On the Road to Collaboration: Nurses and Newly Regulated Midwives in British Columbia, Canada Jude Kornelsen, RN, PhD, V. Susan Dahinten, RN, PhD, and Elaine Carty, CNM, MSN This study describes some of the results of a survey conducted shortly after the introduction of midwives as a regulated and publicly funded provider within the British Columbia health care system. The survey asked hospital-based perinatal nurses about their knowledge and attitudes of midwifery and their experiences with midwives. Results suggest that nurses, for the most part, had a negative view of midwives and their practice and that inattention to the necessary conditions for interprofessional collaboration and positive interprofes- sional relationships have resulted in parallel practice between the professions instead of interdisciplinary practice. J Midwifery Womens Health 2003;48:126 –132 © 2003 by the American College of Nurse- Midwives. keywords: collaborative practice, interdisciplinary care, multidisciplinary care INTRODUCTION On January 1, 1998, midwifery became a regulated and publicly funded autonomous profession in the province of British Columbia under the BC Health Professions Act. Legalization and the subsequent regulation of midwifery were the culmination of an arduous struggle for legitimi- zation by midwives and consumers that stretched back to the 1970s, a struggle that was situated within the larger context of the efforts of participants in the women’s movements to reclaim control over women’s health. Al- though official recognition and public funding were a turning point for the profession, further challenges were faced when midwives began to integrate their practice— which had previously been limited to domiciliary care— into the hospital environment. These challenges came from both the nursing and medical professions who expressed concern over the adequacy of midwifery training, the safety of home birth, and the cost-effectiveness of introducing a new profession into a health care system that is already economically overburdened. These concerns influenced the nature of the relationship between midwives and their professional colleagues, especially nurses, who maintain more continuous contact with birthing women and work more intimately with midwives than do physicians. This study examines the interprofessional relationship between registered midwives and perinatal nurses in British Colum- bia 2 months after regulation BACKGROUND The interprofessional relationships between registered nurses and registered midwives in British Columbia are complicated due to the unregulated standing midwives had in the province until 1998. Prior to this time, the majority of midwife-attended births took place at home attended by “lay” or “community” midwives, and their services were paid for directly by their clients. On January 1, 1998, however, many of the same lay/community midwives and some nurses who had midwifery training successfully completed an evaluation of their skills and competencies through a portfolio assessment, written examination, and a practical/clinical examination. As a result, they received the title of Registered Midwife by the College of Midwives of British Columbia and were able to practice legally both in homes and in hospitals where they had been granted admitting privileges. They were also remunerated through the provincial health care plan. For nurses, this meant a substantial change in the context of their relationships to midwives. Prior to registration, midwives did not have admitting privileges to hospitals. The primary context for interaction between midwives and perinatal nurses, then, occurred upon the transfer of a client from home to the hospital in the case of a problematic home birth, an inherently difficult situation exacerbated by the nursing and medical profes- sions’ disapproval of home birth in general. NURSES, MIDWIVES, AND INTERPROFESSIONAL PRACTICE When midwives began practice in the hospital environment postregulation, there was confusion over the nature of their relationship with nurses. Research on interprofessional relationships in health care often focuses on collaborative practice where collaboration is defined as a joint effort between members of a health care team whose purpose is to integrate their practices in a comprehensive approach to meet the needs of the patient and family. 1 Although nurses and midwives began working together to meet the needs of the childbearing woman and her family in the immediate postregulation period, they did not share an integrated or coordinated approach to care but instead practiced along- side each other in what may be described as “parallel practice.” The parallel practice that defined early relationships was Address correspondence to Jude Kornelsen, PhD, Research Associate, BC Centre of Excellence for Women’s Health & Department of Midwifery, Children’s and Women’s Hospital and Health Centre of B.C. and Providence Health Care (St. Paul’s), E 311-4500 Oak Street, Vancouver, BC V6H 3N1. 126 Volume 48, No. 2, March/April 2003 © 2003 by the American College of Nurse-Midwives 1526-9523/03/$30.00 • doi:10.1016/S1526-9523(02)00424-5 Issued by Elsevier Inc.