Introduction and History
FHCQ is a non-profit, neutral entity that houses a suite of programs centered around quality improvement and patient safety, including the OB Care Outcomes Assessment Program (OB COAP) and Smooth Transitions. Since its inception in 2010, OB COAP has included data on community births in Washington – specifically, data submitted by members of the Midwives’ Association of WA State (MAWS). At the time, many licensed midwives in Washington were already voluntarily contributing their data to MANA Stats, a national midwifery data repository.
In 2014, data collection became mandatory for licensed midwives in Washington as a condition for licensure renewal. Recognizing the value of having data on planned home and birth center outcomes captured in the same database as hospital data, but seeking to reduce the data burden on community midwives, MAWS entered into a data-sharing agreement with the MANA Division of Research and FHCQ that allowed MAWS member data to be exported from MANA Stats into OB COAP. There are now over 14,000 community birth records in OB COAP, and the OB COAP Management Committee includes two members of the LM community.
Why We Created the Community Birth Data Registry
The requirement for all WA licensed midwives to submit their data to a national or state research organization approved by the Department of Health – Historically, MANA Stats was one of two DOH-approved data repositories. In 2018, however, questions began emerging about the long-term viability of MANA Stats: the platform needed updating; there was no significant source of funding; and the Division of Research’s departure from MANA raised concerns about data security, data validation, and access to the database by future researchers. So, in 2019, members of the MAWS Data and Research Committee and the Smooth Transitions Leadership Team began to explore the possibility of building the Community Birth Data Registry (CBDR) at the FHCQ.
High-Quality Research – In 2021, a landmark study, “Birth Outcomes for Planned Home and Licensed Freestanding Birth Center Births in Washington State“ was published in the Journal of Obstetrics & Gynecology. This study analyzed 5 years of community birth data in OB COAP and demonstrated the excellent outcomes that can be achieved when midwives are well-integrated into the health care system. Because the data points in the CBDR more closely align with those in OB COAP, it will be possible to compare outcomes and process measures across all birth settings and provider types. No other database in the United States is capturing such comprehensive birth data.
To promote quality improvement across the whole system – Midwives entering data in the CBDR will be able to access their own data at any time and will receive annual reports from FHCQ comparing their own data to aggregated data of other community midwives (benchmarking). These reports will also compare all community birth outcome data to data from participating OB COAP hospitals. The ability to examine process and outcomes data across all birth settings will afford a unique opportunity to highlight the value of midwifery care.
NOTE: WA State Department of Health has designated the CBDR as an approved state research organization. In accordance with WAC 246-834-370, data from the CBDR will NOT be submitted to the Department. If a midwife gets audited by the DOH during the licensure renewal process, the FHCQ will provide verification only of the midwife’s participation in data collection, as required by law. Aggregated data will be shared with both professional midwifery organizations (MAWS and WARM)to help identify opportunities for continuing education and upskilling. This data may also be shared at the annual OB COAP meetings, inviting inquiry about how community birth practices could improve outcomes for low-risk childbearing people giving birth in hospitals. In addition, Smooth Transitions participants will be able to jointly review data on hospital transfers from planned community births.
Consumer education – FHCQ plans to use aggregated birth outcome data as well as qualitative data on patient experience of care to develop a patient decision aid. This tool will give birthing families in Washington the information they need to choose a birth setting and a care provider type that best matches their values, preferences, and expectations. The Washington State Health Care Authority has indicated interest in certifying and promoting such a tool.