A room is seen at the Alabama Birth Center in Huntsville, Alabama on Wednesday, April 15, 2026. A Montgomery County judge on Sunday ruled that the state's birth centers can continue operating despite a higher court's ruling that the centers are hospitals. (Eric Schultz for Alabama Reflector)
A Montgomery County judge ruled Sunday that the state’s birth centers can keep operating despite an appellate court ruling earlier this year that declared them hospitals subject to regulation by the Alabama Department of Public Health.
The ruling came after ADPH State Health Officer Dr. Scott Harris sent cease-and-desist letters to the birth centers — which provide an option between home and hospital birth — in June.
ADPH said temporary licenses, granted in 2024 under a 2023 order, were “null and void” and that the birth centers “must ‘cease and desist’ [their] operations as a freestanding birth center until’ they receive a new license based on compliance with the regulations, according to court documents.
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But Montgomery Circuit Court Judge Greg Griffin, who granted the temporary licenses in 2024, wrote in his order on Sunday that the law has not changed since those temporary licenses were issued.
“As such, the preliminary injunction assumes that defendant can require birth centers to obtain a ‘hospital’ license to operate but sets limits on the requirements he can impose on birth centers as a condition of receiving such a hospital license, including by preventing the defendant from requiring compliance with the regulations,” he wrote.
Oasis Family Birthing Center in Birmingham and Alabama Birth Center in Huntsville filed the suit against ADPH in 2023, a few months after the agency adopted new regulations requiring centers to be under the oversight of a physician or medical director and to be within 30 minutes of a hospital with OB-GYN services.
The centers, which provide an in-between option for individuals who do not feel comfortable with a home birth but prefer an out-of-hospital birth, said the regulations would make it difficult or impossible for them to provide services around the state, particularly in rural areas that lack hospitals.
The Alabama Court of Civil Appeals in January ruled that ADPH can regulate freestanding birthing centers as hospitals under 1949 state law. The lawsuit went back to the circuit court over 12 other complaints after the Alabama Supreme Court declined to take up the main question of the suit, whether or not birth centers are hospitals under state law.
A message seeking comment from ADPH on Monday was referred to the Alabama Attorney General’s Office. A message seeking comment from Harris’ attorney Ben Albritton was left on Monday.
Whitney White, an attorney with the ACLU Reproductive Freedom Project representing the clinics, said in a statement Monday that they will continue until access to pregnancy care and birth centers are permanently protected.
“More than two-and-a-half years ago, the court recognized that birth centers provide essential care to their communities, and that preventing them from operating in accordance with national standards while this case is ongoing would cause immeasurable harm to the birth centers and the pregnant Alabamians who need their care,” White said. “Yesterday’s order merely confirms that status quo and that the court’s 2023 preliminary injunction remains in place.”
According to the American Association of Birth Centers, 0.3% of births take place in a birth center in the United States, where midwives and doulas take care of expectant mothers. All patients who give birth in birth centers are healthy and low-risk, while about 85% who give birth in hospitals are considered low-risk.
Alabama has long struggled with high maternal mortality and difficulties in accessing prenatal care. According to state data released in November, the state’s infant mortality rate was 7.1 babies per 1,000 live births in 2024, reflecting the rate of infants who died within their first year of life. That was down from 7.8 deaths per 1,000 births in 2023, according to state data. There were 414 infant deaths in 2024. Of those, 222 of the deaths were white babies and 176 were Black babies, the lowest recorded number for Black infants.
But infant mortality rates for Black Alabamians remain far higher than those of white Alabamians. The infant mortality rate among white Alabamians was 5.4 deaths per 1,000 live births in 2024. For Black Alabamians, the rate was 11.8 per 1,000. In 2023, the rates were 5.7 and 13.1 deaths per 1,000 births, respectively.
Courtesy of Alabama Reflector
