CNM · pathways
Where Certified Nurse-Midwives practice without a supervising physician, and what it takes
Three groups: full authority from licensure, conditional authority after a defined transition period, and supervision for the life of the practice.
Full practice authority (25)
Independent from licensure. A physician relationship is optional here.
Conditional independence (15)
Authority arrives after a transition period the statute defines. The conditions below are the feed's summary; each state page has the full rule and its source.
| State | Conditions for independent practice |
|---|---|
| Arkansas | does not prescribe Schedule II controlled substances; not providing intrapartum (labor/delivery) care, which requires a written agreement with a consulting physician regardless of the above |
| California | Practice falls within the codified 'low-risk pregnancy and childbirth' definition (Bus. & Prof. Code §2746.5(a)): single fetus, cephalic presentation, gestational age 37-42 weeks, spontaneous or induced labor, no preexisting condition the CNM cannot independently manage — within this definition, NO physician agreement or supervision is required at all |
| Delaware | ≥2 years of collaborative practice; ≥4,000 hours of clinical practice with a physician or experienced APRN |
| Florida | Same numeric thresholds as `np`: ≥3,000 supervised clinical hours within 5 years; 3 semester hours each in differential diagnosis and pharmacology within 5 years; active unencumbered license; no discipline in 5 years; Board-set financial-responsibility coverage once autonomous practice begins ($100,000/claim, $300,000 annual aggregate, via insurance/surplus-lines/risk-retention group/JUA plan/self-insurance/irrevocable letter of credit); For out-of-hospital intrapartum care: a written, patient-signed emergency transfer-of-care policy meeting §464.0123(3)(b)'s content requirements |
| Illinois | ≥4,000 hours of clinical practice under a written collaborative agreement after first attaining national certification; ≥250 hours of continuing education/training; a notarized full-practice-authority attestation filed with IDFPR |
| Kentucky | same ≥4-year CAPA-NS and ≥4-year CAPA-CS thresholds as general NPs (KRS 314.042) — CNMs share the identical APRN prescribing framework |
| Louisiana | Same unconfirmed hours-based CPA exemption referenced in the general `np` entry (LA Admin. Code tit. 46 §7911.A.5, which secondary sources describe as also covering CNMs) — exact hour threshold and resulting scope not confirmed in this research pass. |
| North Carolina | ≥24 months of practice as a CNM; ≥4,000 hours of practice as a CNM |
| Nevada | ≥2,000 hours of practice under a collaborative agreement — same general APRN threshold as NP (NRS 632.237) |
| Ohio | Same SCA framework as `np` (Ohio Rev. Code §4723.431/§4723.43(A)) — no hours- or experience-based exit exists; an SCA is required for the CNM's entire career, with a PHYSICIAN specifically (not a podiatrist, unlike `cns`) |
| Oklahoma | ≥6,240 hours of supervised clinical practice, then Board of Nursing approval — secondary sources describe CNM as covered by the same H.B. 2298 (2025) framework as CNP/CNS |
| South Dakota | ≥1,040 practice hours as a licensed CNM (or CNP); until then, a written collaborative agreement with a physician OR an already-independent CNP/CNM (SDCL 36-9A-4(5)) |
| Virginia | ≥1,000 hours of practice as a CNM; attestation from a CNM with ≥2 years of clinical experience, or from the licensed physician with whom the CNM held a qualifying practice agreement |
| Vermont | ≥2 years and ≥2,400 hours of practice under a collaborative agreement (≥1,600 hours over ≥12 months if adding a second APRN certification) |
| West Virginia | for prescribing specifically: ≥3 years in a documented collaborative relationship with granted prescriptive authority, then Board of Nursing approval |
Supervision required (12)
No experience- or hours-based pathway. The physician agreement lasts for the life of the practice.