Exploring an Integrated Maternity Care System Across Birth Settings in the Salt Lake Valley

Birth certificate data from 2010 reported that 1.18% of U.S. births occurred out of hospital (OOH) (MacDorman, Declerq, & Mathews, 2013, p. 2). Evidence for safety in births that take place OOH is debated for various reasons. Research methods are observational and not controlled or randomized which allows for multiple interpretations of how variables may influence results. Comparing like birth settings is further limited by multiple variables such as provider management, philosophy of care, educational background and differences in institutional policies. All of these variables influence birth outcomes making comparisons and generalizations difficult if not impractical. The American College of Nurse-Midwives (ACNM, 2011) acknowledges that safety in home birth includes proper "evaluation of transport mechanisms if conditions require personnel and/or equipment available only in the hospital setting" (p. 1). The American Congress of Obstetricians and Gynecologists (2011) states that "assurance of safe and timely transport to nearby hospitals are critical to reducing perinatal mortality rates and achieving favorable home birth outcomes" (p. 3). Safe transport occurs when collaborative relationships are in place. A national meeting of maternity practitioners and other stakeholders on the issue of OOH birth created consensus statements, one of which called for a focus on "interprofessional collaboration and communication" with the goal of providing "respectful, safe, and seamless consultation, referral, transport and transfer of care when necessary" (Home Birth Consensus Summit, 2011, p. 1). The purpose of this project was to identify barriers to the establishment of an integrative system of collaboration, referral and transport among all maternity care providers in the Salt Lake Valley. The first objective of this project was to conduct a community survey of the labor and birth providers practicing in hospital, home and birth center settings. The survey inquired about perceived barriers to the establishment of an integrative and collaborative system and sought to identify key stakeholders who would be needed to establish such a system. The second objective was to conduct focus groups of those interested to further explore the themes identified in the survey. Lastly, the project sought to share project conclusions with providers and all other stakeholders to open the dialogue needed to take action in overcoming such barriers as well as foster communication and collaboration across birth settings. The most frequent reasons limiting collaboration among providers were physician perception of the OOH environment as unsafe, both hospital and community midwives perception of the lack of guidelines to govern collaboration. Focus groups assisted in exploring themes. These findings speak to the need for mutually agreed upon standards governing collaboration, transfer and transport and opportunities for providers across settings to interact professionally.