As hospitals are held increasingly accountable for health outcomes and satisfaction of childbearing families, and the maternity care workforce shortage grows each year, it has never been more critical to reconfigure hospital staffing models. Of key importance is to understand and successfully integrate all available roles and providers, practicing to the full scope of their education, certification and licensure. Decades of research and data from countries that spend far less on maternity care with better outcomes, demonstrate successful integration of Midwives. ACOG continues to endorse advancing Midwives in team-based models of care by providing the right provider, for the right patient at the right time.

Grow Midwives brings over 70 years of combined experience integrating midwifery-led models as Chief Midwives and Service Directors in community-based and academic teaching centers. Our goal is to facilitate the role of Midwives in hospital settings whose mission is to provide quality care that improves the health and well-being of childbearing families.

How to Start a Hospital-Owned Midwifery Service

When starting a hospital-based midwifery service, the assumption is that you will be an employee of the hospital. Has the hospital ever employed midwives before? A hospital may be starting a service for the first time, having never employed midwives on their staff before, which, again, means looking at hospital bylaws and assisting in designing the credentialing process.

What kind of privileges can you ask for to render care in that hospital environment? Such as, can you admit and discharge in your own name? Or do you have to admit and discharge under a physician’s name? Again, staffing questions need to be answered. Is it just a maternity care service or is it full scope? Are you providing care through the lifespan from young girls through aging women?

Who are the collaborating physicians going to be? It’s unlikely that collaborating physician is going to be a family care doctor, because what if the patient needs a cesarean section and they don’t have privileges to do surgery. However, some family physicians have additional training and perform c-sections. If midwives are working in rural health in a hospital team that is primarily family physicians, internists and surgeons’ how can a midwife bring additional assistance to this team?

You need to think about where the hospital is located in terms of resources they have and levels of care that they provide. What does the target market population look like? What is the case mix of the potential caseload? What will insurers cover as a licensed provider?

How to Introduce EBP in Maternity Care Product Line

There are many Evidence Based Practice (EBP) clinical options that deserve more attention by the healthcare community.

Take Nitrous Oxide, it’s slowly emerging across the country as a pain management tool in labor.It is widely used in Europe and contributes to positive outcomes while providing safe care for mothers without risk to the baby.

There are also a number of practices that are nonpharmacologic that hospitals may just not know how to effectively implement, train, orient or evaluate yet. Some of these may be best practices that lead to reducing the number of cesarean sections in a hospital, incorporating doulas into a hospital, providing the option of water in labor in birth, and a variety of other practices that are evidence based.

How to Create a Midwifery Led or Alongside Unit for Low Risk Patients

One of the challenging questions that the midwifery profession is still trying to figure out is, “How do we look attractive in a collaborative relationship? Perhaps it is with a privately owned obstetric group. Maybe it’s 5 obstetricians and 4 midwives. Maybe it’s a hospital based service where physicians are collaborating through mutual employment models. There are many possibilities to fit a variety of situations.

How do you figure out your income and expenses in a collaboration? How do you ensure that all parties make some profit margin that’s respective to the body of work that each has done and to their degree of training? How do you measure the level of acuity of services each provides?

Midwives aren’t surgeons. Midwives primary scope of care is in working with normal, healthy people. One of the important things few midwives have thought about, or accounted for in any kind of data collection, is “How much money are they generating based on the services they provide in a given period of time?” Creating this kind of pro forma is incredibly important for Midwives, yet almost never happens today.

How Do We Open an Accredited Birth Center

Opening an accredited birth center would start with understanding what the American Association of Birth Centers (AABC) promotes as exemplary models of free-standing birth centers. Creating environments that emphasize family centered care for low risk maternity patients in an out-of-hospital setting.

Alongside the AABC, is an accrediting body that is not affiliated with, but works in tandem to promote accreditation of freestanding birth centers, the Commission for Accreditation of Birth Centers (CABC).

Birth Centers can be owned and operated by midwives or physicians or hospitals. When you think about accrediting a birth center, again you need to go back to state regulations. About half the states in our country have state licensure regulations that are additional to an accreditation process. Some insurance companies are likely to mandate both state licensure and accreditation before reimbursing for a facility fee. Additionally, some states do not require accreditation of your birth center or have regulatory requirements. Optimal safe practice is best provided by meeting minimum requirements of CABC accreditation. There is a cost associated with accreditation as with any oversight organization that provides recommendation of quality review.. However, Grow Midwives believes this is the most rigorous process demonstrating public safety and accountability. We believe this is a requirement for safe care.

How Do We Address Burnout and Attrition in the Workplace

Burnout and attrition are significant issues for all health professionals, especially for people whose careers require call time. Physicians and Midwives face this challenge of having to cover 24/7 every day. In addition to a shortage of providers caring for women’s health, there is an overabundance of patients.

Grow Midwives has learned over the last few years that there is an exhaustion factor that comes with working really long shifts. Sometimes for 24, 48 or even 72 hour shifts Midwives are literally on the entire time.

They may have short, little breaks that are built in, but early in 2017 ACNM released a Position Statement suggesting Midwives should not work longer than 16 continuous hours without 4-hours of uninterrupted rest, as well as additional recommendations.

The question then becomes, “Are we not staffing the units properly?” Are we so committed to continuity of care that we don’t realize that a specific Midwife doesn’t have to be the one attending the birth. It could just as easily be one of the other partners. It could be another person in the hospital who doesn’t know the patient at all. What is an appropriate level of personal sacrifice and safety in care delivery versus patient expectation?

Hiring raises its own needs and questions. Are you hiring people with similar philosophies? In that case, does it really matter which of us is there if we are all going to provide the same style and quality of care?

Burnout and attrition in midwifery is high. People are leaving the profession every year or considering leaving. Some feel that they aren’t being paid enough, some don’t feel like they are being acknowledged for the importance of the job they do, some can not take earned vacation time, so simply are exhausted from poor staffing.

Taking care to structure a balanced and supportive collaborative practice will keep both Midwives and Physicians from feeling overworked, underpaid and underappreciated.


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