Labor of Love: One Woman’s Fight to Give Women More Birth Options

Katie Chubb’s baby gestated for nine months. But her proposed birth center has been gestating for six years—and there’s still no date on when the doors will open. Her attempts to serve the mothers of Augusta, Georgia have been blocked by local hospitals. In many states, laws and licensing requirements allow massive hospital networks to strangle competitors in the cradle. 

Chubb became interested in birth centers when she delivered her son in a center in Atlanta. She and her husband had to travel 2.5 hours from home in the middle of labor, but it was worth it to her. Birth centers exist in a middle ground between homebirths and hospitals. Women may have more flexibility to move around during labor or deliver in a tub than they would at a hospital. They also are usually attended by midwives who can provide much of the medical support a woman might receive at a hospital. If a mother’s conditions require more interventions, she transfers during labor to a hospital. 

Birth Centers: Empowering Women

As Chubb envisioned it, her birth center would offer women education, empowerment, and a path to patient autonomy. She had worked as a nurse, and this would be her chance to care for her patients as they ought to be. Chubb believed her birth center would be a particular service to Augusta’s low-income, Black mothers. The birth center would gather mothers with similar due dates to learn about labor and what interventions they’re allowed to decline. Birth centers have lower C-section rates, even when adjusted for the women risked out, helping mothers lower their chances of receiving an unnecessary C-section. 

Unfortunately for Chubb and the mothers she hopes to serve, local hospitals were able to veto her plans using Georgia’s Certificate of Need (CON) laws, which keep new medical providers from entering the market unless they can prove they serve a need that existing providers are neglecting. Nine states plus Washington D.C. make birth centers obtain a Certificate of Need to operate, putting them at the mercy of local hospitals. 

When Chubb submitted her application for a Certificate of Need, she knew she could clear two hurdles: 1) Are you going to serve a neglected population? (yes) and 2) Are you a more cost-effective option (yes). But to be awarded a Certificate of Need, Chubb needed one last thing—a transfer agreement with a local hospital. 

She got an agreement from one local hospital, but the day she filed her application, they pulled out, instantly mooting her chances. She recruited a local Maternal Fetal Medicine doctor to sign an agreement, hoping that, since the doctor’s partner had admitting privileges at three local hospitals, it would allow her access. But Georgia rejected her application and then rejected her request for a rule waiver. She persuaded another hospital to grant her a transfer agreement, but that hospital also pulled out the day she submitted her application.

A Legal Battle

Chubb sued, represented by the Pacific Legal Foundation. As her case played out, the attention she received helped spur her state to revise its CON law to modify the expectations for birth centers. Georgia became one of six states to loosen CON burdens for birth centers between 2023 and 2025. However, Chubb’s center is still failing to progress. 

Georgia no longer requires a Certificate of Need, but it’s still requiring birth centers to get a hospital to agree to a transfer agreement or an admissions agreement, and she’s still being stonewalled. Georgia’s revised rules now require birth centers to partner with a hospital with a Level 3 NICU, while their old rules allowed hospitals with the more common Level 2 NICUs. That makes birth centers impossible to open in many rural counties of Georgia. Even if Chubb could secure an agreement, a hospital could unilaterally withdraw at any time, shutting her down. 

The requirement for a transfer agreement remains baffling to her—mothers don’t need a transfer agreement to be admitted to any hospital when they’re in labor. The federal EMTALA (Emergency Medical Treatment & Labor Act) law specifically requires that hospitals stabilize any pregnant mother who needs care, regardless of her insurance status or ability to pay. Women in Georgia who attempt legally grey homebirths are free to receive emergency medical care at a hospital, no transfer agreement required. 

In the absence of her birth center, Chubb worries that’s a risk that more mothers who do not want to give birth in a hospital will take. As she shared with me, local women have told her, “Because they can’t get the support of having a birth center, they feel a homebirth or free birthing is their only option.” 

Chubb plans to keep on fighting, even if she can’t serve these moms. She says she has been blacklisted as a nurse by the same local hospitals who also blacklisted her birth center, so she’s doubling down on patient advocacy. “I think it’s going to be a 10-year fight,” she told me, “that’s when hospitals start to back down.” 

However many years it takes, she knows what she is fighting for. When her doors finally open, she and her team will be able to deliver an estimated 30 to 40 babies a month. It might be a long time before that first baby knows how much her mother (and Chubb) labored to welcome him or her into the light—but what a gift to give more low-income mothers additional birthing options. 

Leah Libresco Sargeant is the author of The Dignity of Dependence, and Building the Benedict Option, and runs Other Feminisms, a substack community. 

Editor's Note: The opinions expressed in this article are those of the author and do not necessarily reflect the official policy or views of the Institute for Family Studies.