As a Certified Nurse-Midwife, I am licensed as an APRN in Virginia. I see women throughout their lives, from adolescence to menopause, and attend births independently in a hospital setting. When I see a patient who has a high-risk condition, I consult with my collaborating physicians or have the patient to transfer care to a physician.

In 2006, the state legislators allowed Virginia nurse-midwives to better serve women, by changing the requirement for physician supervision in the regulations to collaboration and consultation. Prior to and since that time, CNMs have been safely providing excellent care to women and newborns in Virginia and throughout the United States and other countries. Now new legislation, in the form of HB 346, threatens our ability to continue to practice as safe, independent providers in Virginia.

When the new law is implemented, with a requirement that nurse-midwives function as a member of a physician-led team, new regulations could have a negative effect, by limiting patient access to much needed maternity services. Change in the regulations could limit the nurse-midwife's ability to open and own a practice, admit patients to the hospital for births, or be reimbursed by insurance companies for the care provided.

Our professional organization, the American College of Nurse-Midwives, has nationally recoginzed standards of practice, which should be the model used by Virginia. These standards allow for independent practice but include appropriate consultation, collaboration, and referral to physicians for women who risk out of nurse-midwifery care, giving women the very best each of our professions can offer. This reflects how nurse-midwives currently practice and allows more women to access our services--and results in better health for women and babies in Virginia.

Thank you for the opportunity to comment,
Kris Conrad, DNP, APRN, CNM
Blacksburg, VA