit, according to NBC News.
“There are some places in the state where there’s nowhere to give birth or access pregnancy care nearby,” the plaintiffs’ attorney, senior counsel at the Center for Reproductive Rights, Hillary Schneller, told the outlet. “We have midwives, including our clients, who are ready and willing to fill that gap to serve those families, and the state is treating them like criminals.”
“If you are invested in solving the problem of maternal mortality and infant mortality, it doesn’t really make any sense that you’re not leveraging all of the providers that you can,” Tamara Taitt, one of three plaintiffs named in court filings, added.
The risk of a baby dying in a home birth is twice that of a hospital birth, according to the American College of Obstetricians and Gynecologists.
Proponents of midwives in Georgia argue that alternative measures could help bring down the state’s high maternal mortality rate. For every 100,000 live births, nearly 34 resulted in death in that state, according to a 2018-2021 report from the Centers for Disease Control and Prevention, compared to the national maternal mortality rate of 23.5. A 2025 March of Dimes report concluded that for every 100,000 births in Georgia, 30 mothers die from complications during pregnancy or six weeks afterward.
Georgia is one of 16 states that require a physician agreement for a nurse-midwife to practice. Unlike some other states, Georgia will not license midwives who haven’t been trained as nurses, doesn’t allow licenses for certified midwives who have master’s degrees in midwifery, and doesn’t offer paths to licensure for certified professional midwives who complete training and exams but don’t have degrees.
Such regulations have created a “gray market” of midwives in Georgia, according to an NPR investigation. A midwife, identified as Adjgiwa, who never received formal training, said that when the COVID-19 pandemic hit, demand for her services increased. She has been delivering babies for 45 years, and said she stopped counting at 1,000 births.
“All of the midwives that I knew, if they already had a busy practice, it just got busier,” she said. “Women started losing their faith in the medical system…when it comes to their own lives and the life inside of them.”
Critics believe the physician agreements are often costly, unnecessarily question midwives’ skills, and place an undue burden on them, as they say it can be difficult to find doctors willing to enter into the agreement.
In Georgia, the Atlanta Birth Center, with its certified nurse-midwives, is one of only a few birth centers in the entire state. Center Co-Founder and Midwife Director Anjli Hinman told WABE last year that it has not been easy to keep their doors open and meet the demand for care, citing in part “inequity with reimbursement rates for birth centers and for midwives.” Those concerns were echoed in January by the Georgia chapter of the National Association of Certified Professional Midwives.
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“Birth centers are closing, you know, and it doesn’t matter whether it’s Medicaid or any other insurance. It’s not sustainable,” Hinman said, pointing to what she described as a price disparity for an uncomplicated, low-risk vaginal birth.
“To do a birth [a hospital facility] gets maybe $18,000 to $20,000,” she said. “That same birth happening in a birth center setting gets maybe $2,000 to $3,000. “
