30.005 Midwifery


Midwifery: Texas offers licensure for two types of midwives to deliver newborns. Certified nurse midwives (CNM), also known as advanced practice nurses, are licensed by the Texas Board of Nursing and are required to have at least a masters-level degree in nursing. TMA supports current training standards for certified nurse midwives and encourages the use of CNMs within a medical team setting. Direct-entry midwives, also known as lay midwives or licensed professional midwives, are not required to have a nursing or bachelor’s degree. Direct-entry midwives may choose to be licensed by the Texas Midwifery Board. The Texas Medical Association supports the following measures to promote the safety and health of mothers and newborns who receive care by a direct-entry midwife:

Supervision and Training: The practice of direct-entry midwives should only take place in consultation with a licensed physician practicing obstetrics.

Patient Safety Guidelines and Informed Consent: Texas midwifery rules should specify protocols and standards to be used by practicing direct-entry midwives, including clear standards for the delineation of findings that preclude a woman’s or newborn’s condition as being classified as normal. The definition of a normal pregnancy should be based on national medical guidelines and any indication of a high-risk pregnancy should require immediate transfer to the care of a physician. Any care provided to the infant following birth must adhere to the perinatal care guidelines set forth by the American Academy of Pediatrics.

Direct-entry midwives must maintain a signed transfer agreement with a physician and ensure that each patient pre-registers at a hospital where the patient and/or infant can be transferred in case of an emergency. Any transfer agreement between a midwife and a physician or hospital should stipulate a verbal handoff by the midwife as well as a transfer of all relevant medical records. TMA supports rules to require a standard informed consent form for clients to sign that follows the Informed Disclosure for Midwifery Care standards set by the North American Registry of Midwives.

Accountability and Oversight: TMA supports legislative action to require that direct-entry midwives maintain liability insurance. All direct-entry midwife-assisted pregnancies that are either transferred or referred for emergency care or have adverse outcomes should be reported by the midwife to a midwifery advisory body and the case reviewed by a committee that includes at least one physician. TMA calls for the Texas Midwifery Board to monitor pregnancy and delivery outcomes attended by direct-entry midwives and to report this information to the state. TMA supports new requirements to ensure that the Texas Midwifery Board takes all necessary steps to facilitate transparency and the participation of members and the public, including allowing participation via telephone conference. TMA also supports designating at least one Certified Nurse Midwife, one licensed pediatrician or neonatologist, one licensed obstetrician-gynecologist, and one licensed maternal and fetal medicine physician to serve as members of the Texas Midwifery Board (Committee on Maternal and Child Health, p 125, A-93; CM-MPH Rep. 4-I-01;amended CM-MPH Rep. 3-A-03; substituted policies 30.005, 30.006, 30.009 for this comprehensive policy CM-MPH Rep. 4-A-04; Res. 305-A-04; amended CM-MPH Rep. 1-A-15).

Last Updated On

October 07, 2016