Global Midwifery Advocacy: policies,current issues and its management

Challenges and barriers to CNM/CM clinical practice generally fall into one of two categories: those created by restrictive state laws and regulations and those that, although they may have a regulatory component, can be considered related to the business of midwifery. This section of the paper describes major regulatory and business midwifery challenges.

Regulatory barriers

Both the legislative authority granted to CNM/CMs to practice independently and where they practice varies considerably state to state.According to data compiled by ACNM on State Legislation and Regulatory Guidance ACNM, midwives that are not nurse-midwives are illegal in 10 states, 12 states have no laws or regulations about non-nurse-midwives, and 2 states prohibit CNMs from doing home births.Three major regulatory challenges exist within many states: (1) the requirement for either physician supervision or a written collaborative agreement with a physician (2) the requirement for physician supervision of prescriptive authority even in the presence of otherwise independent practice, as well as the extent to which prescriptive authority is granted (e.g., the ability to prescribe controlled substances); and (3) legislation governing midwives and out-of-hospital birth.

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