Georgia’s maternal mortality rate is among the highest in the country, with Black mothers more than three times as likely to die from pregnancy-related causes compared with white mothers. The state also fares poorly on measures such as severe maternal morbidity and cesarean delivery rates.
Over half of all counties have either no or very limited access to maternity care, and more than one‑third of Georgia’s counties are classified as “maternity care deserts” (meaning they have no obstetric providers, no birth centers, and no hospitals offering obstetric services). Hospital closures and the elimination of labor and delivery units have been major drivers of these access gaps. In rural areas, only a little more than one‑third of rural hospitals still provide obstetric services.
Given that context, midwives, especially those who provide home and birth‑center care, say Georgia underuses a crucial part of its maternity care workforce.
Making It Difficult for Midwives to Practice
Georgia has adopted some of the most restrictive midwifery laws in the country, licensing certified nurse‑midwives while requiring a separate state license for non‑nurse midwives. It is generally unlawful to practice midwifery in Georgia without one of those licenses.
Direct‑entry midwives (midwives trained outside of nursing programs who typically specialize in home and birth‑center deliveries) have no state licensure pathway in Georgia and risk criminal or civil penalties if they practice. Certified nurse‑midwives (advanced practice registered nurses with graduate‑level training in midwifery and authority to provide care for low‑risk pregnancies and related reproductive health services) may only practice under written “nurse protocol agreements” with physicians.
The midwives who brought the recent lawsuit claim that those physician‑oversight contracts often require monthly payments in the hundreds of dollars and can be difficult for midwives to secure, limiting when and where certified nurse‑midwives can provide care.
The Fine Print That Blocks Care
Georgia’s midwifery framework turns on two main sets of state rules: the “Midwifery Statute,” which governs non‑nurse midwives, and the “nurse protocol agreement” requirements that apply to certified nurse‑midwives as advanced practice registered nurses.
Under the Midwifery Statute, it is unlawful for a licensed midwife to “attend any cases other than those of normal childbirth.” “Normal childbirth” is defined by reference to a physician’s examination finding no specified abnormalities. This law also says that midwives must practice under a physician’s direction when complications arise.
For certified nurse‑midwives, Georgia law requires a written nurse protocol agreement with a physician. That agreement is a signed document in which the physician delegates specific “medical acts”, which can include ordering drugs, medical devices, medical treatments, and diagnostic studies, and must spell out the parameters under which those acts may be performed.
These rules did not appear in a vacuum. Over the past century, Georgia’s birth care system has shifted from relying heavily on traditional and Black “granny” midwives to a model in which only certified nurse‑midwives are licensed, and all other midwives are effectively excluded from legal practice through regulatory and licensing changes. While neighboring states like Florida and Tennessee created licenses for certified professional and other direct‑entry midwives, Georgia continued to bar those midwives from lawful practice and kept physician‑agreement requirements in place for certified nurse‑midwives.
The Midwives Behind the Case
Against that backdrop, the lawsuit spotlights three midwives whose careers illustrate how Georgia’s rules play out on the ground.
Jamarah Amani is a Florida‑licensed, direct‑entry midwife and executive director of the Southern Birth Justice Network. She says a traumatic hospital birth in Georgia and the lack of any lawful pathway for community midwifery pushed her to train and practice in Florida instead, even though families in Georgia still ask her to attend their births.
Tamara Taitt, also a Florida‑licensed, direct‑entry midwife, now leads Atlanta Birth Center. She says Georgia’s refusal to license direct‑entry midwives forces experienced midwives into “birth assistant” roles and limits how many patients the center can safely serve.
The third plaintiff, certified nurse midwife Sarah Stokely, lives in Rome, Georgia, but drives more than four hours to work at a Tennessee birth practice because she cannot afford the physician protocol agreement she would need to practice as a midwife at home. Instead, she works in Georgia as a registered nurse while maintaining housing in two states to keep attending out‑of‑hospital births.
Together, the three describe careers built around low‑risk, community‑based maternity care—and a pattern in which Georgia law cuts that work off at the state line.
The Constitutional Fight
The lawsuit, filed in the Superior Court of Fulton County, brings only state law claims under the Georgia Constitution. The defendants are the State of Georgia itself and Georgia officials who enforce the midwifery and nursing laws, including the Georgia Board of Nursing and the Department of Public Health.
The plaintiffs say Georgia’s midwifery scheme violates the right to pursue one’s chosen profession by shutting non‑nurse midwives out of practice and making nurse‑midwives’ ability to work depend on private physicians’ approval.
They also raise equal protection claims, arguing that the state treats midwives differently from comparable providers and burdens patients who want out‑of‑hospital births without a safety‑based rationale. On top of that, they assert improper delegation of governmental power to private actors and due process violations, including vagueness, on the theory that key terms and requirements are too unclear to give fair notice.
The plaintiffs ask the court to declare core midwifery and nursing provisions unconstitutional and to bar their enforcement. Those changes would open a legal path for direct‑entry midwives, let certified nurse‑midwives practice without having to buy physician sign‑off, and could eventually draw in Georgia’s appellate courts and even the Supreme Court if the case advances far enough.
Why This Case Matters
This case is not just about three midwives and some technical licensing rules; it is about whether Georgia will keep treating community‑based midwifery as something to be pushed out or as part of the solution to its maternal healthcare crisis. A win for the plaintiffs could open legal pathways for direct‑entry midwives and give certified nurse‑midwives a way to practice without obtaining physician permission, which, in turn, could make home and birth‑center care a real option for more Georgians. A loss would leave the current system in place — and leave midwives and the patients who want their care working around the same barriers described in the lawsuit.
