Alabama Birthing Center Regulations Are Nearly Impossible To Comply With. State Supreme Court Could Intervene.
"It shouldn't be this hard to give birth safely in the state of Alabama, and it doesn't have to," said the ACLU's lead counsel on the case.
The Alabama Supreme Court could soon hear a case to determine the future of birthing centers in the state.
In 2023, the Alabama Department of Public Health (ADPH) proposed setting strict requirements on the state's birthing centers. By regulating them as hospitals, the rule would require these centers to have a physician or consultant physician on staff, as well as a registered nurse and board-certified midwife. Birthing centers would also have to be within a 30-minute drive of a hospital.
The rule was quickly challenged by a group of Alabama birthing centers represented by the American Civil Liberties Union (ACLU). The plaintiffs argued that the rule created a de facto ban on birthing centers in the state (because the ADPH refused to issue new licenses) and violated their constitutional rights, as well as the rights of their patients. The suit also argued that the ADPH exceeded its statutory authority in making the rule. Under Alabama law, the agency is allowed to regulate general and specialized hospitals, rehab facilities, and abortion and reproductive centers, among others. It makes no mention of birthing centers. Any ambiguity on the question seemed to have been settled in 2017. That year, the Legislature authorized certified midwives to attend home births independently and "did not authorize ADPH to license or regulate that care—which involves the same midwifery care and patient populations as [freestanding birthing centers]," says the ACLU.
In a 2023 complaint filed before an Alabama circuit court, the plaintiffs provided several practical issues with the ADPH's rules. One birthing center in rural Sumter County would have to close or relocate because it is 12 miles "farther from the closest hospital-based labor and delivery care than permitted under the proposed regulations." Another center would have to undergo costly and extensive renovations to comply with the new rule.
As Victoria Tice, a doula in Huntsville, recently told WSFA 12 News, the rules would require birthing centers to meet standards that do not reflect how birth centers function. "For example, the width of doorways for hospital beds to fit through when hospital beds don't exist in birthing centers and width of hallways and specific equipment that is not necessary to attend low intervention physiological birth."
The circuit court sided with the plaintiffs in 2025 and struck down the rule, which the court said was "beyond the scope of ADPH's statutory authority to license and regulate 'hospitals.'" However, in January 2026, an appeals court reversed this decision and allowed the ADPH rule to stand.
Now, the group is appealing this decision to the state's high court. "If the Alabama Supreme Court decides to hear this case and sets aside the appellate decision, it would permanently protect the ability of freestanding birth centers across the state to continue providing essential midwifery care to their communities," said the ACLU in a recent press release.
If the state Supreme Court sides with the ADPH, however, Alabamians can expect birthing center services to get more expensive and their care more sparse, which would be devastating for the nearly 60 percent of Alabama counties that lack "any hospital-based obstetrical care."
"It shouldn't be this hard to give birth safely in the state of Alabama, and it doesn't have to," Whitney White, the ACLU's lead counsel on the case, told WSFA 12 News.
