The American College of Nurse‐Midwives Clarity in Collaboration Project: Describing Midwifery Care in Interprofessional Collaborative Care Models

Abstract

In 2014, the American College of Nurse-Midwives (ACNM) launched a project called Clarity in Collaboration to develop data definitions related to midwifery and maternity care delivery processes. These definitions are needed to ensure midwifery care delivered in collaborative care models is accurately and consistently captured in clinical documentation systems, data registries, and systems being developed as part of health care restructuring and payment reform. The Clarity in Collaboration project builds on the efforts of the Women's Health Registry Alliance (WHRA), which was recently established by the American College of Obstetricians and Gynecologists. Clarity in Collaboration mirrored the process used by ReVITALize, WHRA's first maternity data standardization project, which focused on establishing standardized clinical data definitions for obstetrics. The ACNM Clarity in Collaboration project brought together maternity and midwifery care experts to complete a year-long consensus process, including a period of public comment, resulting in development of 20 concept definitions. These definitions can be used to describe midwifery care within the context of collaborative care models. This article provides a summary of the ACNM Clarity in Collaboration process with discussion of implications for maternity data collection.

Using the Robson 10‐Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives

“…Our study focused on broader perinatal care team composition rather than outcomes by specific types of perinatal care providers. It is not known whether centers with midwives in the CSL had midwifery‐led care or an integrated collaborative care model . However, the observed differences in labor processes and outcomes noted are likely not fully attributable to the care provided by specific perinatal care providers (eg, midwives vs physicians) or care models, but may be influenced by multiple system factors.…”

“…This research would provide valuable information to assist clinicians, administrators, and policy makers in developing strategies for lowering cesarean rates. One impediment to the study of midwifery care is that perinatal care data often only include the provider of record for birth . If a woman is referred by a midwife to a physician at any point in the childbearing cycle, midwifery care becomes invisible within most large databases.…”

“…It is not known whether centers with midwives in the CSL had midwifery-led care or an integrated collaborative care model. 12 However, the observed differences in labor processes and outcomes noted are likely not fully attributable to the care provided by specific perinatal care providers (eg, midwives vs physicians) or care models, but may be influenced by multiple system factors. For example, the presence of midwives in a hospital may shift the institution's unit culture and approach to birth.…”

“…One impediment to the study of midwifery care is that perinatal care data often only include the provider of record for birth. 12 If a woman is referred by a midwife to a physician at any point in the childbearing cycle, midwifery care becomes invisible within most large databases. In addition, the professional background of a woman's prenatal care provider is almost never identified in perinatal care data sets, limiting analysis of the dose of midwifery care in relationship to perinatal outcomes.…”

Neonatal Outcomes in the Birth Center Setting: A Systematic Review

“…However, when women receive care from a variety of providers, it can be difficult to assess the effects of one provider type or model of care. New definitions of midwifery care within interprofessional environments can assist clinicians and researchers in studying the outcomes of collaborative care …”