Collaborative Practice Model Madigan Army Medical Center Peter E. Nielsen, MD a , Michelle Munroe, CNM b , Lisa Foglia, MD c , Roxanne I. Piecek, CNM d , Mary Paul Backman, CNM e , Rebecca Cypher, MSN, PNNP e , Denise C. Smith, CNM f, * The United States spends more than double per capita on health care compared with other industrialized nations, but ranks far below many developed countries in key peri- natal outcomes, including maternal mortality, neonatal mortality rates, and cesarean section rates. 1 Reasons for these disparate outcomes are complex and some factors are beyond medical control. However, recent reports, including the Institute of Medi- cine’s (IOM) “Crossing the Quality Chasm” (2001), 2 the Milbank Report “Evidenced- Based Maternity Care: What It Is and What it Can Achieve” (2008), 3 and the recent “2020 Vision for High-Value, High-Quality Maternity Care System,” 4 present as part of the solution to improve collaboration among different services and providers, including an increase in the use of midwifery care in the United States. a Western Regional Medical Command, BLDG 2006, Liggett Ave., Joint Base Lewis McChord, WA 98433, USA; b Kenner Army Health Clinic, 700 24th Street, Fort Lee, VA 23801, USA; c OB/GYN Residency Program, Madigan Army Medical Center, 9040 A. Fitzsimmons Drive, Tacoma, WA 98431, USA; d Nurse-Midwifery Service, Madigan Army Medical Center, 9040 A. Fitzsimmons Drive, Tacoma, WA 98431, USA; e Madigan Army Medical Center, 9040 A. Fitzsim- mons Drive, Tacoma, WA 98431, USA; f College of Nursing, University of Colorado, Mail Stop C28813120, East 19th Avenue, Aurora, CO 80045, USA * Corresponding author. 912 Kadel Court, Geneseo, IL 61254. E-mail address: denise.smith@ucdenver.edu KEYWORDS  Collaboration between midwives and obstetricians  Graduate medical education  Delivery of healthcare  Military medicine KEY POINTS  This article outlines the structure and processes for establishing a collaborative midwife- physician practice in a military academic medical center.  Preliminary data suggests a reduction in primary c-section rates after implementation of the new practice model, though further investigation is needed to confirm this finding.  Integration of midwifery faculty into resident education has been beneficial to patients, residents and staff. Obstet Gynecol Clin N Am 39 (2012) 399–410 http://dx.doi.org/10.1016/j.ogc.2012.05.008 obgyn.theclinics.com 0889-8545/12/$ – see front matter Ó 2012 Elsevier Inc. All rights reserved.