Montgomery judge says birth centers proved harm from proposed ADPH regulations

By: - October 5, 2023 6:59 am
A woman in a yellow shirt speaking behind a lectern at Montgomery's Mothers of Gynecology monument -- three statues honoring enslaved women who were operated on without anesthesia, and without consent.

Midwife Stephanie Mitchell, who is attempting to open a birth center in Alabama and has sued the state, speaks at the Mothers of Gynecology monument in Montgomery, Ala., this month. Supporters say such centers could improve birth outcomes in the South, which has some of the highest maternal and infant mortality rates in the country. (Anna Claire Vollers/Stateline)

Montgomery Circuit Court Judge Greg Griffin wrote Wednesday that he blocked new Alabama Department of Public Health regulations on birth centers because birth center personnel had shown they could be harmed by the proposed rules.

“The court holds that, while ADPH faces no harm, as discussed [in the opinion], plaintiffs have demonstrated through extensive testimony that they and their communities will continue to suffer serious hardship in the absence of an injunction,” Griffin wrote in a supplemental order on Wednesday.

Griffin’s order prevents ADPH from withholding licenses from birth centers — facilities that offer expectant mothers an option between home and hospital deliveries — that “demonstrate substantial compliance” with state law and standards established by the American Association of Birth Centers.


Lawyers want to know why Montgomery judge blocked birth center regulations

The new rules approved earlier this year would require birth centers to submit to oversight by a physician or medical director. It would also require them to be within 30 minutes of a hospital with OB-GYN services, and to apply for hospital licenses. Birth centers do not meet the criteria of hospitals under law, plaintiffs argued.

Birth center officials sued ADPH in August, saying their facilities fill a critical need in a state with poor maternal health outcomes and that the regulations were meant to shut them down. Requiring a birth center to be near a hospital with OB-GYN services, they argue, could make it difficult to provide midwifery services for low-risk pregnancies across the state, especially in rural areas.

ADPH has not said if it will appeal Griffin’s ruling.

Griffin blocked the new regulations in a three-page order filed on Saturday, but did not explain his reasoning at the time. Lawyers for the birth centers asked Griffin on Monday to submit an opinion supporting his order.

The judge wrote Wednesday that the birth centers had  demonstrated all four factors — reasonable chance of success on the merits; immediate and irreparable injury; lack of adequate remedy at law; and balance of the hardships — necessary for a preliminary injunction.

The judge also wrote that even if ADPH has licensing authority over birth centers, ADPH’s actions refusing to issue licenses to birth centers or to provide a timely path for obtaining such licenses exceeds ADPH’s authority under the law.

“The Court holds that, in the absence of a clear source demonstrating that the Legislature has given ADPH the authority to refuse to license a particular class of facilities, Plaintiffs demonstrated a likelihood of success,” Griffin’s order said.

The order also agreed that without injunctive relief, birth centers, midwives and their patients will continue to suffer immediate and irreparable damages that can’t be monetarily remedied.

Montgomery judge blocks Alabama birth center regulations from taking effect

The ruling from Griffin came after a two-day hearing last week in which attorneys representing birth centers and the Alabama Department of Public Health (ADPH) clashed over the new ADPH regulations.

Dr. Heather Skanes, an OB-GYN and owner of the Oasis Family Birth Center in Birmingham,  testified that ADPH policies cost her tens of thousands of dollars in grant money for the birth center, money that she characterized as “once-in-a-lifetime opportunity.” Skanes said she will not be able to continue to incur ongoing financial costs to maintain the birth center if they are not able to re-open by the end of the year.

Dr. Yashica Robinson, in her testimony, said that her husband took out a loan against his retirement to open a birth center in northern Alabama, and choked up when asked about the impact of the financial strains on her family.

“Such ongoing financial harm, which presents an existential threat to plaintiffs’ businesses, constitutes irreparable harm,” the order stated.

The court also concluded there would be an imbalance of hardships faced and stated that ADPH would not face harm in an injunction, and that “an injunction that simply ensures adherence to the law imposes no hardship.”

“Plaintiffs’ patients, prospective patients, and communities will continue to suffer health-related harms in the absence of a preliminary injunction, given Alabama’s severe maternal and infant health crisis and the fact that ADPH’s actions are denying them access to essential health care that has been proven to improve patient outcomes, reduce health inequities, and expand access to critically needed pregnancy-related care,” the order stated.


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Alander Rocha
Alander Rocha

Alander Rocha is a journalist based in Montgomery, and he reports on government, policy and healthcare. He previously worked for KFF Health News and the Red & Black, Georgia's student newspaper. He is a Tulane and Georgia alumnus with a two-year stint in the U.S. Peace Corps.