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State Variations

In New York, certified midwives' scope of practice will be identical to that of nurse-midwives. In other states (19) where midwifery is a regulated profession without an RN requirement, their scope of practice may be restricted in ways that CNM's practice is not. For those states (11) where other midwifery is legal, but unregulated, their scope of practice may not be defined, and may be severely restricted as a practical matter in terms of payment, admitting privileges, prescriptive authority, etc. For those states (7) where the statutes are unclear on the legality of other midwifery, some professional legal advice or action may be required in order for certified midwives to legally practice. For those states (15) where you have to be an RN in order to practice midwifery, certified midwives and their allies will have to seek legislative changes in order to practice legally.

The attached fact sheet on State Laws Governing "Other Midwifery" provides information on the legal status of midwifery in each state. The ACNM Handbook on State Legislation has more detailed information for each state.

The Political Climate

In any state, certified midwives will be a minority in the midwifery community for some time to come. Their ability to practice to the full extent of their education and training will be determined by the willingness of nurse-midwives, other midwives and their political allies to assist them in achieving their goals. The cohesiveness of the midwifery community may also vary from state to state. In some states, political and philosophical differences among different groups of midwives may have created tension, guardedness and even mistrust. In other states, the relationship is more friendly and cooperative. The creation of a "certified professional midwife" credential by the North America Registry of Midwives (NARM) in 1994 may also have influenced the climate for political change. The two credentials, ACNM's "certified midwife" and NARM's "certified professional midwife," are compared on the enclosed fact sheet. To build a climate for objective dialogue, it is essential that everyone have the facts about certified midwives and their role and relationship within ACNM/ACC.

Weighing Your Options

ACNM chapters may choose to address the issue of practice by certified midwives in their states in theory before it becomes a practical matter. Conducting a proactive education campaign within the health care industry and political arenas may be less stressful and more conducive to public learning than waiting until a crisis forces your chapter to explain and/or defend the decisions of the ACNM and ACC. While you may be concerned that educating the public about "certified midwives" will only confuse your audience, think about the consequences of not educating them: you may yield this political territory to those who are less sympathetic to our goal of creating a unified standard for midwifery practice.

Developing an Education Campaign

The ACNM has developed a series of educational materials your chapter can use to educate people about certified midwives, listed under Essential Documents, below. You can communicate your message through mailings, presentations, small meetings, etc. Your audience(s) should include: managed care organizations, health professional associations, regulatory agencies, state legislators, consumers, and community/state organizations with an interest in health issues. As you plan your campaign, consider the most appropriate timing and context for your message. For example, you might want to start your campaign with an approach to regulatory agencies. Some state regulatory bodies have been very pleased to learn that this new mechanism for educating and credentialing direct-entry midwives is now available. You may want to save your media outreach for the final stage of the campaign, after your key audiences are already on board.

Seeking Statutory/Regulatory Change

As stated previously, certified midwives seeking to practice in your state may need statutory or regulatory revisions in order to legally carry out the work they were educated and trained to do. Some difficult decisions will need to be considered. For example, should the New York model be replicated? Should Boards of Nursing regulate non-nurses? Should the profession of midwifery be unified under one law, or should the nursing distinction be kept? What are the benefits and risks of attempting any of the above through legislation or amendments to the regulations? Should an Attorney General Opinion be sought? Some state chapters have decided that the time to think about these issues is now, rather than when a certified midwife is barred from practicing because s/he doesn't meet the requirements of the current state laws.

Essential Documents

• State Practice Act, Board Regulations, Medical Practice Act, Laws and Regulations Governing Non-Nurse Midwives.
• ACNM Publications: Strategies for Influencing State Policy: Practice Acts and Regulations (June 1997), Handbook on State Legislation, Communication Strategies. Fact Sheets: Class Acts, A Comparison of Certified Midwives and Certified Professional Midwives, State Laws Governing "Other Midwifery".

For additional ideas, contact Alyson Reed, ACNM Policy Analyst, at 202-728-9890