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In a significant legal move, a lawsuit has been filed against the state of Georgia aimed at decriminalising the practice of midwifery, which has become increasingly vital in light of the state’s worsening maternal health crisis. The suit highlights the restrictive regulations that prevent qualified midwives from providing essential care, particularly impacting Black mothers and low-income families who face substantial barriers to safe childbirth.
Midwifery Under Siege
Tamara Taitt, a nationally accredited midwife and director of the Atlanta Birth Center, has found herself in a precarious situation since relocating to Georgia in 2023. Despite her qualifications, Georgia’s laws prohibit her from delivering clinical care to clients at her own centre. Under these regulations, Taitt could potentially face criminal charges for performing routine tasks such as prenatal visits or assisting in deliveries.
Georgia has some of the nation’s most stringent midwifery laws, which restrict practice to “certified nurse-midwives” — licensed nurses who also have midwifery training. This leaves certified professional midwives and traditional community midwives without a legal avenue to practice. Given the state’s alarming shortage of maternal health providers, this legal framework appears increasingly untenable.
A Call for Change
Last week, the Centre for Reproductive Rights initiated a lawsuit on behalf of Taitt and two other midwives, challenging these stringent regulations. The aim is twofold: to decriminalise the work of midwives and to eliminate the requirement for nurse-midwives to operate under physician supervision. This legal action follows numerous unsuccessful attempts over the years to reform midwifery licensing laws in Georgia’s legislature.
Jamarah Amani, another plaintiff in the case, expressed her frustration at having to leave Georgia for Florida, where licensing is more inclusive. Now based in Florida, she runs a mobile clinic that serves predominantly Black families, including young mothers and those from low-income backgrounds. “I am bringing this lawsuit for every Georgian who has called asking me to be their midwife and who I’ve had to turn down because I could not get a license in this state,” Amani stated during a press conference on the lawsuit’s announcement.
The Maternal Health Landscape
Georgia’s maternal health crisis is alarming. The state has seen a significant number of counties classified as “maternal health deserts,” with many lacking basic obstetric services. Since 1994, over 40 labour and delivery units have closed, exacerbating the challenges faced by expectant mothers. The stark reality is that Black women in Georgia are more than twice as likely to die from childbirth compared to their white counterparts, highlighting an urgent need for improved access to care.
Advocates argue that midwifery care could provide a safer alternative to the high rate of medical interventions currently seen in Georgia, where Caesarean sections are performed at three times the rate recommended by the World Health Organization. Angela Aina, executive director of the Black Mamas Matter Alliance, emphasised the need for expanded access to care, stating, “In the face of that reality, the state of Georgia is not expanding access to care; it is actively blocking trained, qualified midwives from practising.”
Historical Context of Midwifery Regulations
The roots of Georgia’s restrictive midwifery regulations can be traced back over a century, when white reformers began imposing stricter standards on traditionally trained midwives, labelling them as “unsanitary.” This shift led to the implementation of burdensome regulations, including certification and inspection requirements, which disproportionately affected Black midwives who were historically the primary maternity care providers in their communities.
Today, the disparity in midwifery practices across the United States is stark. States like New Mexico allow licensed midwives to operate independently, while others, like Georgia, impose stringent regulations that leave many skilled practitioners sidelined. Sarah Stokely, another plaintiff in the lawsuit, has found herself commuting to Tennessee to practise, citing the financial burden of Georgia’s requirement for nurse-midwives to work under physician oversight as untenable.
The Broader Implications
The recent lawsuit exemplifies a growing movement to address the inequities within maternal healthcare systems, particularly for Black women and underserved communities. Despite the legal prohibitions, many families continue to seek the services of unlicensed midwives, highlighting the demand for accessible, culturally competent care. Sekesa Berry, a community midwife, noted that many of her clients express fear of unnecessary medical interventions in hospitals, particularly since the onset of the pandemic.
While Georgia’s restrictions criminalise unlicensed midwives, enforcement has been minimal, with few facing legal repercussions. However, this uncertain status complicates the ability of midwives to coordinate care with hospitals during emergencies. The state now has 30 days to respond to the lawsuit, which seeks to rectify a long-standing issue that has left many skilled practitioners unable to serve their communities effectively.
Why it Matters
The outcome of this legal challenge could have profound implications for maternal health in Georgia, particularly for Black women who disproportionately suffer from inadequate care. By decriminalising midwifery and broadening access to trained practitioners, the state could significantly reduce maternal mortality rates and improve outcomes for families. As the lawsuit unfolds, it represents a critical juncture in the fight for equitable healthcare access, illustrating the urgent need for reform in a system that has long prioritised control over the wellbeing of mothers and their children.
