The labor and delivery process at community hospitals is generally managed by nurses who communicate with physicians on an as-needed basis. This study used focus groups, structured interviews, and medical record review to describe communication between nurses and physicians and its relationship to patient safety at four Midwestern community hospitals. Nurses functioned independently for most of the labor process, communicating with physicians for only 2-4 minutes during routine labor. Although nurses and physicians shared the same overall goal of ensuring a safe delivery, both perceived problems with communication during labor. Management of oxytocin to induce labor was a particular source of conflict, with physicians preferring an "aggressive" approach that frequently conflicted with nurses' preferences for physiologic dosing. Physicians also strongly preferred to work with experienced nurses, which created tension and communication difficulties for newer nurses. As documented in other research, physicians had a more positive impression of the overall level of teamwork than nurses did.