Sandra Cottle has been in a solo midwifery practice since 1994, and currently practices in collaboration with two ob-gyn physicians.  She has maintained active ACNM membership continuously throughout her midwifery career.  As a practice, all members of her service have served as behind-the-scenes supporters of midwifery in various ways over the years, undoubtedly thanks both to Sandy 's subtle and overt championship of midwifery in the hospital setting. 

Sandy has maintained the longest continuous service as Midwifery Section Head in the history of the OB-GYN Department at Charleston Area Medical Center (CAMC), Women and Children's Hospital, in Charleston , West Virginia .  She served for ten years in this capacity, and has served on numerous other hospital committees, representing the voice of midwifery in this highly medical setting.

There are a variety of unique considerations that distinguish longevity for practices in West Virginia .  There are many opportunities in the area.  For example, West Virginia now has the dubious distinction of having the highest cesarean section rate in the United States .  Recently Sandy's collaborating physician has come forward as one of the few physicians currently defending women's choices by openly supporting vaginal birth after cesarean (VBAC), even against enormous pressures by his physician colleagues who would seek to limit this option.  Over the past year or so, CNMs in this particular hospital system have been virtually the only supporters of VBAC until this move for solidarity. 

Sandy has mentored numerous students of midwifery.  She frequently participates in the education of midwives, both formally and informally.  Sandy is always eager to assist and mentor a student midwife as the opportunity arises - she offers participant-observation opportunities to all midwives obtaining new hospital privileges, as well as those who are expanding their delineation of privileges.  Because Sandy is credentialed for several advanced procedures, she is thus able to aid new practitioners who need supervision in adding a new procedure to their professional repertoire.

While West Virginia continues to be a good practice environment by statute, local hospital policies and community Standards of Care have effectively made West Virginia 's capitol city a very conservative practice environment.  Sandy represents CNMs by serving on Peer Review, Quality Assurance, Collaborative Practice Committees, and by supporting other midwifery services when they have come under scrutiny locally.

While Sandy 's midwifery practice is very medical, being on campus in a very medical setting, she has repeatedly demonstrated that she not only possesses but also understands the "heart of midwifery."  Sandy has assisted clients in locating suitable midwifery care when they were seeking alternatives, even though she personally loses business by referring clients out to competing practices, such as to the only birth center that remains in West Virginia, and even to CNM home birth services.