Health Outcomes and Provider Choice under Independent Practice for Certified Nurse-Midwives

113 Pages Posted: 7 Jul 2021 Last revised: 21 Nov 2022

See all articles by Lauren Hoehn-Velasco

Lauren Hoehn-Velasco

Georgia State University - Andrew Young School of Policy Studies

Diana Jolles

Frontier Nursing University

Adan Silverio-Murillo

School of Government, Tecnologico de Monterrey

Alicia Plemmons

West Virginia University

Date Written: November 2022

Abstract

Independent practice grants non-physician providers the ability to manage patient care without physician oversight or direct collaboration.  In this study, we consider whether independent practice for certified nurse-midwives (CNMs/CMs) leads to changes in health outcomes or CNM/CM use. Using U.S. birth certificate and death certificate records over 2008-2019, we show that CNM/CM full practice authority led to little change in obstetric outcomes, maternal mortality, or neonatal mortality. Instead, independent practice increases (reported) CNM/CM-attended deliveries by one percentage point while decreasing (reported) physician-attended births. We then explore which factors led to the rise in CNM/CM-attended deliveries, demonstrating that the increase in CNM/CM births is at least partially driven by an increase in CNM/CM autonomy. Higher patient demand for CNMs/CMs and better reporting of CNM/CM births also likely contribute to the rise in CNM/CM-attended deliveries, while CNM labor supply plays little observable role.

Note: Funding: None.

Declaration of Interest: The authors have no conflicts of interest to declare.

Keywords: Scope of practice, full practice authority, occupational licensing, maternal health, infant health, certified nurse-midwife, consumer safety, Affordable Care Act

JEL Classification: I18, I11, K0, J44

Suggested Citation

Hoehn-Velasco, Lauren and Jolles, Diana and Silverio-Murillo, Adan and Plemmons, Alicia, Health Outcomes and Provider Choice under Independent Practice for Certified Nurse-Midwives (November 2022). Available at SSRN: https://ssrn.com/abstract=3878127 or http://dx.doi.org/10.2139/ssrn.3878127

Lauren Hoehn-Velasco (Contact Author)

Georgia State University - Andrew Young School of Policy Studies ( email )

Department of Economics
35 Broad Street, 6th Floor
Atlanta, GA 30303-3083
United States

Diana Jolles

Frontier Nursing University ( email )

United States

Adan Silverio-Murillo

School of Government, Tecnologico de Monterrey ( email )

Calle del Puente 222
Mexico City, 04210
Mexico

Alicia Plemmons

West Virginia University ( email )

P.O. Box 6025
Morgantown, WV 26506
United States

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