Two longtime midwives are suing Iowa over a state law that they say unconstitutionally discriminates against their profession, preventing them from opening a freestanding birth center that would compete against local hospitals.

The midwives claim that the state’s certificate of need (CON) process is unconstitutional and gives established businesses, particularly hospitals, a so-called competitor’s veto preventing them from opening a proper care facility. At present, they use their clients’ own homes or other locations pre-arranged by clients, including hotel rooms, short-term rentals, or friends’ houses for childbirths.

Critics point out that midwives are ill-suited to handle high-risk pregnancies or serious complications that may take place during childbirth. If things go wrong, the patient will have to seek emergency care from a health care provider with whom she may not be familiar.

But birth centers are popular among women with low-risk pregnancies. They’re generally small businesses or nonprofits run by certified nurse midwives, providing pre-pregnancy, pregnancy, and postpartum care. The centers compete with hospitals and have lower costs, greater autonomy, and a home-like atmosphere; are compatible with personal or religious values; and are a safe option for both mother and child, according to Pacific Legal Foundation (PLF), a national public interest law firm that’s representing the midwives.

Home birth is a lawful option in all 50 states, but in Iowa, anyone wishing to open a birth center must first go through a complex, lengthy, and expensive CON process to demonstrate that it’s needed in the community.

Prospective birth centers also require permission from their direct competitors, the most important of which are hospitals.

Certified nurse midwives Emily Zambrano-Andrews and Caitlin Hainley run a home birth practice called the Des Moines Midwife Collective that allows women to give birth safely and comfortably outside of a hospital setting. Both attended Frontier Nursing University, became doctors of nursing practice, and attained full licensure as certified nurse midwives.

The Midwife Collective is Des Moines’s only home birth service that’s insured and accepts insurance, including Medicaid, which allows it to charge out-of-pocket rates as low as $1,500. By contrast, the only physical birth center in the state charges upward of $10,000, according to PLF.

Several studies have shown that CON laws don’t increase the quality of patient care or the availability of health services and simply force the public to pay more for childbirth services than they would in a state without a CON law, according to the petition filed with the court.

The two women have been delivering babies as certified nurse midwives for almost 10 years together and want to open a modest two- to five-bed center, PLF attorney Jim Manley told The Epoch Times in an interview.

But the state of Iowa’s CON process is “very expensive” and “takes many months,” he said.

“What has happened in the past is hospitals who feel like birth centers are potential competitors have opposed certificates of need for birth centers and prevented pretty much anyone from opening,” Manley said.

“There has only been one freestanding birth center in Iowa, and it recently closed. So currently, Iowa has no freestanding birth centers, in large part because of this certificate of need requirement that allows competitors to veto new entrants into the market.”

The law violates the U.S. Constitution and the Iowa Constitution, which is “very protective of the right to pursue one’s lawful calling,” according to the lawyer.

The petition (pdf) in Des Moines Midwife Collective v. Iowa Health Facilities Council, was filed on Jan. 12 in the Iowa District Court for Polk County. The council is a five-member body appointed by the governor and confirmed by the Iowa Senate. Members serve six-year terms. The state provides administrative support for the council.

“Right now, if someone wants to have a home birth but doesn’t live in the Des Moines area, what they do is they rent an Airbnb [residence] or a hotel room and give birth there and that’s perfectly legal under Iowa law, but it’s not ideal,” Manley said.

“What would be ideal is for these expectant mothers to have the option to go to a birth center, which will ultimately just be a house that has been converted to have the very few amenities that a midwife needs to facilitate natural childbirth. But the state prohibits that in order to protect Iowa hospitals from competition.”

The Epoch Times reached out to the Iowa Department of Health and Human Services for comment. Spokesperson Sarah Ekstrand said by email that the department “does not comment on pending litigation.”


Matthew Vadum is an award-winning investigative journalist and a recognized expert in left-wing activism.

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