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Midwife-led care demonstrably improves maternal and infant outcomes and lowers costs; yet only 10% of births in New York are attended by midwives. This study was done to assess the impact of removing a legal requirement for a written practice agreement in 2010 on any differences in midwives' perceived barriers between 2006 and 2011, and on the relationship between reported barriers and plans to leave or change practice in 2011. The 2006 survey was sent to every New York State licensed midwife. The 2011 survey was available electronically on the state education license renewal web site. The two secondary data sets were analyzed (2006, n=465 and 2011, n=208). Analysis by descriptive statistics was calculated for similarity in years of experience and practice location. Cross tabulation and chi square were used to calculate the relationship between barriers in 2006 and 2011and frequency of reported barriers in 2011. Logistic regression was used to examine the relative contributions of each reported barrier to intended changes in practice. Midwifery practice remains hospital-based (2006=64.7%, 2011=59.1%), although home births did increase significantly between 2006 (4.5%) and 2011 (9.6%, p=.011). The number of midwives who reported working in a hospital birth-center decreased significantly between 2006 (11.0%) and 2011 (5.8%, p=.032). The high cost of liability insurance was the most frequently reported barrier in 2006 (47.3%), and increased significantly in 2011 (57.7%, p=.013). Low reimbursement for midwifery services was the second most frequently reported barrier in 2006 (56.1%) and decreased significantly in 2011 (38.5%, p<.001). The cost of liability insurance was significantly associated with plans to change practice in 2011. There were no differences between the two years for establishing collaborative relationships (2006=28.0%, 2011=27.4%), or hospital privileges (2006=29.0% , 2011=24.5%). Findings from this study suggest that the removal of the written practice agreement improved opportunities for home birth practice, though barriers persist, especially high malpractice premiums and low reimbursement for services. Policies should be considered that address high liability insurance premiums and low reimbursement rates and increase access to hospital privileges and hospital-based practice to increase midwives' presence in the health system. Copies of dissertations may be obtained by addressing your request to ProQuest, 789 E. Eisenhower Parkway, P.O. Box 1346, Ann Arbor, MI 48106-1346. Telephone 1-800-521-3042; e-mail: [email protected]