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ACNM Benchmarking: Defining our contribution

Jessica Schwarz CNM, MSN

Practicing midwifery in a tertiary or quaternary care environment can be challenging. At the Children’s Hospital of Philadelphia (CHOP), midwives are members of an interdisciplinary team comprised of health care professionals from many fields, from pediatric surgeons to respiratory therapists to maternal-fetal medicine physicians. We care for women whose pregnancies have been complicated by a prenatally diagnosed birth defect or genetic condition. What is the role of a midwife in such a setting? What value can midwifery care offer to patients who have chosen to deliver at CHOP, not because they wanted midwifery care, but because of the high level of technology available to their babies? What can a midwife offer to a family who may have already been offered a detailed ultrasound, genetic counseling and testing, an MRI, a fetal echocardiogram, and maybe even fetal surgery? Midwives in less unique settings may ask themselves similar questions. What does midwifery practice look like in institutions where normal birth is not the norm? To what extent are we even practicing midwifery?

These questions were in the forefront of our minds as we submitted our statistics to the ACNM Benchmarking Project last year. We received the results with a degree of sheepish amusement. Thirty-eight percent vaginal delivery rate? Yup, that’s us. Eighty-four percent induction rate? Yup, that’s us too. VBAC rate: 0. Vaginal twins: 0.

So our contribution to our practice, to the care of our patients, and to our institution may not be reflected by typical midwifery statistics. But in reviewing the results of the project, our group of 7 midwives and 2 nurse-practitioners was inspired to begin a dialogue about the shared beliefs that guide our practice. We realized that we could use the data collection process as a tool in ensuring that our practice reflected our shared beliefs. For example, when we looked more closely at our statistics, we found that among patients who had no anomaly-related contraindication to vaginal delivery, 70% went on to have a vaginal delivery. That particular statistic has been extremely helpful in providing patient-centered care and enabling informed choice in delivery planning. In addition to the benchmarking data, we have begun to track some measures that will specifically reflect our contribution to the practice, including number of antepartum encounters with the advanced practice provider group, success with intention for pain relief, and vaginal delivery rates among inductions and spontaneous labors.

More broadly, participating in a national midwifery survey has allowed us to share a non-traditional midwifery practice model. In a complex and changing health care system, midwives may more frequently be called upon to care for patients outside of our traditional area of expertise (low-risk and normal). Recognizing that midwifery practice may look different but can still be midwifery and can be measureable is essential to demonstrating our value in such settings.

Finally, as members of a team which is defining a cutting-edge care delivery system for patients with prenatally diagnosed fetal anomalies, we hope that the data we are collecting may eventually inform an evidence-based, woman-centered model of care for these patients. And is that not midwifery?

Posted By Barbra Elenbaas | 2/19/2014 1:03:55 PM



Any opinions expressed in this blog are those of the individual participant(s) and do not necessarily reflect the views of the American College of Nurse-Midwives. ACNM is not responsible for accuracy of any of the information provided by guest bloggers and/or members via the Comments section. We welcome all feedback – including comments, ideas and suggestions. We also welcome civil, friendly debates. However, any and all content that is deemed inflammatory or rude will not be posted.


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