Yup, I think in some states there is a stricter requirement for the midwives than in others. With my oldest, we were overseas, but in a military hospital, so the regulations were about the same. You can proceed to a certain point (basically when medical intervention is needed) then you have to at least call on the OB who is on call and either get advice, or turn the case over. In that situation, the OB just wrote out the script for the pitocin and told the midwife to keep an eye on things, then went to snooze in the waiting area.