How do I find state regulations for CNMs?

[Charmie981]

I've been looking for years, trying to figure out if CNMs can attend OOH births in LA, and if they are required to have physician backup or not (which would, of course, determine if they could attend OOH birth!).

All I have found is that CNMs are not included in Louisiana's incredibly restrictive midwifery laws and that CNMs are only mentioned briefly and always in the category of advanced practice registered nurse in the Louisiana State Board of Nursing rules.

Is there somewhere else I should be looking?

[Awaken]

I'm also looking for state-by-state laws on midwifery, including CPM's and CNM's- I've found a lot of charts with a 'yes" and "no" but no where have I found the laws themselves to see the particulars, like if CNM's are legal, do they require physician backup?

Anyone know?

[kltroy]

Have you tried contacting ACNM or the state licensure board? This is probably the best source of information on the topic.

[[e-mail]]

Every state legislative website has a search engine for current laws and proposed bills. Googling the name of the state and "legislature" will bring up the website, and then you can either search for a specific term or browse the table of contents. Healthcare practice acts are usually under some variation of "professions and occupations," though not always.

If you have the time to look around, though, it's usually not hard to find the statute you're looking for. In many states, CNMs are included under the nursing or advanced nurse practice acts.

That's the case in LA--I'm including the link for their statute below, which came up when I entered (in quotes) "nurse midwives" into their search engine and restricted the search to "revised statutes" (i.e. the most recent versions of all current statutes).

CNMs in LA are required practice under a written collaborative agreement that outlines their individual scope of practice, which the collaborating physician then signs off on. That provision alone represents a big barrier for OOH practice for CNMs--I believe that 40 states currently have some form of written agreement for CNMs.

So even if the board of nursing has issued no regulations forbidding CNMs from providing OOH care (none are in the statute itself), collaborating physicians have the authority to prevent it.

No states require licensed DEMs (most use all or part of the CPM as the basis for licensure) to enter into a written practice agreement with physicians. CA and AR both had them included in their original laws (they have older statutes predating the CPM) but because no physicians would sign them, the requirements were dropped by their regulatory agencies (someone here may no more about how this worked in CA--I know in AR the Department of Health decided not to enact that provision of the statute because it was unworkable).

The MANA website has links to copies of the various licensure laws for DEMs/CPMs--I'm not sure that all have a direct link, as opposed to a copy of the law. If you want to read it within the context of other statutes (which is often illuminating) you can get to the original via the method I outlined above.

http://tinyurl.com/yvlrxr

Katie Prown
Campaign Manager, The Big Push for Midwives 2008

[BeckiCNM]

Originally Posted by kltroy

Have you tried contacting ACNM or the state licensure board? This is probably the best source of information on the topic.

ACNM has all this information available. Online, it's in the members-only section of the website. But they would probably tell you on the phone if you called.

I have found a couple of states that explicitly state CNMs may not attend home births (Alabama is one). The majority of states have some sort of supervisory or collaborative agreement requirement that makes providing home births either difficult or impossible for CNMs. My state actually has legislation pending to remove the supervision agreement for CNMs who wish to provide home birth services, in order to make it possible for us to do them, since no MD in the state will sign a supervision agreement for a home birth midwife.