Virginia Midwife Leader Interviewed
Dr. Nichole Wardlaw, a certified nurse-midwife in Virginia, was recently interviewed about the state of the profession. Discussions with leaders like Dr. Wardlaw often focus on workforce shortages, barriers to practice, and the need for expanded educational pathways in the Commonwealth.
Recent legislation marks a significant shift for midwifery in Virginia, directly addressing workforce shortages and barriers to practice. A new law, for instance, allows certified nurse-midwives to be on the 24-hour on-call roster for hospital nursery care when a physician is unavailable, a crucial step in ensuring continuous care in underserved areas. This change, part of HB 1904, also formally permits the use of telehealth for physician consultations in these situations. Financial viability for midwifery practices has also been a focus of legislative efforts. Governor Youngkin signed HB 1923, a landmark bill championed by Delegate Jeion Ward, which mandates that private insurers and Medicaid reimburse Licensed Certified Midwives (LCMs) and Licensed Midwives (LMs) at the same rate as Certified Nurse-Midwives (CNMs). This move towards pay parity, effective July 1, 2025, is expected to expand maternal care options, particularly in rural and underserved communities where reimbursement gaps have historically strained services. These legislative wins are critical as nearly a third of Virginia's counties are classified as "maternity care deserts," lacking adequate access to birthing facilities and obstetric providers. According to the March of Dimes, 30.8% of counties in the Commonwealth fit this description, forcing many pregnant individuals to travel significant distances for care, which is correlated with higher rates of poor birth outcomes. The push for expanded scope of practice is grounded in evidence suggesting positive birth outcomes with midwifery-led care. Studies consistently show that midwife-led care is associated with lower rates of cesarean sections, reduced labor inductions, and fewer interventions. One meta-analysis covering 1.4 million pregnancies found that midwife-led care not only reduced interventions but also resulted in shorter hospital stays and a lower risk of ICU admission for both mothers and newborns. As of July 2025, Certified Nurse-Midwives in Virginia with 1,000 hours of supervised clinical experience can practice independently without a formal collaborative agreement with a physician. This change allows experienced CNMs to utilize their full scope of training, which includes providing primary healthcare to women throughout their lifespan, from gynecological care and family planning to attending births in various settings. Professional organizations are at the forefront of this advocacy. The Virginia Affiliate of the American College of Nurse-Midwives (ACNM) and the Virginia Midwives Alliance are actively working to implement these new laws and are collaborating with partners like the Virginia Interfaith Center for Public Policy to address remaining barriers, such as streamlining contracts with Managed Care Organizations. The integration of technology is also shaping the future of maternal care in the state. Telehealth is increasingly being used to connect patients in rural areas with specialty care and consultations. Virginia Medicaid has also clarified coverage for remote patient monitoring for high-risk pregnancies, including conditions like maternal diabetes and hypertension, further expanding access to care through digital health platforms.
