Nebraska Remains a National Outlier in Certified Nurse-Midwife Regulation
Examining Nebraska’s Certified Nurse-Midwife regulations following stalled legislative reform
LINCOLN, NE,, Feb. 10, 2026 (GLOBE NEWSWIRE) -- Nebraska regulates Certified Nurse-Midwives differently than nearly every other state in the country, creating one of the most restrictive practice environments in the United States. It is the only state that explicitly prohibits Certified Nurse-Midwives from attending planned home births and one of only two states that continue to require physician supervision of Certified Nurse-Midwife practice in statute.
Certified Nurse-Midwives are graduate-educated, nationally board-certified advanced practice registered nurses who provide comprehensive, evidence-based women’s health and maternity care across the United States. In most states, CNMs are regulated alongside other advanced practice registered nurses with defined statutory pathways to independent practice. In Nebraska, Certified Nurse-Midwives remain the sole exception. Notably, Nebraska’s Certified Nurse-Midwife workforce is entirely female.
“Many Nebraskans assume our laws reflect standard regulation,” said Elizabeth Mollard, PhD, CNM, President of the Nebraska Affiliate of the American College of Nurse-Midwives. “In reality, Certified Nurse-Midwives are regulated differently than similarly trained advanced practice clinicians and far more restrictively than national norms.”
Over the past several years, Certified Nurse-Midwives and professional stakeholders have engaged in sustained efforts to modernize Nebraska’s statutory framework through established policy channels. These efforts have included participation in interim legislative studies, testimony before legislative committees, collaboration with health care organizations and regulators, and the introduction of legislation intended to align Nebraska law with national regulatory standards.
Most recently, Nebraska lawmakers considered LB676, a proposal addressing Certified Nurse-Midwife regulation that advanced to Select File in 2025 and remains there. While the bill demonstrated strong bipartisan support and reflected extensive stakeholder engagement, it did not result in enacted statutory change. As a result, Nebraska’s Certified Nurse-Midwife statutes remain unchanged.
In the absence of legislative resolution, litigation has emerged as an additional avenue through which the statutory framework is being examined. Two cases, Swanson v. Hilgers and Lindstrom v. Hilgers, raise questions regarding Nebraska statutes that regulate where and how Certified Nurse-Midwives may practice. These cases are proceeding independently of legislative activity and do not involve the Nebraska Affiliate of the American College of Nurse-Midwives as a party.
Hope Lindstrom, a Nebraska mother who relocated from Oregon, said she became aware of Nebraska’s Certified Nurse-Midwife restrictions only after learning that care options widely permitted elsewhere were prohibited in Nebraska.
“I’m kind of still angry that in my most vulnerable state, I’m still going to have to be fierce in advocating for myself and for my new infant,” Lindstrom said.
The organization notes that the existence of parallel legislative and judicial activity reflects the persistence of unresolved regulatory questions rather than a departure from established policy engagement.
“At this point, the mechanism of change matters less than the outcome,” Mollard said. “Whether resolved through legislation, the courts, or executive action, Nebraska needs a coherent statutory framework for Certified Nurse-Midwife care, and we will continue to pursue every appropriate avenue to achieve that clarity.”
Cases Discussed in this release:
Swanson v. Hilgers, Case No. 4:24-cv-03072 (U.S. District Court for the District of Nebraska);
Appellate Case No. 24-3027 (U.S. Court of Appeals for the Eighth Circuit);
Supreme Court Docket No. 25A423 (U.S. Supreme Court).
Counsel for Both Plaintiffs:
Pacific Legal Foundation
minam@pacificlegal.org
Elizabeth Mollard Nebraska Affiliate of the American College of Nurse Midwives NEACNM@gmail.com https://www.nebraskamidwives.com/
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