Arizona Department of Health (AzDHS) has long required your licensed midwives (LM) to submit reports to them about each an every pregnancy and birth they provide care for. These forms have been problematic for many reasons. They have required the LM to give AzDHS identifiable information about you and your care. Their format has changed multiple times with fields being added or subtracted at whim. There has been no consistent or accurate method of compiling or evaluating the data collected. Rumor has it that at one point, AzDHS being uncertain of what else to do with the boxes of paper reports, simply decided to shred them. It is no wonder that these ‘data collection’ forms were useless when trying to evaluate the safety of home births in Arizona a couple years ago.
In an attempt to fix these problems, AzDHS did two things – they took your name off the form and called it de-identified information and they created an electronic reporting form. An electronic reporting form has the potential to be secure, objective, use drop down lists or fill in the blank leaving little room for error, could be easy to compile and easy to retain copies for records. Finally the state would have an accurate and usable method of collecting statistics on Arizona home births, right? Wrong. Here are some of the many problems with the “new” and “improved” electronic reporting forms for Arizona midwives.
1. The format AzDHS decided to use is a public Survey Monkey form. Let me say that again, Survey Monkey. If the mall wants to ask you about which stores you most frequently shop at, if your employers wants to find out how much vacation time everyone in your office wants, or if the local fast food wants to know if your prefer fries or hash browns, they use Survey Monkey. AzDHS has decided it is a good way to also collect sensitive health care information.
2. The reporting form is open for use by anyone who has the link. Here is the link. Feel free to follow the link and browse through the reporting form at will. See what questions AzDHS is asking about your care. Pretend play that you are a midwife and fill in the blanks on the report at this link with whatever information you would like. Try it lots of different ways to get all 45 questions. Need a midwife’s name and license number to fill in, look here. See the training guide, also publicly posted, if you run into trouble.
3. The only way AzDHS “de-identified” the form is by removing your name. Linking your birthday, your due date, your child’s date of birth included in the report with the birth certificates filed by your midwife will easily allow AzDHS to know your personal birth information.
4. The form still contains several options for narrative answers. One of the big complaints about the old reports was that they were not simple and objective enough to analyze data from. This problem will persist when narratives answer questions about poor outcomes.
5. The midwife is unable to keep a copy of the report submitted unless she takes a screenshot or prints each page for her records. Once “Done” is clicked, the form is off and gone. The midwife has no proof of when she did the report, what answers she gave, etc.
6. Nothing in this form, the requirements for its submission, or the data gathered from it will help in “protecting the health and safety of clients,” as was claimed in the letter from AzDHS regarding timely submission. It is strictly for regulation of midwives, or to catch us not appropriately filling in details. Midwives are being penalized for incorrectly filling out the form or turning it in late regardless of reason.
7. This form, or any regulatory reporting form, is a poor substitute for careful evaluation of complications or complaints. AzDHS is incapable of the type of critical chart evaluation needed to ensure quality care and no type of form will fix that.
8. The majority of the midwives in Arizona begged the state to utilize the MANA statistics project instead of the midwife reporting forms as a way to collect accurate data midwife attended births in the state. The state decided to attempt again to collect and analyze this data themselves.
9. Oh, and once a form is started, AzDHS can view whatever answers submitted. So that playing around on the form you did in #2 – yeah, they got that (and will have to spend staffing time and money on evaluating it).
10. There are many errors in the form’s make up that create situations where the midwife is forced to falsify data. For example, if a client transfers out of a midwifes care and there is not a complication (say they just decide to birth in hospital or move out of state at 28 weeks), the survey form forces the midwife to say which hospital, ems, physicians office or certified nurse midwife the client goes to and what the medical reason for transfer is. Many times we don’t know who the new care provider is and there may not be a medical reason for transfer.
I encourage you to look at the Survey Monkey reporting form yourself and decide whether you believe it’s existence improves your and your baby’s pregnancy and birth outcomes. As a midwife, I am sorry that I am forced to submit your story to the health department, especially since you have no choice in the matter and it will come to no good end for me as a midwifery or for midwifery in general. If you are ready to take some concrete action against AzDHS’s increased regulation, write me an email at firstname.lastname@example.org for some ideas.