(CN) - A panel of the Eighth Circuit Court of Appeals has upheld a lower court's decision to dismiss a challenge to Nebraska's Certified Nurse Midwifery Practice Act.

The ruling on Friday comes after a midwife claimed the statute violated the 14th Amendment of the U.S. Constitution.

Heather Swanson - a resident of Long Pine, Nebraska, and an associate professor of nursing with a doctoral degree in nursing practice - sued over the law last year. She said the statute, which dates to 1984, violated numerous protections in the amendment, including due process and equal protection.

In her complaint, from April 2024, Swanson pointed to a shortage of doctors in rural areas of Nebraska - as well as what she said was those doctor's unwillingness to enter agreements with people they consider competitors. Swanson argued she was able to provide safe childbirth services for women wishing to give birth at home. She said she wanted to vindicate not only her rights as a midwife but also "the rights of the mothers she wishes to serve."

The state sought dismissal, arguing Swanson didn't have standing and that the state had a rational basis to regulate births - the health of the mother and child. A federal judge agreed, dismissing her case last year.

Swanson appealed to the Eighth Circuit. Hearing arguments were a panel of three George W. Bush appointees: Chief Judge Steven M. Colloton, Judge Lavenski R. Smith and Judge Bobby E. Shepherd.

In Friday's opinion, authored by Colloton, the judges said the inherit risks of childbirth make it reasonable for a legislature to mandate that backup assistance emergency facilities be available.

Still, they acknowledged that "there may be a robust policy debate over whether the statutory restrictions are optimal."

"Swanson argues that [the restrictions] actually narrow the health care market, reduce choice, and lead some women to undergo unassisted childbirth at home," Colloton wrote for the panel. Nonetheless, "the Constitution leaves the choice among rational alternatives to the legislature, and the district court properly granted the motion to dismiss on Swanson's claim alleging a violation of her rights."

The panel also affirmed the district court's ruling that Swanson did not have adequate standing to challenge the law. The state had argued that while a pregnant woman might have standing, a midwife did not.

"The court cannot reliably know whether the interests of unidentified expectant mothers will align with the midwife's preferences," the judges wrote. Thus, "it would be imprudent to extend the availability of third-party standing to this context."

Swanson was represented in her appeal by Haley Dutch, an attorney at the conservative Pacific Legal Foundation.

In an emailed statement to Courthouse News, Dutch expressed disappointment with the ruling. She said they were considering an appeal but had not made a final decision.

"The Eighth Circuit missed an important opportunity to consider how restricting certified nurse midwives from attending home births denies freedom in childbirth and leaves women with fewer safe options, pushing them toward unassisted births that carry higher risks," she said. "Mothers should be able to choose qualified providers who meet their needs."

A measure addressing midwifery in Nebraska, Legislative Bill 676, advanced out of committee but did not reach a final vote before the state's unicameral Legislature adjourned in May. It may be brought up again in 2026.

Long Pine, where Swanson lives, has about 300 residents. It's just nine miles from Brown County Hospital in the nearby city of Ainsworth.

Nonetheless, the broader region - a stretch of north-central Nebraska known as the Sandhills - is sparsely populated, featuring some of the least-populated counties in the United States. In her complaint, Swanson argued that Nebraska's midwifery regulations are particularly harmful in "maternity deserts" like these, where access to care is limited.

Source: Courthouse News Service