There are few states where it is legally prohibited for CNMs to attend OOH birth. Nebraska comes to mind as one. Was it North Carolina where it just got real ugly for CNMs working OOH? This year? I think so.
There are many other states where it is not prohibited by law, but the requirements for a written collaborative agreement with a physician or mandatory malpractice insurance
equivalent to what an obstetrician must carry creates barriers to OOH CNM practice.
Not legally prohibited. Just financially and/or collaboratively difficult.
Of the CNM practices that were independent (either in hospital or OOH) - they usually had a collaborative relationship with an OB in private practice. And finding an OB in private practice is becoming rarer and rarer. Group practices of physicians don't want to sign on as collaborators for CNMs in private practice. It creates an difficult situation for CNMs.
And it all gets confusing with the laws that do and don't apply to CPMs and DEMs because the public often does not understand the distinction between the different types of midwives.
To obtain a license in my state, CNMs require a written collaborative agreement with a physician. CPMs do not.
A family practice doc is not required to have a collaborating cardiologist or ENT in order to see patients for BP management or sore throats. The scope of practice in OB is the same as for a CNM or family practice doc. The same principles should apply.