As part of our new GA ACNM website, we will include regular spotlights on midwifery practices across Georgia. These spotlights will provide a view for both clients and other midwives into the excellent midwifery practices around our state.
For our first midwifery practice spotlight, we interviewed Susan Fisher, the midwifery practice manager at the Athens Regional Health System midwifery practice.
GA ACNM: When did the midwifery practice at ARMC begin?
Fisher: The practice started in 1976. During this time in Athens none of the community OBGYNs took Medicaid. Many low-income women received no prenatal care. Others went to the health departments to receive care, but there was no continuity between the health departments and the hospital so that women delivered with a “service call” physician who had no access to the prenatal records. The launch of the midwifery practice was a joint community project involving the local OB community, the NEGA health district and the hospital.
GA ACNM: How many midwives are in the practice?
Fisher: We currently have 7 full-time CNMs in staffing, one administrative CNM and 3 PRNs. We also employ three OBGYNs. It is important to note that this practice has always been run by the midwives, the director of the practice is a midwife. We have three wonderful, supportive full-time obgyn physicians who are an essential part of the team. They understand the midwifery model of care and support it. They provide collaborative care for high-risk patients and they also provide care for a number of women in the community who are on Medicare (there are few providers in Athens who take Medicare).
GA ACNM: How many births do the midwives at ARMC attend?
Fisher: We deliver approx 750 babies per year.
GA ACNM: How did the practice at ARMC begin?
Fisher: The local OB community agreed to the midwifery clinic with the caveat that we only see indigent patients, which we did for many years. Eventually that changed. Women with insurance wanted to come to see us and so the hospital relaxed the rules surrounding this. Today our payor mix is approx 30% private insurance, 30% Medicaid and 40% self-pay (mostly undocumented women of Latino origin).
GA ACNM: Do you keep quality improvement statistics in your practice? What are some recent stats?
Fisher: We keep statistics on delivery route including primary and repeat C/S, vbac, operative vaginal deliveries, epidural rate, episiotomy and ¾ degree laceration rates, infant wt, gestational age, apgar score less than 7 at 5 mins, NICU admissions, postpartum hemorrhage, etc. For many years we have had a primary cesarean rate of ~10%. We are known for our low rate of pre-term birth (consistently between 6-7%) even with a high number of high-risk patients in the practice. We were recognized by ACNM for benchmarking “best practice” in 2011 for 3 and 4th degree lacerations.
GA ACNM: How is the practice at ARMC run (manager, protocol, coordination with physician backup, etc.)?
Fisher: The practice is run by a CNM director who is also the hospital department head for the Midwifery department. We have three collaborating physicians who are full members of the practice. All CNMs, MDs and staff are hospital employees. We have written protocols that are updated every two years or so.
GA ACNM: Share with our readers the components of this practice that you see as most important for its success.
Fisher: Most important is the fact that we have been so well supported by hospital administration for 38 years. They can see our statistics and know that we play an important role in cost avoidance by keeping babies out of the NICU. Because of this, we have been provided with the resources and support to expand and grow over the years. Secondly, the MDs that work with us are excellent. All three of them are staunch patient advocates. They are clinically excellent. They understand and support the midwifery model of care. There is a strong sense of trust between the CNMs and MDs and this is only getting stronger over the years that we spend together. Third, we have an incredible group of midwives. Turnover in this practice is extremely low. These are highly skilled women who are able to do what they do well because they have a reasonable work schedule and they are supported by MDs and hospital administrators. We are able to spend enough time with every patient to make sure that all her questions are answered and that she feels personally known and cared for as an individual. We have a dedicated office staff who support the providers and work well together. We are fortunate to deliver in an L&D unit that has had a culture of excellence for many years. The nurses there are very supportive of women who desire low intervention births. Comments on our patient satisfaction surveys consistently mention how all of the office staff, nurses, patient care techs, ultrasound tech, etc. are friendly and accommodating. Last but not least is the Athens community. We have never advertised and yet we are the busiest ob practice in Athens. We know that this is because women who have received care here tell their friends and family about us.