Why Doctors Should Engage with Midwife-Led Care Models
T
he role of midwives on maternity care teams is growing along with the increased use of advanced practice providers across the healthcare system. Collaborative practice between physicians and midwives takes many forms. In some, the system entry point is an OB/GYN physician who delegates routine or lower-complexity care to midwives. In other models, the point of entry is a midwife, who screens for patients who need consultation, collaboration, or referral, but who maintains primary responsibility for patient care unless and until that responsibility is handed off to a physician. The latter type is known as midwife-led primary maternity care models. Such models include birth centers, critical access clinics, midwife laborist teams and home birth practice. Few physicians have experience with such midwife-led models, but substantial evidence suggests growth is afoot. Research shows these models have a high potential to deliver on the “triple aim� of better outcomes, better experiences, and lower costs to the system, and that they can help address problems related to a shrinking obstetric workforce. As a result, payers and policy makers are interested in scaling up midwife-led care. These trends may seem threatening to physician practice and profitability, but midwife-led models can enhance physician practice and provide new opportunities for revenue and professional growth. This article will review some of the maternity care trends that are driving heightened interest By Steve Calvin, MD and Amy Romano, CNM
MetroDoctors
in reform, the evidence supporting midwife-led care as a high-value model, how and why physicians should engage with these models and future directions for collaborative practice. The Problem with the Status Quo
The United States performs worse than almost every other industrialized counSteve Calvin, MD Amy Romano, CNM try on the key outcomes of maternal and newborn survival.1,2 Behind The Value of Midwife-Led these data are unconscionable racial disPrimary Maternity Care parities. In Minnesota, African-American Countries that have better outcomes and mothers are 2.8 times more likely than lower costs tend to have systems designed other mothers to die of pregnancy related around midwife-led primary maternity causes while the risk for American Indian care, integrating physician care based on mothers is an astounding 7.8 times higher.3 the needs of each individual. Research These mothers’ babies are also more likely strongly suggests that under-utilization to die or suffer the long-term effects of of midwives in the United States likely preterm birth. The racial disparities persist contributes to the low performance of the even when controlled for socioeconomic overall system, and that increasing access factors. to midwives can improve the value by adPoor outcomes exist in spite of US dressing all aspects of the value equation: spending that is about twice that of similar outcomes, experience, and cost.7 4 countries. Analysts believe our outlier staMidwives are trained and certified in tus is driven by high utilization of medical, the primary care of women and newborns, surgical, and pharmaceutical interventions including independent management of in maternal and newborn care, high prices low-risk pregnancy and vaginal birth. The for hospital facility charges and low investtraining and philosophy emphasize prement in social determinants of health and vention, wellness and community-based primary prevention strategies, leading to care. The majority of midwives in Minhigher morbidity rates.5,6 nesota (and the country at large) are certiThe status quo is not working. Alarm fied nurse-midwives (CNMs). CNMs are bells are ringing and policymakers are advanced practice nurses and are licensed paying attention. Interest is rising in care in all 50 states. In Minnesota, CNMs models that can address both the poor outhave independent practice privileges and comes and high costs of current practice.
The Journal of the Twin Cities Medical Society
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