ABSTRACTControversy exists concerning the role of nurse‐midwives in tertiary care centers. By tradition, preparation, and practice, nurse‐midwives have not sought to work in the areas of high‐risk obstetrics. However with the advent of modern technology and the prevailing economic and legal climate, many more women are finding themselves referred to high‐risk centers for obstetrical care. All of these factors contributed to the formation of the nurse‐midwifery service at the University of Miami, Jackson Memorial Hospital, Miami, Florida in January 1977. The service is described as it evolved over four and a half years. The success of the model led to the expansion of the philosophy and the development of the three principles of practice–independent management, comanagement, and collaborative management. The nurse‐midwives have performed 8,145 deliveries. Selected data is reviewed and the continued role of nurse‐midwives in perinatal cente