Pillsbury Advises American College of Nurse-Midwives in Lawsuit Challenging Constitutionality of Mississippi's Anticompetitive Prohibition Against Certified Nurse-Midwives Practicing Without a Collaborating Physician

The lawsuit was filed for ACNM, which has CNM members in Mississippi and throughout the country, by Pillsbury, the Mississippi Center for Justice and Amabebe Law PLLC. As alleged in the lawsuit, the collaboration requirement severely limits the number of CNMs in the state and creates a major barrier to closing Mississippi’s gaps in prenatal and maternal care that were identified by the Mississippi State Department of Health in August 2025 when it declared a public health emergency in response to rising infant mortality rates across the state. 

Proposed bills have been filed in the legislature to eliminate the collaboration requirement for CNMs. The passage of such a bill would lead to the withdrawal of the lawsuit. 

According to the lawsuit, “[t]his collaboration can be expensive, and sometimes impossible, for CNMs to obtain because few Mississippi physicians are willing to collaborate with CNMs who often compete to serve the same patients.”  

The lawsuit explains that CNMs possess the training and experience to provide the full range of prenatal, delivery and postnatal care for pregnant women and often at a lower cost than physicians, which provides an incentive for physicians to limit the number of CNMs who practice. The lawsuit also claims “that the collaboration requirement means that physicians can effectively limit CNMs from practicing and can require significant fees in order to permit any individual CNM to practice.”

The collaboration requirement, contained in Section 73-15-20 of the Mississippi Code, applies to all advanced practice registered nurses, but since the ACNM represents only CNMs, the lawsuit seeks only to prevent the application of the requirement to CNMs, claiming that it is a violation of their right to practice their profession under the Fourteenth Amendment to the United States Constitution. 

In addition to the collaboration statute, the lawsuit also challenges the related regulations adopted by the Mississippi State Board of Nursing as well as more extensive regulations imposed on physicians willing to collaborate by the Mississippi State Board of Medical Licensure (MSBML) which itself is composed of physicians. Because the MSBML regulations place additional limitations on CNMs and reduce competition for physicians, the lawsuit alleges that they also violate federal and state antitrust laws.

“The physician collaboration requirement is an outdated, unnecessary restriction that has nothing to do with patient safety and everything to do with limiting competition and control over who can provide care,” said ACNM Chief Executive Officer Michelle Munroe. “Certified nurse-midwives are fully trained, nationally certified professionals who deliver high-quality, cost-effective maternity care every day across this country.”

ACNM is represented by Rob McDuff of the Mississippi Center for Justice (MCJ), Michael Sibarium, Drew Navikas and Vinny Sidhu of Pillsbury, and Eremipagamo Amabebe of Amabebe Law PLLC.

“With Mississippi suffering from severe shortages of professionals who can deliver babies and provide prenatal and postnatal care, we need to do everything we can to increase the numbers of certified nurse-midwives in the state,” said Rob McDuff of MCJ. “Hopefully the legislature will change the law this session. If not, we will move forward with our lawsuit to strike it down.”

Speaking on behalf of the Pillsbury team, Michael Sibarium noted: “While these practice restrictions on highly trained nurses have long been recognized as anticompetitive in other states, they are utterly irrational given the healthcare crisis facing pregnant women and their newborns in Mississippi. Pillsbury stands with ACNM in fighting for better healthcare for mothers and their children in Mississippi.”

The American College of Nurse-Midwives is the professional association representing certified nurse-midwives and certified midwives in the United States. ACNM sets standards for midwifery education and practice, advances evidence-based care, and advocates for policies that improve maternal and reproductive health outcomes.

The Mississippi Center for Justice is dedicated to dismantling the state’s culture of inequity and injustice. Supported and staffed by attorneys and other professionals, the Center pursues strategies to combat discrimination and poverty statewide.

Pillsbury is one of the world’s foremost law firms, advising clients ranging from entrepreneurs working out of a garage to the largest public and private companies. Operating across the Americas, Europe, Asia, Africa and the Middle East, the firm’s market-leading practices are consistently recognized for excellence by Chambers & Partners, Financial Times, and other publications.

Amabebe Law PLLC is a top-tier boutique law firm dedicated to helping businesses, creatives, and mission-driven organizations mitigate risk and resolve complex disputes.