Debbie Pulley v. Janice Izlar, President of the Georgia Board of Nursing

Georgia midwife sues to continue speaking truthfully about her profession

Cases > Freedom of Speech and Association > Debbie Pulley v. Janice Izlar, President of the Georgia Board of Nursing
Won: Board of Nursing agrees to stop enforcing titling restrictions against non-practicing midwives.

Debbie Pulley has been a Certified Professional Midwife in Georgia for 24 years, both working as a midwife and advocating for midwives. The state’s rules changed in 2015, allowing only licensed nurses to practice midwifery in Georgia. So Debbie turned her efforts to reforming Georgia’s laws and advocating for access to midwifery care. But in 2019, Debbie received a cease and desist letter, threatening her with a $500 fine any time she publicly identifies herself as a midwife. Even though she can’t practice in Georgia right now, Debbie is still a midwife by any normal definition and wants to be able to truthfully describe her qualifications on her website and in her advocacy work—just as doctors and lawyers do. So she’s fighting back.

Debbie Pulley began attending births in 1970 as a nursing assistant at a Hong Kong Hospital. Later, as a midwife in Georgia, she helped establish the Georgia Midwifery Association, which worked closely with the state’s health department to establish and enforce standards of care for midwives—contributions so significant that she received a certificate of honor from the Georgia Secretary of State.

Debbie’s qualifications don’t stop there. The North American Registry of Midwives certified her as Certified Professional Midwife (CPM) in 1995. The CPM certification is the prerequisite for licensure as a midwife in 35 states. She also serves on the Registry’s board, actively advocates for expanded access to midwifery in legislatures and to the public, and runs the office for Atlanta Birth Care.

Today, however, even though Debbie is a midwife by any normal definition, she is not allowed to publicly—and honestly—call herself a midwife or CPM in the state of Georgia.

In 2015, the Georgia Board of Nursing took over midwifery regulation from the state health department and began requiring midwives to get a nursing degree and become a Certified Nurse Midwife (CNM) in order to practice independently. That is, only licensed nurses can practice midwifery in Georgia.

In June 2019, the Board of Nursing sent Debbie a cease and desist letter forbidding her to identify herself as a “midwife” in any form, and it threatened her with a $500 fine for each violation.

Though she no longer practices midwifery, Debbie feels she shouldn’t have to get a nursing license in order to call herself a midwife. And she wants to be able to truthfully describe her qualifications on her website and in her advocacy work—just as doctors and lawyers do when they are not actively practicing their professions.

Represented by PLF free of charge, Debbie is challenging the state’s assault on her free speech rights in a federal lawsuit. Government cannot hijack a word as a licensing condition.

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What’s at stake?

  • People should be able to accurately describe themselves by their profession without government censorship.
  • Government cannot restrict speech and reduce its constitutional protection through licensing alone.

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