• Suellen Miller CNM, PhD,

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    • Suellen Miller is associate director of Field Placement Studies and an instructor in the Department of Maternal and Child Health, School of Public Health, University of California, Berkeley. At the time this article was written she was a postdoctoral research Fellow at the Institute for Health Policy Studies, UCSF, having received her PhD in Family Health Care Nursing from the School of Nursing, UCSF. She received her midwifery certificate at Meharry Medical College in 1977 and has been involved in clinical midwifery, education, and research for more than 20 years. She has participated in three different collaborative practices.

  • Tekoa King CNM, MPH,

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    • Tekoa King is a member of the Faculty Practice Group at University of California, San Francisco Moffitt Hospital San Francisco, USA, where she is a clinical professor of obstetrics and gynecology. She received her midwifery certificate in 1978 and since that time has been active in nurse-midwifery-physician collaborative practices. She obtained her MPH at University of California, Berkeley. She was also a faculty member of the Community-Based Nurse, Midwifery Education Program at the time of this study.

  • Peter Lurie MD, MPH,

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    • Peter Lurie, is an assistant professor in the Department of Family and Community Medicine, University of California San Francisco USA, a researcher at the Center for Aids Prevention Studies, University of California San Francisco USA, and co-director of the Advanced Training in Clinical Research Methods Program, Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.

  • Paul Choitz BS

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    • Paul Choitz is a communications specialist and was the systems operator of the Banyan Tree Bulletin Board System of the Community-Based Nurse Midwifery Education Program, Frontier School of Nursing at the time of this study. He is the author of the continuing education program, “The Banyan Tree.”

  • Preliminary findings of this study were presented at the University of California, San Francisco Antepartum and Intrapartum Management Conference, June 9, 1995.

Suellen Miller, CNM, PhD, 402 San Francisco Blvd, San Anselmo, CA 94960.


This pilot study was designed to describe the clinical areas of collaboration, financial structures, and sources of conflict for certified nurse-midwives (CNMs) involved in nurse-midwife and physician collaborative practice (CP). A questionnaire was posted on an electronic bulletin board maintained by the Community-Based Nurse Midwifery Education Program of the Frontier School of Nursing. The nonrandom, convenience sample consisted of 78 respondents. Their mean age was 42 years; they had been in practice for a mean of 10 years, and 56% had graduate degrees. Eighty-nine percent reported involvement in CP. Eighty-three percent co-managed higher-risk women, and 46% performed vacuum-assisted deliveries or were first assistants at cesarean sections. Forty-eight percent of CNMs did not bill in their own names, and only 12% had full hospital privileges. The most common sources of conflict in CPs were clinical practice issues (100% ever encountered), power inequities (92%), financial issues (66%), and gender relations (58%). Collaborative practice is a common form of practice for CNMs and suggests a model for collaboration in other sectors of the health care system. Future research should explore methods of reducing the potential for conflict between CNMs and physicians.