Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Do Certified Nurse Midwives decrease risk and improve outcomes to pregnant women?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Comparison to be made: other health care providers offering ob/midwife care: 1)OB/GYN, 2)FP, 3)Direct entry midwives.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Women and infants/neonates and their families

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

all

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Decreased c/s rate. Decreased intervention rate; decreased preterm birth. Improved birth outcomes (less infection, less c/s, less complications r/t c/s, less admissions to NICU, less elective induction of labor, evidence based care including delayed cord clamping, skin to skin care, improved breastfeeding rates all which may improve longterm outcomes including into adulthood)

Describe any health-related risks, side effects, or harms that you are concerned about.

see above

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Developmental delays, attention-deficit hyperactivity disorder, and autism
• Pregnancy, including preterm birth

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Children

Federal Health Care Program

• Medicaid
• Medicare
• State Children's Health Insurance Program (SCHIP)

Importance

Describe why this topic is important.

I have seen an imbalance in the United States with physician groups in some areas of the country limiting the practice of CNMs despite current evidence that shows as good as or improved outcomes to women and their children.

Limiting midwifery care 2/d to political stance is unethical. Limits should be removed. The goal is that we should have stratified care for pregnancy with CNMs being the basic level of care for childbirth as c/w other countries that have improved maternal and neonatal outcomes (the US is shit-poor in outcomes)

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

Vested interest. I am a CNM and I have seen these limitations imposed. My goal would be to improve teamwork while removing potential political barriers.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Limitation of access for midwifery care. Lack of education for the value of midwifery care with physician groups historically lobbying for restrictions.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Improved teamwork. Removal of artificial barriers (hospital guidelines for requirements of written or legal work agreements, state laws requiring written comanagement agreements.) Physicians should not have to legally tie themselves to a provider. The relationship should be more equitable.

Describe the timeframe in which an answer to your question is needed.

There is already much information that has been gathered. It would need to be analyzed. See chocrane data base.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Women and children.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Improved teamwork. Removal of artificial barriers (hospital guidelines for requirements of written or legal work agreements, state laws requiring written comanagement agreements.) Physicians should not have to legally tie themselves to a provider. The relationship should be more equitable.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

online