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Editor's Pick

Governments Infringe on Women’s Right to Decide Where to Have Their Baby

Jeffrey A. Singer

Birthing centers have been gaining popularity as alternative venues for labor and delivery. Nurse midwives usually operate them. In some regions of the country, such as rural Alabama, they enable African‐​American women to give birth in culturally familiar places with more compassionate treatment than hospitals. An added benefit of birthing centers in areas like rural Alabama is that mothers in labor often must travel long distances to deliver at a hospital. For instance, about 28 percent of women in Alabama have no hospital within a 30‐​minute drive.

Alas, the state of Alabama has decided to deny these women the ability to exercise their right to choose from whom and how they wish to seek health care services. Alabama announced new regulations threatening to close many of Alabama’s birthing centers effective October 15.

The new regulations require birthing centers to have a physician on call and within a 30‐​minute drive of the center. In a recent New York Times article, Emily Baumgartner and Erin Schaff powerfully profile the roadblocks many state laws and lawmakers in Alabama and elsewhere place in the way of birthing centers.


In some states, such as Kentucky, Certificate of Need (CON) laws block the opening of birthing centers without a commission—often strongly influenced by entrenched incumbents—deciding that there aren’t “enough” places for women to deliver babies and allowing them to exercise their right to have their babies at a proposed new birthing center.

I have written about how CON laws protect incumbents, raise health care costs, and reduce access to health care services. But CON laws are not the only culprit. States also impose onerous licensing requirements on birthing centers that block pregnant women from access.

Women have had babies in their homes since the beginning of recorded history, and in modern times are increasingly opting for home births. Fortunately, they don’t need to obtain a Certificate of Need or meet other state requirements before having their baby at home.

Yet home birthing carries risks. Meanwhile, free‐​standing birthing centers only take low‐​risk patients. The evidence to date suggests that free‐​standing birthing centers are associated with lower pre‐​term delivery rates, higher birth weights, higher breastfeeding rates, and lower rates of Cesarean sections.

In Alabama, as in many states, most board members who impose regulations on free‐​standing birthing centers are appointed by the state medical association or hospital association. As with Certificate of Need commissions, the entrenched incumbents have a vested interest in making it difficult for innovations and entrants to threaten their positions.

In Recovery, a new book from the Cato Institute, Michael F. Cannon writes, “In many ways, U.S. residents are less free to make their own health decisions than residents of other nations.” Erecting obstacles to free‐​standing birthing centers is just one example.

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