Georgia has a long history of Black midwifery and maternity care. But in 1991, the state passed a law banning midwives who aren’t certified nurses practicing under the supervision of a physician.
Jamarah Amani, co-founder of the National Black Midwives Alliance, is one of three plaintiffs—all midwives—in a lawsuit challenging Georgia’s ban.
Here, Jamarah tells her story to writer Bonnie Fuller, special correspondent for Courier Georgia.
I gave birth to my second baby at a hospital in the Atlanta area, where I was living, and it was a horrible experience. I couldn’t give birth the way I wanted to.
The nurse wouldn’t let me get out of bed and labor while I was standing up and walking around.
She told me that if I didn’t stay in bed, it could kill my baby. I knew it was a lie, but it was really upsetting to hear her insisting on that repeatedly.
What you need when you are in labor is support, affirmation, and compassion, and I didn’t get that. I got a lot of harshness and was told what not to do.
Luckily, one of my best friends was my doula, and she was attentive to what I needed, which was to be upright. I could not be on my back in the bed.
Editor’s note: Doulas provide physical and emotional support during pregnancy, childbirth, and the postpartum period.
The first time that I gave birth, I was at a birth center at Pennsylvania Hospital in Philadelphia. I had a midwife there when I was in labor, and she was a quiet, gentle presence by my side most of the time.
Giving birth was a very affirming and empowering experience. That’s why I had expected to have another good experience for the birth of my second child, but instead I had to labor in the bathroom, where I could stand upright.
Every time the nurse came into the room, my friend would tell her, “Oh, she’s peeing again in the bathroom.” Meanwhile, I was in there, working through my labor and contractions.
Then, when I felt that the baby’s head was coming down, I told my doula friend to call in the nurse and doctor, and I jumped back in bed, and I was like, “Okay, I’ll push this baby out.”
Once they were there, it was only about two pushes and the baby was out.
But afterward, I realized that I should not have had to duck and dodge and be in fear also that if I didn’t follow “the rules,” as a Black mother, the hospital might call Child Protective Services and say that I was a bad mother, and then I might not walk out of there with my baby.
There have been cases like that, and so there is a hyper-awareness around Black women that “I can’t really break the rules.” There is risk-taking in standing up for yourself.
It was after this dehumanizing experience of giving birth to my daughter that I received my calling to become a midwife.
Editor’s note: Midwives are healthcare professionals trained to provide care during pregnancy, childbirth, and the postpartum period. They also offer routine gynecological checkups and family planning counseling.
‘Archaic laws still exist’ in maternal healthcare
I was already deeply involved in the reproductive justice movement in Georgia, fighting to make healthcare better and emergency contraception easier to obtain for women, and I was thinking about what else I could do.
Then the clear calling to become a midwife came to me in a series of dreams. I already knew some doulas and had met some midwives, but I quickly learned that there was no way to get a legal midwifery education in Georgia, and there still isn’t today.
It also isn’t legal for midwives to practice in Georgia at all unless they are certified nurse midwives, and even then, they can practice only under the supervision of a doctor.
That’s why I’m now one of three midwives in a lawsuit working with the Center for Reproductive Rights, challenging the law in Georgia that has made most midwifery illegal in Georgia.
Editor’s note: The lawsuit, which was filed in April, challenges two laws in Georgia. The first is a Georgia law that prevents any midwife from practicing in the state unless she also holds a nursing degree. The second challenges a law preventing certified nurse midwives from performing their work unless they are under the contractual supervision of a physician.
Meanwhile, Georgia has one of the highest maternal mortality rates in the country, with 37.9 deaths of women per 100,000 live births and with 87% of those deaths considered preventable. Tragically, Black women are 3.2 times more likely to die before, during, or after giving birth in Georgia than white women. Infant mortality was 7.22 per 1,000 live births in Georgia in 2025, also among the highest in the country.
This could be because 65% of Georgia counties lack a birthing center or a hospital with a labor and delivery unit, making them maternity care deserts.
I wanted to become a plaintiff in this lawsuit because I think there’s an opportunity to raise awareness of the fact that these archaic laws still exist and to highlight the connection between midwifery and saving lives.
We know from research in the United States and around the world that having a midwife-led maternity healthcare system saves lives.
We know that 80%-90% of maternal deaths are preventable and that maternal mortality disproportionately impacts Black and Indigenous birthing people, many of whom live in areas considered maternity care deserts where they can’t receive necessary care.
So we need midwives in Georgia to be able to practice to lower the maternal mortality rate. When the amazing folks at the Center for Reproductive Rights decided that they could use a lawsuit to effect change in Georgia, I was like, “Sign me up as one of the plaintiffs.”
Midwifery extends beyond pregnancy and childbirth
I actually was forced to leave Georgia after I realized that there weren’t any legal pathways to becoming a home birth midwife in the state. I picked up my family and moved to Florida in order to pursue my midwifery education.
In Florida, midwifery is legal and licensed by the state. You can go to school for three years. I went to the International School of Midwifery, and there are three or four other midwifery schools in Florida.
Then you take a national board exam after attending and helping in 100 births.
I graduated in 2011, was licensed in 2013, and have been a licensed midwife at a birth center in Miami, Florida, ever since.
I absolutely love it. In my opinion, there is no better—also no harder—profession. I need to be on call, so there’s a big lack of sleep 24/7.
But my clients are always grateful, so it’s highly rewarding, though it is often undercompensated, since we spend so much time supporting our clients, including after birth, helping moms establish breastfeeding.
Our clients can choose whether they want to give birth at home, at the birth center, or in a hospital. We provide fertility and preconception care, prenatal care, and postpartum care. We also do routine gynecological checkups, breast exams, and testing for STDs.
If you look at the maternal mortality statistics, two-thirds of those deaths occur in the weeks after childbirth. You know, in a typical hospital birth, people are checked by their medical provider 24 and 48 hours after giving birth, but then not for six weeks.
That’s a real issue in our current healthcare system, but with midwifery care, we check on our clients at least weekly. I typically do four or five postpartum visits to screen for things like postpartum depression, hemorrhaging, and challenges with breastfeeding or issues with the baby.
We want to intervene before anything becomes a life-threatening emergency.
In Florida, midwife care is covered by Medicaid and all insurance, though it usually covers only two postpartum visits. That means those important additional visits are covered by grants or the kindness of our hearts.
I love home births. It’s really special because people get to prepare their own food, wear their own clothes, and the baby comes in the rhythm of the family. I can’t give a medical explanation for that, but if the family has kids, the baby’s coming after they go to bed.
‘I’m very, very hopeful that we can succeed in changing the law’
Midwifery is spiritual. There’s a sacredness to birth for that mom, that family, and the baby. My job is to be a guardian of that process, and we have medications on hand if we need them to keep the birth safe, though we usually don’t.
There’s nothing more special than placing the newborn baby on the birthing parent’s chest right after birth. We call that the golden hour. In that first hour, the oxytocin levels are higher than they’ve ever been in that person’s life.
Oxytocin is the love hormone, and it bonds us together as humans. You experience oxytocin when you first fall in love, when you have a first kiss, but the highest levels of oxytocin come when you give birth.
It’s rare for us as mothers having a home birth to need to go to the hospital. When they do, it’s usually because the labor’s really long or because the mom’s changed her mind. She is tired, and she wants some pain management.
But we go with them to the hospital to continue to support them. I tell people at the hospital that you’re still my client.
Even when a mom ends up going to the hospital or has had a C-section, we safeguard that golden hour. All the things you need to do, like listen to the baby’s heartbeat and lungs, do other newborn checks, and do the APGAR score, we do all that while the baby’s on the mother’s chest.
We don’t even cut the umbilical cord in that hour unless the family requests it or there is a medical reason to do it, because we don’t want to disturb what is happening.
The breastfeeding relationship usually begins in that first hour, with the first latch.
In accordance with Florida law, midwives carry important medications to home births. We carry oxygen, IV fluids, Pitocin (a synthetic hormone that helps induce labor), Methylergonovine (a medication that helps stop excessive bleeding), and Cytotec (which helps induce labor).
In addition to working out of the birthing center, we use a bus for a nonprofit we established—the Southern Birth Justice Network—that houses a mobile clinic, allowing us to travel to other communities to provide reproductive healthcare services.
Midwives are the earliest profession. We’ve been around since the beginning of time. Most communities have welcomed their babies into the care of midwives for the majority of history. Hospitals and doctors, which I think most people think of when it comes to birth in the US, are relatively new.
We filed the lawsuit—to make it legal for midwives to practice in Georgia—on April 2, and now we’re going through the legal process.
I’m very, very hopeful that we can succeed in changing the law and bringing midwives back to Georgia.
