When Gwen Herndon learned she was pregnant, she did what most first-time moms do: she made an appointment with a popular OB/GYN at her local hospital. But it wasn’t a good fit, so she soon found herself searching the area for other options.
That search led her to Oasis Family Birthing Center in Birmingham, Alabama. What she wanted was the relaxed, hands-off feel of a home birth—but within a more controlled environment than her apartment. She also didn’t want pain management offered to her and wanted to deliver her baby in whatever position felt natural.
Her search led her to Dr. Heather Skanes, an OB/GYN who founded Oasis Family Birthing Center in Birmingham’s West End in 2022.
“I chose Dr. Skanes because she respected my choices,” Herndon told IW Features.
Oasis Family Birthing Center proved to be a welcome reprieve for mothers like Herndon who were seeking an alternative to hospital-based maternity care, especially in a state with a long record of hostility toward midwives and home births.
The concept of low-intervention, individualized care is the ethos of birth centers all over the country. They operate under a physician’s oversight, but are staffed and run by midwives, serving only low-risk pregnancies that require little to no medical intervention.
For patients like Herndon, that approach was the appeal of Dr. Skanes’s practice. But it also attracted scrutiny from the state.
Shortly after opening, Oasis caught the attention of the Alabama Department of Public Health. The ADPH pursued the center and its staff, as well as another birth center in Huntsville, for allegedly lacking the proper licensure to operate. Oasis closed as litigation took off, but was able to reopen in 2024.
Much of the battle between providers like Oasis and the state is over how to define what a birth center is. The Alabama Department of Public Health argued that to ensure patient safety, birth centers need the same regulations that dictate the operations of medical centers five or 10 times their size. Oasis and its co-litigants, who first filed suit against the state in 2023, contend that birth centers are not hospitals and shouldn’t be subject to standards that create unnecessary burdens and undermine their mission. In fact, the majority of birth center patients, like Herndon, choose the birth center for that very reason.
The conflict reflects a much older controversy in Alabama. For decades, midwives have operated under intense scrutiny as medical authorities and state regulators have imposed increasingly restrictive rules on the profession. For example, the state only licenses midwives with four-year college degrees.
Alabama is also known nationally as one of the most unfavorable states for home births and midwife-led deliveries. Neighboring states like Tennessee have fewer restrictions, motivating many midwives in Alabama to maintain dual licensure in both states. These restrictions also force patients to travel across state lines, where women pregnant with multiples or seeking a vaginal birth after Caesarean (VBAC) have greater freedom to labor outside a hospital setting.
Charity Howard, a student midwife at Oasis, told IW Features that even meeting Alabama’s criteria for licensure provides little protection for midwives.
“[The state] requires us to have four-year degrees, and even then, you could still get in trouble,” she said.
Howard, along with other midwives and doulas, thinks the dispute extends beyond questions of patient safety. They believe that the case isn’t so much about regulation as it is about eradicating birth centers in the state, which would benefit hospitals while limiting patient options for maternity care.
The American Civil Liberties Union, which represents the birth centers and their staff, agrees, saying that the state’s “onerous, hospital-like regulations for birth centers are clinically unnecessary and would make it extremely difficult for them to operate at all.”
Last year, an appeal filed by the public health department was decided in the state’s favor. Oasis and the other plaintiffs requested review from the Alabama Supreme Court, but in May the state’s high court declined to issue a judgment, ,leaving in place the appellate court’s ruling—a devastating blow for the plaintiffs’ interests.
For birth workers across the state, the potential consequences extend beyond the courtroom. Doulas like Rachel Bailey worry what even fewer options will mean for families, particularly in rural counties where labor and delivery units are sparse and access to prenatal and postpartum care is more challenging. Bailey stressed that patients in larger cities can operate on preference because there’s a wider variety of options for care. Women in rural communities can’t.
A lack of options could motivate some women to seek labor without any provider present at all, a practice known as freebirthing, and one that brings far greater risk to women and their babies. When Howard surveyed patients, she said she found that “every single one chose that over a hospital.”
According to Bailey, the state’s onerous regulations on midwives and birth centers reflect a deeper issue.
“There’s a fundamental lack of trust in a mother’s ability to make decisions,” she said.
Even though the Alabama Supreme Court declined to take up Oasis’s case, the issue is far from over. For patients, midwives, doulas, and women in between, the larger question remains unresolved: whether the state will expand access to maternity care or continue to limit the options available to mothers.
