Expanding access to midwifery care: using one practice's success to create community change

Starting in 1991, Marin's County Certified Nurse-Midwife-Physician Collaborative Practice has proven to be a successful model of care for underinsured women. Functioning within the same hospital as traditional physician-led practices, the practice displayed excellent clinical outcomes and gained respect within the community. Twenty years later, the Marin obstetric community decided to restructure its programs to incorporate the care of underinsured and privately insured women into one system. The goal was to design a system that would be patient-centered, financially and professionally sustainable, and accessible to all women and would provide evidence-based care with excellent outcomes. The community agreed, based on its own experience and on current literature, that continuing and expanding the midwife-led model of care was a way to achieve these goals. Here we describe the history, practice, and outcomes of Marin's county practice and the factors that contributed to extending the availability of midwifery care to privately insured women.