Professional autonomy for midwives. An essential component of collaborative practice.

Although full admission privileges are considered the hallmark of full practice autonomy, the majority of certified nurse-midwives (CNMs) are denied the right to autonomously admit and discharge patients or have access to privileges only through the authority of a physician. This practice jeopardizes the independence of certified nurse-midwives and identifies them as adjuncts to the attending medical staff. The situation can only become more complicated now that the American College of Nurse-Midwives certifies nonnurses (CMs). Midwifery has a unique and a once autonomous history that is separate in philosophy from medicine. Midwives require physician services for consultation, referral, and collaborative management, but not for authority to practice midwifery. State legislation is not consistent nationwide concerning the definition and governing of nurse-midwifery practice. The Joint Commission on the Accreditation of Health Care Organizations does not regulate admission privileges but provides standards for hospitals. These standards do provide an avenue for admission privileges. Recognizing the CNM/CM as competitive in the health care market is essential. Denial of privileges can be interpreted as a restraint of trade. Without professional autonomy, unfavorable economics may limit the professional practice of midwifery.