What is normal, physiologic childbirth and what can care providers do to support it in every birth setting?
Physiologic birth not only benefits the families receiving care, but also the institutions and organizations that provide the care.
The Alabama Birth Coalition (ABC) advocates for high quality, affordable, respectful care for all Alabama families, in every birth setting. Let's examine the maternity care situation as it applies to home birth, birth in freestanding birth centers, and most commonly, hospital birth.
Birthing Spaces
Home Birth.
In seeking physiologic childbirth, more women are turning to the Midwives Model of Care in freestanding birth centers and homes.
Certified Professional Midwives (CPMs) are the gold standard when it comes to out-of-hospital care. They are uniquely required to undergo clinical training out-of-hospital. They are trained to screen candidates, conduct resuscitation, administer medication, and follow emergency management and transfer protocol. Unlike Nurse Midwives, they do not care for women who have been given induced labor or epidural medication.
Birth Centers.
For many families, a birth center is the right middle ground between home and hospital. It's a calm, home-like place where healthy people with low-risk pregnancies get prenatal, birth, and postpartum care from midwives, and it has clear plans for moving to a hospital if one is needed. Research links birth center care to better health outcomes, and it can bring care closer to home in a state where 43 of 67 counties have little or no access to maternity care.
Alabama now has birth centers, which wasn't true a few years ago. Oasis Family Birthing Center in Birmingham opened in 2022. The Alabama Birth Center in Huntsville opened in 2024. Birth Sanctuary Gainesville in rural Sumter County is the state's first birth center owned and run by midwives. Their future is still being fought over in court.
Our position: The Alabama Birth Coalition strongly supports independent, midwife-led, freestanding birth centers. Birth centers are not hospitals and shouldn't be licensed or staffed like hospitals. We believe Alabama should create birth center licensure based on national standards from the American Association of Birth Centers, with no required physician supervision, no mileage limits that shut out rural families, and full practice for Certified Professional Midwives and Certified Nurse-Midwives.
Where things stand
- 2023: ADPH forced Oasis to close and adopted hospital-style rules. These require a physician on call within 30 minutes, 24-hour nurse staffing, and hospital transfer agreements that hospitals don't have to sign. Birth centers and midwives sued in August. On September 30, a Montgomery judge blocked the rules for centers that meet national standards.
- May 2025: The trial court ruled that birth centers are not hospitals. A 2025 bill (SB87) that would have recognized midwifery care in birth centers stalled in the Legislature.
- January 2026: The Court of Civil Appeals reversed that ruling and held that birth centers are "hospitals" under a 1949 law. In May, the Alabama Supreme Court declined to review it.
- June–July 2026: ADPH ordered the birth centers to stop operating. The judge ruled that the 2023 injunction still protects them, so they remain open while the challenge to the rules themselves continues into 2027.
The courts can only do so much. A lasting fix needs the Legislature to create fair, separate birth center licensure.
What you can do
- Contact your legislators. Use our Find My Legislators tool and ask them to support independent birth center licensure in the 2027 session.
- Share your story. Families who used birth centers, or wish they had one nearby, make the strongest case.
- Get involved. Visit our Take Action page.
Hospital Birth.
The vast majority of U.S. births occur in the hospital setting. Hospitals specialize in treating acute illness and injury, so they are an obvious choice for women who have underlying morbidities, pregnancy complications that require medical or surgical intervention, or who choose to have high-intervention births. A hospital delivery is also a good choice for women who elect to use pain medication or feel the most safe and relaxed knowing that surgical facilities are on the premises should the birth deviate from its normal course.