The Patient Self-Determination Act was passed by the U.S. federal government in 1990 and became effective in December 1991. This federal law requires institutions that accept Medicaid funding to provide written information about rights to make decisions about medical care to all persons admitted for care. To meet federal guidelines, many health care institutions provide this information in the admission packet. Studies have shown that compliance with addressing this subject has been uneven at best and that providers may be uncomfortable discussing this issue with clients. Midwife-attended births accounted for 7.3% of all births in 2000. The majority of these births occur in the hospital setting; therefore, laboring women are subject to the Patient Self-Determination Act. This article addresses the responsibilities of the certified nurse midwife/certified midwives in counseling women and their families regarding advanced directives.