About the Author

These articles are intended to inform the best practices of certified nurse-midwives/certified midwives and the unique liability challenges that they face in clinical practice. The information provided will include, but is not limited to, standards of practice, midwifery liability challenges, hospital systems failures, professional conduct, avoiding litigation, cultures of care in corporate healthcare systems, and various legal considerations associated with safe practice.

Nurse-midwives may choose to have their own practice, independent physically and financially from a collaborating physician. A variety of arrangements can exist and the CNM actually is in complete control of her practice. This type of arrangement is increasingly rare, these days but the following descriptions may prove helpful.

Currently, in the U.S., the majority of home-birth attendants are Certified Professional Midwives (CPMs). In nearly every State, Certified Nurse-Midwives (CNMs) are licensed to attend home deliveries, if that is their preference.

Fed Agencies and CNM Practice

Federal agencies such as Health and Human Services and the Centers for Disease Control and Prevention have played a role in defining certified nurse-midwifery practice, especially in the context of research, training programs and clinical care sites. 

Professional associations with other healthcare providers, such as physicians, are varied among States in regard to mandatory written collaborative agreements. The legislative requirements among CNMs/CMs are somewhat different from State-to-State.  This affects whether CNMs can provide reproductive care to the full extent of their education, training, and scope of practice.

Clinical Practice Guidelines:

Nurse-midwifery guidelines, policies, procedures, and protocols are not rules or standards, per se, but they exist to support reasonable conduct and quality of care.

Clinical Practice Guidelines

Clinical Practice Guidelines are recommendations for clinicians regarding the care of patients with specific conditions and ailments. 

Midwifery as practiced by certified nurse-midwives (CNMs) and certified midwives (CMs) encompasses the independent provision of care during pregnancy, childbirth, and the postpartum period; sexual and reproductive health; gynecologic health; and family planning services, including preconception care.

Midwifery as practiced by certified nurse-midwives (CNMs) and certified midwives (CMs) encompasses the independent provision of care during pregnancy, childbirth, and the postpartum period; sexual and reproductive health; gynecologic health; and family planning services, including preconception care.

Federal agencies such as Health and Human Services and the Centers for Disease Control and Prevention have played a role in defining certified nurse-midwifery practice, especially in the context of research, training programs and clinical care sites.  Federal agencies have also been known to publish treatment guidelines, which may define or limit how a CNM/CM will practice. 1 In similar fashion, programs such as Medicare and Medicaid establish guidelines for practice related to their reimbursement of clinicians and health care entities.  Through the Health Care and Financing Act (HCFA), limits can be placed on the type and amount of care offered in a given care setting. *

State Legislation of Practice Environments and Collabotative Agreements:

Professional associations with other healthcare providers, such as physicians, are varied among States in regard to mandatory written collaborative contracts. The legislative requirements for CNMs/CM vary from State to State. Legislation-imposed collaborative agreements affect whether CNMs/CMs can provide maternity care to the full extent of their education, training and scope of practice. Every State has designated the specific practice environments for CNMs. Some States allow CNMs and APRNs to practice with complete autonomy.

Legal Foundations for practice

CNMs and CMs must demonstrate compliance with the Core Competencies for Basic Midwifery Practice of the American College of Nurse-Midwifery (ACNM) upon completion of their midwifery education programs and must practice according to the ACNM Standards for the Practice of Nurse-Midwifery.