University of Wisconsin–Madison Medical College of Wisconsin

Barriers to Self-Disclosing Level of Maternal Care: What Are Wisconsin Hospitals Worried About?

Jenna L. Racine, MD; Katie Gillespie, DNP; Kathy Hartke, MD; Cynthia Wautlet, MD, MPH; Kathleen M. Antony, MD, MSCI

WMJ. 2021;120(1):45-50.

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Objective: The American College of Obstetrics and Gynecology (ACOG) has recommended every hospital disclose their level of maternal care (LOMC) to categorize the capabilities of their birthing center and regionalize perinatal care. Of the 98 birthing centers in Wisconsin, 44% have self-disclosed their LOMC. In many states, disclosing LOMC is mandated but, despite evidence and professional association recommendations, Wisconsin relies on voluntary self-reporting. We surveyed all birthing centers in Wisconsin to better understand the barriers to disclosing their LOMC.

Study Design: An anonymous survey was sent to all 98 birthing centers in Wisconsin. Survey recipients were hospital administrators, nursing supervisors, or physician directors of obstetric units. The survey sought information on perceived barriers to completing self-assessments and disclosing their hospital’s LOMC. Quantitative descriptive statistics were used for data analysis.

Results: Of 98 birth centers in Wisconsin, 40 (40.8%) responded. Fifteen of the 40 responses were from birthing centers that have not yet disclosed their LOMC. Of these, 93% were unsure how to disclose, 73% found the paperwork confusing, and 80% did not have the time or staff to complete the paperwork. Respondents did not report lack of departmental support, concerns about losing business or reputation, or future physician recruitment as barriers. Of all respondents, 77.5% were aware of ACOG’s LOMC recommendations, but only 35% thought disclosing their LOMC would be beneficial to maternal care.

Conclusions: Birthing centers in Wisconsin need further guidance on how to complete a self-assessment of their LOMC. In order to increase self-disclosure of LOMC, statewide perinatal organizations will need to continue to emphasize the benefits of releasing this information. Organizations should also provide additional support to level 1 and 2 birthing centers and improve maternal and neonatal care overall.

Author Affiliations: Department of Obstetrics and Gynecology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (Racine, Gillespie, Antony, Wautlet); Wisconsin Department of Health Services, Madison, Wis (Gillespie); Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, Wis (Hartke); Wisconsin Association for Perinatal Care, Madison, Wis (Hartke); Wisconsin Perinatal Quality Collaborative, Madison, Wis (Wautlet).
Corresponding Author: Jenna Racine, MD, 1010 Mound St, 4th Floor McConnell Hall, Madison, WI 53715; phone 608.417.6099; email; ORCID ID 0000-0003-3793-8177.
Acknowledgements: We would like to thank Kathy Kostrivas, Wisconsin Association for Perinatal Care, the Wisconsin Perinatal Quality Collaborative, and the Wisconsin Section of the American College of Obstetricians and Gynecologists for their collaboration on this project. Survey design support was provided by the University of Wisconsin Survey Center. We also thank all hospitals with birthing centers in Wisconsin for their commitment to providing accessible and safe care to women in this state.
Funding/Support: This project and the use of REDCap was supported by the Clinical and Translational Science Award (CTSA) program, through the NIH National Center for Advancing Translational Sciences (NCATS), grant UL1TR002373. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Financial Disclosures: None declared.
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