State Regulation of Practice and the Utilization of Nurse-Midwives for Medicaid Funded Prenatal Care

Tuesday, 14 July 2009: 2:05 PM

Andrea Sonenberg, NP, CNM, MS, DNS
Lienhard School of Nursing, Leinhard School of Nursing, Pace University, Pleasantville, NY

Learning Objective 1: identify three areas related to maternal child health for which there are health disparities for vulnerable populations in the United States.

Learning Objective 2: identify three categories of regulation of practice that are correlated with total medicaid funded nurse-midwife services.

Purpose: The aims of this descriptive correlational health policy study were to: 1) describe any association between a state’s CNM Professional Practice score and the proportion of Medicaid funded CNM services in the fifty states of the United States, 2) describe  any association between a state’s CNM Professional Practice score and the proportion of Medicaid-funded prenatal care delivered by CNMs in exemplar states;  3) describe the category of regulation of practice within the index that has the greatest association with the proportion of Medicaid-funded CNM services; and  4) describe which of the factors within that category has the greatest association with the proportion of Medicaid-funded CNM services.

Methods: The association between State regulation of CNM practice, outcomes related to utilization of Medicaid funded CNM services, select maternal/newborn outcomes, and select demographic indicators in 2000-2003 was determined.  Correlations between each of the three categories of Professional Practice Score with each of the outcome variables were calculated.  To establish if extreme differences in Professional Practice Scores influenced the outcome variables more than the overall difference of all 50 states, states with scores on either end of the spectrum were analyzed.

Results: The key findings were: 1) there is a paucity of data related to individual and specific Medicaid funded services provided by nurse-midwives; 2) states with the fewest barriers to practice have the greatest proportion of CNM births; 3) states with the most restrictive practice regulation also have the highest proportion of vulnerable populations and higher percents of adverse perinatal outcomes; and 4) states with the greatest autonomy in three areas: professionalism, business practices, and clinical practice may have the greatest access  to care for vulnerable populations. 

Conclusion: Future studies in nurse-midwifery practice should focus on improving research methodologies in the areas of state regulation and outcomes.  Health policy implications fall into three categories related to nurse-midwifery practice: organizational policy related to research, regulation of practice, and access to care for vulnerable populations.