Tamara Taitt is a nationally accredited midwife and the executive director of the Atlanta Birth Center, one of the few freestanding birth centers in Georgia. Despite her credentials, she exists in a legal paradox: under state law, she cannot provide routine clinical care for her own clients. If she were to grab a patient’s vital signs, conduct a prenatal visit, or deliver a baby, she could face criminal charges, including fines of up to $1,000 or imprisonment.
This restrictive environment has led to a growing movement of Black women in Georgia turn to midwives for safer births as a means of avoiding the systemic risks associated with hospital deliveries. In a state where Black women are more than twice as likely to die from childbirth as white women, many families are seeking holistic, less medicalized care to avoid invasive interventions. However, the state’s legal framework effectively criminalizes many of the remarkably providers these families trust.
The tension between public health needs and state regulation has culminated in a federal lawsuit filed by the Center for Reproductive Rights. The suit, brought on behalf of Taitt and two other midwives, seeks to decriminalize “direct-entry” midwives and remove the mandatory physician oversight requirements that currently burden licensed nurse-midwives.
The Divide Between Midwifery Credentials and Georgia Law
To understand why Taitt is barred from practicing clinically, one must look at the narrow definition of midwifery in Georgia. The state only recognizes “certified nurse-midwives” (CNMs)—professionals who are licensed nurses in addition to their midwifery training. This excludes “direct-entry” midwives, including Certified Professional Midwives (CPMs) like Taitt, who undergo extensive clinical training and are licensed to practice in 39 other states.
The impact of this gap is felt most acutely in Georgia’s “maternal health deserts.” Currently, half of the state’s counties lack an obstetrics provider, and more than 40 labor and delivery units have shuttered since 1994. For women in these regions, the lack of accessible, legal midwifery care often means a choice between a long commute to a city center or relying on community midwives who operate in a legal gray area.
Jamarah Amani, a plaintiff in the lawsuit, noted that these restrictive laws eventually drove her to leave Georgia for Florida, where a broader range of midwives are licensed. Amani focused her practice on Black families, utilizing a mobile clinic to serve low-income mothers. “I am bringing this lawsuit for every Georgian who has called asking me to be their midwife and who I’ve had to turn down because I could not obtain a license in this state,” Amani said.
A Legacy of Control and Systemic Exclusion
The current legal restrictions are not new; they are the result of a century-long shift in how maternity care is regulated. According to research from the Black Mamas Matter Alliance, thousands of traditional midwives once served Georgia’s families. However, at the turn of the 20th century, white reformers began labeling these providers as “unsanitary and superstitious,” pushing for literacy requirements and strict physician supervision.
The passage of the federal Sheppard-Towner Act in 1921 further tightened licensing. Within two decades, the number of midwives in Georgia plummeted from 9,000 to just 2,000. Angela Aina, executive director of the Black Mamas Matter Alliance, argues that these regulations were never truly about safety. “Black midwives are the original maternity care providers in this country,” Aina said. “They sustained entire communities, and they were systematically excluded through regulations that were never about safety. They were about control.”
Even for those who are licensed, the barriers remain high. Sarah Stokely, a certified nurse-midwife and lawsuit plaintiff, lives in Georgia but often commutes two hours into Tennessee to practice. She describes Georgia’s requirement for physician oversight as financially untenable, noting that such arrangements can cost providers up to $1,000 per month.
The Risks of “Underground” Care
Despite the threat of criminalization, many women continue to seek out community midwives. Sekesa Berry, a direct-entry community midwife, reports that many of her clients arrive to her out of fear. “My most common phone call, specifically since the pandemic, is: ‘I don’t want to die,’” Berry said. These mothers are often reacting to the high rates of maternal mortality and the prevalence of unnecessary C-sections in Georgia, which occur at three times the rate recommended by the World Health Organization.
While evidence suggests that midwifery-led care can result in better outcomes and fewer unnecessary interventions for low-risk pregnancies, the “underground” nature of unlicensed practice creates a dangerous gap in coordination. Community midwives report that their precarious legal status makes it more difficult to coordinate emergency transfers to hospitals when complications arise.
Medical organizations, including the American Medical Association and the American College of Obstetricians and Gynecologists (ACOG), have generally opposed expanding the scope of practice for non-physicians, citing the need for physician oversight to ensure patient safety. However, the World Health Organization suggests that universal access to midwifery care could prevent more than 60% of maternal and newborn deaths globally.
Disclaimer: This article is provided for informational purposes only and does not constitute legal or medical advice.
The state of Georgia now has a 30-day window to respond to the lawsuit filed by the Center for Reproductive Rights. The outcome of this legal challenge will determine whether Georgia continues to limit midwifery to nurse-midwives or opens a legal pathway for the thousands of trained providers currently sidelined by the law.
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