Legal answers written in the language
midwives actually use.

A collaborative practice agreement must, at minimum, define the scope of collaborative services, identify the consulting physician(s) by name and NPI, specify conditions requiring consultation or referral, and outline the process for emergent transfer. ACNM standards are clear that a signed agreement is not required as a condition of licensure in most states — but your state's nursing board may have additional requirements. The agreement should also clarify that the CNM is not an agent or employee of the collaborating physician to limit vicarious liability exposure. Counsel's collaborative agreement template is state-specific and includes a liability-limiting nonagency clause.

CNMs have prescriptive authority in all 50 states, but the scope varies. 25 states grant full autonomous prescriptive authority including Schedule II substances. Other states require a collaborative agreement specifically for Schedule II prescriptions, even if general prescriptive authority is independent. New York, Oregon, and Washington grant full Schedule II authority without a physician agreement. Texas and Georgia require a supervising physician for controlled substance prescriptions. Counsel's state-by-state prescriptive authority matrix is updated quarterly when state legislatures are in session.

Following documented practice guidelines is your primary defense — but the documentation must be thorough, contemporaneous, and clearly tied to your clinical reasoning. According to ACNM, 32% of midwives will be named in a malpractice suit at some point in their careers. Your chart notes must reflect that you performed individualized risk assessment, obtained informed consent, documented all consultations and referrals, and followed your written practice guidelines. Gaps in documentation — not gaps in care — are what turn adverse outcomes into successful malpractice claims. Counsel's documentation checklist walks through every chart entry that matters in litigation.

Only if you hold an active license in the state where the client is physically located at the time of the visit. The Interstate Medical Licensure Compact (IMLC) does not apply to CNMs — the Nurse Licensure Compact (NLC) governs, and it currently covers 41 states. If your client crosses a state line during her prenatal care, you need to verify whether that state participates in the NLC. You also need a telehealth-specific informed consent that addresses technology limitations, privacy, and emergency protocols. Counsel's telehealth compliance guide covers NLC member states and includes a compliant consent template.