Several federal legislative proposals and policy initiatives are seeking to reshape midwifery practices in the United States.
Policymakers have introduced proposals that could expand and further regulate the midwifery profession. These efforts come after midwives and advocacy groups challenged policies they deemed restrictive and anticompetitive. As the nation continues to face high maternal mortality rates, growing maternity care deserts and shortages in obstetric providers, the maternal health crisis is more strongly felt in rural and underserved communities.
In response to the steadily growing issue, lawmakers have identified midwives as part of the solution.
New Insurance Mandates Could Create New Barriers For Midwives
As states move to expand and regulate midwifery practice, some lawmakers are turning their attention to malpractice coverage requirements. Several state-level proposals are aiming to require professional liability insurance for all practicing midwives.
Midwifery insurance advisor and liability specialist Monica Moniz tells HealthStack that these insurance mandates could create barriers without changes to the current market.
“While a universal insurance requirement sounds ideal for patient protection on the surface, a federal mandate for direct-entry midwives could severely harm maternal healthcare access,” she explains.
Although medical malpractice insurance is intended to act as a key safeguard for both patients and providers, many out-of-hospital midwives, especially direct-entry midwives, are unable to secure affordable coverage in the current market. Moniz warns that a blanket federal requirement could push many midwives out of practice.
“Because affordable insurance options for out-of-hospital midwives practically do not exist in the current market, a strict federal mandate would effectively price independent midwives out of business,” she says. “This would create deep maternal care deserts, particularly for communities of color and rural populations who heavily rely on midwifery care to combat rising maternal mortality rates.”
How Can Lawmakers Resolve The Insurance Issues Before Expanding Requirements
Policies historically aimed at restricting the field have included requirements for community midwives to purchase costly liability insurance. Some states have required midwives to submit extensive perinatal outcome data to research registries. Others have required detailed emergency transport protocols with local hospitals before midwives can register with state boards.
Moniz believes that the solution to the rising insurance issue in the midwifery industry should be ironed out before any federal mandates are put in place.
“The government and insurance industry must first create viable, affordable risk pools or state-backed insurance programs to give these clinicians a realistic way to comply,” she says.
Midwives And Policymakers Seek To Restructure The Insurance Market
With the introduction of the Midwifery Licensing Act, which requires licensed midwives to maintain malpractice insurance, midwives often faced limited or unaffordable coverage. Few commercial insurance carriers write malpractice policies for out-of-hospital care. As a result, some midwives practiced without malpractice insurance.
If the lawmakers pass the law, insurance companies would need to provide malpractice insurance for midwives in the state. The Department of Banking and Insurance would also require malpractice insurers to offer coverage for both nurse-certified and direct-entry midwives.
The new law would also establish new statewide licensing guidelines with three pathways to licensure existing in the state.
The proposed legislation passed the Senate Commerce Committee, receiving extensive media attention. It is currently advancing through the New Jersey Senate.
Education Rises As Another Barrier to Midwifery
Federal education policy has recently emerged as a concern for the midwifery workforce. The Department of Education issued a rule that excluded certain post-baccalaureate nursing programs from the “professional degree” category. Without that designation, graduate nursing and midwifery students received lower federal student loan limits and increased financial barriers.
In response, the House Appropriations Committee adopted a bipartisan amendment. If passed, the measure would protect advanced practice nursing programs, including certified nurse-midwife programs, from exclusion from professional degree classifications.
In June, a federal judge blocked parts of the rule, allowing nursing students to take out higher federal student loan amounts. Despite the small gains, midwifery remains a battleground on the professional front.
Midwifery Largely Remains A State Issue
State lawmakers are increasingly proposing changes to midwifery regulation. However, lawmakers haven’t proposed or passed federal bills focused specifically on midwifery this year.
Last year, lawmakers introduced the Midwives for MOMS Act, the BABIES Act, and the MIDWIVES for Servicemembers Act. All three measures remain pending in Congress and have not been signed into law.
Federal reform proponents argue that a national approach is needed to address maternal health challenges and expand access to care. Others argue that stronger oversight, licensing standards, and malpractice requirements are necessary, but should remain decisions made by individual states.
