Expansions in scope of practice provider regulations for certified nurse midwives & maternal-infant health outcomes: evidence from PRAMS

Abstract Growing shortages in women’s health care providers can delay prenatal care, increasing risks for both mothers and infants. To address this, many states have expanded regulations on non-physician practice authority, allowing certified nurse midwives to deliver a wider range of services, independent of direct physician supervision. Supporters argue that these expansions can help fill provider gaps and improve access to early prenatal care. Critics question whether the quality of care might decline without physician oversight. Despite growing policy interest, there is limited evidence on how independent practice affects maternal and infant health. This study examines the impact of practice reforms for Certified Nurse Midwives on health outcomes with data from the Pregnancy Risk Assessment Monitoring System. Using a difference-in-differences approach, we find that regulatory expansions in the autonomy of Certified Nurse Midwives lead to earlier prenatal care without negatively affecting birth outcomes. Our findings suggest that regulatory flexibility can improve access to care without compromising quality.