Lindsey Wilson spent years as a certified nurse-midwife in rural Missouri in the mid-2010s but, after moving away from the area and back again, Wilson chose to practice in Kansas because laws restricting the services she could offer proved too burdensome.
The decision meant Wilson commuted every day from her home in Lee's Summit to work in Overland Park, where she and her coworkers still served a large contingent of Missouri residents.
That's because neighboring states like Kansas, Nebraska, and Iowa have adopted what's called full practice authority, which allows certified nurse-midwives, who have a registered nursing license and have graduated from a nationally-accredited program, to practice without physician supervision or sign-off. The full practice policy makes it easier for nurse-midwives to offer women's reproductive care, childbirth, and primary care in those states and increases treatment options for patients, she said.
"We served women from 40-plus counties, half from Missouri and half from Kansas," Wilson said of her time at New Birth Company, which closed in 2024.
The dilemma meant Wilson was often on call, and the Kansas-based business' coverage area was expansive, causing some patients to drive hours to receive care, she said.
"Sometimes they are actively laboring, and we can't make it for the birth or things like that because of the distance they were having to drive," Wilson said.
While Missouri mothers-to-be can find similar care at birthing centers, most of those are attached to a hospital, rather than being freestanding. That's because the state requires advanced practice nurses like nurse-midwives to enter into a collaborative practice agreement with a local physician.
Other neighboring states like Arkansas and Illinois have eased similar restrictions, and Missouri is just one of 11 states in the country that require this oversight.
The mandate adds another expense for practicing nurse-midwives, since physicians can charge for their time and oversight, which can cost thousands of dollars per year.
Peter Johnson, president of the American College of Nurse-Midwives, is among those pushing for expanded authority in Missouri. Last weekend, many of these providers gathered and discussed these challenges for the annual ACNM conference in Kansas City.
Johnson noted they aren't trying to circumvent physicians or diminish the need for medical expertise.
"What we want is for people to just rely on us to be able to work to our full scope of practice, knowing that we are legally and ethically responsible for collaborating with other experts when something falls outside of our scope of practice," Johnson said. "That's what women and families deserve."
A 2024 PubMed review compared midwife-led care to that of obstetricians and found that midwife-led care heavily reduces delivery interventions, including unplanned cesarean sections.
When providers like Wilson are pushed out of state, some mothers and families can cross the border to follow, but many won't or can't. And while nurse practitioners are more likely to practice in rural communities, more than half of Missouri's counties are classified as maternity care deserts.
Kendra Wyatt, former CEO of the New Birth Company, where Wilson worked, said that's in part due to the state's strict policies, which make practitioners more likely to leave for surrounding states.
Even in urban metropolitan areas like Kansas City, accessing new-patient OBGYN visits is a challenge, she said.
Since 2009, Missouri has lost 11 hospital maternity wards, including at Research Medical Center in Kansas City, Missouri. That's why midwives have been pushing to get the law changed. Thus far, there has been little movement.
"We need to have the entire team of all practitioners, including certified nurse midwives, to be playing the game," she said. "And right now not only have we not let them on the field, we don't let them on the sidelines or in the locker room. We don't even let them in the stadium."
Wyatt considers the change as a pain-free way to maximize healthcare in Missouri.
"We know the budget is gonna be tough next year, and this is a free piece of legislation," she said.
A 2026 bill in the Missouri General Assembly would have allowed independent practice for certified nurse-practitioners without oversight after they had completed 2,000 hours of collaborative practice, but it died in committee.
Nationwide, 27 states allow certified nurse-midwives to practice to the full scope of their licensing. A 2025 study from the University of South Carolina showed states that currently impose restrictive practice environments have the worst maternal health indicators.
Regular healthcare and hospital closures around the state increase the need for certified nurse-midwives to have expanded scope, Wilson said.
"We have massively underserved populations where they're having to travel long distances for obstetrical care," she said.
It's not about replacing physicians, but building a stronger healthcare net, Wilson said. "This just allows us to work where we live and to be able to serve clients that are most vulnerable in our communities."
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