How could maternity unit closures in Missouri affect the general assembly?
General assembly faces pressure to address restrictive nurse-midwife rules The closures of maternity units, such as the one at Research Medical Center in Kansas City, Missouri, are linked to restrictive state rules requiring certified nurse-midwives to have a collaborative practice agreement with a physician. This has led to more than half of Missouri counties being considered maternity care deserts. This situation puts political pressure on the general assembly to reconsider or loosen the rules, as lawmakers have already attempted to pass a bill to allow certain advanced practice nurses to practice without such an agreement.
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How it reaches general assembly
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The maternity unit at Research Medical Center in Kansas City, Missouri, has closed, among 11 hospital maternity wards lost in Missouri since 2009. This trend is linked to state rules requiring certified nurse-midwives to sign a collaborative practice agreement with a physician in Missouri. In contrast, Kansas and Iowa allow nurse-midwives to practice without such an agreement. These agreements can cost thousands of dollars annually, a barrier that may prevent small or rural clinics from offering midwifery care.
The full event1independent outlet -
The resulting closures and the existence of maternity care deserts, where families must travel long distances for obstetrical care, create public pressure on the general assembly. This pressure is evidenced by lawmakers previously attempting to pass a 2026 bill to loosen the rules, which ultimately died in committee.
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The facts so far
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- Missouri has lost 11 hospital maternity wards since 2009.medicaldaily.com
- Missouri requires certified nurse-midwives to sign a collaborative practice agreement with a physician.medicaldaily.com
- More than half of Missouri counties are considered maternity care deserts.medicaldaily.com
- A 2026 Missouri bill would have allowed certain advanced practice nurses to practice without a collaborative agreement after 2,000 hours, but it died in committee.medicaldaily.com
Why it matters
The state of Missouri faces a significant public health challenge due to the loss of maternity units and the resulting care deserts. The restrictive rules on nurse-midwives are cited as a key driver of these closures, forcing expectant families, particularly those in rural counties, to travel long distances for care. This issue impacts vulnerable populations, including Medicaid patients and families without reliable transportation.
This situation is part of a broader pattern of rural healthcare decline, where state regulations directly influence the availability of specialized care. The debate over midwife practice rules is not isolated; studies have shown that states with collaborative or restricted practice rules tend to have worse maternal health indicators, raising the stakes for the general assembly's legislative decisions.
What we don't know yet
- Will lawmakers introduce new legislation to loosen the practice rules in the next session?
- How many nurse-midwives have left Missouri due to the current practice rules?
What would change this answer
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Given the current restrictive rules, what specific scope of practice is currently limited for Certified Nurse-Midwives in Missouri?
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Reporting
- medicaldaily.comSunday
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