A structural analysis of physician-midwife interaction in an obstetrical training program

In June 1987 a major Southwestern Medical Center hired a complement of Certified Nurse Midwives to help relieve an increased Labor and Delivery workload. Prior to that time, all deliveries had been done by Obstetrics/Gynecology resident physicians, who continue to deliver the majority of patients. This paper analyses interaction between the two groups of obstetrical practitioners, and relates conflicts to the differing structural models of their relationship held by the two groups--and unwittingly reinforced by administrators. Recommendations for reducing structural conflicts are presented.