Re:  18VAC90-30 Regulations Governing the Licensure of Nurse Practitioners

As certified nurse-midwives (CNMs), our practice includes consultation and collaboration with physicians. This positive step forward in nurse-midwifery practice in Virginia occured when the regulations governing the licensure of nurse practitioners were changed to remove the supervisory language and instead called for collaboration and consultation between physicians and nurse-midwives. We have continued to demonstrate safe practice Virginia--without supervision by other professions, but instead in collaboration with others--to provide optimal care to the families of Virginia.  

In collaborative relationships, each provider practices to the full extent of his or her education while best serving the needs of the patient. Introducing requirements for membership in care teams can restrict patient choice and access to care and raise costs to consumers. When placed as subordinates on a team, CNMs are likely to have difficulty obtaining hospital privileges, staffing birth centers, and securing insurance reimbursement, all things which decrease patient access to midwifery care.  

Nurse-midwifery practice in Virginia should follow the Standards of The American College of Nurse-Midwives (ACNM), which allows for independent practice. The Standards of the ACNM allow for practice which includes consultation, collaboration, and referral, and any regulations which prevent nurse-midwives from practicing to the full scope of their education and training will ultimately be detrimental to the health of women and families in Virginia.

Respectfully, The Virginia Affiliate of the American College of Nurse-Midwives Executive Board

Kristin H. Conrad, DNP, CNM--President

Risa Rispoli, CNM--Vice-President

Deborah Meslar-Little, NP, CNM--Treasurer  

Phyllis Turk, MSN, CNM--Secretary

Karen King, MS, CNM--Legislative Chair