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JOINT STATEMENT OF PRACTICE RELATIONS BETWEEN OBSTETRICIAN/GYNECOLOGISTS AND CERTIFIED NURSE-MIDWIVES/CERTIFIED MIDWIVES*

It is critical that obstetrician-gynecologists and certified nurse-midwives/certified midwives have a clear understanding of their individual, collaborative and interdependent responsibilities. As agreed upon by the American College of Nurse-Midwives and the American College of Obstetricians and Gynecologists, the maternity care team must include either an obstetrician-gynecologist with hospital privileges or other physician with hospital privileges to provide complete obstetric care. The American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives believe that the appropriate practice of the certified nurse-midwife/certified midwife includes the participation and involvement of the obstetrician-gynecologist as mutually agreed upon in written medical guidelines/protocols. The American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives also believe that the obstetrician-gynecologist should be responsive to the desire of certified nurse-midwives/certified midwives for the participation and involvement of the obstetrician-gynecologist. The following principles represent a joint statement of the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives and are recommended for consideration in all practice relationships and agreements.

1. Clinical practice relationship between the obstetrician-gynecologist and the certified nurse-midwife/certified midwife should provide for:

* mutually agreed upon written medical guidelines/protocols for clinical practice which define the individual and shared responsibilities of the certified nurse-midwife/ certified midwife and the obstetrician-gynecologist in the delivery of health care services;
* mutually agreed upon written medical guidelines/protocols for ongoing communication which provide for and define appropriate consultation between the obstetrician-gynecologist and certified nurse-midwife/certified midwife; and other health care providers in the services offered (ACNM, 1997);
* informed consent about the involvement of the obstetrician-gynecologist, certified nurse-midwife/certified midwife, and other health care providers in the services offered;
* periodic and joint evaluation of services rendered, e.g., chart review, case review, patient evaluation, review of outcome statistics; and
* periodic and joint review and updating of the written medical guidelines/protocols.
2. Quality of care is enhanced by the interdependent practice of the obstetrician-gynecologist and the certified nurse-midwife/certified midwife working in a relationship of mutual respect, trust and professional responsibility. This does not necessarily imply the physical presence of the physician when care is being given by the certified nurse-midwife/certified midwife nor statutory language requiring supervision of certified nurse-midwife/certified midwife.

3. Administrative relationships, including employment agreements, reimbursement mechanisms, and corporate structures, should be mutually agreed upon by the participating parties.

4. Access to practice within the hospital setting for the obstetrician-gynecologist and the certified nurse-midwife/certified midwife who have a practice relationship in concurrence with these principles is strongly urged by the respective professional organizations.

The American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives strongly urge the implementation of these principles in all practice relationships between obstetrician-gynecologists and certified nurse-midwives/certified midwives.

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* Midwifery as used throughout this document refers to the education and practice of certified nurse-midwives (CNMs) and certified midwives (CMs) who have been certified by the American College of Nurse-Midwives (ACNM) or ACNM Certification Council, Inc. (ACC).

Resources:
American College of Nurse-Midwives. Collaborative management in midwifery practice for medical gynecological and obstetrical conditions. Washington, DC: ACNM, 1997

American College of Obstetricians and Gynecologists. Guidelines for implementing collaborative practice. Washington, DC: ACOG, 1995

September 1, 2001
American College of Nurse-Midwives
American College of Obstetricians and Gynecologists