Georgia midwives and allies challenge state restrictions as they say the laws limit care, worsen maternity deserts, and hurt outcomes.

Georgia’s midwives are taking their fight to court, arguing that state rules are blocking a ready workforce and reducing options for families during pregnancy and birth.

Jamarah Amani, who previously relied on midwifery care in Pennsylvania, says the difference in Georgia has been stark.. After moving. she described a second birth that forced her into repeated disputes with hospital staff over basic decisions during labor—positions. movement. and interventions she felt were unwanted.. She said the experience pushed her toward becoming a midwife herself. but the path she needs is increasingly constrained by state law.

Amani’s ambition ran into a legal wall in Georgia: direct-entry midwives—those without nursing degrees—are not allowed to practice.. To obtain the credentials she believed would enable her to serve families outside a hospital setting. she moved to Florida for licensure.. Even then. she kept hope of returning. holding onto her Georgia home while she waited for possible change—an effort that. she said. began nearly 18 years ago.

In April, Amani became one of three plaintiffs in Amani et al.. v.. State of Georgia, filed in Fulton County Superior Court.. Backed by the Center for Reproductive Rights. the lawsuit challenges two central features of Georgia’s midwifery framework: a ban on direct-entry midwives and a requirement that certified nurse-midwives maintain written agreements with physicians in order to practice independently.. The plaintiffs argue those restrictions violate the Georgia Constitution and. in practice. limit maternity care in areas where families lack other options.

The stakes, the plaintiffs argue, are heightened by Georgia’s maternal health profile.. Georgia has one of the highest maternal mortality rates in the country. and the suit contends that the state’s limits on midwifery care are adding to the harm rather than reducing it.. For plaintiffs. the core issue is whether Georgia is narrowing access to a type of care that is designed for out-of-hospital birth settings. especially where other providers are absent.

Those who take the direct-entry route often do so for a specific reason: training and practice that centers on out-of-hospital births and community-based care.. Plaintiffs say that training differs from the hospital-focused pathway used for certified nurse-midwives.. They argue that Georgia’s approach prevents direct-entry midwives from serving in the very environments—birth centers and home-like birth settings—where that specialized preparation is meant to be used.

Birth centers, in turn, offer care that is more like home for low-risk pregnancies.. Yet Georgia has only three birth centers, all located in the Atlanta metro area.. The state’s oldest birth center, which operated in Savannah for nearly 40 years, shut down in February, shrinking access further.. The lawsuit also points to the geographic unevenness of care: more than one-third of Georgia counties qualify as maternity care deserts. meaning families may have no obstetric provider. birth center. or hospital obstetric care nearby.

Plaintiff arguments extend to the question of growth and access.. The lawsuit claims the legal requirements make it harder for new birth centers to open and to serve areas that do not have other options.. In other words. the restrictions don’t just limit current practice; they may reduce the chances of building capacity where it is needed most.

Tamara Taitt is another plaintiff and a direct-entry midwife.. She spent nearly a decade directing a freestanding birth center in Florida and now lives in Georgia. where she leads Atlanta Birth Center.. But Taitt says Georgia’s restrictions prevent her from practicing as a direct-entry midwife at the center she runs.. She also described how the structure of the staffing model changes as a result. with direct-entry midwives on her staff working as birth assistants to nurse-midwives rather than delivering the care they are trained to provide.

Taitt said the limitations translate into lost time and diminished flexibility.. Without the ability to hire direct-entry midwives. she argued. more training time is required to prepare a nurse-midwife to adequately cover a birth center.. For her. the result is not only reduced access for families. but also a strain on resources for providers who are already operating to meet community demand.

Georgia’s rules do allow certified nurse-midwives to practice in hospital and birth center settings. but the lawsuit argues their ability to practice independently is restricted.. The requirement hinges on written protocol agreements with physicians.. Plaintiffs say physicians have discretion on whether to accept those arrangements and can terminate them at any time. leaving nurse-midwives exposed to sudden disruption.

The agreements, the plaintiffs say, can also be financially burdensome.. Physician requests for monthly fees ranging from hundreds of dollars to more than a thousand have been reported by the suit’s supporters as part of why independent practice becomes difficult.. When those costs stack up. the plaintiffs argue. access to care becomes less about clinical readiness and more about the ability to secure and retain agreements.

Sarah Stokely is the third plaintiff.. She holds an active Georgia nursing license and lives in Rome, a rural area with few maternity care providers.. After nursing school. she began working at a small birth practice. but she said the practice could not afford physician agreements beyond a single nurse-midwife.. The result was that she could not practice to the fullest extent of her licensure.

Stokely now makes a long commute—more than four hours each way—to work at a birth cottage in Tennessee.. She told supporters she does not want to pay a physician when another state offers a pathway where those agreements are not required.. She also said she prefers to work alongside direct-entry midwives. arguing that the ability to collaborate across midwifery roles would better serve families.

In support of that argument, the lawsuit points to licensing systems elsewhere.. Tennessee is described as one of 36 states that offer direct-entry midwives a path to licensure. and Stokely said she hopes the Georgia case could help bring similar change.. She framed the issue as existential for practitioners—if they cannot practice in Georgia. their livelihood and their access to the communities they already serve are threatened.

The lawsuit’s underlying narrative ties today’s restrictions to a longer history. Georgia has been central in the long-running controversy over midwifery regulation in America, and the plaintiffs say the current rules reflect the same impulse to control who may provide care.

In the early 20th century, Georgia reportedly had between 5,000 and 9,000 working midwives, about half of whom were Black women.. Many of those midwives, often described as “granny midwives,” served rural communities where physicians were scarce.. In 1925. Georgia began formally regulating midwives. according to an account by a member of the Georgia State Board of Health. describing the effort as a gradual “elimination” of those deemed “old. ” “unclean. ” or “unfit.” The report also urged local physicians to “assist in this weeding out. ” a framing plaintiffs say was tied to racial exclusion.

Requiring nursing credentials became, in the plaintiffs’ view, a mechanism that would lock many Black midwives out.. Amani said Black people were intentionally barred from the schools where nursing training was available. describing the policy as aimed at decimating the Black midwife workforce before major Civil Rights-era changes.. Over time. Georgia shifted toward hospital delivery as the ultimate goal—declaring that direction by 1963—and in 1979 stopped certifying new midwives.. Today, only 6 percent of the U.S.. midwifery workforce is Black, the suit’s supporters point out.

Plaintiffs connect that absence to current disparities in maternal health.. The lawsuit says the loss of Black midwives removed a trusted source of care for many Black families in Georgia.. It also notes that Black Georgians are more than twice as likely to die from pregnancy-related causes as White Georgians. citing a report from the Georgia Department of Public Health.

The plaintiffs argue that other Southern states took different paths later.. They point to Florida and Texas creating new direct-entry licensing frameworks starting in the 1980s, while Georgia did not.. Supporters of Georgia’s restrictive approach, the report notes, argue patient safety requires tighter oversight.. Some maintain physician collaboration protects patients when complications arise during labor.

But plaintiffs counter with evidence cited in their case.. A 2018 study. supporters say. found that states with the most midwife-friendly laws had significantly lower rates of preterm birth. low-birth-weight infants. and neonatal death.. They also highlight that in places like Washington—where midwives practice with greater autonomy and direct-entry midwives have paths to licensure—maternal and neonatal outcomes are better or comparable to Georgia’s.

At the heart of the constitutional challenge is a dispute over motive as much as mechanics.. The midwives suing Georgia say the rules are more about control than safety.. They argue physician power over protocol agreements effectively allows a third party to stop a midwife’s ability to practice. potentially undermining continuity of care for patients.

Taitt put it in terms of capacity and pathways.. She said that if the purpose is to keep people healthy during pregnancy. then policy should focus on using the full workforce and skills available.. For her. that means creating routes that allow midwives to practice to the extent of their training rather than forcing workarounds that dilute their role.

The Georgia lawsuit is also part of a broader push in the courts over midwifery restrictions nationwide.. The Center for Reproductive Rights previously challenged a Hawaii law that criminalized Native Hawaiian cultural birth practitioners.. That case was settled, and Hawaii passed laws decriminalizing midwifery.. More recently. the American College of Nurse-Midwives filed suit in Mississippi over physician agreement requirements. indicating that multiple midwifery policy issues are now moving through federal and state legal systems.

In Georgia, legislative change has stalled.. House Bill 520. introduced in the 2025 session. would have created a licensing pathway for direct-entry midwives and eliminated the physician agreement requirement. but it never moved out of committee.. Amani said the lack of momentum in the legislature is unacceptable. arguing that while there have been supporters in Georgia’s legislative process. the issue has largely been ignored.

For Amani. the message from the courtroom and beyond is clear: this is not framed as a request for special treatment. but as a demand for rights tied to families’ access to care.. The lawsuit seeks to challenge a system that. she and her fellow plaintiffs argue. is preventing qualified practitioners from meeting need—particularly in communities where maternity care deserts already leave many expecting parents with few options.

Georgia midwives lawsuit direct-entry midwives physician agreement requirement maternity care deserts maternal mortality Fulton County Superior Court Center for Reproductive Rights