Document Type

Report

Publication Date

2020

Comments

In partial fulfillment of the degree requirements for the degree of Doctor of Midwifery

Abstract

Introduction: Birth certificate data is a cornerstone of public health reporting, yet numerous studies document that much of the data collected is unreliable. Limited evidence suggests that the attendant at birth item may not be accurately captured on the current birth certificate, therefore not representative of the care provided by midwives in the United States. The primary purpose of this study was to determine whether midwives are accurately represented as attendant at birth on the Pennsylvania birth certificate. A secondary purpose was to assess midwives’ motivation to improve data collections if significant discrepancies were found.

Methods: A cross-sectional survey was completed in 2019 to gather individual and practice level data from Pennsylvania midwives (N = 471) who attended births in 2017 in order to compare midwife reported birth numbers to state-level data from the Bureau of Vital Statistics. Additional survey questions assessed Pennsylvania midwives’ perceived value of collecting correct birth certificate data and also described individual midwife, practice, and hospital level factors that affect accurate birth number tracking and birth certificate data accuracy.

Results: The survey yielded responses from 54 (11.45%) of the currently licensed midwives in the state of Pennsylvania. A majority of midwife survey respondents found it important to themselves and the profession to be accurately recorded as attendant at birth on the birth certificate. Comparison between midwifery reported birth numbers and state-level vital data was completed for 53.7% of facilities reporting midwife attended births in 2017. Overall, 45% of the facilities were inaccurate in reporting midwifery attended births, with some facilities underreporting while others overreported midwifery attended births.

Discussion: Utilization of midwifery services is rising in the United States, but vital statistics may not be accurately documenting the midwifery contribution to care. Some midwives in the United States may not recognize their important role in data collection. Identifying individual facilities or midwifery practices who could benefit from better-quality data collection processes is an opportunity to implement quality improvement techniques to increase accuracy on the birth certificate. Improving the birth certificate data accuracy may be achieved through examining the barriers to accuracy and developing formal quality improvement projects to improve the data.

Language

English

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