Defining 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. 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. *
1. Bradford, Heather M. Women’s health and maternity care policies: Current status and recommendations for change. Supporting a Physiological Approach to Pregnancy and Birth, 301, 2013.
* Federal law only allows the use of federal funds for abortion care in cases of rape, incest, or life endangerment of the pregnant individual. In most States, Medicaid coverage for abortion is limited to these circumstances. Many States have banned abortion and it may be very difficult to locate a provider to obtain an abortion, even in cases of rape or incest. However, 17 States go beyond these limitations and use State funds to cover abortions for people enrolled in Medicaid. State laws may be financially limiting to nurse-midwives who may be providing this care through organizations such as Planned Parenthood.