Cardinal News: Then & Now takes a look back at the stories we brought you over the last 12 months. Through the end of the year, we’re sharing updates on some of the people and issues that made news in 2025. This installment: the status of new state rules governing midwives.
Certified nurse midwives can now perform newborn care on their own in Virginia hospitals, a change supporters say could help keep labor and delivery units open in rural areas.
The new law, HB 1904, which was signed into law in July, amended a long-standing rule that required hospitals to have a pediatrician on call 24 hours a day to operate a labor and delivery unit. With the change, hospitals can instead rely on certified nurse midwives to meet round-the-clock staffing requirements for newborn care.
Since the bill became law, the Virginia Department of Health has worked to write new regulations and amend the state code. These were finalized last month and went into effect on Nov. 19.
Now, hospitals must decide whether to adopt the change. Hospitals have their own bylaws, and can impose restrictions on who can provide care. Though the new law makes it possible for midwives to provide this care, it’s not a requirement, said Katie Page, a prominent certified nurse midwife in Lynchburg and women’s health advocate.
“It’s really left to the clinicians working within hospitals or the patients, the individuals in the communities that are served by these organizations to demand change and ask questions,” Page said. “And then midwives, for example, are at the mercy of health systems because we don’t routinely have voting rights within the medical staff.”
The transition from research and knowledge to widespread acceptance and implementation of new medical regulations can take about 17 years, Page said. She’s skeptical this new regulation will be widely adopted in the near future.
To shorten the amount of time it takes for hospitals to consider adopting new policies, Kathryn Haines with the Virginia Interfaith Center for Public Policy is hoping for additional education about what the law allows.
Under the previous rules, hospitals could not operate a labor and delivery unit unless a pediatrician was on call at all times and able to arrive within 30 minutes to provide newborn care. Labor shortages, especially in rural hospitals, contributed to temporary and permanent closures of labor and delivery rooms across the state.
The updated regulations from the Virginia Department of Health allow certified nurse midwives and licensed certified midwives to provide nursery care when a pediatrician is not available. These providers are trained in neonatal resuscitation, including intubation, and must recertify every two years. Doctors can also consult via telehealth when a certified nurse midwife provides care.
Certified nurse midwives are registered nurses who hold a master’s degree with specialized training in women’s health and childbirth. They typically work in labor and delivery rooms in a hospital.
Haines said some hospital leaders may not know about the new law or may not fully understand what it allows.
“During the session, [hundreds of] bills are passed. It’s information overload. Whose job is it then to call around?” Haines said, adding that it’s possible there may be resistance due to a misunderstanding of midwifery training.
Haines is working with Del. Rodney Willett, D-Henrico County, and Sen. Creigh Deeds, D-Charlottesville, on legislation that would create a task force to address barriers to midwifery care.
Willett sponsored HB 1904, legislation that grew out of his work as chairman of the House Select Committee on Advancing Rural and Small Town Health Care.
He said the goal of the midwifery taskforce would be to better understand midwives’ scope of practice and ensure they can fully use their training in Virginia.
“You’re an hour-plus away from a hospital to have a baby in some of these rural areas. That’s just not acceptable,” Willett said, adding that the drive would be even longer in far Southwest Virginia if additional closures occur.
The task force will address insurance coverage barriers for midwifery services. Currently, insurers set their own credentialing and participation requirements for in-network providers, and those standards vary widely, according to Page.
In many cases, the requirements exclude midwives from joining insurer networks, limiting their reimbursement rates and preventing patients from using their insurance to cover midwifery care.
For example, small practice midwives may be unable to meet malpractice insurance thresholds set by certain health insurance companies due to cost. This bars them from participating in the network, Page said.
Willett is also hoping to tackle legislation aimed at workforce shortages, including funding for residencies and tuition assistance for doctors interested in working in rural areas.
For Haines and other midwives, the need for a more collaborative care model is at a precipice. Federal changes to the ways hospitals are reimbursed by Medicaid will likely result in a financial strain on hospitals. When there is a decrease in funding, obstetrics services are often the first eliminated due to the high staffing needs for the department. Medicaid also pays for about 50% of rural births, which is reimbursed at a much lower rate than the actual cost of care.
Haines is hopeful that a task force would shed light on new ways to integrate midwives into hospital systems, helping to fill gaps left from workforce shortages.
“I think you get the best legislation when you can bring all the stakeholders together,” Haines said. “So we’re going to ask to convene and bring together the insurance companies, the midwives, the maternal health organizers in one space so we can understand what the issues are.”