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What's Your Data, Baby?

Midwives appreciate and utilize interventions when necessary, but many midwives are being pressured to use invasive and costly interventions when caring for women with low risk pregnancies. How can we change this? Sharing collective midwifery data may be the key.

by Leslie Ludka, CNM, MSN

For the first time in 26 years, I became a consumer of intrapartum midwifery care when my granddaughter was born. My daughter had written her ideal birth plan, but Mother Nature had an entirely different plan in mind.

Cliff Notes: 40 year old, postdates primip, PROM, pitocin, chorio, persistent variables, fetal bradycardia, scalpels sharpened, baby recovered, labor progressed, NSVD, healthy mom, healthy baby, happy grandmother.

At one critical point, the midwife said, “There’s a reason we have an 11% c-section rate in this practice.” I’ve thought about that statement many times since. As a mother, grandmother, and consumer, the data reassured me. As a midwife, the data reminded me that midwives are experts at recognizing the true signs of fetal and maternal well-being. Our vigilance and caution are paramount to our excellent outcomes, especially when a labor falls off the curve. If this inner-city midwifery practice with a high-risk population has an 11% cesarean section rate, I wondered what the average cesarean section rate is for midwives nationwide.

The World Health Organization (WHO) recommends a national cesarean section rate of 5% to 10%, yet the latest CDC data reports an all time high of 31.8%. Does anyone really believe that nearly one third of US women are incapable of delivering healthy babies vaginally? Labor inductions doubled from 1990 to 2005. Augmentations are also on the rise. Even with these interventions, US maternal and fetal outcomes continue to decline when compared with other countries, and our costs are skyrocketing.

Of course, midwives appreciate and utilize interventions when necessary, such as in my daughter’s case. But many midwives are being pressured to use invasive and costly interventions when caring for women with low risk pregnancies instead of being supported in the art and science of watching, waiting, and shepherding normal childbirth. Unfortunately, the basis for these pressures may have less to do with optimal care and more to do with convenience, profit, and liability fears.

How can midwives influence this process? Sharing collective midwifery data may be the key. Data is the universally acknowledged language of change in health care. Data is powerful!

Imagine if we were able to make a statement such as, “US midwifery cesarean section rates are under 20% in every state.” Mothers, grandmothers, consumers, policymakers, insurers, administrators, and every bean counter would want to know how we do it. The problem is this: we do not have all-inclusive midwifery data.

So, how do we gather that data? An excellent option is to participate in the ACNM Benchmarking Project.

Even in solo practice, tracking numbers is critical to your survival. Some midwives write, “I just don’t have time,” or “No one really cares about my numbers.” Believe me, your supporters and your opponents care a great deal about your numbers. It is important to make the time.

Most practices routinely collect data on such things as: 1) primary and repeat cesarean sections 2) preterm birth 3) low birth weight 4) induction/augmentation rationale and 5) Apgar scores. Imagine the impact if you collected and pooled those totals with all the midwifery practices in your town?

Are we talking about more work? Okay, let’s think outside the box. How about asking a bright, community service minded high school student to total these numbers? Wouldn’t that look impressive in the volunteer section of their college application? Maybe a nursing, business, or women’s studies student needs a term project?

If every practice in your town kept data, it would be simple enough to join forces with other towns and cities in your state. Who would help with this? Maybe your chapter has a midwifery student, or a retired member looking for a way to give back? Maybe a statistics-loving midwifery consumer would like to help? Again, we need to be creative.

Now imagine being able to make a statement like, “The overall cesarean section rate for CNMs/CMs in my state is 30% lower than the state average.” Wow!

The more midwives link together in data collecting, the more powerful our data becomes. With larger numbers, midwives can speak authoritatively to insurers, consultants, and policymakers about which clinical practices need to be encouraged or discouraged to produce excellent outcomes.

Organizing and sharing data is our vehicle to collectively empowering women and midwives. Each and every midwife needs to get on board and drive this bus right now, or the art and science of midwifery care may be left at the curb.

Article adapted from original column published in spring 2009 issue of Quickening

This page was last reviewed Wednesday, March 07, 2012


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