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Understanding State Practice Environments
ACNM has developed two tools to help you understand how the states differ from each other with regard to the midwifery practice environment. 

The first tool is a slide deck that contains a set of maps.  The maps contain the following state-specific details:

  • Where are your CNM/CM colleagues? How many are in each state? How many are ACNM members? How many CNMs/CMs are there compared to the state population? Where are the midwifery education programs located?
  • How many births occur in each state?  What percent are attended by CNMs/CMs?  By CPMs?  Where do CNM and CPM attended births typically occur?  How many birth centers are in the state and how many of them are accredited?
  • What is the rate for induction, epidural, cesarean birth, VBAC, low birth weight, and pre-term birth in each state?
    Which states require physician supervision or collaboration?  What do state laws and regulations say about hospital privileges or participation on medical staff?  Which states license direct entry midwives?  Which states license or regulate birth centers?
  • What percent of births in each state are covered by Medicaid?  What are income eligibility levels to quality for coverage under Medicaid in each state?  What percent of CNM/CM attended births are covered by Medicaid in each state? How do state fee-for-service Medicaid payments compare to Medicare?  How many Medicaid beneficiaries are covered under a managed care plan?  What do commercial insurers pay physicians for professional services around a vaginal birth?
  • How CNM/CM salaries differ by state and how they compare to OB/GYN physician salaries in each state.  
  • Using Medicaid and commercial payment rates, how much revenue might a CNM/CM generate who attends 70 vaginal births in a year?  How does that revenue compare to average annual wages?

The second tool lets you evaluate which is the best state in which to be a midwife, according to your preferences.  This is done with an Excel spreadsheet that contains a set of dynamic graphs.  The graphs provide a score for each state based on how it compares to the median among  states across a range of factors and how much you weight the importance of each factor.  So you get a personalized ranking of the states based on what you care about.

American College of Nurse-Midwives
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