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Collaborative Care Models

Licensed Midwives (LMs) collaborate with Physicians and Nurse Midwives as needed to provide optimal care to their pregnant, birthing, postpartum and newborn clients. LMs engage in an ongoing process of risk assessment that begins during the initial consultation and continues through the completion of care. When presented with a significant deviation from normal, LMs seek physician consultation. Midwifery is an autonomous profession, but midwives work interdependently with each other and other health care providers to promote the optimal health and well-being of women and babies. Read on for some examples of Collaborative Care Models that work in our community.



Audrey Levine, LM, CPM – Thurston County
Since 2005, I have been able to offer collaborative care with Dr. Phoebe Ho, an OB-GYN in Tacoma with privileges at St. Joseph Medical Center, for my clients with twin pregnancies and for those seeking a vaginal birth after cesarean (VBAC). This innovative arrangement has enabled my clients to have midwifery care throughout their pregnancies and planned hospital births with doula support from their midwife, followed by comprehensive postpartum care, including extensive breastfeeding support. Of the care she received, one of my clients wrote: “Having collaborative care for our 2nd VBAC could not have gone any better. The hospital environment provided us with the base comfort of knowing that we could clinically handle anything that might happen. However, having our midwife provide collaborative prenatal care and act as our doula provided the comfort, confidence, knowledge and support to have a birth experience that was not only amazingly wonderful for myself and my baby, but also encouraged and inspired the hospital staff for how pure and great a natural birth can be. There is no doubt – having our midwife as part of our collaborative care made our daughter’s birth wonderful beyond expectations.”


Michelle Antonich, ND, LM, CPM, Lisa Litton, CNM, and Ashley Ulmer, CNM - Skagit County
We have enjoyed positive working relationships with our local hospitals for the past 12 years, and are thrilled to have expanded this collaboration in 2011. Lisa and Ashley have hospital privledges at Island Hospital and are able to admit and care for most of the mamas who need non-urgent hospital services. Clients are able to experience the midwifery model, and continued care with midwives they know even when they need hospital care. We provide prenatal care primarily for women who desire birth center or home birth, and less commonly planned hospital birth for women who want an out-of-hospital experience and midwifery care, but need the hospital setting for reasons that do not risk them out of midwifery care. Additionally, we recently began taking midwife-to-midwife transfers for select women in need of hospital care.


Jennifer Boelter, LM, CPM and Melanie Parsons, LM - King County
As Licensed Midwives, having been invited to join a Nurse-Midwife in her long standing solo practice, we have found that we all benefit greatly from our varying, yet complimentary training & experiences. In this practice model it is so nice to be able to offer our clients continuity of care. We see this demonstrated best in cases when a labor transfer is needed from home to hospital. We take pleasure and joy in bridging a gap between Licensed and Nurse Midwifery.


Heather Chorley, LM - King County
As a Licensed Midwife in Seattle I so value my relationships with CNMs. When clinically appropriate we transfer to CNMs in Seattle hospitals--to the Group Health Hospital nurse midwives and to Sally Avenson, CNM. Over my years of practice I have had the opportunity to return the favor for Sally, by covering her practice while on vacation or attending a home birth when she was tied up at the hospital. I have also had the great privilege to participate in the care of women who are CNMs planning to birth at home and in birth centers. The benefit of having a relationship based on mutual trust cannot be overstated--when I know and feel comfortable with the person I am calling to attend a birth, transfer care or if she is calling me to cover call for her own practice then our clients benefit. We can better predict for them how care will unfold and be secure in the knowledge that they will receive excellent midwifery care.