Virginia has removed the physician supervision requirement for certified nurse-midwives, allowing them to practice independently across the state. The change means that highly trained midwifery professionals can now provide the full range of care their education qualifies them for — without needing a doctor’s sign-off. For a state where maternity care shortages are acute in rural areas, the practical consequences could be significant.
At a glance
- Autonomous midwifery practice: Virginia’s new law eliminates the requirement that certified nurse-midwives operate under physician oversight, enabling independent practice within their full trained scope.
- Maternity care deserts: Several rural Virginia counties have no hospital obstetric services and no independent obstetric providers — making nurse-midwives the only realistic option for many pregnant women.
- National momentum: Virginia joins a growing list of states aligning their licensing laws with full practice authority standards endorsed by major nursing and midwifery organizations.
Why this law took so long
The passage wasn’t quick. Midwifery advocates and professional organizations spent years building the case that certified nurse-midwives — who complete graduate-level clinical training — are fully equipped to manage low-risk pregnancies and births on their own.
Their persistence reflects a broader national effort to match state licensing law with what the clinical evidence actually supports. The United States has a well-documented maternal health crisis: outcomes lag behind peer nations, and the disparities fall sharply along racial lines. Black women in the U.S. face significantly higher rates of pregnancy-related complications and death than white women — a gap rooted in systemic inequities in access to care. Expanding the supply of independent, qualified providers is one concrete way to respond.
A smarter division of care
Supporters argue the law doesn’t create competition between providers — it creates a more rational system. When nurse-midwives handle low-risk pregnancies independently, physicians can concentrate on the complex, high-risk cases that genuinely require their specialized training.
That logic matters most where the alternative to a nurse-midwife is no care at all. Maternity care deserts — counties with no hospital obstetric services and no obstetricians — affect millions of Americans. For pregnant women in those communities, autonomous midwifery practice is not an abstract policy debate. It is a question of whether anyone qualified is available when they need care most.
What the research supports
The evidence on midwifery outcomes is consistently encouraging. Studies show that midwife-led care for low-risk pregnancies is associated with lower rates of unnecessary medical intervention, high patient satisfaction, and outcomes for mothers and newborns that are comparable to — or better than — standard obstetric care.
The World Health Organization has identified midwifery as a critical component of global strategies to reduce maternal and newborn mortality. The American College of Nurse-Midwives has long advocated for full practice authority, citing both safety data and the role midwives play in reaching underserved communities.
Virginia’s law is expected to improve birth outcomes and give women more genuine choice in who provides their care. But its real-world impact will depend on implementation — specifically, whether the number of practicing nurse-midwives grows to meet demand, and whether insurance reimbursement expands to keep pace with their new scope. Rural communities will need particular attention to make sure the benefits of this policy reach the people who need them most.
Part of a larger shift
Virginia’s move is part of a wider trend. More than two dozen states have already granted nurse practitioners and nurse-midwives full or reduced-supervision practice authority, and the results in those states have informed the policy case in others. The American Association of Nurse Practitioners tracks this landscape and has consistently found that expanded practice authority improves access without compromising quality.
There is still meaningful work ahead. Equity in who benefits from this change — by geography, race, and insurance status — will require sustained attention from policymakers, health systems, and the midwifery community alike. But the removal of a supervisory requirement that was never rooted in evidence is a real step forward for maternal health in Virginia.
Read more
For more on this story, see: Nurse One Stop
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