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Heather M. Bradford, CNM, ARNP, MSN, School of Community Medicine and Public Health, University of Washington, 930 1st Street South, Kirkland, WA 98033, 425-803-3337, firstname.lastname@example.org, Vicky Cárdenas, PhD, MPH, School of Nursing, University of Washington, Box 359960, Seattle, WA 98104, and Mona T. Lydon-Rochelle, PhD, MPH, CNM, School of Nursing/School of Community Medicine and Public Health, Univerisity of Washington, Box 357262, Seattle, WA 98195-7262.
Data from live-birth certificates and hospital discharge summaries are relied upon heavily for national surveillance and research on childbirth. Despite the great importance of these data sources, the variation in accuracy by birth attendant in reporting this information has not been evaluated. The study objective was to compare the accuracy of recorded maternal medical conditions, pregnancy complications, intrapartum and postpartum events in birth certificate and hospital discharge data between physicians and certified nurse-midwives. We conducted a population-based validation study of 19 nonfederal short-stay hospitals in Washington State. The accuracy of reporting of maternal medical conditions and pregnancy complications was consistent between birth attendants except for pregnancy-induced hypertension, where CNM accuracy was greater in the birth certificate record. CNMs had substantially higher true positive rates than did physicians for several intrapartum and postpartum recorded birth certificate data, including premature rupture of membranes, augmentation of labor, and induction of labor. CNM reporting was more accurate when examining birth certificate or hospital discharge data combined for augmentation of labor. Given that CNMs deliver 10% of all U.S. vaginal births each year, our findings have important implications for public health policy, clinical practice, and individual decision-making among women. If national priorities are to be established and effective interventions that improve maternal and infant health are to be practiced, the assessment of factors related to CNM and MD care using administrative data sources must be based on both accurate and comparable data.
Keywords: Maternal and Child Health, Epidemiology
Presenting author's disclosure statement:
Any relevant financial relationships? No
The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA