By Anna Claire Vollers and Nada Hassanein, Stateline.org

Dr. Heather Skanes opened Alabama’s first freestanding birth center in 2022 in her hometown of Birmingham. Skanes, an OB-GYN, wanted to improve access to maternal health care in a state that’s long had one of the nation’s highest rates of maternal and infant mortality.

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Those rates are especially high among Black women and infants. Skanes’ Oasis Family Birthing Center opened in a majority-Black neighborhood, offering midwifery services as well as medical care.

But about six months after the center’s first delivery — a girl who was Alabama’s first baby born in a freestanding birth center — the state health department ordered Skanes to shut it down. A department representative informed her that by holding deliveries at the birth center, she was operating an “unlicensed hospital,” she said.

Hospital labor and delivery units are shuttering across the nation — including more than two dozen in 2025 alone. Freestanding birth centers like Skanes’ could help fill the gaps, but they too are struggling to stay open.

They face some of the same financial pressures that bedevil hospitals’ labor and delivery units, including payments from insurers that don’t cover the full cost of providing maternity care.

Birth center owners also must contend with arcane state rules and antipathy from politically powerful hospitals that view them as competition, especially in rural areas with few births.

Nationwide, the number of freestanding birth centers doubled between 2012 and 2022, but more recently the pressures have taken a toll: About two dozen centers have closed since 2023, bringing the total number down to about 395, according to the most recent data from the American Association of Birth Centers.

In November, Pennsylvania Lifecycle Wellness and Birth Center announced it would shut down birth center services, citing pressure from regulatory challenges and sharp surges in malpractice premiums. It had served Philadelphia for 47 years. And New Mexico’s longest-operating freestanding birth center stopped delivering babies in December.

“When a new business opens, within the first three to five years you expect a certain number will close,” said Kate Bauer, executive director of the American Association of Birth Centers. “But we’ve had several long-standing birth centers close [in 2025] and that hits particularly hard.”

In California, which has some of the strictest birth center licensing rules in the country, concern over the closure of at least 19 birth centers between 2020 and 2024 prompted the state legislature to pass a law in October to streamline birth center licensure.

An appealing alternative

Freestanding birth centers are not attached to hospitals and aim to provide a more homelike, less traditional medical setting. They employ midwives and focus on low-risk pregnancies and births. Some also have an OB-GYN or family medicine doctor on staff, and they often have partnerships with nearby hospitals and doctors if more specialized care is required.

Some Black and Indigenous midwives and doulas say birth centers can be helpful alternatives to their community members, many of whom have had experiences in more medicalized settings that left them feeling marginalized, dismissed or unsafe.

Midwife Jamarah Amani, executive director of Southern Birth Justice Network, runs a mobile midwifery clinic serving majority-Black and Latino neighborhoods in Miami-Dade County, Florida. The nonprofit, which aims to make midwife and doula care more accessible, recently bought a building for a freestanding birth center it aims to open in 2027.

“[Midwifery] presents like a luxury concierge-type of service, and our goal is to really change that and to bring it back to the community in a very grassroots way,” Amani said. She added that expanding access to prenatal care could help address inequities in maternal health, as maternal death rates among Black women are three times higher than those among white women.

Freestanding birth centers also can be a solution for communities without a hospital nearby.

The closest hospital to the Colville Indian Reservation, located in northern Washington state, is half an hour away, said Faith Zacherle-Tonasket, founder of the nonprofit xa?xa? Indigenous Birth Justice.

So far, the group has trained nearly a dozen tribal doulas and midwives to serve the area. In the next few years, it plans to open a freestanding birth center. Zacherle-Tonasket said Indigenous-run birth centers are crucial alternatives for tribal women, who also have some of the highest maternal mortality rates in the nation and often face prejudice in clinical settings.

“They don’t feel safe. So a lot of them just don’t get prenatal care,” said Zacherle-Tonasket. “Bringing traditional midwives that are from our own communities, that were born and raised in our communities, that know the families — we know that those babies will be birthed with love.”

Regulatory hurdles

When the Georgia legislature relaxed state health care regulations in 2024, it felt like a long-awaited win for Katie Chubb. A registered nurse and mother of three who’s worked in health and nonprofits, Chubb has spent years trying to open a birth center in Augusta.

The state denied her application to open the center in 2021. Georgia, like many states, requires health care providers to get state approval, called a certificate of need, before they can build a new facility or expand services. Rival providers, like other hospitals, can challenge an application, effectively vetoing their local competition.

That happened in Chubb’s case: Two local hospitals filed letters of opposition against her and refused to say they’d accept emergency transfers from her birth center, another requirement for opening.

Georgia currently has three freestanding birth centers, a fraction of the more than two dozen that operate in neighboring Florida.

“We’re seeing women giving birth in hospital hallways or at home unassisted, because there’s no in-between option like a birth center,” Chubb said. In October, Georgia lost another labor and delivery unit at a rural hospital two hours north of Augusta.

“Women are just left to figure things out.”

In Kentucky, the Republican-controlled legislature passed a bill in March that aimed to clear the way for freestanding birth centers by exempting them from the certificate of need process.

But Republican lawmakers attached a last-minute anti-abortion amendment to the bill, prompting Democratic Gov. Andy Beshear to veto it. The legislature eventually overrode his veto. Midwifery advocates hope the new law will help make it easier to open a birth center in the state.

Georgia legislators similarly revised Georgia’s certificate of need rules in 2024, exempting freestanding birth centers. Chubb, who championed the new law, hoped it would clear the path for herself and others.

But they hit another roadblock. The state still requires birth centers to secure a written agreement with a local hospital to accept transfers of clients in emergencies. Chubb and at least one other prospective birth center owner have been unable to get their local hospitals to sign such transfer agreements.

“We’re still fighting,” Chubb said. “Behind closed doors we’re still working very hard on getting legislation and regulations changed to make opening birth centers more equitable.”

Some hospitals view birth centers as a threat to the viability of their labor and delivery units, siphoning off patients and revenue from a service that’s already unprofitable for most hospitals.

Daniel Grigg, CEO of Wallowa Memorial Hospital, a 25-bed critical access hospital in northeast Oregon, said there aren’t enough births in the area for both hospitals and birth centers.

“When you’ve got a small-volume community like we have, every birth helps the providers keep their skills up and their competency,” he said. “When you’ve got a midwife taking, say, 10 patients out of that pool,” it can have an impact on physicians and hospitals.

Alabama lawsuit

After the Alabama Department of Public Health shut down Skanes’ birth center in 2023, she joined with two other women who had also been attempting to open birth centers in Alabama: Dr. Yashica Robinson, an OB-GYN in North Alabama, and Stephanie Mitchell, a licensed midwife in Alabama’s rural and economically disadvantaged Black Belt region. Together they sued the Alabama Department of Public Health over what they called a de facto ban on birth centers.

The state insisted its tighter regulations would ensure that birth center facilities are safe. The birth center owners said the state’s rules were overly burdensome and clinically unnecessary for the low-risk, nonsurgical births that are attended by midwives. And, they said, the rules prevented more families from accessing care where it’s desperately needed. The state has lost at least three hospital labor and delivery units since 2020.

“Entire swaths of the state are maternity care deserts without access to essential health care,” said Whitney White, a staff attorney with the American Civil Liberties Union, which is representing the birth center owners and their co-plaintiff, the Alabama affiliate of the American College of Nurse-Midwives.

“Hospital labor and delivery units are closing, and pregnant folks are reporting they’re really struggling to access the care they need, struggling to get appointments, struggling to find a provider,” White said.

Last May, an Alabama trial court permanently blocked the state from regulating freestanding birth centers as hospitals. Birth center staff are still overseen by state boards of midwifery and nursing.

All three Alabama centers are now open. But their licensed midwives are delivering babies under a cloud of uncertainty about the future.

The state appealed the ruling in November. The case is ongoing.

Struggles and solutions

Bauer, of the American Association of Birth Centers, said many centers face the same financial barriers. Uncomplicated births at freestanding birth centers cost less than they do at hospitals, but research has shown that insurers, including Medicaid, reimburse centers at lower rates. Some state Medicaid programs don’t cover some of the nonclinical services, such as lactation consultants and doulas, that birth centers may provide. And malpractice premiums are rising.

“We’re volunteering our time, essentially, to keep the birth center open as a service to the community,” said Sarah Simmons, co-owner of Maple Street Birth Center in rural Okanogan County, Washington. The center can’t afford to hire a front-desk staffer or another midwife, Simmons said. She added that on average, the center makes less than a third of what the local hospital makes for providing the same obstetric service.

But there may be solutions to some of these financial problems. For example, the Center for Healthcare Quality and Payment Reform, a national health care policy center, has recommended that health insurance plans, both Medicaid and commercial, pay hospitals and birth centers monthly or quarterly “standby capacity payments” per woman of childbearing age covered by that health plan in the facility’s service area. It also recommends that plans pay a separate delivery fee for each birth.

In 2024, Democratic U.S. senators proposed a bill to allow for a similar payment model.

Standby payments could help freestanding birth centers, especially those that fill gaps in maternity care deserts — but not unless centers receive payments that are comparable to those that hospitals get, said Simmons, whose center serves four sparsely populated counties along with the Colville tribal communities.

“This would be most beneficial to freestanding birth centers if pay parity laws were enforced, so rural freestanding birth centers were paid the same rates for the same services as rural hospitals, ” she said.

State grants also can help, but birth centers say a one-time infusion won’t be enough. In 2024, Washington opened grant applications for distressed hospital labor and delivery units and freestanding birth centers.

Ashley Jones, of True North Birth Center and president of the Washington chapter of the American Association of Birth Centers, said the grant has helped keep their doors open.

Meanwhile, Chubb, the Georgia nurse, recently had to take another job to support her family while her birth center remains in legal limbo.

“I’m just waiting until the government figures out what they’re doing.”

Stateline reporter Anna Claire Vollers can be reached at avollers@stateline.org. Stateline reporter Nada Hassanein can be reached at nhassanein@stateline.org.

©2026 States Newsroom. Visit at stateline.org. Distributed by Tribune Content Agency, LLC.

By JACK BROOK, Associated Press/Report for America

NEW ORLEANS (AP) — Federal immigration officers are pulling out of a Louisiana crackdown and heading to Minneapolis in an abrupt pivot from an operation that drew protests around New Orleans and aimed to make thousands of arrests, according to documents obtained by The Associated Press.

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The shift appeared to signal a wind-down of the Louisiana deployment that was dubbed “Catahoula Crunch” and began in December with the arrival of more than 200 officers. The operation had been expected to last into February and swiftly raised fears in immigrant communities.

The Trump administration has been surging thousands of federal officers to Minnesota under a sweeping new crackdown tied in part to allegations of fraud involving Somali residents. More than 2,000 officers are taking part in what the Department of Homeland Security has called the biggest immigration enforcement operation ever.

The officers in Minneapolis have been met with demonstrations and anger after an ICE officer fatally shot a woman on Wednesday.

Documents obtained by the AP indicated that federal officers stationed in Louisiana were continuing to depart for Minneapolis late this week.

“For the safety of our law enforcement, we do not disclose operational details while they are underway,” DHS said Friday in response to questions about whether the Louisiana deployment was ending in order to send officers to Minnesota.

In December, DHS deployed more than 200 federal officers to New Orleans to carry out a monthslong sweep in and around the city under Border Patrol Cmdr. Gregory Bovino, who was also the face of aggressive operations in Chicago, Los Angeles and Charlotte, North Carolina. Bovino has been seen in Minneapolis this past week.

“Catahoula Crunch” began with a target of 5,000 arrests, the AP first reported. The operation had resulted in about 370 arrests as of Dec. 18, according to DHS.

The operation heavily targeted the Hispanic enclave of Kenner just outside New Orleans, leading immigrant-run businesses to close down to protect customers and out of a fear of harassment.

Documents previously reviewed by AP showed the majority of people arrested in the Louisiana crackdown’s first days lacked criminal records and that authorities tracked online criticism and protests against the deployment.

Republican Louisiana Gov. Jeff Landry welcomed the crackdown. But New Orleans’ Democratic leaders called the 5,000-arrest target unrealistic and criticized videos that showed agents arresting or trying to detain residents, including a clip of a U.S. citizen being chased down the street by masked men near her house.

New Orleans’ Democratic leaders have been more welcoming of a National Guard deployment that President Donald Trump authorized after Landry asked for help fighting crime. The troops arrived just before the New Year’s Day anniversary of a truck attack on Bourbon Street that killed 14 people.

Associated Press writer Rebecca Santana contributed to this report from Minneapolis.

Brook is a corps member for The Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.

MARTIGNY, Switzerland (AP) — Switzerland held a national day of mourning on Friday for the 40 people who died in an Alpine bar fire during a New Year’s Eve celebration, as prosecutors requested one of the managers to be placed in pre-trial detention.

Valais region’s chief prosecutor Beatrice Pilloud said in a statement the detention of the man was needed to avoid a “risk of flight.” The man’s wife and co-manager will remain free under judicial supervision, the statement said.

A Swiss business register lists French couple Jacques and Jessica Moretti as the owners of Le Constellation bar, in the Alpine resort of Crans-Montana, where a fire broke out less than two hours after midnight on Jan. 1. As well as the fatalities, 116 people were injured, many of them seriously.

Local media reported that Moretti was being held in custody pending the court’s decision after the couple were questioned by prosecutors in Sion on Friday morning.

Swiss authorities have opened a criminal investigation into the owners, who are suspected of involuntary homicide, involuntary bodily harm and involuntarily causing a fire.

A memorial service and a minute’s silence marked Friday’s national homage, while church bells across Switzerland rang out for five minutes, beginning at 2 p.m.. Across the country, people gathered to light candles, put down flowers for the victims and followed the national ceremony that was livestreamed on public television.

Speaking at the memorial ceremony in Martigny, Swiss President Guy Parmelin said that “the memory of that terrible night illuminates the faces of the 156 victims, their happy days, their carefree spirit.”

He added: “Our country is appalled by this tragedy. It bows before the memory of those who are no longer with us. It stands by the bedside of those who are about to embark on a long road to recovery.”

Investigators have said they believe sparkling candles atop Champagne bottles ignited the fire when they came too close to the ceiling. Authorities are looking into whether soundproofing material on the ceiling conformed with regulations and whether the candles were permitted for use in the bar. Fire safety inspections hadn’t been carried out since 2019.

The severity of burns made it difficult to identify some victims, requiring families to supply authorities with DNA samples. Police have said many of the victims were in their teens to mid-20s.

An autopsy has been ordered for five of the six Italian victims and has been delegated to the prosecutors’ offices in Milan, Bologna, and Genoa, where the bodies of the victims have been returned.

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“What happened is not a disaster: It’s the result of too many people who didn’t do their job or who thought they were making easy money,” Italian Premier Giorgia Meloni said during a press conference on Friday. “Those responsible must be identified and prosecuted.”

Meloni said the State Attorney General’s Office has contacted the Swiss Attorney General to follow the investigation. She also confirmed that the Rome Prosecutor’s Office has started a separate probe.

“The families have my word that they will not be left alone while they seek justice,” she added.

The Paris prosecutor’s office Monday announced that it was opening a probe to assist the Swiss investigation and make it easier for families of French victims to communicate with Swiss investigators. Nine French citizens were killed, the youngest of them aged 14, and 23 others were injured.

By CLAIRE GALOFARO

The federal officer steps in front of the Honda SUV, parked nearly perpendicular across a one-way residential street in Minneapolis, with snow piled up on the curb.

Within seconds, he would shoot and kill the driver, Renee Good, a 37-year-old mother of three.

Federal officials said the officer acted in self-defense, that the driver of the Honda was engaging in “an act of domestic terrorism” when she pulled forward toward him and that he was lucky to escape alive.

Policing experts say some of the choices the officer made in that moment defy practices nearly every law enforcement agency have followed for decades.

‘A dangerous decision to make’

Videos filmed by bystanders from several angles show the Honda stopped on Portland Avenue just before the shooting. It’s straddling multiple lanes, but not entirely blocking traffic: the driver-side window is open, the driver waving their left arm as if to signal cars to go around. One large SUV drives around the front of the Honda and down the street. Multiple unmarked federal vehicles are idling on the road nearby.

Some bystanders heckle officers: “Go home to Texas,” one woman shouts from the sidewalk. “Why won’t you let your faces be seen?” shouts another. Some blow whistles to alert neighbors immigration agents are in the area, others honk.

A gray four-door Titan truck comes to a stop facing the driver’s side of the Honda. Two officers climb out and approach the Honda. Both officers wear what appear to be wool hats and black masks covering their noses and mouths.

A woman can be heard saying “go around.”

One officer says, “Get out of the car. Out of the car. Get out of the f—ing car.”

The Honda’s reverse lights come on, and it begins to roll slowly backward as one of the officers grabs the driver-side door handle and tries to pull it twice, then puts his arm into the open driver’s window.

A third officer, who had been out of the way on the passenger side of the car then walks around the Honda’s hood, stands just in front of the driver and appears to be holding his phone up like he’s filming.

“Why would he do that? Why would he put himself in a more dangerous position than he was already in?” asked Geoffrey P. Alpert, an expert on policing at the University of South Carolina, who called it “absurd” for an officer to use his body to try to block a 4,000-pound SUV.

Darrel W. Stephens, former chief of the Charlotte-Mecklenburg Police Department, also pointed to this moment as the baffling first step in a series of questionable actions that most police departments have discouraged for years. As a police chief, he prohibited officers from standing in front of cars in the early 1990s.

“I can’t explain why he would stand there and place himself in front of the car,” Stephens said. “That’s a dangerous decision to make.”

‘A 4,000 pound unguided missile’

Homeland Security Secretary Kristi Noem described the incident as an “act of domestic terrorism” carried out against ICE officers by a woman who “attempted to run them over and rammed them with her vehicle. An officer of ours acted quickly and defensively, shot, to protect himself and the people around him.”

President Donald Trump said in a post on Truth Social that the ICE officer shot the driver in self-defense. Trump said based on that video “it is hard to believe he is alive.” He said the driver “viciously ran over the ICE officer.”

But it’s unclear in the videos if the car makes contact with the officer.

The Honda starts to drive forward, its tires turning to the right as the officer stands in front.

“Why doesn’t he step out of the way? Why doesn’t he move?” asked Alpert.

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The officer unholsters his gun. Within a second he shoots into the windshield and then lurches backward away from the car as it turns away from him.

Homeland Security Secretary Kristi Noem has not publicly identified the officer who shot Good. But she spoke of an incident last June in which the same officer was dragged by a fleeing vehicle. Court records from that case identify the officer as Jonathan Ross.

Most police departments long ago prohibited officers from shooting at moving vehicles except for very limited circumstances where there’s no other option to save lives, experts say.

“And the reason is a good one,” said Sharon Fairley, a law professor and criminal justice expert at the University of Chicago. “If the officer is successful at shooting the driver, then you have a motor vehicle, a two-ton vehicle that’s not being directed, and it creates a huge public safety risk.”

The officer shoots a second time. By then, he’s at the side of the car, an arm’s length from the driver-side window. A third shot immediately follows.

None of the other officers draw their weapons.

The officer who fired the shots watches the car careen down the road and re-holsters his gun. The street is quiet for a moment.

Three seconds later, the Honda crashes into a parked car with such force its tires fly off the street, the pile of cars lurches forward several feet and snow billows.

“Thank goodness no one was in the car she hit on the side of the road,” Alpert said, “and fortunately there were no kids playing out there and no one else got hurt.”

Alpert described the car at that point as “a 4,000 pound unguided missile.” People don’t hit the brakes when they’ve been shot, Alpert said.

There were pedestrians on the street. One video shows a woman walking a poodle.

Drops of blood stain the snow

A pedestrian in a flannel shirt runs toward the crash.

The officer who fired the shots walks slowly in that direction. Most of the federal agents remain with the unmarked vehicles.

Drops of blood stain the snow.

None of the agents immediately go to the Honda to render aid; a minute after the crash the pedestrian in the flannel shirt is seen in the video leaning alone into the open driver’s side door. A medic runs toward the crash site.

Bystanders begin screaming.

“Criminals!” shouts a woman. “What did you do?”

A man billows “murderers!” over and over.

Officers order everyone to get back.

One bystander trains her camera on the officer who fired the shots as he walks away from the crash and toward his colleagues at the parked federal vehicles, telling them to call 911. He does not appear injured.

“You,” she screams, “shame, shame.”

He climbs into an SUV as the bystander shouts, “don’t let the murderer leave!”

The SUV drives away.

Fairley, the University of Chicago professor, said the investigation into what happened here will have to examine whether the officer acted reasonably, both in firing his gun and in the moments leading up to it. It can weigh questions like whether the agent put himself in danger by stepping in front of the car, and if along the way there were other choices the officers might have made to avoid a death.

“The question is going to come down to is was the officer reasonable in their belief that the driver presented an imminent threat of death or bodily harm to himself or to someone else,” she said. “That’s really the legal question that has to be answered.”

The car’s license plate, for example, was visible throughout the ordeal.

One alternative, Fairley said, was to have just let her leave, and go arrest her later.