Quality Assurance, Documentation, and Peer Review by Home Birth CNMs


  • M. Elisa Morales CNM, MN,

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    • M. Elisa Morales received her nursing degree from the Intercollegiate Center for Nursing Education in Spokane, Washington in 1984 through Eastern Washington University. She received her nurse-midwifery education and master of nursing degree from Oregon Health Sciences University in Portland, Oregon in 1992. She has a private home birth practice in Portland and is a teaching associate with the Frontier School of Midwifery and Family Nursing, Community Based Nurse-Midwifery Education Program. She also holds the position of instructor in the nurse-midwifery education program at Oregon Health Sciences University.

  • Sandra Maliszewski CNM, CFNP, MS,

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    • Sandra C. Maliszewski received her certificate of midwifery from State University of New York at Downstate Medical Center in Brooklyn, New York in 1991. She also completed the family nurse practitioner program at Pace University where she received her master of science degree. She is in private practice in Garden City, New York. Also working for Island Peer Review Organization as an independent contractor on quality improvement projects, she is a member of the local ACNM chapter peer review committee.

  • Margaret Greenlees CNM, MS

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    • Margaret Greenlees received her certificate in midwifery from the University of Medicine and Dentistry of New Jersey in 1982. She is the founder and former partner in a home birth practice on Long Island, New York. She practices in a hospital-based midwifery service and provides clinical experience for midwifery students. She is an active member of Winthrop University Hospital's Obstetrical Quality improvement Committee. She is also a member of the Nassau County Department of Health Infant Mortality Review Team.

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The unique characteristics of home birth practice for certified nurse-midwives (CNMs) are applied to a quality assurance program. This article explores the multiple purposes, benefits, and elements of documentation as they specifically apply to home birth. The steps of documentation for a home birth practice are outlined and the three current models to consider in setting up positive peer review programs in which CNMs can succeed and learn are presented. Recommendations are made for 1) a more positive emphasis on the purposes of documentation and collection of statistics, 2) networking to close the gaps of isolation and task duplication for home birth CNMs, 3) ongoing development of models for positive peer review to facilitate participation in the mandate of the American College of Nurse-Midwives, and 4) identification of clinical indicators for quality assurance specific to home birth practice by CNMs.