A northwest collaborative practice model.

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.