The possible enactment of licensure for Certified Professional Midwives (CPMs) by the state of Michigan provides an opportunity to reexamine the CPM-obstetrician (OB) relationship that has grown up under CPMs' unlicensed state of practice. This article examines the legal and institutional factors that shape the CPM-OB relationship in Michigan, with comparisons to two other neighboring states, Indiana and Wisconsin, as well as to a more distant example, the Netherlands. Four potential relationships are identified and explored: Exclusion, Coexistence, Subordination and Cooperation. Other factors that may shape the relationship are also studied, such as medical malpractice liability, liability insurance availability, scope of practice determinations, hospital transport protocols, and private health care insurance and Medicaid coverage. The article asserts that CPMs, as the only childbirth professionals specifically trained to attend out-of-hospital births, are well-positioned to meet the trend of both an increasing desire for home births and a continuing need for accessible, quality prenatal care. In conclusion, the relationship of Cooperation, in which CPMs retain their autonomy yet are able to work in concert with OBs, is found to be optimal for allowing OBs and CPMs to most effectively provide safe and accessible care to their patients.

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