Midwifery - Questions & Answers
- 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 49 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. 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.
- 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
- Order and interpret laboratory tests and diagnostic studies and devices and interpret results
- Order durable medical equipment and medical devices
- 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
- Are Certified Nurse Midwives CNM and Certified Midwives CM equivalent under New York State education law?
Yes. New York State has legislated the term licensed midwife to encompass both forms of certification, Certified Nurse Midwives and Certified Midwives. Both of the credentials meet the requirements for licensure. The CNM/CM credential is identical for New York State Licensed Midwives.
- Are NYS Licensed midwives required to have a nursing license to practice midwifery in NYS?
No. Licensed midwives are not required to have or maintain a nursing license registration to practice midwifery.
- Are New York State licensed midwives authorized to prescribe medications and order diagnostic tests?
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 . 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."
- Must prescriptions written by a New York State licensed midwife be counter-signed by a physician?
No. A licensed midwife certified to prescribe and administer medications is not required to obtain a counter-signature from a physician.
- Are licensed midwives authorized to order diagnostic tests and consultations?
Yes. Licensed midwives have the authority by law to prescribe and administer drugs, immunizing agents, diagnostic tests and devices, and to order laboratory tests, as established by the board in accordance with the commissioner's regulations.
- May a New York State licensed midwife provide care or write prescriptions for men?
No, with one exception, New York State Law limits midwifery practice to the treatment of women with exception of partner treatment for the STD, STI Chlamydia Trachomatis (Ct) Under the guidelines for “Expedited Partner Therapy Guidelines for Health care Providers in NYS for Chlamydia Trachomatis” , Licensed midwives may treat male partners. http://www.health.ny.gov/diseases/communicable/std/ept/guidelines_for_providers.htm
- May a New York State licensed midwife who has prescriptive privileges possess prescription medication and devices related to the practice of midwifery?
Yes. Medications and devices must be properly maintained and secured.
- Can a New York State licensed midwife dispense medications?
Yes. A licensed midwife certified to prescribe and administer medications may dispense medications to his or her patients 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.
- 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 a 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 nonpharmacologic 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.ny.gov/regulations/nycrr/title_10
- Where may New York State licensed midwives practice?
Licensed Midwives may practice in a wide variety of settings including hospitals, clinics, birth centers, clients' homes, and private professional offices.
- May New York State licensed midwives care for women with disabilities?
Yes. Licensed midwives provide services to women with disabilities. Meeting the health care needs of the disabled woman is within the scope of practice for licensed midwives.
- How do I locate a New York State licensed midwife?
- Midwifery organizations may help identify members of their organizations that can assist you. Information is available from the American College of Nurse-Midwives (ACNM) at http://www.acnm.org/ or NYS Association of Licensed Midwives (NYSALM) at http://newyork.midwife.org/index.asp. You may 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 may 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 http://www.op.nysed.gov/opsearches.htm.
- What is the relationship between licensed midwives and physicians?
Licensed midwives are not supervised; they are independent practitioners. New York State law provides that licensed midwives shall have collaborative relationships with:
- a licensed physician who is board certified as an obstetrician-gynecologist by a national certifying body; or
- a licensed physician who practices obstetrics; or
- a hospital, that provides obstetrics through a licensed physician having obstetrical privileges at such institution, that provide for consultation, collaborative management and referral to address the health status and risks of his or her patients and that includes plans for emergency medical gynecological and/or obstetrical coverage.
A midwife shall maintain documentation of such collaborative relationships and shall make this information available to his or her patients.
- What is a collaborative relationship?
A collaborative relationship entails contacting, consulting and possibly referring according to the health status of the patient. The goal is to provide seamless access to the full range of health care for woman and newborns. Examples of which include, but are not limited to electronic, telephone or personal consultation, collaborative management, shared management, referral or transfer of care.
- Who can collaborate with a New York State licensed Midwife?
Possible collaborators include but are not limited to: Licensed midwives, licensed physicians of any specialty (Maternal-Fetal Medicine, Obstetrician-Gynecologists, Pediatricians, Neonatologists, Family Practice physicians, Anesthesiologists, Psychiatrists, Radiologists, General Internal Medicine and Medical and Surgical sub-specialties), hospitals and other health care providers such as nurse practitioners, nurse anesthetists, physician assistants, nutritionists, social workers, chiropractors, acupuncturists and physical therapists.
- How is a collaborative relationship documented?
The following are examples of documentation of a collaborative relationship in multiple clinical settings.
- The medical record shall reflect the communication between a licensed midwife and collaborator.
- The patient will be provided an educational document which includes plans for emergency medical, gynecological and/or obstetrical care.
- The midwife may contact the referral hospital and or a collaborating physician. Documentation of plan(s) will be noted in medical record.
- Licensed Midwives, (CMN/CM) midwives may be employed at an Article 28 facility.
- Midwives may be self-employed or employed in a practice groups in private practice or hospital based practice, where they may be credentialed by a medical care facility.
- Midwives may be affiliated with a Birth Centers and have an established mechanism for patient transfer (Section 405.21 Perinatal services, (c) General requirements (9)(i))
- Are New York State licensed midwives required to submit written documentation of their relationships with physicians to the State Education Department?
- Does a NYS Licensed Midwife need a written practice agreement for reimbursement from health insurance carriers?
No. In accordance with Education Law, Article 140 effective November 1, 2010, licensed midwives do not require a written practice agreement for practice or reimbursement of midwifery services.
- 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". Likewise, a registered nurse who becomes licensed as a midwife need not maintain a current registration in nursing.
- Is a candidate for licensure in midwifery required to have a Master's
Yes. Regulations of the Commissioner of Education, as amended and effective January 1, 2011, require a registered program in midwifery leading to a Masters 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: http://www.op.nysed.gov/prof/midwife/midwifelic.htm#educ
- 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. 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 have an alien registration number or control number issued by the United States citizenship and Immigration Services (USCIS).
- May a midwifery license in New York State be issued solely on the basis
of an applicant being licensed in another country or another U.S. jurisdiction?
No. 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.
- Does New York State Education law require a midwife to purchase
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.dfs.ny.gov/insurance/health/hregindx.htm.
- Does New York State Education law address payment or reimbursement issues?
The New York State Education Department does not have the authority to resolve fee disputes. Reimbursement issues may be addressed by SED only if the actions of the midwife constitute professional misconduct or fraud. Issues can be addressed by contacting the:
- New York State Insurance Department at: http://www.dfs.ny.gov/insurance/dfs_insurance.htm
- NYSDOH Office of Health Insurance Programs Managed Care at: http://www.health.ny.gov/health_care/managed_care/contact/reachus.htm
- New York State Association of Licensed Midwives at: http://www.nysalm.org/
- Do health insurance plans 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 licensed midwife in their provider network, they might not provide out-of-network reimbursement. When an insurance company does not include licensed midwives in their provider network, they must reimburse for maternity services provided by a licensed 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), Article 43 and 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
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. 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), Article 43 and 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/. New York State Laws, then PBH (Public Health), 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 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.
- 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.
- How may I file 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
- New York State Board of Midwifery, (518) 474-3817, ext. 130
- Midwifery Organizations:
- Other Organizations:
- American College of Obstetricians/Gynecologists
- Office of Managed Care
- NYS Department of Health (DOH)
- NYS Insurance Department
- American College of Obstetricians/Gynecologists (ACOG)