Autonomy Progress for Nurse-Midwives

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Autonomy Progress for Nurse-Midwives

New law would end physician supervision requirements

By Working Nurse
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Greater autonomy for California’s approximately 1,200 certified nurse-midwives may be in sight. A new bill that would remove physician supervision requirements for nurse-midwives recently passed the Assembly, which may also be good news for other advanced practice registered nurses in California.  


Current California law regarding midwifery contains a peculiar conundrum: Although certified nurse-midwives generally have more education and training than is required of licensed midwives (see the sidebar), the Nursing Practice Act still requires physician supervision for nurse-midwives despite a 2013 law that removed that mandate for licensed midwives.

The new bill, A.B. 1306, would rectify that imbalance, allowing the state’s certified nurse-midwives to practice autonomously. Assembly Member Autumn Burke of the 62nd Assembly District, who introduced A.B. 1306 back in February, notes that California is one of only a handful of states that still requires physician supervision for nurse-midwives.

The California Nurse-Midwives Association (CNMA) says that greater autonomy for nurse-midwives would improve healthcare access for people in rural or medically underserved areas, particularly in the nine California counties that currently lack even a single practicing ob-gyn. Burke calls A.B. 1306 “a commonsense measure that removes an onerous restriction on women’s access to healthcare.”


A.B. 1306 passed the Assembly on June 3 on a vote of 74–0 and is now being considered in the Senate. If the bill becomes law, it will set an important precedent for other advanced practice registered nurses seeking greater autonomy.

Physicians’ groups have opposed previous efforts to remove supervision requirements for nurse practitioners, but accepted autonomy for midwives because enforcing the requirement had become impractical.

If autonomous nurse-midwives can deliver safe, high-quality care at lower cost, it will be harder to argue that other APRNs could not do the same. You can read the full text of A.B. 1306 and follow its progress at


Nurse-Midwives and Midwives are Not the Same

Nurse-midwives and midwives have similar scopes of practice — including attending normal childbirth, managing prenatal and postpartum care and providing family planning services — but the two professions also have some significant differences.

Training and Practice

Certified nurse-midwives are advanced practice registered nurses, regulated and licensed by the BRN. A nurse-midwife must be a licensed RN and either complete a board-approved nurse-midwifery program or demonstrate comparable professional qualifications. Although it’s not a current licensure requirement, many California nurse-midwives have earned the American Midwifery Certification Board’s CNM certification, which requires a master’s degree or doctorate. Nurse-midwives may practice in hospitals or offices as well as birth centers, clinics and homes.

In California, midwives are licensed and regulated by the Medical Board, which also oversees physicians. Midwives must complete a three-year postsecondary midwifery program at an approved school and pass the North American Registry of Midwives (NARM) exam. Most midwives work in patients’ homes or in birth centers or clinics rather than hospitals.

Physician Supervision

Since 2014, licensed midwives in California have been allowed to practice without a doctor’s supervision except in certain cases (multiple births and any complications must still be referred to a physician) and also to independently prescribe related drugs or medical tests.

Currently, a certified nurse-midwife is authorized to provide the same range of services as a midwife, including attending normal singleton births and furnishing drugs and medical devices, but only with the supervision of a qualified obstetrician and surgeon. (The physician doesn’t have to be present so long as he or she has provided written standard procedures and is available for consultation or to handle complications.)

If A.B. 1306 passes, it will remove the physician supervision requirements and authorize certified nurse-midwives to provide “a full range of gynecological and obstetric care services for women from adolescence to beyond menopause.”

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