From the Neighborcare Health Midwifery Service; and Group Health Department of Obstetrics, Gynecology, and Midwifery, Seattle, Washington.
Obstet Gynecol. 2011 Sep;118(3):673-677. doi: 10.1097/AOG.0b013e31822ac37f.
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.
产科医生-妇科医生和认证的注册护士助产士之间的合作实践在 Group Health 的家庭起点产科病房取得了成功，至少有三个原因。每个医疗服务提供者群体都能够独立实践，从而提供当地社区所寻求的产妇和妇女保健服务。华盛顿州的法律框架支持广泛的产妇保健实践，并包括合理的提供者保险计划。在不同群体在不同的实践范围内运作的边界是明确界定和沟通的。这使得提供者能够在每个病例中根据需要顺利地将客户从中助产士转移到产科医生，然后再转回。家庭起点模式的成功通过与全国和华盛顿州分娩结果指标的有利比较得到了证明。在存在适当法律框架的州，以及在制定注册护士助产士认证政策的机构中，在其他地方复制该模式取决于在产科和助产士专业中建立对合作产妇保健的支持，如果这些支持不存在，则建议所有从业者共同倡导更明智的方法。
