American College of Nurse-Midwives (ACNM)
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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. The Core Competencies define baseline midwifery practice; the collection of skills that every Certified Nurse-Midwife and Certified Midwife must have.
American College of Nurse-Midwives' competencies and standards are consistent with or exceed the global competencies and standards for the practice of midwifery as defined by the International Confederation of Midwives. To maintain the designation of CNM or CM, midwives must be recertified every five years through the American Midwifery Certification Board (AMCB) and must also meet specific continuing education requirements. 1
State Regulation and Power of the Nursing Board
Alexander Andrews
Certified nurse-midwives and certified midwives are licensed and regulated at the individual State level. Professional practice rules vary among the States, but typically, they are found in State Statutes, Boards of Nursing, Medical Boards, and Midwifery Boards. State regulatory boards are composed of experts who are required to be members of the field of practice they regulate.
Unfortunately for CNMs, there are very few midwifery boards. In most States, CNMs and CMs are regulated by boards of nursing that may not include them as members or staff. It is potentially problematic and unfair when governing boards and disciplinary panels, lacking representation from CNM/CM, draft regulations and vote on disciplinary actions specific to midwifery practice. In their decision-making capacity, boards of nursing may lack critical information related to care models, standards of practice, scope of practice, core competencies, and ethical considerations specific to CNMs.
Women’s Healthcare Nurse-Practitioners or Adult Nurse-Practitioners, for example, do not share the specific education, experience, or capacity to judge the CNM model of care and vice versa. Although nurse-practitioners and CNMs are frequently lumped into one category of Advanced Practice Providers (APP) or Advanced Practice Registered Nurses (APRN) under board jurisdiction, it is inappropriate, at best, to allow an APP or APRN (outside of midwifery) to investigate, evaluate, or pass judgment on the alleged misdeeds of a CNM or CM. Yet, this disciplinary issue affects CNMs nationwide.
State Board of Nursing Issues
It is crucial for midwives involved in State Board of Nursing disciplinary actions against them to determine whether their State Board has CNMs/CMs on the disciplinary panel that will hear their case. If these panels lack CNM representation, nurse-midwives must consider seeking independent legal representation from counsel versed in CNM standards of practice. A nurse practitioner serving on a State Nursing Board disciplinary panel could adversely affect the career of a certified nurse-midwife without ever determining or understanding the competencies, scope of practice, or practice standards of a CNM/CM.
Vino Li
Punitive Employment Contracts
Although the care models, education, and standards of practice among APRNs/APPs are diverse and unique, it is increasingly common for governmental agencies and corporate health care systems to treat non-MD professional providers of care as oneindistinguishable mass. Of particular concern, hospital corporate entities are presenting employment contracts to varied specialties of nurse practitioners, CRNAs, physician assistants, and CNMs under the auspices of an “APP” contract.
Without meaningful delineation of the distinct and separate backgrounds, education, and duties of individual practitioners, these generic, mostly punitive, contracts might eventually be challenged and found unenforceable. Drawing up non-specific, barely intelligible contracts is doubtless expedient, but likely to result in watered-down legal documents that will inevitably fail all parties involved.
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Agenda of the Boards of Nursing
Boards of nursing, along with other regulatory boards, exist for one reason only: to ensure safe practice and protect consumers of health care. Regulatory boards do not advocate for care providers that they license. Never forget this fact. From the moment you are licensed by your State as an RN and CNM/CM, it is in your best interest to conduct yourself responsibly and professionally, keeping up with all of the requirements to maintain the integrity of your licensure. Beyond the obligatory licensing requirements, it is also in your best interest to avoid any negative attention from the board.
If the board receives a consumer or other legal complaint against you, seek immediate legal advice or counsel. Many legal professionals offer free initial consultations. If you are unfortunate enough to become involved in professional negligence litigation, remember that the boards have a vested interest in supporting these actions, as they are attached to their duty to protect the consumer. If a complaint is filed against you, do not expect sympathy or support from the regulatory/nursing board.
Litigation and the Board of Nursing
One of the first things that a trial lawyer may do before trial or settlement of a professional negligence case will be to inform the relevant State Board that has issued the CNM/CM’s professional license. The board may request and receive the pertinent legal documents from the litigation so that it can form an independent assessment of the conduct in question and the original legal complaints filed. You may end up settling a negligence lawsuit or having a claim against you dismissed. Still, the Regulatory Board will have the opportunity to decide if there is any action that they need to take against your license. The Board will be aware of any trial court proceedings and verdicts returned for or against you.
The Board of Nursing may also decide to conduct its own legal proceedings if the negligence allegations against you are deemed particularly strong. The State’s Attorney General’s Office may be summoned to represent the Board of Nursing in proceedings against you, which will take place in a courtroom and resemble a district court lawsuit. An Administrative Law Judge, rather than a district court or federal judge, will preside, and there is no jury involved. Instead of money damages, your nursing license is at stake. Depending on the circumstances and results of your conduct, criminal charges may also be filed. It is unlikely, but always possible, that you can be involved in civil/criminal litigation and a separate State Board action stemming from the same alleged misconduct. As a CNM/CM, if your legal issues reach this point, and you have not retained your own personal defense counsel, this may be the time to consider it.
© 2025 Martha Merrill-Hall
American College of Nurse-Midwives. Definition of Midwifery, Scope of Practice of Certified Nurse-Midwives.