Colorado’s long-running tug-of-war over who gets to deliver babies has moved into a courtroom, with a group of direct-entry midwives accusing state regulators of using a heavy hand that is driving providers out of practice and shrinking options for out-of-hospital births.
In a class-action lawsuit filed in early May, the midwives say the Department of Regulatory Agencies relies on long investigations, summary suspensions, and an opaque complaint system that has sidelined practitioners and left some rural communities with almost no local birthing providers. The case names the Division of Professions and Occupations and its program director and asks a judge to order changes to how midwifery complaints are handled.
What the suit says
According to Aspen Public Radio, the complaint alleges that regulators show bias and engage in sex-based discrimination, and it asks the court to certify the case as a class action that would cover midwives across Colorado. Plaintiffs and their attorney, Indra Lusero of the Denver organization Elephant Circle, say the enforcement system feels punitive rather than restorative and often leaves midwives financially and professionally exposed while they wait for answers.
The suit names specific midwives who say they were pushed out of work and calls for a range of reforms, from faster investigations to different oversight structures altogether. In their telling, the state’s safety system functions less like a guardrail and more like a trap door.
Records show disparate enforcement
Public records obtained through a Colorado Open Records Act request and reported by The Colorado Sun show that midwives are far more likely than other providers to be pulled off the job while a complaint is investigated.
The Sun found that interim cessation agreements, which are orders that bar a midwife from practicing during an investigation, appeared in 14% of midwifery complaints between 2015 and 2025. For comparison, the rate was 2% for physicians and 6% for nurses over the same period. The outlet also reported that complaints against direct-entry midwives tend to stay open much longer than those involving other professions, which plaintiffs say effectively removes them from the workforce while cases drag on.
Those numbers form a central plank of the lawsuit’s argument that the complaints process is being applied unequally and that the supposed neutral rules hit midwives much harder than their colleagues.
How Colorado’s rules work
Under state law, oversight of direct-entry midwives sits inside the Department of Regulatory Agencies’ Division of Professions and Occupations. Instead of a professional license board, a single program director oversees the field, according to official legislative materials.
The structure and a set of recent changes are laid out on the legislature’s SB21‑101 page, which details the director’s authority and the statutory framework for certified professional midwives. Separate legislation approved this year ordered studies of perinatal care closures and set timelines for reporting, work that is expected to feed into broader rulemaking and oversight debates around the state.
How organizers are responding
While the lawyers handle the court filings, organizers are trying to rewrite the playbook behind the scenes. Elephant Circle, the Denver-based birth-justice group supporting the plaintiffs, has launched a Midwifery Task Force that aims to push for rule changes, help midwives serve as expert reviewers, and pursue policy fixes such as Medicaid reimbursement for community births, according to the organization’s website.
The task force also says it is pressing for clearer complaint procedures and for permission to carry medications that reflect current standards of care for community birth. Organizers describe the lawsuit as both a legal strategy and a community organizing tool intended to force systemic change, not just win relief for a handful of midwives.
What the data show
The stakes extend well beyond professional turf. The state’s Maternal Mortality Review Committee reported 174 pregnancy-associated deaths in Colorado between 2016 and 2020 and found that about 90% of those deaths were preventable, according to materials on the Colorado Department of Public Health and Environment’s website.
Advocates say those numbers, combined with persistent racial disparities and the loss of local obstetrics services, make access to skilled community-based providers increasingly important for rural and underserved counties. They argue that, between provider shortages and several hospital service closures, restrictive enforcement of midwifery rules only adds fuel to an existing access crisis.
Regulators’ response and what’s next
In a statement to reporters covered by The Colorado Sun, the Department of Regulatory Agencies said that over the past five years, the Office of Direct-Entry Midwifery Registration has issued one suspension, eight final disciplinary actions, and dismissed five cases. The agency said that investigative timelines vary based on the complexity of each case.
The Sun also reported on a May 5 rally at Civic Center Plaza, where more than 50 midwives and supporters protested the division’s rules and enforcement practices. One of the plaintiffs, Kalie Caler, has been barred from practice since a 2022 complaint and is scheduled for an administrative hearing in July, according to the outlet.
DORA told the Sun that it has amended midwifery rules repeatedly to keep up with current practice and that the agency remains committed to evidence-based oversight, even as critics say the numbers tell a different story.
Legal and policy stakes
The lawsuit seeks declaratory and injunctive relief and directly challenges the way complaints are handled, arguing that the process is discriminatory and unlawful in its effect. Plaintiffs are pursuing class status and broader systemic reform, not just individual case reversals.
At the same time, lawmakers this session passed measures that require new studies and reporting on the state’s maternal health infrastructure and on facility closures. That includes provisions in HB24‑1262 that direct state agencies to analyze perinatal service gaps and send their findings back to the legislature.
With a statutory review and rulemaking process now underway, the lawsuit could end up shaping not only the careers of a few midwives but also the future of how Colorado regulates and supports community birth options statewide.
