Issue Summary
All states but one (Maryland) have laws or regulations that explicitly or implicitly allow CNMs to admit patients to a hospital. Five states similarly allow CMs to admit. Thirty-four states allow CNMs to be included on a hospital's medical staff, while four states allow CMs to be so included.
The more serious issue is the willingness of hospital boards and medical staff to credential midwives, give them admitting privileges, or include them on the medical staff. Even where state laws allow these actions, individual hospitals may not, or may allow privileging only with physician supervision, or may allow partial participation in the medical staff (e.g., not being able to vote on issues before the staff).
Applicable ACNM Policy Statements and Standard Setting DocumentsCollaborative Management in Midwifery Practice for Medical, Gynecologic, and Obstetric Conditions
In the context of midwifery care, the midwife may need to consult with
other members of the health care team to provide additional expertise
necessary to meet the health needs of the patient. This document defines
the concepts of consultation, collaboration, and referral.
Core Competencies for Basic Midwifery Practice
The Core Competencies for Basic Midwifery Practice address the
fundamental skills, knowledge, and behaviors expected of a new
practitioner.
Creating a Culture of Safety in Midwifery Care
This statement reviews the principles endorsed by ACNM to promote client
safety and decrease the risk of adverse outcomes for women and infants
during pregnancy, labor, birth, and throughout a woman's lifespan.
Definition of Midwifery and Scope of Practice of Certified Nurse-Midwives and Certified Midwives
An overview of the education and training of CNMs/CMs, including
definition of scope of practice and iteration of practice settings.
Expansion of Midwifery Practice and Skills Beyond Basic Core Competencies
As science and technology advance to create changes in the delivery of
health care, CNMs and CMs may desire to or be required to attain
knowledge and skills beyond the basic level of midwifery practice as
defined by ACNM Core Competencies. This document reviews ACNM's
recommendations for expanding midwifery skills beyond core competencies.
Independent Midwifery Practice
Midwifery practice is the independent management of women's health care.
Independent practice is not defined by the place of employment, the
employer-employee relationship, requirements for physician co-signature,
of the method of reimbursement for services.
Joint Statement of Practice Relations between Obstetrician-Gynecologists and Certified Nurse-Midwives/Certified Midwives
ACOG and ACNM believe health care is most effective when it occurs
within a system that facilitates communication across care settings and
among providers. OB-gyns and CNMs/CMs are experts in their respective
fields of practice and are educated, trained, licensed independent
providers who may collaborate with each other based on the needs of
their patients.
Principles for Credentialing and Privileging Certified Nurse-Midwives and Certified Midwives
An overview of the principles that policymakers who develop language
regarding credentialing and privileging for CNMs and CMs should
consider.
Standards for the Practice of Midwifery
CNMs and CMs must practice in accordance with the Standards for the Practice of Midwifery.
Other ACNM Documents of Interest
- ACNM Talking Points to Support Legislation Seeking to Require Full Medical Privileges for Midwives
- ACNM 2020 Privileging Survey Data
- TAKE ACTION NOW: ACNM Congressional Call to Action for Full Medical Privileges for Midwives
- TAKE ACTION NOW: Template for Provider/Health System Support for Full Medical Privileges for Midwives
- ACNM Comments on Proposed Regulation on Medicare Conditions of Participation (December 21, 2011)
- Physician Certification of Inpatient Admissions under Medicare -- ACNM Issue Brief
Additional Tools and Resources of Interest
- Conditions of Participation for Medicare - Page maintained by CMS
- Regulatory text containing hospital conditions of participation for Medicare related to Medical Staff
- Coalition Joint Statement on APRNs and Medicare's Conditions of Participation
- The American College of Obstetricians and Gynecologists. Collaboration in Practice: Implementing Team-based Care.
The report was written by the interprofessional Task Force on Collaborative Practice and is intended to appeal to multiple specialties (eg, internal medicine, pediatrics, family medicine, and women's health) and professions (eg, nurse practitioners, certified nurse-midwives/certified midwives, physician assistants, physicians, clinical pharmacists, and advanced practice registered nurses). This document provides a framework for organizations or practices across all specialties to develop team-based care. In doing so, it offers a map to help practices navigate the increasingly complex and continuously evolving health care system. The guidance presented is a result of the task force's work and is based on current evidence and expert consensus. The task force challenges and welcomes all medical specialties to gather additional data on how and what types of team-based care best accomplish the Triple Aim and the Institute of Medicine's expectations of health care.