Last month, the parents of a 7-year-old girl whose nose wouldn’t stop bleeding took her to Portland Adventist Health in Portland, Oregon, for urgent care. Before the family could get through the doors, federal immigration agents reportedly detained them in the parking lot and took them to a detention center in Texas.

At Hennepin County Medical Center in Minneapolis, workers say U.S. Immigration and Customs Enforcement officers hang around the campus, asking patients and employees for proof of citizenship. Last month, tensions came to a head when ICE agents used handcuffs to shackle a 31-year-old Mexican immigrant to his hospital bed. ICE claimed the man, who had broken bones in his face and a fractured skull, had run headfirst into a wall on purpose while handcuffed and trying to flee.

And last summer, ICE agents chased an immigrant into the Ontario Advanced Surgery Center in Ontario, California, precipitating a confrontation with two surgery center workers wearing scrubs. The two workers were later indicted by a federal grand jury, charged with assaulting and interfering with federal immigration officers.

As the Trump administration intensifies its immigration crackdown, health care workers in multiple states say ICE is increasing its presence in health care facilities, deterring people from seeking medical care and creating chaos that jeopardizes the safety of their patients.

Even before Trump took office last year, Republican-led states such as Florida and Texas began mixing health care and immigration enforcement by requiring hospitals to ask patients about their immigration status. Now that ICE has extended its enforcement activities to hospitals and health care facilities — areas that were largely off-limits during the Biden administration — an increasing number of Democratic-led states are pushing back.

Last month, Massachusetts Democratic Gov. Maura Healey filed legislation “to keep ICE out of courthouses, schools, child care programs, hospitals and churches,” and signed an executive order to limit ICE actions on state-owned property.

In December, Illinois Democratic Gov. JB Pritzker signed a measure that bars health care providers from sharing sensitive health information with federal immigration agents and requires hospitals to develop policies around how they will interact with agents.

And in September, California Democratic Gov. Gavin Newsom signed legislation that makes immigration status and place of birth protected health information, and prohibits agents from entering nonpublic, patient-sensitive areas of health care facilities without a warrant signed by a judge.

Other Democratic states — including Maine, New Jersey, New York, Oregon and Washington — are considering similar bills.

Meanwhile, Republican lawmakers in Arizona are pushing legislation that would require hospitals accepting Medicaid patients to include a question on intake forms about immigration status.

Skipping medical care

Whether or not ICE presence is actually increasing at health care facilities, it’s clear that people living in the country illegally are being deterred from seeking medical care, said Drishti Pillai, director of immigrant health policy at the health policy research group KFF.

A KFF and New York Times survey released last November showed that 43% of respondents identifying as immigrant parents living in the country illegally skipped or delayed health care for their children over a 12-month period because they were concerned about immigration enforcement. Even among lawfully present immigrants,10% said that they avoided seeking medical care for their children due to immigration-related concerns.

Pillai also pointed to the Trump administration’s efforts to consolidate the bits of personal data held across federal agencies, creating a single trove of information on people who live in the United States.

“We are expecting that these fears have further been exacerbated this year since the data sharing agreement was made public, and there are certain concerns around privacy of data going forward,” Pillai told Stateline.

Dr. Paula Latortue, an OB-GYN in Washington, D.C., who volunteers with the Migrant Clinicians Network, a nonprofit group that provides health care to immigrants, said it’s unclear how many people are avoiding health care, and how often.

“The one part that is really hard to know is people who are not showing up to the hospital when they usually would for some sort of urgent or emergency complaint,” Latortue said in an interview. “But I think there’s a concern for many physicians in the community that has happened.”

States step in to protect sensitive locations

The Biden and Obama administrations directed ICE to avoid enforcement activities in “sensitive” places such as hospitals, schools and churches unless it received permission from top leaders at the U.S. Department of Homeland Security.

In January 2025, however, the Trump administration rescinded those guidelines, opening up these spaces to immigration enforcement.

Stateline reached out to the White House and the Department of Homeland Security multiple times but did not receive a response. When the administration changed the guidelines, the Department of Homeland Security said that opening up “sensitive” areas to agents “empowers the brave men and women in CBP [Customs and Border Protection] and ICE to enforce our immigration laws.”

The previous guidelines didn’t prohibit ICE from operating in those locations, but it did “strongly discourage” them, according to Sophia Genovese, a legal fellow specializing in immigration law at Georgetown University.

She added, however, that states and cities can enact laws to protect such spaces, even though they are limited in their capacity to “infringe and engage in immigration lawmaking.”

“Warrants are always needed to conduct searches or investigations in private, nonpublic areas, and these warrants need to be signed by a judge. This is just a basic Fourth Amendment right,” Genovese said. “When it comes to ICE entering hospitals and gaining access to private areas of hospitals, that’s an issue of individual hospital policy.”

Genovese said states also can require that hospitals standardize their policies on where law enforcement agents can go within a medical facility and create protocols to ensure agents are presenting a warrant before entering the premises.

Health care workers want protections

Those moves are exactly what health care workers in many states are asking for.

“There’s a high level of fear and anxiety. Nurses see the videos of what’s happening around the country, and nurses have experienced it themselves,” Peter Starzynski, spokesperson for the Oregon Nurses Association, told Stateline.

Last month’s incident involving the 7-year-old girl and her parents in Portland highlighted the importance of protecting health care spaces from ICE, he said.

“That should never happen. That’s disgusting,” Starzynski said.

The Oregon Nurses Association also has condemned ICE’s presence at Legacy Emanuel Medical Center in Portland, claiming agents are violating hospital policies, including on access to patients. Legacy has disputed the union’s allegations, saying that no ICE officers have entered its facilities “unless accompanying a patient in custody.”

“Nurses in emergency rooms deal with local law enforcement on a regular basis, and those relationships are built on mutual respect, where law enforcement understands what they need to do once they enter a hospital,” Starzynski said. “That has changed with the increase in federal agents in Oregon.”

Stateline reporter Shalina Chatlani can be reached at schatlani@stateline.org.

Sarah Simmons, a midwife and co-owner of Maple Street Birth Center in rural Okanogan County, Wash., holds a newborn. Freestanding birth centers can address maternal health inequities, but many are facing mounting financial and regulatory pressures. (Photo courtesy of Sarah Simmons)

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.

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.