The morning after the leak of a U.S. Supreme Court draft opinion on Roe v. Wade, Dr. Yashica Robinson woke up, opened her eyes and decided she wasn’t going to talk to any reporters that day.
Robinson, a board-certified OBGYN who also runs one of Alabama’s three clinics that provide abortions, just didn’t have it in her to give one more interview about what it would mean for her patients to have their right to an abortion stripped away. It didn’t feel like anybody was truly listening anymore.
When she got to her office, the calls started coming in. Her assistant at the front desk offered to reroute them to voicemail.
But Robinson’s highly visible role as one of a handful of abortion providers in a heavily pro-life state weighed on her. “I thought about other people who care about this issue who may not be getting calls, who may not have that platform to make a statement,” she told Reckon. “Then I felt like I have to speak, that it’s my responsibility to do it.”
That sense of responsibility has, in the past two years, driven Robinson toward a new battle.
In the middle of a national uproar over abortion rights, one of Alabama’s few abortion providers has also quietly been fighting for reproductive choice on a different front: She wants to open the state’s first midwife-staffed birth center.
Robinson, who runs a busy OBGYN practice in Huntsville, Ala., has been working since 2020 to make the birth center happen, fighting a lawsuit and labyrinthine state regulations not designed to offer birthing choice to Alabama parents.
She’s used what she’s learned advocating for abortion access to help her push for expanding birthing options, particularly for her low-income patients.
“These are my people,” said Robinson, who chose to go into medicine after her own birth experience as a teen. “If I don’t take care of my own people, if I don’t have enough compassion and desire to make sure their care is equitable and that they get quality care, who else is going to do it?”
The Alabama Birth Center opened in Huntsville, Ala., early this year for clinic visits and classes. Robinson hopes that, after jumping over a few more regulatory hurdles, her center’s midwife will be delivering babies at the center by the end of the year – a first for Alabama.
Changing the narrative
Alabama legalized out-of-hospital midwives just a few years ago. Unlike most other states, it has no birth centers and is home to fewer than 50 midwives. About half of those can legally attend low-risk births outside of hospitals.
In a poor state like Alabama, Medicaid pays for about half of all births but it does not cover out-of-hospital midwifery care.
The relative scarcity of midwives and lack of insurance coverage for their care means that for most Alabama parents, the only option for giving birth is at a hospital, attended by a doctor.
That lack of choice didn’t sit well with Robinson. An Alabama native, she knows the statistics: Alabama has historically high rates of maternal and infant mortality, more than half of its counties lack a hospital with obstetrical services and stark health disparities mean Black women are nearly three times as likely to die from pregnancy-related causes as white women.
She’s spoken about those statistics before Congress, using them to illustrate the importance of access to a full spectrum of reproductive healthcare, including abortions. To Robinson, Alabama’s abysmal pregnancy and birth outcomes are a compelling argument for offering more birth choices.
Until a few years ago, she’d never worked with midwives or doulas. But she said she began hearing from patients who wanted the kind of diverse maternity care options available in other states.
“I found people are really looking for care that is more supportive, more family-centered, where there’s a lot more shared decision-making than the way I was taught,” she said. “If we educate our patients, they want to be able to participate in their care, to take some of the power back.”
Robinson said patients came to her practice asking if she would allow them to do things like walk around during labor, or labor in specific positions – practices that sometimes aren’t allowed by doctors or hospitals, but which she said are reasonable requests.
“As I talked to patients, I realized there was almost this attitude that the patients and the providers were on two different teams,” she said. “It felt really important to change that.”
In her mind, a birth center would offer those with low-risk pregnancies another choice for where and with whom they had their babies.
But the road to offering that choice has been filled with potholes.
After she found an office complex with space for her birth center, another tenant took her to court, disputing that she had the right to purchase the space. As an abortion provider, Robinson is no stranger to legal battles.
The Alabama Women’s Clinic, where she provides abortion care, has been the target of lawsuits related to the state’s abortion laws. After Gov. Kay Ivey signed into law a near total abortion ban in 2019, Robinson joined with the ACLU of Alabama and other organizations to block the bill from going into effect. They were ultimately successful, but the law could go into effect if the U.S. Supreme Court overturns Roe. She also went to court to keep the state from restricting access to abortions during the outset of the COVID-19 pandemic under a vague state health order banning non-emergency medical and surgical procedures.
Those experiences prepared her to navigate uncharted regulatory waters with the birth center. Because Alabama doesn’t have birth centers, there’s no existing licensing framework for what kind of permits a birth center needs to be open. A midwife in rural southwest Alabama is also trying to open a birth center, but faces some of the same regulatory hurdles.
In Robinson’s experience, the state leaves no room for paperwork errors when it comes to reproductive choices.
“With me providing abortion care (at the other clinic), I knew we can’t just open the birth center now and ask forgiveness later,” Robinson said. “So we’re working with attorneys right now.”
Choosing your service
She’s taking steps to become accredited through the American Association of Birth Centers, a standard followed by other states that license birth centers. She hopes Alabama will eventually adopt those guidelines.
If the birth center isn’t licensed – Alabama doesn’t currently have a process for licensing birth centers – she said she’ll be unlikely to negotiate contracts with health insurance companies to pay for births for her patients. And Alabama Medicaid, which pays for pregnancy and birth care for low-income people and covers about half of all births in the state, does not cover out-of-hospital midwifery care. That could take midwifery care and birth center births out of reach for many of her patients.
Robinson has a workaround for that, modeled on stop-gap solutions she’s used to help patients afford abortion care.
“Much in the way women are able to (pay for) abortions using private donations, we’ll have funding from private donors” that patients can apply to receive to pay for a birth center birth, she said.
Eventually, Robinson hopes to hire more midwives to staff the birth center and attend low-risk deliveries, as she continues to see patients at her clinic and deliver babies in the hospital.
“I think a lot of physicians see (a midwife-staffed birth center) as competition, like it’s going to take away from their practice, but I don’t see it that way,” she said. “If you’re really here to be a person of service, then you don’t do that by pigeonholing people so that they have no option but to choose your service.”
The day of the Supreme Court opinion leak, Robinson had finished a surgery and was sitting with her colleague, Dr. Sanithia Williams. Williams asked what Robinson’s plan would be if Roe were overturned.
“We’ve been talking about this possibility for a couple of years now because they’re constantly chipping away at access to care,” she said. “But even though we’ve been trying to do some contingency planning, we didn’t expect it would be so severe, so quickly.
“I can’t say I feel like I’ve wrapped my hands around it. I’m still holding out hope there’s going to be something, a Hail Mary at the last minute. But, for now, I’m focused on what I know and how my work impacts the people I care for.”