A federal lawsuit filed on January 20, 2026, is questioning certain laws in Mississippi that limit how certified nurse-midwives (CNMs) can practice.
The lawsuit was brought by the American College of Nurse-Midwives (ACNM) and challenges a state rule requiring CNMs to have a formal collaborative agreement with a licensed physician before practicing.
Under current Mississippi law, CNMs, who are advanced practice registered nurses (APRNs) specially trained in prenatal, childbirth, and postpartum care, can’t practice independently unless they find a physician willing to sign a collaborative agreement.
These agreements can come with high fees and logistical barriers, and some physicians in the state may be reluctant to enter into them, especially in rural areas with fewer OB/GYNs. That means many CNMs are unable to fully use their training.
Understanding nurse-midwife practice authority
Nurse-midwife practice authority refers to the legal rights and responsibilities granted to CNMs, including their ability to assess patients, manage prenatal and postpartum care, deliver babies, and prescribe medications — with or without physician involvement. This isn’t standardized nationwide, and laws vary widely from state to state.
In the U.S., states typically fall into one of three categories:
- Full practice authority: CNMs can practice independently to the full extent of their training without physician oversight.
- Reduced or collaborative practice authority: CNMs must have a written agreement with a supervising or collaborating physician.
- Restricted practice: CNMs are legally limited in what they can do without physician oversight.
These differences in laws have a direct effect on how midwives practice and on how some patients access care, especially in maternal health deserts where OB/GYNs are scarce.
Why does practice authority matter for patient care?
CNMs have graduate-level education in nurse-midwifery and specialize in prenatal care, labor and delivery, postpartum support, family planning, and overall women’s health. Midwifery-led care has been associated with better health outcomes in many populations, including:
- Lower rates of preterm birth
- Reduced need for cesarean sections (C-sections)
- Higher patient satisfaction
- Improved outcomes for mothers and newborns, especially in underserved communities
In fact, according to the Yale School of Medicine, first-time mothers at medical centers working with midwives were 74% less likely to have labor induced and 12% less likely to have a C-section than care teams without midwives.
Despite this, many states still impose laws that require CNMs to have physician oversight, which can limit their ability to serve communities. Currently, there are 19 states that require physician oversight for CNM practice, with 17 states requiring a signed collaborative practice agreement.
“Certified nurse-midwives are fully trained, nationally certified professionals who deliver high-quality, cost-effective maternity care every day across this country,” said Michelle Munroe, DNP, APRN, CNM, FACNM, FAAN, ACNM Chief Executive Officer, in a statement on the Mississippi Center for Justice’s (MCJ) website.
Challenging restrictions on CNM practice
This federal lawsuit, which is supported by the MCJ, challenges Mississippi’s laws that restrict CNMs from practicing without a formal physician collaboration agreement.
Currently, in Mississippi, CNMs must have a written collaborative agreement with a licensed physician to practice. In these cases, some physicians may be unwilling to enter into these agreements due to liability concerns or lack of incentive.
In addition, some physicians may charge high fees to sign these agreements, which can start at $500 to establish, in addition to monthly fees. This can create financial and logistical barriers for CNMs, especially in rural areas.
As a result, many CNMs in Mississippi are either unable to practice or are forced to work in highly constrained environments, limiting the scope of care they can provide. This especially impacts rural areas, where there are fewer OB/GYNs available for collaboration.
The lawsuit comes amid a broader maternal health crisis in Mississippi. The state declared a public health emergency in August 2025 due to increasing infant mortality rates and disparities in maternal outcomes.
“With Mississippi suffering from severe shortages of professionals who can deliver babies and provide prenatal and postnatal care, we need to do everything we can to increase the number of certified nurse midwives in the state,” said Rob McDuff, an attorney at MCJ, in a statement on their website.
The lawsuit’s goals and potential outcomes
This lawsuit seeks to overturn Mississippi’s collaboration requirement, arguing that it isn’t medically necessary and unlawfully restricts competition in healthcare.
Interestingly, Mississippi lawmakers have introduced bills (House Bill 418 and Senate Bill 2553) in recent sessions that would remove this requirement and grant full practice authority to CNMs.
However, if the lawsuit succeeds, it could:
- Set a legal precedent for other states with CNM practice laws.
- Expand access to maternal care for thousands of patients, especially those in rural and underserved communities.
Final thoughts
The outcome of this lawsuit could significantly impact how CNMs practice in Mississippi and potentially influence similar laws in other states. As the state works to improve maternal health outcomes, changes to current regulations may play a key role in expanding access to care.
