The law passed by the General Assembly in 2012 regarding the practice of CNMs and the regulations stemming from it is a backword step for CNMs when it comes to requiring CNMs to work in "teams" under a physician leader.   This decreases our ability to provide care in areas where physicians refuse to work in teams with us due to concerns about liability or competition.  The requirements including the requirement for practice agreements increase the costs for midwifery and decrease access to midwifery care.  Nurse -midwifery practice in Virginia should follow the Standards of the American College of Nurse-Midwives (ACNM).  ACNM standards do not require practice agreements with physicians, supervision by physicians, or medical teams.  In fact the law/regulations are at odds with itself because they state that the practice should be according to the standards of the ACNM then deviate from the standard by requiring practice agreements and teams.  There is no valid safety reason for the requirement to have a practice agreement with physicians.  Both the ACNM and the American College of OB/GYNs have a joint statement against practice agreements.

In order to meet the need for chart reviews, it will increase the cost for access to electronic medical records.  It increases the time our birth center medical director must spend reviewing charts.  It increases the costs to those CNMs who must pay physicians by the hour to review charts and be "leader of the team".  These costs are passed on to clients and insurance companies and Medicaid.  

The requirements put midwives at unfair disadvantage in the marketplace and are a restraint of trade, in direct opposition to the Constitution of Virginia.  I hope that the General Assembly, Governor, and Joint Boards will rectify this situation soon to allow freedom in the provision of health care in our state. 

Physicians are not educated in Midwifery and Midwives are not educated in Medicine.  We are separate, though overlapping in some areas, disciplines.  We work together through collaboration and consultation as needed for our clients.  We don't need the state requiring agreements.  LESS REGULATION AND MORE FREEDOM will allow CNMs to follow ACNM standards, equal better care and access to care, and more consumer control of the health care market.