Georgia Midwives Face Criminalisation Amid Maternal Health Crisis Lawsuit
A new lawsuit filed against the state of Georgia seeks to decriminalise the work of midwives who are currently banned from providing essential care, as the state grapples with a worsening maternal health crisis. The legal action highlights the severe restrictions that leave many trained midwives unable to practice legally, even as families increasingly turn to them for safer birth options.
Midwives Blocked from Providing Care
Tamara Taitt, a nationally accredited midwife and executive director of the Atlanta Birth Center, finds herself in an extraordinary position under Georgia law. Despite her credentials, she cannot provide routine clinical care to clients at her own center and could face criminal charges, including fines up to $1,000 or imprisonment, for doing so. Taitt is a certified professional midwife (CPM), a credential recognised in 39 states, but Georgia only licenses certified nurse-midwives, who hold nursing degrees, excluding other trained professionals like CPMs and traditional community midwives.
This restriction persists despite Georgia's catastrophic shortage of maternal health providers, with half of its counties lacking an obstetrics provider and a third classified as maternal health deserts. Over 40 labour and delivery units have closed since 1994, exacerbating the crisis.
Lawsuit Aims to Decriminalise Midwifery
Last week, the Center for Reproductive Rights filed a lawsuit on behalf of Taitt and two other midwives, challenging Georgia's midwifery restrictions. The suit seeks to decriminalise midwives like Taitt and remove physician oversight requirements for nurse-midwives, which can cost them $1,000 monthly. Plaintiff Jamarah Amani, who left Georgia due to its laws and now works with Black families through a mobile clinic in Florida, stated, "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."
Advocates argue that these laws disproportionately harm Black women, who are more than twice as likely to die from childbirth as white women in Georgia. Angela Aina, executive director of Black Mamas Matter Alliance, noted, "In the face of that reality, the state of Georgia is not expanding access to care. It is actively blocking trained, qualified midwives from practicing."
Historical Context and Current Challenges
Historically, thousands of traditional midwives served families in Georgia, but regulations in the early 20th century, driven by white progressive reformers deeming midwives unsanitary, drastically reduced their numbers. Federal legislation like the Sheppard-Towner Act imposed stricter licensing, cutting midwife numbers from 9,000 to 2,000 within decades. Aina emphasised, "Black midwives are the original maternity care providers in this country. They sustained entire communities, and they were systematically excluded through regulations that were never about safety. They were about control."
Today, midwives like Sarah Stokely, a certified nurse-midwife licensed in Georgia, find the state's requirements financially untenable, forcing her to commute two hours north to care for mothers in Tennessee. Families in rural areas often drive long distances for care, highlighting the access issues caused by these laws.
National and Global Perspectives
Georgia is an outlier with its severe restrictions, as most neighbouring states offer licensure pathways for direct-entry midwives. Legal battles have occurred elsewhere, such as in Hawaii, where restrictions against Indigenous midwives were challenged. Physician groups, including the American Medical Association, oppose expanding nonphysicians' scope of practice, citing safety concerns, despite global health organisations like the World Health Organization advocating for expanded midwifery care to prevent maternal and newborn deaths.
Unlicensed midwives in Georgia, like Sekesa Berry, continue to serve clients, particularly Black women afraid of unnecessary medical interventions in hospitals. Berry noted, "My most common phone call, specifically since the pandemic, is: 'I don't want to die.'" However, their precarious legal status complicates emergency care coordination with hospitals.
Future Implications
The state of Georgia has 30 days to respond to the lawsuit. For now, midwives like Taitt remain unable to fully utilise their skills, even as demand for their services grows. Taitt concluded, "If not for these restrictions, I could be helping to meet the urgent gaps in maternity care, including for clients at our own birth center. Instead, Georgia is choosing to leave a skilled, committed workforce on the sidelines even as communities struggle to access care."
