OB resident passing comment: “The midwives have a high rate of third- and fourth-degree lacerations”
Another OB resident: “I can’t believe your c/s rate is only 13%, I thought it was much higher given my experience”
OB colleague: “Patients who push for more than five hours never have vaginal births“
OB biller: “I can see that the midwife service only attended 103 births last year” (actual was >550 births)
Responding to statements like these with accurate and verifiable data is crucial to promoting financial accuracy and interprofessional relationships when continually advocating for the presence of midwives and the midwifery model of care.
When the University of Michigan Nurse-Midwifery Service started caring for their first pregnant patients in 1983, they used paper data collection forms tracking basic demographics and birth outcomes for every client. Those founding midwives knew the only data they’d have reliable access to regarding midwifery care was data that they collected themselves.
In the early years, data was used to justify increased midwifery staff to care for patients (documenting a steady increase in patient volume) and legitimacy among physician colleagues and hospital administrators by sharing cesarean rates, breastfeeding rates, laceration rates that were not easily abstracted from paper medical records.
Over the last 40 years, midwives have continued the tradition of collecting key data for quality improvement and used the de-identified data with IRB approval to share some of our practices and outcomes with the larger maternity care community (on waterbirth, PROM management, no routine IV access during labor, etc.).
When the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Physicians (AAP) re-released their joint statement in 2014 regarding lack of evidence for the safety of waterbirth, we were able to share 15 years of data demonstrating safe waterbirth practice with good outcomes to our perinatal committee.
Collecting midwifery data is an excellent way to promote the longevity and productivity of a midwifery program.
Tips for collecting your own data include:
1. Limit the number of variables you collect. It’s tempting to track all sorts of detailed midwifery care practices, but it’s a burden to everyone writing down the numbers. If you make it too difficult, it won’t get done consistently. A good place to start is the ACNM benchmarking variables!
2. Don’t count on data to be easily retrieved or accessible from your institution’s electronic medical records (EMRs). Unless you are fortunate and have an institutional commitment to share this data easily, it is often not regularly accessible.
3. Be sure that you have an institutionally secure location (electronic file folders and paper copies) to store the data. HIPPAA-compliant data storage is a must!
4. Share your basic data frequently. Your administrators should be reminded of what you bring to the table by providing midwifery care. Sharing data with those who are recording it makes it feel like a meaningful part of their work. Your midwife team should celebrate together who had the most births in the last year and who had the most new OB visits! They should also celebrate your low laceration and cesarean rates and high breastfeeding success rates.
If you want to learn more about our experiences with midwifery practice data collection, please join our upcoming session, “Creating and Sustaining Midwifery Data Collection for Quality Improvement and Research” at the ACNM 66th Annual Meeting, held virtually May 23 – 25, 2021.
Joanne Motino Bailey, CNM, PhD is the director of nurse-midwifery at Michigan Medicine and a lecturer in Women’s and Gender Studies at the University of Michigan.