Why It Matters
A Montgomery Circuit Court judge’s ruling preserves the operating licenses of Alabama’s freestanding birth centers, at least temporarily, preventing the state health department from closing facilities that serve as alternatives to hospital deliveries for low-risk pregnancies.
What Happened
Montgomery Circuit Court Judge Greg Griffin ruled that Alabama birth centers may continue operating despite a state appellate court determination that they should be regulated as hospitals. The decision came after the Alabama Department of Public Health sent cease-and-desist letters to birth centers in June and declared their temporary licenses, granted in 2024, “null and void.”
The dispute centers on licensing granted under a 2024 order by Judge Griffin, who had previously ruled on the matter. Two facilities—Oasis Family Birthing Center in Birmingham and Alabama Birth Center in Huntsville—filed suit against the health department in 2023 after the agency adopted new regulations requiring birth centers to have physician or medical director oversight and operate within 30 minutes of a hospital offering obstetric services.
In January, Alabama’s Court of Civil Appeals ruled that the state health department has authority to regulate freestanding birthing centers as hospitals under a 1949 state law. The Alabama Supreme Court declined to take up the central question of whether birth centers legally qualify as hospitals under state law, effectively allowing the lower court’s decision to stand.
An attorney with the ACLU Reproductive Freedom Project representing the clinics said that “more than two-and-a-half years ago, the court recognized that birth centers provide essential care to their communities,” framing the judge’s action as consistent with prior judicial recognition of their role.
By the Numbers
0.3% — share of U.S. births occurring in birth centers
85% — proportion of hospital births involving low-risk patients
7.1 — infant deaths per 1,000 live births in Alabama in 2024
11.8 — infant death rate per 1,000 live births among Black Alabamians in 2024
5.4 — infant death rate per 1,000 live births among white Alabamians in 2024
30 minutes — required distance from birth centers to nearest hospital with obstetric services under state regulations
Zoom Out
The Alabama case reflects a broader national tension over how states regulate birthing alternatives. While birth centers remain uncommon in the United States, they serve a specific market of women seeking lower-intervention childbirth experiences for pregnancies deemed low-risk. States have taken varying approaches to licensing and oversight, with some treating them as distinct from hospital settings and others, like Alabama’s health department, moving to classify them under existing hospital regulations.
The dispute also occurs against Alabama’s documented challenges with maternal and infant health outcomes, particularly racial disparities in mortality rates.
What’s Next
The ruling preserves the birth centers’ ability to operate under their temporary licenses while legal proceedings continue. The state health department’s next move remains unclear, though the January appellate court ruling indicates potential avenues for the agency to pursue further enforcement of its hospital-classification interpretation. The case will likely turn on how courts ultimately resolve the statutory question of whether 1949 state law permits the health department to regulate freestanding birth centers as hospitals or whether they constitute a separate category of licensed facility.