Bill to broaden practice authority for certified nurse-midwives advanced

A bill that seeks to provide Nebraska certified nurse-midwives with full practice authority was given first-round approval April 24 after senators rejected an effort to add two additional proposals to the measure.

Currently, certified nurse-midwives who are authorized to practice in Nebraska may do so only in a hospital or birthing center and under the supervision of a licensed practitioner. Individuals who hold a CNM credential must be licensed as a registered nurse and complete a nurse-midwifery education program.

LB676, introduced by Blair Sen. Ben Hansen, would remove the requirement that a CNM have a practice agreement with a collaborating licensed practitioner. The bill also would eliminate location restrictions on where a CNM may perform authorized medical functions and update the Nebraska Hospital-Medical Liability Act to include certified nurse-midwives.

Hansen said nearly every other state has fewer practice restrictions for CNMs, resulting in Nebraska having the reputation of being one of the worst states in which to practice midwifery. He said certified nurse-midwives are the only advanced practice registered nursing group that is not allowed to practice independently.

“[LB676] respects [a mother’s] right to deliver in a manner they feel is safe, empowered and best for their baby,” Hansen said. “It is time we take advantage of what other states have already been doing for years and find support through midwifery.”

A Health and Human Services Committee amendment would remove the provision to place CNMs under the Nebraska Hospital-Medical Liability Act. The amendment would replace that provision with language requiring a CNM to refer a patient who requires care beyond their scope of practice to an appropriate health care provider.

A health care provider that accepts a transfer of such a patient would not be liable for an outcome arising from the action or inaction of a CNM under the amendment.

The amendment also would add provisions from two other measures heard by the committee this session. LB701, introduced by Omaha Sen. Ashlei Spivey, would require the state Department of Health and Human Services to provide Medicaid coverage for doula and full spectrum doula services, beginning no later than Jan. 1, 2026.

The bill defines a doula as a trained professional who provides emotional, physical and informational support for individuals before, during and after labor and birth — including attending prenatal visits, support during delivery and providing resources during the postpartum period.

Spivey said Nebraska currently ranks 19th in maternal mortality rates, with 93% of all maternal deaths in the state deemed to have been preventable.

“Doula care is one effective intervention to improve health outcomes,” she said.

Also included in the committee amendment are provisions of LB374, introduced by Hansen, which would add certified professional midwife as a new category of state licensure under the Uniform Credentialing Act. The measure also would create a Board of Licensed Midwives and a CPM licensure process.

Under the amendment, a licensed CPM would be authorized to attend physiological childbirths and provide prenatal, postpartum and newborn care for up to six weeks after birth.

Omaha Sen. John Fredrickson introduced an amendment to replace the underlying bill and the committee amendment. Fredrickson’s amendment would retain the provisions of Spivey’s LB701, provide guardrails for certified nurse-midwives and remove all provisions relating to certified professional midwives.

Fredrickson said licensing CPMs would grant them a scope of practice that currently exceeds that of advanced practice nurses and physician assistants, despite significant differences in training and clinical preparation.

While CNMs must have a nursing degree and a masters or doctoral level of training in midwifery, Fredrickson said, CPMs are not required to have any formal nursing or medical training beyond the accreditation process.

“Any pathway forward must ensure that the safety of women and newborns remains the top priority,” he said. “While these midwives are deeply committed to supporting pregnancy and birth, their educational pathways vary widely and are not held to a standardized medical training benchmark.”

Whitman Sen. Tanya Storer supported the Fredrickson amendment, noting the importance of having trained medical professionals in situations where emergencies can arise quickly.

She said emergency services can be several hours away in many rural areas and accessible only by medical helicopter or ambulance.

“We have to keep the whole state in mind when we are making these provisions in law,” Storer said. “It’s important that … moms have a certified nurse-midwife that has a broader scope of ability to care for some of the emergency issues that certainly can come up in childbirth.”

Sen. Mike Jacobson of North Platte also opposed licensing CPMs, saying the health of the mother and newborn should be the state’s top priority. He cited a study indicating that neonatal death rates are significantly higher during home births attended by a midwife who is not a CNM.

Lincoln Sen. Jane Raybould supported LB676 and opposed the exclusion of CPMs. She said midwives know their medical limitations and can refer patients to a hospital or other provider if a complication were to arise.

Sen. Glen Meyer of Pender said LB676 would be an important step toward increasing access to maternal health care in Nebraska. He said there are only 40 hospitals in the state that deliver babies, most of them in urban areas.

“We’re trying to increase the safety and availability of births in our state,” Meyer said. “We cannot legislate all the risks out of our people’s lives.”

Fredrickson withdrew his amendment before a vote could be taken. He said he intends to reintroduce it during the second round of debate if a compromise cannot be reached before then.

An amendment offered by Hansen, which failed on a 21-14 vote, would clarify that CPMs are not authorized to practice in a hospital and limit their ability to provide newborn care to seven days after birth.

His amendment also would require CPMs to provide patients with an informed consent form outlining two referral options to licensed physicians or CNMs and information regarding the level of liability insurance they possess.

Sen. Machaela Cavanaugh of Omaha offered a motion to reconsider the vote on the Hansen amendment, saying it would address concerns regarding CPMs from opponents in the medical community. The motion was successful.

A second vote on the Hansen amendment also failed on a vote of 22-11. Twenty-five votes were needed.

After also rejecting the committee amendment 23-17, lawmakers advanced the underlying LB676 to select file on a vote of 40-3.