CPM Quality System
Understanding the Urgent Need for a CPM Quality System
The urgency of a comprehensive and robust quality system is highlighted by the current state of maternity care in the United States. Despite the country spending more per capita on maternity care than any other nation, it ranks poorly in terms of maternal and infant health outcomes, especially among marginalized communities. Black, Indigenous, and rural birthing people face significantly higher mortality rates and are more likely to experience complications. In 2020, the National Academies of Science, Engineering, and Medicine (NASEM) pointed to universal access to high-quality midwifery care, especially in underserved areas, as a key solution to these disparities. Midwifery care, particularly when integrated into broader healthcare systems, has been proven to improve outcomes while lowering costs.
Developing a national CPM Quality System aligns with best practices for healthcare quality recommended by leading organizations such as the Institute for Healthcare Improvement (IHI) and the National Quality Forum (NQF). Steps such as building partnerships with quality assurance agencies, establishing nationwide data collection systems, and creating formal avenues for case review and process improvement will ensure that CPMs continue to provide safe, effective, and equitable care.
Moreover, a robust CPM Quality System is crucial for the sustainability and growth of the midwifery profession. It supports efforts to establish licensure in the remaining U.S. states and territories, clears the path for federal recognition and reimbursement through Medicaid and TRICARE, and demonstrates the profession’s ability to deliver positive outcomes. This, in turn, encourages more individuals to pursue careers as CPMs, expanding the workforce and increasing access to high-quality maternity care for all.
From Components to System Development
A comprehensive Certified Professional Midwife (CPM) Quality System is essential for ensuring high standards of care, especially given the longstanding commitment CPMs have shown towards quality despite operating with limited resources, inadequate state support, and no federal backing. Over the past three decades, CPMs have worked to develop a system components that focuses on multiple areas, from education to clinical practice. With key foundational pieces developed it is now time to connect the components and build a robust system with the strength and ability to evolve, provide continuous updates to essential competencies, standards, and guidelines as new evidence and scopes of practice emerge.
How the CPM national organizations work in partnership.
At the heart of the CPM Quality System are the three national organizations for CPMs. The North American Registry of Midwives (NARM) as the credentialing agency establishes the essential competencies and the minimum requirements to become a CPM as well as provides evaluation and examination to qualify for certification. The National Association of Certified Professional Midwives (NACPM), as the professional organization, is charged with maintaining the standards, scope, and guidelines of practice as determined by the CPM community. While the Midwifery Education Accreditation Council (MEAC) ensures that education and training are comprehensive on the accredited route of training.
CPM Data Collection
Data collection is a cornerstone of any quality system, and the CPM system is no different. Collecting and analyzing data allows the profession to spot gaps in knowledge or skills that may lead to poor outcomes. This information feeds back into the system, ensuring that continuing education units (CEUs), clinical skills, and educational standards evolve in response to the profession's needs. Moreover, quality systems teach midwives how to engage in peer reviews and grievance processes while ensuring that clients are provided with transparent, informed choice documents. This is crucial for fostering client autonomy while making sure the risks and benefits of various decisions are clearly understood.
Partnership with Community
A comprehensive quality system also takes into account the social determinants of health, addressing systemic and ethical conflicts. It fosters smoother relationships between community-based care providers and hospitals, promotes public health system cohesion, and enhances cultural and social safety for CPMs.
Transferring from Community to Hospital Responsibly
Creating smooth transitions from community settings to hospitals during labor, delivery, or the postpartum period is crucial for ensuring the safety and well-being of both mother and baby. Effective communication and collaboration between the client, midwife, EMS, and hospital staff are essential for a seamless transfer when complications arise. Programs like the Smooth Transition Program emphasize the importance of preparing all parties for these transitions, fostering relationships between community-based providers and hospital staff, and promoting mutual respect and understanding. Additionally, Step Up Together is instrumental in developing drills that simulate emergency scenarios, starting in home or birth center settings and walking through each step of a transfer to the hospital. These drills provide midwives and medical professionals the opportunity to practice their roles in real-time, ensuring that everyone is aligned on protocols and can act quickly and efficiently. By prioritizing preparedness and coordination, these efforts improve outcomes and ensure that clients receive timely, appropriate care in all birth settings.
Informed Choice Documents
A cornerstone of midwifery care is the preservation of client autonomy—their right to make informed decisions about their care. Midwives play a critical role in supporting this autonomy by providing transparent, high-quality education, and sharing evidence-based information to guide clients through the decision-making process. This involves not only offering detailed explanations of medical options and risks but also ensuring clients understand the broader political and systemic factors that may influence their care choices, such as access to certain services or state regulations. Midwives must be equipped to present clear, unbiased information while respecting the client's values and preferences. To support this responsibility, various states and organizations have developed resources and documents aimed at enhancing the process of informed decision-making for Certified Professional Midwives (CPMs). These tools serve as vital frameworks for ensuring that clients receive comprehensive, evidence-based information, empowering them to make choices that align with their personal needs and circumstances.
Is your peer review actually protected?
Peer review in midwifery is essential for continuous quality improvement because it allows midwives to reflect on their cases, learn from one another, and address areas where care could be enhanced. Through peer review, midwives can discuss complex cases, evaluate clinical decision-making, and ensure adherence to standards of care. It fosters accountability, encourages professional growth, and promotes the sharing of knowledge within the profession. However, an identified issue is that in all unlicensed and some licensed states, peer reviews conducted by Certified Professional Midwives (CPMs) are not legally protected, meaning the information shared can be used in civil suits or criminal investigations. This lack of protection discourages open and honest discussions, which are vital for quality improvement. NACPM is currently conducting a landscape analysis to explore this issue, seeking to propose existing and innovative solutions that could better protect CPM peer review processes. With adequate funding, new models could be developed to ensure that peer reviews remain confidential and continue to serve as a key component of midwifery quality systems.
Ensuring a Quality CPM Credential
While the main components of a CPM Quality system focuses on improved performance, knowledge, skills, and abilities, enforcement is also a critical component of a comprehensive quality system, particularly when addressing egregious misconduct. Ensuring that Certified Professional Midwives (CPMs) are held to clear, consistent standards not only upholds the integrity of the profession but also fosters public trust and confidence. This accountability demonstrates to legislators and consumers that the midwifery profession is committed to maintaining high standards of care, which is essential for advancing licensure efforts across states. Additionally, a strong enforcement mechanism supports the push for federal recognition by showing that midwives operate within a framework of professional responsibility, further bolstering efforts for integration into national healthcare programs like Medicaid and TRICARE.
Special Thank You
A special thank you to the Quality Consortium that has gathered for many weeks learning about quality systems, gathering known components across the nation, helping to write language explaining the importance, categorizing domains and focuses. The group is excited about developing this important area for Certified Professional Midwives. 10/2024