Certified nurse-midwives in Massachusetts no longer need to have a physician sign on the dotted line in order to work in the state.

Under a new state law, nurse-midwives do not have to practice under a physician’s supervision.  Instead, they will be required to practice within a health care system and have a clinical relationship with an obstetrician-gynecologist.

At a practical level, the law means that nurse-midwives, who long have been able to write prescriptions and order tests, won’t need a doctor to oversee their decisions.  Massachusetts only licenses certified nurse-midwives, so the law does not apply to any other midwives.

Kathryn Kravetz Carr, president of the Massachusetts Affiliate of the American College of Nurse-Midwives, said the changes will make it easier for women to access health care. For example, in a rural area with few health care providers, nurse-midwives no longer will have to find supervising physicians, who may be reluctant to assume liability for them.

“It decreases barriers to practice, which in turn increases access to midwifery care and, more broadly, women’s health care,” she said.

The change makes some doctors nervous, though.  For example, radiologists in the state are concerned that nurse-midwives lack the training needed to interpret certain tests.

The Massachusetts Medical Society ultimately weighed in against the law, citing the concerns of various specialty groups.  Bill Ryder, state legislative and regulatory counsel at the organization, said that the supervisory system Massachusetts has long used works well and that the law is ambiguous about how nurse-midwives will interact with the health care system.

“It remains to be seen what that will mean,” he said.

Carr stressed that nurse-midwives must work under the same standards of care they always have, which means consulting and working with medical doctors when appropriate.  Nurse-midwives won’t be able to ignore those standards — nor would they want to, because they value their patients’ safety, according to Carr.

“We provide a piece of the puzzle, but we need each other,” she said.

Joanna King, director of government relations at ACNM, said that across the country, states are increasingly moving away from requiring a supervising doctor for nurse-midwives or a contractual relationship between a doctor and a nurse-midwife. Once Massachusetts updates its regulations to conform with the new law, only five states will require doctor supervision of a nurse-midwife’s overall practice, although some others still have supervisory requirements regarding prescribing authority, according to King.