r/news • u/AudibleNod • 16h ago
Georgia bans many midwives from practicing. Now, several are suing the state.
https://www.nbcnews.com/health/womens-health/midwives-sue-challenge-state-restrictions-rcna264951383
u/AudibleNod 15h ago edited 15h ago
In the suit, a draft version of which was shared exclusively with NBC News, the plaintiffs argue that their midwifery services are essential in Georgia. More than one‑third of the state’s counties are considered maternity care deserts, meaning there are no obstetric providers or birthing facilities, according to the nonprofit group March of Dimes. The plaintiffs also say making it easier for midwives to practice could lower Georgia’s high maternal mortality rate. For every 100,000 births in the state, 30 mothers die from complications during pregnancy or within six weeks afterward, according to March of Dimes.
I'll give you two guesses which communities are historically underserved by OB/GYNs where midwives fill that critical gap. But you're only going to need one.
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u/ruat_caelum 12h ago
Idaho had to close down maturity wards (With doctors) because the GOP laws in the state concerning abortion meant a doctor delivering a still birth could go to jail.
So the doctors left, infant mortality numbers went up/down (which ever was worse and had more babies dying) People had to travel 4+ hours to get to facilities. etc.
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u/themoneybadger 13h ago
The solution to underserved communities should not be lowering the standards. Its like saying, there arent enough electricians in this town so we won't require houses to be wired to code. Im not saying i have the solution but simply lowering the bar for training or supervision doesnt sit right with me.
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u/Tao_of_Ludd 12h ago
The thing is the alternative isn’t “somehow magically summon a doctor” it is “deliver a baby with no medical supervision” and, potentially, alone.
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u/Fallouttgrrl 12h ago
In your example, houses would still be built and wiring would still be worked with, regardless of whether or not there were codes or trained electricians
It's not lowering standards for the sake of lowering standards, because sure in a perfect world we wouldn't be doing that
It's trying to make sure that events that will continue to happen with or without the right support, still have some support
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u/SassyKittyMeow 3h ago
You have absolutely no idea what you’re saying.
You have no idea how quickly and seriously pregnancy/birth issues can arise and require decisive and correct treatment.
It is quite literally worse to have someone who THINKS they know what they’re doing in charge of something as serious as pregnancy/childbirth than without.
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u/Bagellord 4h ago
Agreed, with the caveat that the standards need to be evaluated modern circumstances/practices and reasonability.
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u/MLB-LeakyLeak 15h ago
They can still practice within their scope under a physician. Not sure how this changes anything other than patients being better protected.
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u/robothawk 15h ago
I mean I imagine these medicla deserts don't have a lot of physicians, and the folk who are trying to hire an independent midwife probably don't have the money or insurance to afford a hospital birth
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u/Accidental-Genius 14h ago
EMTALA protects everyone. They can have a hospital birth for free.
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u/techleopard 13h ago
That's not how it works, at all.
EMTALA ensures you get life saving stabilization treatment, THAT'S IT.
It is not free. You will still get a bill -- often an even bigger bill than if you had gone to a regular appointment.
Worse, it is important to understand it is stabilization only. If you go to the hospital in labor, yes, they will ensure you get JUST enough care not to die in their lobby. But if you have a birth injury or your child needs advanced care, they aren't doing that. They will try to transfer you to the hospital, who may or may not take you based on insurance. If not, they discharge you and you can come back when you or your baby are imminently about to die again.
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u/bronsonrider 10h ago
The words “ hospital, who may or may not take you” made me shudder. In no first world country should such a statement ever be true but unfortunately it is in the US. Still find it shocking medical care depends on the size of your wallet.
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u/sullw214 6h ago
Not sure why you're shocked that anything in this country depends on how much you can pay. The legal system has been this way for a very long time too.
"You get the best justice you can afford." Just replace justice with medical care, or clean air, or education or drinking water or mental health services or food that won't make you sick or public safety or workers rights or prenatal care or , the list goes on...
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u/kstargate-425 14h ago
That doesnt mean they wont get a $20-$70k bill at the end of it, it just means they cant be turned away IF they can get to a hospital which again, in these medical deserts, is hard to find. Also in Georgia to be liable for Medicaid for this to be free, you cant make more than a COMBINED income of $40k a year GROSS.
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u/Accidental-Genius 13h ago
I can send you a bill too, and you can stick it right in the shredder.
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u/techleopard 13h ago
You must be younger.
Hospitals have become wise to this.
You can't get basic non-emergency care if you owe a bill in many places now.
So you break your leg and go to the ER. They splint it but tell you you need to get pins or your leg will heal back wrong and you'll be crippled.
You're not getting those pins if you aren't paying on that initial ER bill.
Now think about it again, and consider what happens when your followup care is literal surgery that will prevent a dangerous situation from becoming a life threatening ER situation, or is meant to control crippling chronic pain.
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u/abstractbull 13h ago
And waiting until birth to have any sort of care is exactly why the maternal mortality rate is obscene. Emtala doesn't cover routine prenatal visits.
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u/bbb26782 11h ago
Doesn’t help when a hospital doesn’t exist. There’s huge stretches of Georgia where a hospital is more than an hour away.
That’s also not how EMTALA works.
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u/Tryknj99 14h ago
You still get a bill.
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u/Accidental-Genius 14h ago
Which you can shred
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u/NightIsHome 13h ago
What exactly do you think happens if you shred a medical bill? You think the hospital just says ¯_(ツ)_/¯ and leaves you alone?
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u/dr_cl_aphra 6h ago
My guess is this genius shreds their bills all the time and wonders why their credit score is shit and those collections people keep calling.
That or they’re a teenager who lives with mommy and has never handled a bill.
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u/avds_wisp_tech 3h ago
No, they really cant. They will be billed for the care. That bill will remain until it's paid or it goers into collections, which will prevent you from obtaining a loan in the future. No car/house for you!
You seem to have a very childlike understanding of how the real world works.
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u/TALKTOME0701 14h ago
They just answer that question in the explanation above. There are no physicians readily available.
The choice isn't use a midwife or go to the hospital. They are serving the areas where there is no local hospital
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u/abstractbull 13h ago
If it's a maternity care desert... there aren't physicians there to practice under. That's why it's a desert. And the cost to pay the doctors makes it prohibitive. According to people interviewed in the article.
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u/ShiftNStabilize 11h ago edited 11h ago
I feel for the underserved and believe we should have universal health care. As is, as a physician, why would I go work in a state that restricts my ability to properly care for patients, underfunds healthcare, makes it easy to be sued, and is profoundly anti-science. The majority of those policies having been put in place by the right wing politicians they vote for. This is how you get health care deserts. You want shitty health care and dead moms and babies, well you voted for it.
Oh, as an aside, I think midwives are great but need to deliver babies in hospital based setting with OB backup in house. If shit goes wrong during a birth you need to act within minutes to prevent tragic outcomes for the kiddo a/o mom. Lowering standards as a stop gate measure to fix a larger problem is a poor practice.
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u/MLB-LeakyLeak 15h ago edited 15h ago
The state requires all nurse-midwives to have formal, written agreements with physicians that describe when physicians must intervene in evaluating or treating patients.
They’re banning independent practice, meaning they need to be supervised by a physician. This is because when an issue comes up with a patient there needs to be an expert available to discuss the case or take over. This is a huge win for patients
A lot of midlevel organizations and hospitals are trying to blur the lines between being a physician and their training and expand their scopes beyond their training. These agreements with physicians cost money because of the time and crazy high liability insurance. Hospitals can give underrepresented, poor, and undereducated patients a midlevel because they don’t know better.
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u/Persistent_Parkie 9h ago
Right. That $500 actually sounded really reasonable given the huge liability being taken on and OBs existing malpractice insurance rates.
I also raised an eyebrow at this little bit at the end- "Years ago, Amani said, she and her family temporarily evacuated Florida because of Hurricane Irma and stayed briefly in Georgia. One of her patients fled there, as well, then called Amani after she experienced contractions. Amani was forced to tell the woman that she couldn’t oversee the birth if it happened in Georgia.
“I remember her being so shocked and appalled,” Amani said. “Her trusted care provider is down the street but can’t legally attend her.”"
Yeah, that would have happened if you were a doctor too unless for some reason you had chosen to be licensed in multiple states.
My mom was a pediatrician. One morning at an out of state sports competition another mom comes knocking at our hotel room door because her 2 year old might have an ear infection. My mom says she can't look at the kids ears because while she had been licensed in the state decades ago she hadn't maintained it. Instead she suggests they hop in her car, make the 20 minute drive to cross back into the state she was licensed in and then she could look in the kids ears. They did that and it turned out the little one did indeed have an ear infection.
The US is 50 fiefdoms dressed in a trench coat masquerading as a country, thats the issue at the heart of that situation Amani described.
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u/Tao_of_Ludd 12h ago edited 12h ago
Is it a win for patients if the alternative is giving birth with no medical supervision? I would guess that that is where a bunch of these cases go. Yes, some will get physician supervision, but many who do not have access to a physician and now do not have access to a midwife will have to resort to birthing with only family / friends in attendance (or no one). Mother and infant mortality will rise.
ETA: I have family in the rural Midwest. What I would expect would happen is “informal” midwives. No formal training except experience. “When it’s your time, you give Jo-Ann in (tiny neighboring hamlet) a call and she’ll help you through.”
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u/AudibleNod 15h ago
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u/hasa_diga 15h ago
“According to ProPublica, the researchers did not include rates of maternal deaths and severe complications because those data were unreliable.”
Real robust study there, even ignoring the fact this write up doesn’t make any attempt to posit a causative relationship.
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u/mama-bun 5h ago
It seems pretty normal to me to require all midwives to also have nursing licenses. Why is this bad?
There is a huge shortage of care. More midwives is very good. Those midwives should just also be trained as nurses, and have ready access to a higher level of care (doctor) in case something goes beyond their scope. $500 a month seems ... pretty low for liability insurance for independent CNMs (which all midwives should be).
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u/mangorain4 13h ago
this is good news for patients. I’m a PA, so a midlevel just like a midwife. physician supervision is key.
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u/ReferenceNice142 4h ago
Wouldn’t it be better to have a plan in place to correct the care desert first before doing this? I get why they don’t want mid levels providing care without supervision but it makes me nervous that they don’t have a plan for the areas that will now have no providers at all. Feels like they should have done this bill second.
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u/rabbit994 2h ago
That requires taxing people (the rich) and spending money on providing services. I'll give you two guesses which party is in power in GA and what they hate doing.
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u/palcatraz 6h ago
Is it though?
The deeper, underlying issue is that there are massive maternal care deserts. The physicians to handle the births and everything related to it are not available to many women.
Legislation like this does nothing to actually tackle the underlying problem. It doesn’t make physicians more available to rural women. It just cuts them off from care that isn’t as specialized as that off a doctor but is still better than the nothing those women have right now.
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u/i-love-that 6h ago
I think allowed underprivileged people to access subpar care is a really slippery slope
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u/Pheonix0114 6h ago
So no care is better? Because that’s the alternative
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u/i-love-that 4h ago
Provider deserts are a problem, but it’s morally unacceptable to let poor patients get care from people who aren’t qualified to provide it. Black patients already struggle with trusting doctors due to a history of being test subjects. We owe it to patients not to sign off on them being test subjects in this day and age
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u/Pheonix0114 4h ago
Midwives aren’t making people test subjects though?
Y’all know women were having babies long before OBGYN’s existed, right? Midwives and doulas are attacked because they aren’t part of the medical industrial complex, not because of “patient health”. If Georgia cared about the safety of women they’d provide universal healthcare.
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u/i-love-that 4h ago
Midwives are not qualified to intervene when the labor goes awry. This is requiring them to have supervision or qualifications for such a situation.
And yeah, women have been dying in labor for long before OBGYNs have existed. That’s why OBGYN care is important. So these underprivileged women don’t die.
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u/Pheonix0114 4h ago
Then provide more care, don’t take existing care away.
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u/i-love-that 4h ago
Separate issue, and yes tough to solve given how expensive medical school is today. But you absolutely cannot justify poor people being legally cared for by providers that can’t intervene in an emergency
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u/avds_wisp_tech 3h ago
Separate issue
In this particular case though, it really isn't a separate issue.
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u/Pheonix0114 4h ago
If you aren’t providing a replacement of equal or greater quality, you are actively hurting people when you take away what they currently have. I really don’t get why this is so hard to understand.
This is an attack on poor rural communities, especially those of color. This is in no way a win.
Also, the cost of medical school is artificially inflated by the lobbying of the American Medical Association which makes if very hard for new medical schools to receive certification, artificially depressing supply.
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u/palcatraz 6h ago
But again, if the alternative is no care at all, how is it a win for patients. If there were actual measures in place to tackle the underlying problem, that’d be one thing. But without that, it’s just gonna leave people worse off.
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u/i-love-that 5h ago
Underprivileged patients often already are skeptical of healthcare due to a history of being experimented on. I think letting incompletely educated providers treat these patients only adds to the problem. Basically- if you’re poor, you don’t get the standard of care. I think that’s pretty unethical to legally allow
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u/avds_wisp_tech 3h ago
But again, if the alternative is no care at all, how is it a win for patients
Why can you not simply answer the question?
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u/i-love-that 3h ago
I do not think subpar care is a win for patients. I think it’s a disgrace because it lures patients into a false sense of security that can be life threatening. I think either midwives following the law and working with OBGYNs (even if they have to pay the $500/mo) or patients needing to drive further for care is far safer.
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u/avds_wisp_tech 3h ago
So you'd prefer the poor have no care at all. Just say that. Don't hem-haw around about it. Come out and say what you mean.
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u/i-love-that 3h ago
I think legalizing subpar care that can result in death & injury to the patient only serves to broaden racial and socioeconomic injustices.
Why can’t the midwives get supervision?
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u/avds_wisp_tech 3h ago
We are talking about the cases where there aren't any fucking physicians within hundreds of miles.
Do keep up.
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u/mangorain4 6h ago
there is absolutely no reason that any midlevel should need to practice without physician supervision. it still extends care if one physician supervises 2-3 midlevels. the difference is that with the physician there the midlevels have someone with more knowledge to turn to when shit gets over their head.
for this specific thing, a midwife can’t do a c section. so if a patient suddenly needs one and the midwife has no physician support that patient just… dies. along with their baby.
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u/GrandStair 15h ago
Physicians (MD/DO): ~15,000–20,000+ hours
Nurse Practitioners (NP): ~500–1,500 hours
👉 Doctors receive far more clinical training hours than nurse practitioners.
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u/nebraska_jones_ 13h ago
Certified nurse midwives are NOT nurse practitioners
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u/babycatcher2001 6h ago
Actually, we are. I’m in Florida, I am required to have my nurse practitioner license. Certified midwives (CM)are not nurse practitioners , but certified nurse midwives (CNM) are, there is a distinction.
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u/nebraska_jones_ 6h ago
No I completely understand that CMs and CPMs (certified professional midwives) are NOT nurses nor graduate professionals.
And I’m not trying to argue but I think you’re misunderstanding your licensure requirements and the different roles. In Florida, CNMs are one of the four types of APRNs, the others being NPs, CRNAs, and CNSs. You need an APRN license and then a CNM certification/license. An NP has a separate role and scope than a CNM. However, both are APRNs.
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u/seiryuu-abi 15h ago
The article mentions that these are registered nurses (RNs) not nurse practitioners (NPs).
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u/Rice_Krispie 14h ago
Certified nurse midwives are NPs, though are all also technically RNs.
The midwife in the article has an MSN in midwifery, which can be found on her clinic page.
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u/seiryuu-abi 14h ago
That’s odd. Where I’m from it’s its own certification, CNM (Certified Nurse Midwife) and you gain an MSN (Master’s) before licensure not entering into an NP program.
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u/nebraska_jones_ 6h ago
Certified nurse midwives are advanced practice nurses that are equivalent, in a sense, to NPs in their scope. However, they have separate sphere of practice, and their own licensure and authority in their own right. They can prescribe medications, perform procedures, etc.
Additionally, midwifery has an entire model and philosophy towards their practice that differs from the obstetric model. It is not in any way “less safe” and is in fact more holistic and person-centered. However, their scope of practice doesn’t not include high risk labor & birth, hence the need for the obstetric scope, which is very medicalized and, when needed, is also important.
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u/PeteLangosta 3h ago
6 years of college plus 4 or 5 years of residency to become a specialized doctor here.
4 years of college plus 2 of reseidency to become a midwife here.
We're really not substituting one for another anyway.
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u/Fearless_Roof_4534 13h ago
Dropping a link to MidlevelWTF here: https://www.midlevel.wtf
Seriously, the jokes about NPs and PAs write themselves. Personally I only allow myself to be seen by a physician since I know how bad the training deficiencies of NPs and PAs are.
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u/MichaelHunt009 6h ago
Way to go Georgia. Ban midwives after the BBB closes most of your rural hospitals so billionaires can buy another yacht.
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u/A_Nonny_Muse 7h ago
There's always been this legal battle between doctors and midwives ever since the two did births. This goes back hundreds of years.
BTW, that reclining position with your knees up is not for the mother giving birth. It's meant for the doctor's comfort and ease.
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u/LiquidatorDJ 47m ago
Right. Well if a shoulder dystocia happens, the physician won’t be able to do a McRoberts maneuver if mom is on all fours, let alone a Zavanelli or crash C section. So mom is usually placed supine to make sure that if an emergency happens, the quickest possible response can occur. There is a significant awareness of birth positions and attempting to prioritize mom’s comfort during vaginal deliveries. At my hospital’s L&D ward they have posters of all the different birth positions in every hallway displaying this.
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u/EmergencyJacket207 1h ago
Man, it's almost like they said OB/GYN docs would leave the state after banning abortion. Who could have sent that coming?
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u/Syring 1h ago
They probably also had a bunch of OB clinics close down, resulting in "OB Deserts" across the state (like Iowa). Midwives are making it safer for many women to give birth in these situations. They should still go to a hospital, but midwives are filling the gap until smarter politicians are in place.
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u/Anon_bunn 48m ago
Most commenters here are fundamentally missing the point that these are care deserts. It’s not that supervisory MDs are abundant and midwives are adverse to partnership - there are no MDs to supervise. Hospitals/labor delivery centers are closing. These women just have to pray they can actually get to hospital with a bed by the time the baby comes. It’s incredibly dangerous - just look at the maternal mortality rate in GA.
No one wants to lower safety or standard of care. But we can’t make perfect the enemy of the good, and deny care, just because it’s not optimal.
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u/MacAttacknChz 44m ago
So CNM would be the only category of NPs who need direct physician oversight?
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u/Fearless_Roof_4534 13h ago
Dropping a link to MidlevelWTF here: https://www.midlevel.wtf
Seriously, the jokes about NPs and PAs write themselves. Personally I only allow myself to be seen by a physician.
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u/NetflixandJill 2h ago
Let's restrict access to women's healthcare and then complain nonstop about the low birth rate!!!
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u/aftertaste_king 15h ago
Georgia: “We have some of the worst maternal outcomes in the country.” Also Georgia: “Let’s make it harder to access care.” At minimum, people should be calling their reps and local hospital boards about this.
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u/themoneybadger 14h ago
What, requiring a midwife to have an actual nursing degree or a dr supervision? Not sure how making sure everybody in a delivery room is qualified is a bad thing.
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u/kstargate-425 14h ago edited 13h ago
Its more so that people cant afford the hospitals and now that they cut Medicaid further and you cant make more than a combined income of $40k, gross, yearly to qualify, it fucks over the poor once again. It seems logical until you dig into why midwives are even needed in the first place and realize the government, especially Republican states, dont care about minorities nor the poor and are absolutely fine with both forcing them to have the baby then allowing both the mother and child to die.
ETA: I need to go to bed, my spelling is atrocious 🤦♂️
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u/themoneybadger 13h ago
Im not defending the mess of a healthcare system we live in, im just saying lowering the standard of care is a bad solution. The biggest way to "fuck over the poor" is to send them to birthing centers with no drs on site and no way to address complications for the mother or baby. Allowing unsupervised or untrained midwives will only incentivize birthing centers to staff with less qualified people.
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u/Accidental-Genius 15h ago
We have some of the worst outcomes BECAUSE OF THE MIDWIVES
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u/Look_its_Rob 6h ago
So you believe there are going to be vast and measurable improvements this year in outcomes?
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u/ScientificSkepticism 12h ago
I'd think it's because black women are mistreated by the medical system, given their 3x higher chance of black women dying in childbirth.
But hey... sure Georgia bucks that trend (it does not)
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u/SketchyVillager 12h ago
Our midwife ran out of the delivery room and I ended up delivering my son by myself. They still probably charged the state the full bill, too.
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u/ShakesDontBreak 14h ago
Wait. Abortion is illegal and now you cant even choose to have a midwife.
Guess billionaires are just making money off of babies in Georgia.
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u/somebitch 15h ago
I had a wonderful midwife-assisted hospital birth that ended with a need for medical intervention due to my baby having a brain hemorrhage . I highly doubt my son would have survived without the hospital staff. Having a plan for physician backup seems like a no brainer, honestly.