Alabama Court Rules Birth Centers Must Meet Hospital Rules
Alabama Appeals Court says freestanding birth centers fall under State hospital law, a shift that reshapes access to midwifery care
The Alabama Court of Civil Appeals has unanimously ruled that freestanding birth centers in Alabama are “hospitals” under State law and must comply with licensing and regulatory standards set for hospitals by the Alabama Department of Public Health. The decision overturns a lower Court ruling and could reshape how birth centers operate — even as providers seek further review.
Judge Terry Moore wrote that the centers deliver “obstetrical care … to the public generally,” making them subject to the Hospital Acts regulated by the State. His opinion said there was no clear indication the Legislature intended to treat alternative midwifery settings differently when similar health and safety risks are involved.
The ruling comes from Dr. Scott Harris, in his official capacity as State Health Officer v. Oasis Family Birthing Center, LLC et al. (CL-2025-0419). The Court’s published opinion walks through decades of law defining what constitutes a hospital and concludes birthing centers must fall under those rules — a decision that could substantially increase compliance costs for smaller facilities.
Oasis Family Birthing Center in Birmingham and Alabama Birth Center in Huntsville went to Court in 2023 after the Alabama Public Health Department adopted new rules. Those rules required centers to be overseen by a physician or medical director and be within 30 minutes of a hospital with obstetrics services — limits critics said would effectively block many birth centers, especially in rural areas.
The Alabama chapter of the American Civil Liberties Union, representing the centers, called the decision troubling for access to midwifery care. “Birth centers are needed here. Midwives and doulas are needed here,” said ACLU of Alabama Executive Director JaTaune Bosby-Gilchrist in a statement. “We are committed to continuing this fight on behalf of our clients and all Alabamians.”
The ACLU said it will seek further Court review. In the meantime, the current lower-Court injunction remains in place, allowing birth centers to continue operating while litigation proceeds.
Alabama continues to struggle with maternal and infant health outcomes. The State earned an “F” grade on the 2025 March of Dimes Report Card for maternal and infant health, ranking 49th in the nation for preterm births. More than 7,300 babies were born preterm in 2024, and deep racial and access disparities remain widespread.
Rural health care challenges have compounded access issues. Many rural hospitals have closed or cut services, leaving residents to travel long distances for care. Alabama lawmakers enacted the Rural Hospital Investment Act of 2025, creating a tax-incentive program for donations to struggling rural hospitals, but leaders warn that even these efforts may not save every facility at risk.
Meanwhile, the Alabama Legislature has considered — but not yet passed — bills affecting midwifery and related newborn screening requirements — illustrating broader debate over how to regulate and support out-of-hospital care while ensuring safety and public health.
The birth center case remains active as plaintiffs prepare to challenge the appeals Court’s interpretation — in a legal fight with significant implications for providers, families, and the future of maternal care in Alabama.
