Are hospital limitations on midwife scope of practice discriminatory?
New Jersey is a great state in which to practice as a certified nurse midwife (CNM). We are governed under the Board of Medical Examiners rather than the Board of Nursing, and laws clearly delineate that we are affiliated with physicians rather than supervised by them. In our state, CNMs provide maternity and well-woman care “within a health care system, which provides for consultation, referral and collaboration” with a physician.
I'm happy to say that my group of collaborating physicians is excellent. They trust my clinical judgment, do not unnecessarily question my management and are there when I need them. I feel comfortable asking them for guidance or assistance in any circumstance.
Unfortunately, the hospital system in which I work does not completely recognize the nature of midwifery practice in our state. We do not have admitting privileges, and a physician must cosign most of our documentation, including histories and physical exams. This is not a state policy, as midwives at other local hospitals have full admitting privileges.
Although midwives have been practicing at this hospital for more than 35 years, these limitations make us feel like second-class citizens. I also feel that there is definitely a lack of respect that has trickled down from the restrictions on our hospital practice.
Recently when calling anesthesia to request an epidural for a laboring patient, the anesthesiologist asked the name of the requesting provider. When I identified myself as the nurse-midwife requesting the epidural, he asked me who my attending was for the day. I reminded him that I was in fact managing this patient's care and did not need to have my collaborating physician present.
Later in that same day, another anesthesiologist was surprised to learn that our patients do not have to be seen by a physician during the pregnancy unless they are high risk or specifically request a doctor. He said to me, “I thought the midwives were just here to make the doctors lives easier.”
Though this ignorance is infuriating and frustrating, I'm comforted by the fact that our patients trust in our ability to manage their care and recognize our unique, yet evidence-based approach to obstetrics and gynecology. Patients often see exclusively midwives for both pregnancy and well-woman care, and I'm proud to say that many women transfer into our practice because of the reputation that we have established.
I'm not a physician, and I don't ask to be treated like a physician. But I do ask that I be allowed to practice within the full scope of midwifery practice and state regulations, both in the office and the hospital setting.
Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.