This research focuses on the extent to which choosing a certified nurse-midwife (CNM) for the management of birth in the hospital is an option. Licensing laws affect this option by determining access to hospitals for CNMs in the form of hospital practice privileges. Data for this descriptive case study of Washington, D.C. hospitals were collected from interviews with CNMs and hospital personnel, including physicians, and from secondary sources, including legislative acts and hospital bylaws. Our findings suggest that although the option for a CNM managed birth has increased in the District with the granting of hospital privileges to CNMs in 3 of 9 hospitals providing obstetrical services, restrictions on CNM practice still exist. These are the capacity to admit atients in the CNMs' name and the issue of supervision of CNMs y a physician in the hospital.