On October 1, 1983 the Midwifery Law was passed and nurse-midwives were no longer categorized as nurse practitioners. This change necessitated the formation of an autonomous Joint Subcommittee which included two nurse-midwives and two ob-gyn physicians. This new administrative group adopted the name "Midwifery Joint Committee." The newly formed committee met frequently in Raleigh in order to develop rules and forms for operationalizing the law. Prescritive priveleges were granted to nurse-midwives according to Nurse Practitioner Regulations. The rules were initially adopted on February 1, 1984 and have been amended several times; the last change occurred March 1, 1994.

The officers of the Midwifery Joint Committee rotate among the four additional members and usually alternate chairmanship from MD to CNM. Our (the Midwifery Joint Committee's) goal was to promote the practice of midwifery in North Carolina. It was determined that much of the work could be accomplished by mail. This enabled the Committee to expedite not only the work of the committee, but also the application process for individual nurse-midwives. The Board of Nursing offered secretarial support and has continued to be instrumental in expediting this process.

When an application is received it is verified for accuracy by the Board of Nursing and reviewed by an ob-gyn member and a CNM member of the committee. Members of the committee are asked to approve applications by mail referendum. An annual meeting is held to approve applications which have previously been approved by mail referendum. An annual meeting is held to approve applications which have previously been approved by a quorum of members by mail referendum.

Standardized practice guidelines were adopted in 1986 which outline individual onsite guidelines for each practice. Each nurse-midwife is responsible for maintaining and updating individualized guidelines which are kept onsite in cooperation with their supervising physician(s).

Other actions of the Midwifery Joint Committee include the temporary approval and guidelines for practice as a graduate nurse-midwife pending passage of the National Board Examination and approval for CNM and MD supervision of student nurse-midwives. The designation of primary and secondary supervising physician was recently deleted from the application form so that all backup physicians are listed as supervising physicians.