Iowa
Midwives’ lawsuit challenging Iowa certificate-of-need law can continue, judge says
A pair of central Iowa midwives fighting for the right to build a stand-alone birthing center can continue their lawsuit against the state, a federal court ruled Wednesday.
Caitlin Hainley and Emily Zambrano-Andrews, who together make up the Des Moines Midwife Collective, are challenging a state law requiring any new medical facility obtain a “certificate of need” from regulators. That involves, among other expensive and time-consuming steps, giving any potential competitor notice of the proposal and the opportunity to argue why the new facility is not truly needed.
Hainley and Zambrano-Andrews, who currently provide home birth services throughout the Des Moines metro, want to open a birth center with tubs and other equipment so patients can give birth in a home-like setting. Their attorneys say that midwife service, whether at home or a birth center, is fundamentally different than that provided by hospital maternity wards. Their lawsuit, filed in February 2023, argues it is unconstitutional for the state to grant what amounts to a “competitor’s veto” to established businesses.
The state filed to dismiss the lawsuit. Wednesday’s ruling, by Chief District Judge Stephanie Rose, largely denies that motion. But Rose did rule the certificate of need law does not infringe on any “fundamental right” under the U.S. Constitution, meaning it will be easier for the state to prove its law is constitutional.
From 2023: MercyOne Des Moines to shut down its midwives program. What that means for pregnant moms:
The Iowa Attorney General’s Office did not respond to a message seeking comment. Wilson Freeman, an attorney with the libertarian-leaning Pacific Legal Foundation who is representing the midwives, said in an email they believe they will prevail even if the court does not agree the law infringes on their fundamental rights.
Strict scrutiny or rational basis?
Any law that burdens what courts consider to be a fundamental right — such as freedom of speech, the right to marry and have children, and more — must survive what is known as strict scrutiny, meaning it must be found to be “narrowly tailored” to serve a “compelling” government interest.
If a law does not implicate a fundamental right, courts instead apply what is known as rational basis review, meaning the law must only be “rationally related” to a “legitimate” government interest.
In this case, the midwives argued the certificate of need law violated multiple fundamental rights, including the right of mothers to choose their place and manner of giving birth and the right of the plaintiffs to earn their living. But the judge rejected those claims, finding other courts have declined to make birth setting a fundamental right and noting the U.S. Supreme Court’s “unmistakable resistance” to recognizing additional rights as fundamental.
Case can continue, judge rules
Attorneys for the state had asked for the case to be dismissed entirely, but Rose refused, finding the plaintiffs have “plausibly” argued the certificate of need law might fail even under rational basis review.
Among other arguments, Rose noted that the midwives raise the question of why they are allowed to provide home births without a certificate of need, but do need a certificate to provide the same service in a centralized location. Such a distinction does not improve the cost, availability or quality of maternal care, the women argue. Rose wrote the women have asserted a “plausible claim for relief” that the law lacks a rational basis, and agreed the lawsuit should continue.
Previously: Iowa finally passed a law to license midwives. Will it help sway medical field doubters?
Freeman, representing the midwives, told the Register they’re prepared to fight that fight.
“There is no rational reason for the state to require a certificate of need for midwives who want to help women give birth in a dedicated facility, while allowing midwives to attend births literally anywhere else without such a certificate, Freeman said. “While we continue to believe a fundamental right is implicated by the regulation, the law is unconstitutional under either standard.”
And although rational basis review is favorable to the state, similar laws have failed that test before, Freeman said. A Kentucky law requiring a certificate of need for moving companies was struck down under rational basis in 2014.
The case currently is scheduled for a bench trial before Rose in January 2025.
William Morris covers courts for the Des Moines Register. He can be contacted at wrmorris2@registermedia.com or 715-573-8166.
Here are the candidates for High School on SI’s Iowa high school athlete of the week for April 13-18. Read through the nominees and cast your vote.
Voting closes at 11:59 p.m. PT on Sunday, April 26. The winner will be announced in the following week’s poll. Here are this week’s nominees:
Taylor Roose, Pella boys track and field
Roose competed in three events at the Norwalk Invitational, winning all three in the 100-meter dash, 200-meter dash and long jump.
Daxon Kiesau, Urbandale boys track and field
Kiesau swept the throwing events at the Norwalk Invitational, taking first place in the shot put and the discus.
Alex Burger, Southeast Valley boys track and field
Competing at home, Burger dominated, earning four gold medals. He won the 400-meter hurdles and the long jump while running on the winning 4×200-meter relay and shuttle hurdle relay.
Kolby Hodnefield, Clear Lake boys track and field
Hodenfield, a defending state champion, broke the meet, venue and school record in the 200 and the 400 at the Clear Lake Invitational. He added victories as part of the 4×100 and 4×400 relays. Both relays also set meet records.
Easton Moon, North Polk boys tennis
Moon has started off his senior season on the courts unbeaten, winning all four matches while dropping just one game in 44 played.
Ava Lohrbach, Gilbert girls golf
One of the top golfers in the state, Lohrbach has had a hot start, firing a 35 in her nine-hole debut and a 72 for her 18-hole opener.
Nathan Manske, Algona boys golf
An elite quarterback and basketball player, Manske is showing his golfing skills this spring, coming out with a state-low 30 in a nine-hole event.
Ella Hein, Tipton girls track and field
Hein set school records in the 400-meter run and long jump at the Tiger/Tigerette Relays while also locking in the Blue Standard and qualifying for the Drake Relays. She won the long jump (18-6) and was second in the 400.
Maeve Bowen-Burt, Iowa City High girls track and field
The sophomore helped the Little Hawks land three Drake Relays events on the last night of qualifying, advancing in the 400 hurdles, along with the sprint medley and 4×400 relays.
About Our Athlete of the Week Voting
High School on SI voting polls are meant to be a fun, lighthearted way for fans to show support for their favorite athletes and teams. Our goal is to celebrate all of the players featured, regardless of the vote totals. Sometimes one athlete will receive a very large number of votes — even thousands — and that’s okay! The polls are open to everyone and are simply a way to build excitement and community around high school sports. Unless we specifically announce otherwise, there are no prizes or official awards for winning. The real purpose is to highlight the great performances of every athlete included in the poll.
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The late boxing great George Foreman lies buried in a cemetery in the northwestern corner of Iowa – a place he has no connection to outside of a lone visit to the region nearly 40 years ago.
Foreman died March 21, 2025, at the age of 76 in Houston and was buried in Logan Park Cemetery at Sioux City, Iowa, a month later, city officials confirmed. Foreman’s family returned Thursday to his burial site, holding a news conference with Sioux City Mayor Bob Scott to reveal Foreman’s burial place, marked by a large monument that bears an image of him as a teen following his Olympic gold medal boxing win.
The family explained in a statement released by Sioux City officials that he had visited the Iowa city in 1988, and often recalled the sense of peace he experienced there.
After traveling to the city on April 17 last year to bury Foreman, his family said they immediately understood the region’s appeal.
“Our father lived a life of purpose, faith and gratitude,” the family said in a statement released by Sioux City officials. “To see him laid to rest in a place that brought him peace means everything to us.”
Scott joined the family at Foreman’s monument that lies just a few miles north of the Missouri River in an upper Midwest city of nearly 87,000 people. The cemetery overlooks the scenic Loess Hills, created by windblown silt deposits that reach up to 200 feet high (about 61 meters) and line the river along the Iowa border for 200 miles (322 kilometers).
“Their story is a reminder of how one place can stay with someone for a lifetime,” Scott said.
A native Texan, Foreman rose to fame when he made the 1968 U.S. Olympic boxing team, winning gold in Mexico City. He became the heavyweight champion of the world in 1973 by defeating the great Joe Frazier, only to lose the title a year later to Muhammad Ali in the famous “Rumble in the Jungle.”
A full 20 years later in 1994, Foreman became the oldest man to win the heavyweight championship at 45, defeating Michael Moorer in an epic upset.
Foreman retired in 1997 with a 76-5 career record.
He then moved on to the next chapter in his life as a businessman, pitchman and occasional actor, becoming known to a new generation as the face of the George Foreman Grill. The simple cooking machine sold more than 100 million units and brought him more wealth than boxing.
A biographical movie based on Foreman’s life was released in 2023.
Copyright © 2026 by The Associated Press. All Rights Reserved.
DUBUQUE, Iowa (KCRG) — About 50 Iowans braved the threat of severe storms to hear from Republican candidate for governor Zach Lahn at his town hall in Dubuque Friday night.
Lahn, a farmer and businessman, said his campaign is about solving the long-term systemic issues facing Iowans.
One priority is addressing what Lahn calls a cancer crisis in Iowa, as the state has the second-highest cancer rate in the country. Solving the crisis means ensuring Iowans have access to clean, nitrate-free drinking water, working with farmers to reduce agricultural runoff.
“Iowans are just ready for something that they should be able to count on, like clean drinking water,” Lahn said. “We have ways to clean up the drinking water in Iowa that isn’t on the backs of farmers, but is working alongside with them because they’re drinking the water too, and they want to do what’s right.”
Lahn also wants to stop Iowa’s “brain drain,” as more of Iowa’s college graduates left the state for opportunities elsewhere.
“Don’t leave! Give me some time! I’m going to fight to keep you here,” Lahn said. “I was one of these kids. I thought I had to leave the state to find something better. We have to prioritize Iowa’s incentive dollars to make sure they’re going to grow Iowa businesses that are going to be here for the long haul, so our kids have places to work.”
Running a distinct campaign feels challenging this election, as Lahn is one of five GOP candidates who want to be Iowa’s next governor, facing U.S. Rep. Randy Feenstra, former Department of Administrative Services Director Adam Steen, state Rep. Eddie Andrews and former state Rep. Brad Sherman.
Iowa Auditor Rob Sand is the only Democrat running for the state’s top office.
Lahn said he stands out by promising Iowa will be for Iowans, pledging to ban the use of eminent domain for private gain and tax out-of-state landowners and data centers at higher rates to lower property taxes.
“It always goes back to follow the money, so when it comes to not being a weak-kneed Republican today, I believe the paramount piece of that is answering only to the citizens of Iowa, not to special interests to pad their bottom line, but what’s best for the people of Iowa,” Lahn said.
Copyright 2026 KCRG. All rights reserved.
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