Midwife Collaborations Continue to Evolve

Midwife Collaborations Continue to Evolve

As collaborations between certified nurse midwives and physicians continue to grow, professional groups for both are working to outline best practices for meeting the health care needs of women.

“I don’t think you’ll find one size fits all,” said Jeanne Conry, MD, president of the American Congress of Obstetricians and Gynecologists (ACOG). “It truly is an evolutionary process. But you will see more practices shift to where physicians are looking at how to achieve balance in their practices.”

While many practices have had long-standing collaborations with nurse midwives, the use of midlevel practitioners, nurse midwives in particular, is expected to continue to grow, she said.

The prevalence of nurse midwives in private practices, labor and delivery rooms, and clinics suggests that women are becoming accustomed to a visit that doesn’t always mean seeing a physician, said Ginger Breedlove, PhD, CNM, APRN, FACNM, president of American of College of Nurse-Midwives (ACNM).

The shift can be seen in a number of ways, one of them being the steady increase in the rate of midwife-attended births, which has grown nearly every year since 1989, when the data was first made available. This shift is also apparent in individual hospitals, where more midwives are occupying hospital labor and delivery floors, and in private practices, where more patients are asking to see a midwife.

“There is a shift in awareness that the ob/gyn world sees a value in our role,” Breedlove said. “We’re approaching the 60th anniversary of our professional association—we’ve been around a long time—and we’re getting closer to a tipping mass. It’s hard to ignore the fact that there is a master-level professional provider who excels in caring for normal-health women.”

However, there are still unknowns and irregularities in how certified nurse midwives and physicians can best collaborate. With that in mind, the ACNM board voted this month to form a task force on how to best approach their colleagues at ACOG about jointly creating a tool kit to outline the best practices for collaboration, Breedlove said. The tool kit would cover working together in any number of settings from labor and delivery hospital wings to federally qualified health centers and rural and urban private practices, she said.

“We need templates for how collaborations in different settings work,” she said. “It’s really urgent that we begin to put this together in a way that can be easily transferred into someone needing help establishing a collaborative practice and wanting to move in this direction.”

This is by far the first of such efforts to better define and outline the future roles within an increasingly collaborative environment. Researchers are seeking better ways to measure how patient outcomes and satisfaction rates are influenced by midwifery care. Elsewhere, insurance billing rates, malpractice liability, and the process of gaining hospital privileges can still vary wildly by region, prompting some to call for more uniformity where possible.

“Where midwives can get privileges, what they can do, and how they function is still evolving,” said Lani Pincus, CNM, MS, NP, who works with two physicians and one other certified nurse midwife at Mid Hudson Medical Group in New York. “Some hospitals are more restrictive. It usually takes one person to break that mold to where other physicians see that this could be a standard.”

Helping to break that mold in regions where midwifery is scarce is part of what Breedlove hopes a tool kit could provide. “There is still a lot of confusion and fear,” Breedlove said. “But there are answers … And taking that collective knowledge, experience, and success and putting it in a way that doesn’t make it seem so daunting reduces that fear.”


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