Certified Nurse-Midwives Challenge Mississippi Law Limiting Practice Authority
- ACNM sues Mississippi boards over collaboration requirements that prevent CNMs from practicing independently.
- Mississippi declared a maternal health emergency August 21, 2025 amid rising infant mortality rates.
- Lay midwives face no collaboration rules, while licensed CNMs risk jail for practicing without physician agreements.
A federal lawsuit filed in January 2026 argues that Mississippi’s long-standing physician collaboration requirement for certified nurse-midwives (CNMs) is worsening the state’s maternal and infant health crisis by preventing qualified nurses from practicing to the full extent of their training.
The American College of Nurse-Midwives (ACNM) filed suit in the U.S. District Court for the Southern District of Mississippi against the Mississippi State Board of Medical Licensure and the Mississippi Board of Nursing, seeking to block enforcement of statutes and regulations that require CNMs to obtain and maintain physician collaboration agreements before they can practice.
A Public Health Emergency
The complaint opens by framing Mississippi’s maternal health outcomes as an emergency, stating plainly: “There is a public health emergency in Mississippi.”
According to the lawsuit, Mississippi ranks at or near the bottom nationally for infant mortality, maternal mortality, preterm birth, and cesarean delivery rates. The filing notes that on August 21, 2025, the Mississippi State Department of Health formally declared a public health emergency in response to rising infant mortality and urged action to eliminate OB deserts and expand prenatal and postpartum care.
The lawsuit argues that restrictive laws governing CNM practice are directly undermining those goals.
What Mississippi Law Requires of CNMs
According to Stateline, in Mississippi “advanced practice nurse practitioners, including certified nurse-midwives, can’t practice without a signed ‘collaborative practice agreement’ with a doctor.”
The complaint explains that without physician collaboration, a CNM “may not begin practicing, continue practicing, or renew their license.” If a physician withdraws from a collaboration agreement for any reason, the CNM must immediately stop practicing unless a new agreement is approved by the Board of Nursing.
The lawsuit emphasizes that physicians are under no obligation to collaborate and may refuse or terminate agreements “for any reason or no reason at all.”
“Irrational and Anti-Competitive”
ACNM argues the collaboration requirement does not improve patient safety because CNMs are already educated, trained, licensed, and regulated to provide maternity care independently. The complaint states that the requirement “does nothing to advance patient safety or quality of care” and instead creates barriers that are “irrational and anti-competitive.”
The lawsuit further alleges that additional rules imposed by the Mississippi State Board of Medical Licensure make collaboration harder and more expensive by converting it into a formal contract, imposing geographic limits, and allowing standardized pricing for collaboration fees. According to the filing, these regulations “discourage physicians from collaborating, raise the price of collaboration, and give physicians even more incentive to exclude CNMs, who are their potential competitors.”
Evidence on Safety and Outcomes
The complaint cites decades of research showing that midwife-led care for low-risk pregnancies produces outcomes comparable to, or better than, physician-led care. It notes that “extensive empirical literature demonstrates that midwife-led care for low-risk pregnancies produces outcomes comparable to—or better than—physician-led care, while improving access in underserved areas.”
The filing also references a Federal Trade Commission report concluding that mandatory collaboration requirements are associated with reduced access, higher costs, and less competition, and are “not justified by legitimate health and safety concerns.”
Stark Contrast with Other Midwives
One of the lawsuit’s most striking claims is that Mississippi law places stricter requirements on CNMs than on other types of midwives. The complaint explains that lay midwives and certified professional midwives may practice in Mississippi without physician collaboration or state oversight, while CNMs — who hold graduate degrees and national certification — face license revocation and even criminal penalties if they practice without a collaborator.
The filing states that “any person in Mississippi who is not a nurse may open a business and offer services assisting with the delivery of babies,” while a CNM may not do so without risking license revocation and jail time.
What the Lawsuit Seeks
ACNM is asking the court to declare Mississippi’s collaboration statute unconstitutional as applied to certified nurse-midwives and to permanently block enforcement of both the statute and related board regulations. The lawsuit argues these requirements violate due process, equal protection, and federal and state antitrust laws.
If successful, the case could significantly expand access to CNM-led maternity care in Mississippi, and potentially influence scope-of-practice debates in other states with similar restrictions.
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