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A Northwest Collaborative Practice Model

Darlington, Ann CNM; McBroom, Kelly CNM; Warwick, Susan MD

doi: 10.1097/AOG.0b013e31822ac37f
Current Commentary

Collaborative practice between obstetrician–gynecologists and certified nurse-midwives has been successful at the Family Beginnings obstetric unit at Group Health for at least three reasons. Each provider group is able to practice independently and thus give the kind of maternity and women's health care sought by the local community. The legal framework in Washington State supports a wide range of maternity care practices and includes a reasonable provider insurance scheme. The boundaries between different groups operating within distinct scopes of practice are well-defined and communicated. This allows providers to smoothly share or transfer clients from midwife to obstetrician and back as needed in each case. The success of the Family Beginnings model is demonstrated by a favorable comparison with national and Washington State metrics of delivery outcomes. Replicating the model elsewhere depends on building support for collaborative maternity care across the obstetric and midwifery professions in states where an appropriate legal framework exists, and in institutions where policies for credentialing nurse midwives are in place. Where these supports do not exist, all practitioners jointly advocating for more enlightened approaches is recommended.

The success of this collaborative practice model of obstetrician– gynecologists and certified nurse-midwives is rooted in independent practice, mindful communication, and mutual trust and respect among providers. SUPPLEMENTAL DIGITAL CONTENT IS AVAILABLE IN THE TEXT.

From the Neighborcare Health Midwifery Service; and Group Health Department of Obstetrics, Gynecology, and Midwifery, Seattle, Washington.

See related editorial on page 503 and related articles on pages 663, 678, and 683

Additional information is available in the Appendixes online at

Presented at the American College of Nurse-Midwives 56th Annual Meeting and Exposition, May 24–28, 2011, San Antonio, Texas.

Corresponding author: Ann Darlington, CNM, Neighborcare Health Midwifery Service, 905 Spruce St. Suite 300, Seattle, WA 98104; e-mail:

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.