NCMS Comments on Rule Permitting Unsupervised Nurse Midwifery

The NCMS filed comments with the Midwifery Joint Committee on Monday objecting to a proposed temporary rule that would allow Certified Nurse Midwives (CNMs) to practice indefinitely without physician supervision, if their supervising physician unexpectedly terminates the supervision agreement. The Committee issued an emergency rule two weeks ago citing a single incident in which one physician terminated supervision of seven nurse midwives.

The NCMS expressed on four major concerns related to the rule:

  1. The Midwifery Joint Committee lacks the necessary statutory authority to develop a rule permitting unauthorized practice by nurse midwives;
  2. Contrary to the requirements of North Carolina law, the Midwifery Joint Committee’s proposed temporary rule actually protects the nurse midwives’ access to patients, rather than the patients’ access to safe obstetrical care from supervised CNMs or physicians;
  3. If the first two problems can be fixed (we do not think they can), then the proposed temporary rule should be amended to define how the Midwifery Joint Committee will determine if a midwife should be permitted to practice without supervision; and
  4. Again, if the first two problems can be fixed, the proposed temporary rule should be amended in six specific ways (see link to NCMS comments, above) to mitigate serious patient safety concerns that accompany unsupervised practice by nurse midwives.

The proposed temporary rule next goes to the Rules Review Commission, which will determine if the Midwifery Joint Committee has the necessary authority. The NCMS will continue its efforts to have the above issues addressed throughout the promulgation of the temporary rule, and the permanent rule if necessary. Watch the Bulletin for updates on the midwifery rule.


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