Date of Award


Document Type

Open Access Thesis

Degree Name

Doctor of Nursing Practice (DNP)


Yale University School of Nursing

First Advisor

Cecilia Jevitt



Limited access to care and rising perinatal mortality rates have pivoted attention once again to practice barriers. Despite numerous studies reporting that CNM care is equal quality to physician care for the scope of practice provided, legislated restrictions remain in 25 states. The goal of this project was to determine if legislated restrictions affect the outcomes of care provided by midwives. Following a literature search, a retrospective descriptive review of “before and after” perinatal outcomes following midwifery care in three states was conducted. Three years of data from the period when the state had some form of supervisory regulation was compared to 3 years of data after the restrictions were lifted. Each state was compared against itself. This project used aggregated data from the Centers for Disease Control and Prevention’s National Center for Health Statistics public use website, Vital Statistics Online and CDC Wonder. Variables were the quality measures of neonatal mortality, preterm birth, and low birth weight analyzed by CNM care or care by other providers. The results were decreased low birth weight, preterm birth, and infant mortality with CNM care after the removal of restrictions, with an increase in CNM-attended births over three years. There was either statistically equivalent or improved safety in CNM care after the lifting of practice barriers. Further investigation may determine if removal of scope of practice restrictions increases access to care while maintaining or improving perinatal outcomes.

Open Access

This Article is Open Access