A group of nurses and midwives is suing Mississippi over restrictions on their practice

A midwife in rural Okanogan County, Washington holds a newborn baby. A group of nurses and midwives is suing Mississippi over restrictions on their practice. (Photo courtesy of Sarah Simmons)

This week, the American College of Nurse-Midwives sued the state of Mississippi in federal court, challenging the state’s requirement that nurse-midwives practice in collaboration with a physician.

In Mississippi, advanced practice nurses, including certified nurse-midwives, cannot practice without a “collaborative practice agreement” signed with a physician. This typically involves the nurse midwife paying a monthly fee, the lawsuit states, and obstetricians can refuse to enter into such agreements.

Many states enforce similar requirements. Supporters say such policies protect patients and promote communication between advanced practice nurses and doctors. But a group of nurses and midwives argues that they are unreasonable and do little to ensure doctors are available when needed.

A case filed in the United States District Court for the Southern District of Mississippi against the Mississippi Medical Licensing Board alleged that this requirement violates federal and state antitrust laws by limiting the number of certified nurse-midwives, thereby reducing competition for physicians.

The lawsuit filed by Pillsbury Law and the Mississippi Center for Justice also argues that the law prevents nurses and midwives from filling gaps in maternal health care in a state that has some of the worst maternal and infant health records.

Getty Israel has been advocating for the repeal of these requirements for years. Israel, founder of Sisters in Birth, wants to build the first free-standing facility in Mississippi birth centerbut state requirements for collaborative practice make the project tough and make it tough to hire midwives, she added.

Mississippi Republican Dan Eubanks wrote letters to the Federal Trade Commission, which enforces federal antitrust laws, arguing that the state requirement “created an unfair economic disadvantage to [certified nurse-midwives] in Mississippi, effectively preventing them from practicing.” Eubanks filed ca Bill this session, which would waive this requirement.

“Currently there are only 26 of them [certified nurse-midwives] are registered with the Mississippi Board of Nursing, he wrote in a 2023 letter, and “only a few practice maternity care” because of the rules. The rest could not find work as nurse-midwives, he wrote, and were forced to take up nursing work at a lower level. In October, he wrote another letter to the FTC.

Clarke Edwards, Acting Director of the Federal Trade Commission’s Office of Policy, he wrote I returned to Eubanks last month.

“Cooperative or supervisory requirements imposed by the state that restrict [advanced practice registered nurses] from practicing their profession to the fullest extent of their abilities, may impede access to care and thwart the development of pioneering, team-based approaches to health care,” Edwards wrote.

The lawsuit also references a 2014 FTC staff report that recommends that state legislatures establish rules, but notes that based on the agency’s review of available research, “oversight requirements … do not appear to be justified by legitimate health and safety concerns.”

Stateline reporter Nada Hassanein can be reached at: nhassanein@stateline.org.