Midwifery
Midwifery - Question & Answers
Who Are Licensed Midwives
- Who is a licensed midwife or "LM"?
A New York State licensed midwife is a health care provider who may care for the health needs of pre-adolescent, adolescent, and adult women throughout their life span. Licensed midwives provide primary well woman health care including: gynecologic care, and care during pregnancy and childbirth, as well as care of the newborn following birth. In New York State, the Board of Regents and the State Education Department (SED) oversee the licensure and practice of midwifery and 46 other licensed health, business and design professions.
- What credentials must a New York State licensed
midwife have?
New York licensed midwives must be graduates of midwifery educational programs that are registered by SED or programs determined by SED to be equivalent.
Licensed midwives who are also nurses may use the title "nurse-midwives" or "certified nurse-midwife" (CNM). Others use the title "certified midwives" (CM's). All New York State licensed midwives must have passed a licensing examination approved by the State Education Department. Therefore, regardless of title, all New York State licensed midwives are held to the same entry-level standard of theoretical knowledge and clinical practice and must demonstrate mastery of a formalized body of knowledge and skills in the areas of maternal and newborn health, primary care, well-woman care, pharmacology, and family planning. For consistency, the credential "LM" is used to identify New York State licensed midwives on New York State birth certificates.
Services Midwives Can Provide
- What services can New York State licensed midwives perform?
Midwifery is defined as the management of normal pregnancy, childbirth and postpartum care, as well as primary preventive reproductive health care. To the extent they fall within that definition and within each midwife's professional competency, midwifery services may include, but are not limited to:
- Annual exams including gynecological care, primary care, health screening and counseling with a focus on health promotion and disease prevention
- History and physical examinations
- First exams for young women
- Family planning and prescribing of birth control methods
- Pre-conception counseling
- Well woman and adolescent gynecological care
- Perimenopausal and postmenopausal counseling and care
- Comprehensive maternity care including prenatal, labor, delivery, postpartum & newborn care
- Hospital admission, rounds and discharge
- Newborn circumcision
- First assisting at surgical procedures
- Obstetric and gynecologic screening procedures
- Evaluation and treatment of common health problems
- Public education activities
- Referral to specialists
- Can New York State licensed midwives prescribe
medications?
Yes. Licensed midwives may become certified by SED to prescribe medications and to order diagnostic tests within their scope of practice and consistent with their practice protocols. Licensed midwives authorized to prescribe have obtained training to prescribe medications and order diagnostic tests within their scope of practice and collaborative agreement. Licensed midwives may obtain a Drug Enforcement Administration (DEA) number and thereby prescribe both controlled and non-controlled substances. Most midwives have met the requirements to prescribe, and those midwives are identified on our web site as "Certified with prescriptive privilege."
- Can New York State licensed midwives augment and
induce labor?
Yes. New York State licensed midwives who are certified to prescribe medications and have met the hospital's criteria for privileging and credentialing practitioners in the management of labor and delivery, may induce and augment labor by using both pharmacologic and non-pharmacologic modalities. For other conditions that must be satisfied and procedures which must be followed relating to the augmentation or induction of labor, see Title 10 of NYCRR, Section 405.21(e) at http://www.health.state.ny.us/nysdoh/phforum/nycrr10.htm
. - Where do New York State licensed midwives
practice?
Midwives practice in a wide variety of settings including hospitals, clinics, birth centers, clients' homes, and private professional offices.
- Do New York State licensed midwives care for women
with disabilities?
Yes. Licensed midwives provide services to women with disabilities. As with any patient, the appropriateness of providing services will depend on the particular condition and needs of the patient as well as the particular competencies of the midwife. You should speak to your midwife about your particular situation and inquire about any accommodations you may need.
How To Locate Or Find Information About Midwives
- How do I locate a New York State licensed
midwife?
- Midwifery organizations may be able to help identify members of their organizations who can assist you. Information from the American College of Nurse-Midwives is available at http://www.acnm.org/ or visit the NYS Association of Licensed Midwives website at http://www.nysalm.org/.
- Consult with people you know who have had a successful experience with a licensed midwife.
- You can also search under "Midwives" in the yellow pages of your telephone book.
- Please note: The State Board of Midwifery cannot refer you to a practitioner.
- How do I find out if an individual is licensed and
registered as a midwife in New York State?
You can verify that an individual is currently licensed and registered in New York State as a midwife through the Office of the Professions (OP) on-line verification service or by calling (518) 474-3817.
Practice Issues
- Does New York State law require that licensed
midwives be supervised by a physician?
No. New York State law does not require supervision by a physician. Rather, the law provides that licensed midwives must establish a collaborative practice and maintain a written practice agreement with a physician or hospital and practice in accordance with that agreement. (see also questions 12-15 below)
- Does the New York State Education law allow home
birth?
New York State law neither prohibits home birth nor requires licensed midwives to participate in them. Patients should discuss the issue of home birth with their LM.
Practice Agreements
- What is the relationship between licensed midwives
and physicians?
Licensed midwives are independent practitioners with expertise in the care of essentially healthy women. Under New York State law, licensed midwives are required to establish and maintain a collaborative relationship with physicians, and to practice in accordance with a written agreement with a licensed physician or a hospital. Such agreements provide for physician consultation, collaboration, referral and emergency obstetrical coverage and include written guidelines and protocols. Agreements also include guidelines for identification of pregnancies which are not considered normal and the procedures that are to be followed in such cases. They provide that the judgment of the collaborating physician will prevail as to whether the pregnancy, childbirth or post-partum care is normal and whether the woman is essentially healthy, unless otherwise provided in the practice protocol. Licensed midwives consult with, co-manage or refer patients to collaborating physicians when a woman's and/or a newborn's condition indicates the need.
- Are New York State licensed midwives required to
submit written practice agreements with physicians to the State
Education Department?
No. Practice agreements must be maintained and made available upon request by the State Education Department. Both the licensed midwife and the physician must maintain the agreement for a minimum of ten (10) years after the amendment or termination of the agreement.
- Are there any circumstances under which a New York
State licensed midwife can practice without a practice agreement
with a physician or hospital?
No. New York State law requires licensed midwives to practice pursuant to a written practice agreement at all times.
- How often must the written practice agreement be
reviewed?
Regulations of the Commissioner of Education require that the parties to the agreement review the agreement at least annually.
Licensure Issues
- Is an applicant for licensure in midwifery required
to be licensed and registered as a registered nurse (RN) to
practice midwifery in New York State?
No. Licensure in nursing is not a prerequisite to licensure as a midwife in New York State. However, only an individual licensed as both a nurse and a midwife may use the title "nurse midwife".
- Is a New York State licensed midwife who is also a
New York State licensed RN required to maintain a current nursing
registration to practice as a midwife in New York?
No. A licensed midwife must only maintain a current midwifery registration to practice as a midwife in New York State.
- Is a candidate for licensure in midwifery required to
have a Master's Degree to practice midwifery in New York
State?
No. Regulations of the Commissioner of Education recognize registered programs in midwifery leading to a baccalaureate degree or higher, and the equivalents of such programs. Detailed information on New York State licensure requirements in midwifery can be found on this site.
- Is a New York State licensed midwife required to
maintain American Midwifery Certification Board (AMCB)
certification or other certification in order to renew his or her
registration to practice in New York?
No. New York State law does not require any national certification in order to renew a registration to practice.
- Is a New York State licensed midwife required to
deliver a minimum number of babies every year to maintain a
midwifery registration to practice?
No, there is no required minimum.
- Is a New York State licensed midwife required to
complete a minimum amount of continuing education in order to
renew a registration to practice?
No. There is no formal continuing education requirement in midwifery. However, licensed midwives practice in an ever-changing healthcare environment with evolving technology, new modalities, increased consumer expectations and other emerging issues. Practice in this changing environment requires ongoing development of knowledge and skills. It is critical that all licensed professionals remain current with changes and developments in their profession to render quality services and to ensure public protection. Because of this need, section 29.1(b)(9) of the Rules of the Board of Regents makes it unprofessional conduct for a licensed individual to accept or perform professional responsibilities which they are not competent to perform.
- May a candidate become licensed without being a
United States citizen?
Yes. However, if not a US citizen, a candidate must be a permanently admitted resident ("green card" holder) to qualify for a license.
- Can a midwifery license in New York State be issued
solely on the basis of an applicant being licensed in another
country or another US jurisdiction?
NYS law authorizes the Board of Regents to endorse a license issued by another state or country if the applicant satisfies various requirements relating to education, experience, examination, age, citizenship or immigration status, and character.
Prescriptive Authority
- May a New York State licensed midwife who has
prescriptive privileges possess prescription medication and
devices related to the practice of midwifery?
Yes. However, medications and devices must be properly maintained and secured to avoid adulteration, diversion, etc.
- May a New York State licensed midwife provide care or
write prescriptions for men?
No. New York State law explicitly limits midwifery practice to the treatment of women.
- Must prescriptions written by a New York State
licensed midwife be counter-signed by the collaborating
physician?
No. A licensed midwife certified to prescribe and administer medications is not required to obtain a counter-signature from a physician.
- Can a New York State licensed midwife dispense
medications?
Yes. A licensed midwife certified to prescribe and administer medications may dispense medications but only to his or her patients and with certain limitations. For example, there are limits on fees that may be charged by prescribers who also dispense. This subject is covered more fully in Education law §6807.
Liability & Reimbursement Issues
- Does New York State Education law require a midwife
to purchase malpractice insurance?
No. Insurance requirements of licensed health professionals are not governed by the NYS Education Department. Information on insurance matters may be obtained by contacting http://www.ins.state.ny.us/nyins.htm.
- Does New York State Education law address payment or
reimbursement issues?
The New York State Education Department generally does not have the authority to resolve fee disputes. Some reimbursement issues may be addressed by SED if the actions of the midwife constitute professional misconduct. Issues can be addressed by contacting the New York State Insurance Department (http://www.ins.state.ny.us/nyins.htm), the Office of Managed Care ( http://www.health.state.ny.us/health_care/managed_care/reachus.htm), and the New York State Association of Licensed Midwives (http://www.nysalm.org/).
- Does health insurance cover New York State licensed
midwifery services?
Yes. The New York State Insurance Law states that all insurance companies under the jurisdiction of the New York State Insurance Department or the NYS Office of Managed Care must include midwifery services for the provision of maternity care. If an insurance company has a midwife in their provider network, they might not provide out-of-network reimbursement. When an insurance company does not include midwives in their provider network, they must reimburse for maternity services provided by a midwife even if there is no out-of-network provision. To view the text of Insurance Law §4303(c) go to http://assembly.state.ny.us/leg/ - select New York State Laws, then ISC Insurance, and Article 43 to Section 4303.
There are companies that are not under State jurisdiction, but fall under Federal ERISA (Employee Retirement Income Security Act of 1974). The health insurance plans offered by these companies vary. Women should check with their insurance provider for details.
ERISA is a Federal law that exempts self-funded health and other benefit plans (employer and union) from state jurisdiction. These benefit plans are governed by the US Department of Labor. Seven out of ten US employees are in self-insured plans. The ERISA law allows self-insured benefit plans to avoid paying premium taxes to the states. The US Department of Labor requires that these plans provide an explanation of benefits to members, and if a claim is denied, explain why the claim was denied and inform the individual of his or her rights to appeal. ERISA exempts self-insured plans from state law.
In addition, Medicare, a federally funded program which provides health care for the disabled and elderly, provides coverage for midwifery services, Section 4073 of the Omnibus Reconciliation Act (OBRA) 1987 (PL 100-203). OBRA 1993 (PL 103-66) §13544 – amended payment of services to include all covered services legally authorized to be performed under state law. There are no restrictions on settings where these services may be furnished.
Under Medicaid, midwifery services authorized to be performed under state law must be covered, Title XIX of the Social Security Act, Section 1902 (a) (10) (A). Section 13605 OBRA 1993, PL 103-66, amended 1905 (a) (17) of the act to remove the limitation that a nurse-midwife can provide services only during the maternity cycle and included “all covered services legally authorized to perform under state law or regulations”. There are no restrictions on settings where services may be furnished. For additional information, go to
http://www.ssa.gov/OP_Home/ssact/title19/1902.htm and http://www.ssa.gov/OP_Home/ssact/title19/1905.htm#a - Are Health Maintenance Organizations (HMOs) required
to contract with licensed midwives?
Yes. §4303(c) of the NYS Insurance Law mandates coverage of midwifery services. §98.13c of the HMO Regulations is interpreted to require HMO’s and/or Managed Care Organizations (MCO’s) to contract with licensed midwives. Insurance Law §4303(c) can be found at http://assembly.state.ny.us/leg/ - select New York State Laws, then ISC Insurance, and Article 43 to Section 4303.
In addition, HMO’s and MCO’s providing services to Medicare and Medicaid beneficiaries must cover services that a midwife is legally authorized to perform under state law or regulations. Information on this requirement may be found at http://assembly.state.ny.us/leg/ - select New York State Laws, then PBH, and Article 44.
Chapter 645 of the Laws of 1994: Direct Access for Ob/Gyn Services by HMO Enrollees amended the Public Health Law (4406-b) to provide females with greater flexibility in obtaining primary and preventive Obstetric and Gynecologic services from qualified providers, including licensed midwives, in health maintenance organizations (HMOs). It removed barriers to allow women enrolled in HMOs to access primary and preventive Ob/Gyn services and to remove restrictions in accessing care related to pregnancy. For additional information, go to http://assembly.state.ny.us/leg/ - select New York State Laws, then PBH, and Article 44.
Record Keeping
- How long must medical records be retained?
Licensed midwives must securely maintain patient records for at least six (6) years; this includes the obstetrical record, unless the law requires otherwise. If the patient is a minor, the patient's records must be retained for at least six years and until one (1) year after the minor reaches the age of twenty-one (21) years.
Although practice agreements must be maintained for ten years, it is recommended that they be retained to correspond to all years of practice.
- How do I proceed with a
complaint against a NYS midwife?
The Office of Professions' Office of Professional Discipline investigates complaints of professional misconduct. More information of what constitutes professional misconduct is on OP's website. To file a complaint against a licensed midwife, please call our toll free complaint hotline at 1-800-442-8106.
- Where can I go for more
information?
- State Board of Midwifery, (518) 474-3817, ext. 130
- Midwifery Organizations:
- American College of Nurse Midwives (ACNM) http://www.acnm.org
- American Midwifery Certification Board (AMCB) http://www.amcbmidwife.org
- NYS Association of Licensed Midwives (NYSALM) http://www.nysalm.org/
- North American Registry of Midwives (NARM) http://www.narm.org/
- Other Organizations:
- American College of Obstetricians/Gynecologists (ACOG) http://www.acog.org/
- Office of Managed Care http://www.health.state.ny.us/health_care/managed_care/reachus.htm
- NYS Department of Health (DOH) http://www.health.state.ny.us/
- NYS Insurance Department http://www.ins.state.ny.us/nyins.htm
