When Jamarah Amani was in labor at a Georgia hospital, she fought with medical staff over her delivery preferences — a harrowing experience during which she recalled a nurse saying her birthing choices would “kill the baby.”Â
After delivering her second child and after enduring that conflict with the medical team, the mother of four felt called to help protect others from having negative birthing experiences.
“No one should have to fight when they’re in labor, and so it really motivated me even more to become a midwife,” said Amani, a licensed midwife and co-founder of the National Black Midwives Alliance. “All of that really brought me to the understanding that I needed to be a part of this movement to reclaim midwifery as a vital part of how we give birth.”
Midwives are trained medical professionals who specialize in and provide care to pregnant individuals, focusing on low-risk and natural births. Depending on their training and licensing, midwives facilitate at-home births and work in birthing centers, clinics, and hospitals.
But when Amani, 45, set out to become a midwife in Georgia, she said that the state’s restrictions around the practice forced her to move to Florida in 2008 to pursue her career. The state does not allow midwives without a nursing degree to provide care. Those with a nursing degree, certified nurse-midwives, are required to work under the supervision of a physician. Advocates say that Georgia’s midwife policies are some of the most restrictive in the country.
Now nearly two decades later, Amani is suing Georgia over the same regulations that have kept her and others from practicing midwifery in the Peach State.
“I even kept my [Georgia] house because I thought I’d be back,” she said. “But here we are, 18 years later, and the laws have not changed.”
The lawsuit, which is being led by the Center for Reproductive Rights and includes two other midwives as plaintiffs, was announced this month at the end of the state’s legislative session as lawmakers failed to pass House Bill 520, a measure that would have largely repealed restrictions on midwifery in the state.
Advocates argue the state’s restrictive policies on midwifery not only hinder a capable workforce and reduce access to care for pregnant people across the state, but that the policies are also contributing to the growing maternal health crisis.
A shrinking system of care
The lawsuit comes amid alarming trends in maternal health care access in the state as Georgia has seen the closure of birthing centers and a decline in hospital-based maternity services, particularly in rural areas.
Last September, St. Mary’s Health Care System in Lavonia closed down its labor and delivery unit due to Medicaid cuts. At the beginning of this year, a birth center in Savannah closed, leaving only three birth centers in Georgia.
The result of these closures is a growing number of “maternity care deserts,” where pregnant people have few to no options for care.
According to a report from the March of Dimes, in Georgia, nearly 35% of counties are defined as maternity care deserts, compared to around 33% in the U.S.
Tamara Taitt, one of the lawsuit’s plaintiffs, said at the state Capitol on April 2 that midwives could help tackle the growing number of maternity care deserts in Georgia.
“Georgia has a maternity care crisis and the state continues to squander a workforce that could help change that,” said Taitt, a Florida-licensed midwife and executive director of Atlanta Birth Center.
“Currently, there are not enough maternal health care providers in Georgia. The solution is more midwives, and lawmakers need to let us practice. As the U.S. continues to fall behind in maternal mortality and morbidity, the rest of the world employs the solution: more midwives. As a country and as a state, we are visibly failing pregnant people — especially Black women, rural families and communities of color.”
For Black women, the lack of access to maternal care carries dire stakes as they face significantly higher rates of maternal mortality and complications. In 2021, there were more than twice as many pregnancy-related deaths among Black women as white women in the state, according to the Georgia Department of Public Health.
Amani and other advocates say systemic racism within health care institutions contributes to these disparities.
“We know from research that 80 to 90% of maternal deaths are preventable and that many of the causes are systemic, and the number one cause, especially when it comes to Black women, is racism,” Amani said. “And similar to the experience that I had in my second birth, where a white nurse was telling me as a young black mother that I could kill my baby … the threatening words that were said to me, the stress it put on my body and on my baby — completely preventable and unnecessary.”
Georgia is not alone in facing legal challenges over midwifery restrictions. Similar lawsuits have been filed in multiple states, including Mississippi, Nebraska, and Alabama. In some cases, legal pressure has already led to change.
Following a 2024 lawsuit, Hawaii expanded access to certain types of midwives as it forced the state to repeal many of their midwifery restrictions.
Amani hopes that their Georgia lawsuit will have a similar outcome.
“I’m really hoping that what happens is that we’re able to organize and galvanize the community around this goal and raise more awareness around why midwifery is so important,” Amani said. “Logically, midwives are the best solution to the maternal health care crisis.”
