Across the South, Black midwives are complaining that they face unfair regulations that are preventing them from doing their jobs and serving women who have limited access to maternal care. Now, a number of these birthing professionals are suing the states that they say are discriminating against them.
Black midwives sue three Southern states over regulations
Stateline reported that Black midwives in three states — Alabama, Georgia and Mississippi — have filed various lawsuits against their states over regulations. The lawsuits, brought by various midwives and operators of birthing centers in each of the states, generally target state laws that require midwives to have “collaborative practice agreements” with physicians. These agreements, midwives complain, are expensive and hard to obtain, as many physicians are wary of working with midwives.
The lawsuits also target state laws that regulate birthing centers in the same way that hospitals are regulated. Midwives argue that this places an unnecessary burden on birthing centers that generally handle low-risk pregnancies.
The midwives behind the lawsuits argue that their services are particularly important for Black women, who are more than 2.5 times more likely than the national average to die during childbirth. They point to studies of “culturally appropriate maternity care services” that suggest minority women benefit from having maternal caregivers from their communities and cultures. White people make up 82% of the almost 15,000 certified midwives in the United States, and the birthing professionals suing their states argue that regulations are hampering the ability of Black midwives to practice.
Providing key services in ‘maternity deserts’ and other in-need areas
In Georgia, two Black midwives, Jamarah Amani, co-founder of the National Black Midwives Alliance, and Tamara Taitt, have joined white midwife Sarah Stokely in suing over regulations that are among the strictest in the United States. NBC News reported that, in addition to requiring midwives to have often-expensive agreements with physicians, Georgia also requires midwives to have nursing degrees to practice in the state. This limits the supply of midwives in a state where one-third of the counties have no birthing centers or obstetricians and where maternal mortality is above the national average.
“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,” Taitt told NBC News.
The legal fights over midwifery have extended beyond the South. In Colorado, a group of direct-entry midwives are suing the Colorado Division of Professions and Occupations over how they are regulated. Unlike other types of midwives who hold degrees and are regulated by oversight boards, direct-entry midwives do not need degrees, and in Colorado this category is governed by a single government official. This has led to a situation, the lawsuit alleges, in which direct-entry midwives are regulated more harshly than their counterparts with degrees, with midwives often subjected to investigations that can lead to suspensions.
Such punishments lead to even fewer maternal care options in a state where many women, including almost half of rural women, do not live close to a birthing hospital.
“Right now, we’re in a crisis,” says Justina Nazario, who is one of Colorado’s few Black certified professional midwives as well as the statewide operations coordinator for the reproductive health advocacy organization Elephant Circle, which is supporting midwives in the Colorado suit.
As hospitals and other facilities close throughout the state, Nazario says, “We need to figure out a way to make sure that these maternity deserts are being filled, and the midwives can do that, but it’s a rough landscape.”
Overall, as women in the United States suffer fatal pregnancy-related complications more often than women in other developed nations, Black women are particularly at risk for maternal fatalities. Midwives, particularly Black midwives in areas with limited health resources, are arguing that their services are key to making childbirth safer for many vulnerable women, and they are increasingly fighting regulations that they say interfere with their work.