Sunday, May 24, 2009

ACNM Interviews CIMS' Birth Survey Team

The Coalition for Improving Maternity Services (CIMS) recently unveiled The Birth Survey Overall Results which offers ratings for mothers—by other mothers—on more than 9,500 providers and 2,300 birthing facilities across the US – all of which are accessible by expectant parents online at

ACNM took a few moments to chat with Mayri Sagady Leslie, CNM, MSN, and Nasima Pfaffl, MA to discuss The Birth Survey and the history behind it.

In a 2009 ACNM Annual Meeting session, Leslie and Pfaffl will unveil detailed survey data that isn’t available anywhere else! They will present (Education Session #508) on Monday, May 25 at 12:30 p.m.

Q. What information is available on The Birth Survey (TBS)?
Nasima: The consumer reviews which were just released include …overall ratings and recommendations for birth facilities and care providers, and a seven-item set of questions on providers’ interpersonal and communication skills, state reported facility intervention rates, and information on finding good care.

Mayri: The information on TBS encourages families to be more informed consumers of health care. It promotes evidenced- based, quality maternity care that is consistent with the Mother-Friendly Childbirth Initiative model and increases both transparency and the public’s access to information.

Q: You mentioned that part of The Birth Survey project is a nationwide campaign to make facility-level intervention data available to the public. In which states is this information available?
Mayri: We now have [information] for facilities in ten states…We … just received intervention data from Maryland, our latest state! We also have links to data for facilities in VA, TX, AK, CA, FL, MA, NJ, NY, and UT. This kind of public reporting supports informed choice and fosters transparency, which has been shown to improve outcomes for mothers and babies. Check out
to learn more about what data is available in your state and how to get involved with making this data more transparent in the other 80% of the US.

Q. How are you all promoting this new survey?

Mayri: CIMS itself is a coalition of many organizations throughout the country as well as professionals, advocates and families. Many of our own organizations have been extremely supportive along the way as TBS has grown, such as Lamaze International, Childbirth Connection, Birth Network National, Citizens for Midwifery, Choices in Childbirth, Midwives Alliance of North America, and of course the American College of Nurse-Midwives. But the real ‘miracle’ of the project, I think, is the grassroots nature of it.

Nasima: In the past year, we have trained more than 150 ambassadors to help spread the word about TBS in their local communities and to act as liaisons to their state departments of health to make available the facility-level intervention rates. This involves many dedicated individual grassroots activists and local level organizations who are promoting the project along with our national organizational supporters.

Q. How long did it take to make the consumer survey a reality?
Nasima: We have an amazing group of people who have worked countless hours over the last three years to develop and maintain TBS. We piloted in New York from 2007-2008. The survey launched nationally August 15, 2008 and the overall ratings results came online April 28. We have been training local-level ambassadors, spreading the word nationally about TBS, and fundraising. This progress is all the more amazing because we are a 100% volunteer powered group.

Q. Can’t consumers search Joint Commission or even state websites for this information? How is the Birth Survey different? What can a mother give or get?

Nasima: Much of the data collected by the Joint Commission or state agencies is not publicly available or very applicable to consumers when deciding where and with whom to birth. One such area is facility-level intervention data. A facility’s intervention rates directly impact a woman’s chance of experiencing an intervention- and she needs access to this information prior to choosing a birth setting. Women need access to this information to make more informed health care decisions.

Mayri: If you were selecting a car, you can look at consumer reports. But you cannot find a report that helps you, really tells you what you need to know when choosing where to have your baby in this country. And it’s critical to know intervention rates, because those rates are associated with complications for both mothers and babies. The two most important choices a mother makes in her pregnancy are what kind of provider they have and where they give birth. It’s so critical because mothers in US often make this choice blindly and some may have no choice at all. For the first time, women will be able to compare “apples to apples” in their town. And from the survey results, they can hear from other mothers what happened in their experiences and how they felt about their providers and places of birth.

Nasima: You’ll find other online reports that focus on quality and intervention rates for cardiac care and other health care, infection rates etc …but you just don’t find that many reports that touch on maternity care and none with the depth of TBS.

Q. In reviewing the feedback results, was there anything that surprised you? Any observations that would be of interest to CNMs and CMs?
Nasima: I saw in women’s free-text comments how women want a place to tell their birth stories and to have their voices heard. That was repeated over and over. I was surprised that of the women who had a c-section, 15% felt they were pressured into having a c-section.
For midwives, generally speaking, they are rated …highly on the overall ratings and on the specific interpersonal and communication skills questions. For more of a sneak peak of detailed results, visit our session at the ACNM conference.

Q. What’s next for The Birth Survey?
Nasima: In the summer of 2009, TBS will be adding free-text responses to the website. People love to read other people’s comments… so we are excited about this feature. And in 2010, detailed information on patients’ experiences with prenatal, labor, birth and postpartum care will be added to the website as searchable custom reports.

Q. How can midwives or their patients get more involved?
Nasima: We always need volunteers to help with the leadership, development, and maintenance of TBS. Also, many midwives around the country hand out our postcards to their clients. Midwives can access web buttons, banners, and cards at under “PR Materials.” Both midwives and the general public can get involved by taking one of our monthly ambassador training webinars [insert over webinars } to become a local ambassador. Lastly, developing a good list of midwives is challenging. If midwives see that their contact information on TBS is out of date we would love for them to email updated information to This is critical to help expectant parents contact providers after researching on TBS.

Interested in learning more about The Birth Survey? Please visit where you will find more information, including promotional materials to share with clients (banner ads, postcards, etc) or email . Attending ACNM Annual Meeting? See Mayri and Nasima for Education Session #508—on Monday, May 25 at 12:30 p.m.

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