The Scope of Midwifery Practice Regulations and the Availability of the Certified Nurse‐Midwifery and Certified Midwifery Workforce, 2012‐2016

Abstract

Introduction: Studies have linked midwifery practice laws to the availability of midwives but have generally not related workforce data to potential demand for reproductive health services. We examined state regulatory structure for midwives and its relationship to midwifery distribution and vital statistics data at the state and county level. Methods: Midwifery distribution data came from the Area Health Resources Files, distribution of women of reproductive age came from the US Census, and birth statistics came from US Natality Files from 2012 to 2016. Midwifery regulations were drawn from American College of Nurse-Midwives Annual Reports. We used bivariate analysis to examine the relationship between state midwifery practice regulations and the number of midwives available in states and counties to potentially meet women's health care needs. Results: Twenty states and the District of Columbia had autonomous practice regulatory frameworks, whereas 24 states had collaborative practice regulatory frameworks during the years between 2012 and 2016. Six states changed regulations during that period. In 2016, the number of midwifeattended births per number of midwives in a state was not related to the regulatory framework. However, states with autonomous frameworks had 2.2 times as many midwives per women of reproductive age (P Ͻ .0001) and 2.3 times as many midwives per total births when compared with states with collaborative statutory frameworks (P Ͻ .0001). At the county level, 70.1% of US counties had no midwife. Of those states with autonomous practice, only 59.7% of counties had no midwives, compared with 74.1% in states with collaborative models (P Ͻ .0001). Discussion: Midwives have the potential to help address the shortage of maternity and reproductive health service providers. Our research suggests that increasing the number of states with autonomous regulatory frameworks can be one way to expand access to care for women in the United States.

Health Policy Effects on Health Systems

“…For CNMs specifically, Ranchoff and Declercq (2020) found that restrictive practice environments for CNMs are related to women's access to maternity and reproductive health services from these providers. They further suggest that expanding midwifery practice in states with restrictive environments may significantly improve access to maternity care services.…”

“…They further suggest that expanding midwifery practice in states with restrictive environments may significantly improve access to maternity care services. In addition, CNMs and corresponding documentation for the rise of maternity care that strongly suggests the need for regulatory reform (Ranchoff & Declercq, 2020).…”

Midwives and Universal Health Care: A Call to Action

“…Slow recognition at the state and federal level of the full scope of midwifery practice persists. US midwifery was and continues to be caught in a web of conflicting laws, limitations on the ability to practice, and marginalization in health policy 9 . Midwifery practice is limited by state regulations that improperly define scope of practice, require supervisory or other professional agreements with physicians, and limit access to full staff privileges in hospital settings.…”

Medication access and midwifery integration: An example of community midwifery advocacy for access in Washington State, USA

“…A profession's practice authority is related to the practitioners’ ability to practice across the full scope of their education and credentialing 12 . Increased practice authority for midwives and advanced practice nurses improves use of services and affects the size and demographics of the workforce without negatively impacting quality of care, thereby expanding client choice of practitioner and increasing access to care, particularly in medically underserved rural and urban areas 12‐18 …”