SPEAKIN’ OUT NEWS
When Dr. Heather Skanes opened Alabama’s first freestanding birth center in 2022, she did so with a clear mission: save lives. Alabama has long ranked among the worst states in the nation for maternal and infant mortality, with Black women and babies facing the highest risks. Skanes, a Birmingham native and OB-GYN, believed expanding access to community-based maternity care could help close that deadly gap.
Her Oasis Family Birthing Center opened in a majority-Black Birmingham neighborhood, offering midwifery services alongside medical care for low-risk pregnancies. Just months later, the center made history with Alabama’s first baby born in a freestanding birth center. But about six months after opening, the Alabama Department of Public Health ordered the facility to shut down, claiming it was operating as an “unlicensed hospital.”
The shutdown highlighted a broader crisis unfolding nationwide. Hospital labor and delivery units are closing at alarming rates, including more than two dozen nationwide in 2025 alone. In Alabama, at least three hospital delivery units have closed since 2020, creating maternity care deserts in both rural and urban communities.
Freestanding birth centers are often seen as a solution — but they, too, are under pressure. Nationwide, the number of freestanding birth centers doubled between 2012 and 2022. However, financial strain and regulatory barriers have taken a toll in recent years. Since 2023, about two dozen centers have closed, bringing the national total down to roughly 395, according to the American Association of Birth Centers.
After Oasis was shut down, Skanes joined Dr. Yashica Robinson of North Alabama and licensed midwife Stephanie Mitchell from the rural Black Belt in a lawsuit against the state. The group argued that Alabama’s regulations amounted to a de facto ban on birth centers.
“Entire swaths of the state are maternity care deserts,” said Whitney White, a staff attorney with the American Civil Liberties Union, which represents the birth center owners. “Pregnant people are struggling to access care, get appointments, and find providers.”
In May 2024, an Alabama trial court blocked the state from regulating freestanding birth centers as hospitals. While all three Alabama centers are now operating, uncertainty remains. The state appealed the ruling in November, leaving providers unsure about long-term stability.
Financial challenges persist as well. Birth centers typically cost less than hospital births, yet Medicaid and private insurers often reimburse them at lower rates and fail to cover services like doulas and lactation support. Advocates say payment parity and sustainable funding are essential.
For many Alabama families — especially Black and rural communities — birth centers represent access, dignity, and survival. As maternity care options disappear, protecting these centers may be critical to confronting Alabama’s maternal health crisis head-on.