Health Outcomes and Provider Choice under Independent Practice for Certified Nurse-Midwives
73 Pages Posted: 7 Jul 2021
Date Written: May 31, 2021
This study examines whether full practice authority for certified nurse-midwife (CNMs) affects obstetric outcomes. Using U.S. birth certificates over 2008-2019, we track labor & delivery characteristics before and after states enacted CNM full practice authority. We find little change in health outcomes, but we discover a one percentage point increase in CNM-attended deliveries. The observed increase in CNM-attended deliveries is most apparent in states that passed full practice authority post-2010 and is not present in states that passed prescriptive authority or pre-2010 reforms. Based on the heterogeneous effects, we explore the contribution of other state-level policies, including certificate-of-need laws, the Affordable Care Act (ACA) Medicaid expansions, and the general passage of the 2010 ACA. Overall, our findings suggest that the impact of full practice authority may be context-dependent, with the effects sensitive to reform timing and state-level policies in place.
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: Suggested Citation