Midwives and the Law in Texas

State laws give certified nurse midwives more flexibility to practice in hospitals than the hospitals do themselves. At least that's the case in Austin, the only major city in the state without midwifery services in any hospital.

Two midwifery programs -- one at Seton Medical Center and the one it managed at the city-owned Brackenridge Hospital -- were canned last year because in-house rules requiring physicians to be on-site during midwife-attended labor and deliveries were too restrictive to be economically feasible. Knowledgeable sources say the nurse midwives were unfairly singled out, because the same rules did not apply to other "advance practice nurses" at the hospital, such as nurse anesthetists.

The laws governing advance practice nurses allow for them to practice independently -- "and/or in collaboration" -- with other physicians in hospital settings. Susan Jenkins, a Washington-based attorney and former general counsel to the American College of Nurse-Midwives, said that most Texas hospitals with midwifery services require some variation of physician sponsorship of midwives but that the sponsorship requirements at Seton and Brack were more restrictive than any other hospital in the state. Seton "was letting the doctors set the rules on who could join the club," Jenkins said.

Both Seton and the Capital Ob-Gyn physician group at Brack issued a joint "no comment" statement for this article, citing an ongoing state attorney general investigation into possible anti-trust violations.

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Seton Medical Center, Brackenridge Hospital, Capital OB / Gyn, Susan Jenkins, American College of Nurse-Midwives

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