{ "source": "Cooked Index — occupational AI risk register", "page": "https://cookedindex.com/jobs/nurse-midwives/", "methodology": "https://cookedindex.com/methodology", "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.", "scored_at": "2026-08-11", "model": "claude-opus-5", "occupation": { "title": "Nurse Midwives", "soc_code": "29-1161", "category": "Healthcare", "us_employment": 7920, "median_annual_wage": 134040 }, "verdict": "SAFE", "risk_resistance": 89, "contested": false, "near_boundary": false, "dimensions": { "task_resistance": 16, "embodiment": 20, "liability_shield": 18, "trust_premium": 19, "judgment_accountability": 16 }, "reasoning": { "task_resistance": "At 16 the digitisable slice is real but narrow — Cochrane-style patient handouts, GBS and Rh protocol reminders, EFM strip pattern flagging, and prenatal visit documentation can be offloaded, while cervical checks, fundal height palpation, Leopold's maneuvers, perineal support at crowning, shoulder dystocia maneuvers like McRoberts and suprapubic pressure, and third-degree laceration repair have no digital substitute at all.", "embodiment": "A 20 is unarguable: you catch a baby with your hands in a room where the blood pressure crashes, the cord prolapses, or the shoulder impacts without warning — birth center, hospital L&D, or a client's bedroom floor at 3 a.m., none of them controlled environments.", "liability_shield": "18 reflects a state APRN/CNM licence plus DEA-registered prescriptive authority in most states, meaning your NPI is on the Pitocin order, the misoprostol, the epidural consult, and the birth certificate — the ceiling short of 20 only because collaborative-practice agreements in restricted-practice states share some exposure with a named physician.", "trust_premium": "19 because continuity of care is the clinical model, not a nicety — clients choose a specific midwife at 10 weeks and expect that same person present through a 26-hour labor, and demonstrated trust changes whether a woman discloses IPV, prior sexual trauma, or the fact she's been bleeding since Tuesday.", "judgment_accountability": "16 sits high because you own the calls no algorithm will sign for: whether a Category II tracing is reassuring enough to keep laboring, whether prolonged second stage warrants transfer, when to escalate a postpartum hemorrhage past uterotonics — but ACOG/ACNM guidelines and hospital transfer criteria do structure the outer bounds, which is why it isn't 19." }, "rationale": "Nurse midwives conduct pelvic exams, monitor labor, deliver babies, suture lacerations, and manage postpartum and newborn care — physical work in an unpredictable environment where the clinician's hands and presence are the service. APRN licensure and prescriptive authority make a named human legally accountable for every order, delivery, and referral to obstetric surgery. AI will absorb charting, patient education handouts, and risk-stratification prompts, but the intrapartum decisions — when to push, when to transfer, when to call the OB — stay with the midwife.", "outlook": "Demand grows through the 2030s as health systems lean on midwives for cost-effective maternity care; AI trims documentation load but does not touch the delivery room.", "what_would_raise_it": { "levers": [ { "dimension": "liability_shield", "change": "Full practice authority expansion: remaining collaborative-practice states (e.g., CNM supervision requirements in states like Alabama, Mississippi, South Carolina) moving to independent APRN practice under the AANP/ACNM full-practice-authority push makes the midwife the sole named signer on intrapartum orders and transfers rather than a co-signer, plus malpractice carriers (e.g., CNA/NSO midwife policies) requiring a named licensed attendant of record for any AI-generated fetal-monitoring interpretation to be actionable", "plausibility": "already happening", "would_add": 2 }, { "dimension": "judgment_accountability", "change": "If AI continuous fetal-monitoring interpretation (the category FDA has been clearing as CDS) becomes standard, the midwife's documented role shifts to overriding or accepting algorithmic category-II/III calls under ambiguity — an explicitly attributable decision. Joint Commission perinatal-safety standards or a state maternal mortality review committee requiring documented human rationale for each escalation/no-escalation decision would formalize this", "plausibility": "plausible", "would_add": 3 }, { "dimension": "task_resistance", "change": "Task-mix shift: this role genuinely has two tiers. If charting, prenatal education, and risk stratification are absorbed by ambient documentation tools, the residual day is almost entirely hands-on intrapartum management, suturing, and transfer decisions — the automatable tier shrinking raises the resistant share", "plausibility": "already happening", "would_add": 2 }, { "dimension": "trust_premium", "change": "Growth in freestanding birth centers and planned home birth, where clients explicitly select and pay out-of-pocket for continuous human presence; AABC accreditation and state birth-center licensure rules that require a named midwife physically present throughout active labor make the human the purchased good", "plausibility": "already happening", "would_add": 1 } ], "ceiling_note": "At 89/100 with embodiment already at 20 and trust premium at 19, there is almost no headroom; the realistic gains are 2-3 points in judgment accountability and liability shield. The occupation's risk is not displacement but headcount — hospital labor-and-delivery unit closures and OB-led staffing models shrink positions regardless of how AI-resistant the work is." }, "adjudication": null, "employment_history": { "points": [ { "y": 2017, "emp": 6530, "wage": 100590 }, { "y": 2018, "emp": 6250, "wage": 103770 }, { "y": 2019, "emp": 6930, "wage": 105030 }, { "y": 2020, "emp": 7120, "wage": 111130 }, { "y": 2021, "emp": 7750, "wage": 112830 }, { "y": 2022, "emp": 7950, "wage": 120880 }, { "y": 2023, "emp": 6960, "wage": 129650 }, { "y": 2024, "emp": 8280, "wage": 128790 }, { "y": 2025, "emp": 7920, "wage": 134040 } ], "from": 2017, "to": 2025, "change_pct": 21.3, "comparable_from": 2019, "spans_soc_revision": true }, "pivots": [], "license": "https://cookedindex.com/terms" }