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

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