Tennessee Midwife CollaborativeForming Partnerships to Offer Otoacoustic Emissions Hearing Screens to the Homebirth

PopulationJulie Beeler, MA, CCC-A/SLP, Audiologist, Tennessee Newborn Hearing Screening Program, University of Tennessee Center on Deafness, Knoxville

Yinmei Li, MD, PhD, State Chronic Disease Epidemiologist, Tennessee Department of Health, Nashville

BackgroundLate in 2011 and early in 2012, Tennessee’s Newborn Hearing Screening (TN NHS) Program embarked on an initiative to offer hearing screens to Tennessee’s homebirth population.

TN NHS Program provided otoacoustic emissions (OAE) screening units and training to seven midwifery practices across the state. Currently, two units are being shared by four midwives. Three units are being used exclusively by three midwiferies. Some midwives within the collaborative are collaborating with other midwives in their region to provide screens to additional families.

In 2013, there were 849 live births in private residences (0.99% of total live births). In 2012, there were 803 (1.08% of total live births).

The CollaborativeOAE equipment was provided through Health Resources and Services Administration (HRSA) grant funding via the TN State Department of Health and University of TN Center on Deafness. Midwives who received equipment expressed a prior interest in offering an objective means of hearing screening to the families they served. Several attended TN’s NHS Statewide Task Force Meetings and remained in touch with TN NHS staff.

TN’s NHS Audiology Consultant provided face-to-face training to all midwives within the collaborative, with follow-up telephone conferences and ongoing technical support. Midwives were introduced to at least one pediatric audiologist in their region for referrals. Screening outcomes were shared with each midwife periodically, along with letters of appreciation from the NHS Program.

Midwife Reports• OAE screenings are easy to conduct with babies

who are between 7 and 14 days old.• Equipment is user-friendly, and ear tips are

reasonably priced.• Sharing equipment is feasible when partners

communicate well with one another and are located within same geographic region.

• Parents frequently request OAE screening for older sibling(s) who did not receive screening during their homebirth experience.

Feedback

“ We have been pleased to offer this valuable service to our families and the families of other practitioners.  This screening equipment is very easy to use.  The families are very excited to be able to have their babies hearing screening done in the comfort of their own homes.”

-Mary Anne Richardson,Tender Beginnings Birth Service, Nashville

ConclusionsMidwives who are well-trained and motivated to use OAE hearing screening in their practices can achieve positive screening outcomes, some reaching a screening rate of 100%. Use of OAE screening units can result in a decrease in the average number of days to complete a hearing screen for the homebirth population. Some midwives with smaller caseloads can have success sharing equipment.

Future• Expansion of collaborative, with issuance of five

additional OAE units across the state in 2014.• Encourage midwives within collaborative to

explore new partnerships with other midwives to reach as many homebirth babies as possible.

• Examine lost-to-follow-up trends for homebirth babies who refer on their initial OAE screen.

OutcomesIncreased screening rates

Table 1 shows the collective screening rates of midwives within the collaborative as compared to the screening rate for all TN homebirths from 2011 through 2013. Most practices within the collaborative began using equipment early in 2012.

Decrease in days to complete screen

Table 2 shows the average number of days to complete the initial hearing screen for TN’s homebirth population from 2009 through 2013. All seven midwives in the collaborative are conducting the OAE hearing screen during the newborn follow-up visit, which is typically scheduled 7 to 14 days following birth.

Acceptable refer ratesThe average OAE refer rate for the homebirth population (4.85% for 2012-2013) is not significantly different from that found for babies born in TN hospitals (4.45% for 2012-2013).

2009 2010 2011 2012 20130

5

10

15

20

2523

20 20

12

9

Average days to complete initial screen

2011 2012 2013

24

60

72

25

3441

Private residence screening rates

Midwife collaborative births All home births

Range:6%-100%

Range:59%-100%

Range:5%-58%

Special thanks to:Jacque Cundall, Newborn Hearing Screening Coordinator, TN Department of Health, NashvilleFenyuan Xiao, Epidemiologist, TN Department of Health, NashvilleDavid Smith, Director, University of Tennessee Center on Deafness, Knoxville

A Birth at Home , Nashville Family Birth Services, LouisvilleFull Circle Midwifery, Memphis Journey Midwifery Services, ChattanoogaTender Beginnings Birth Service, FranklinTrillium Woman Care, MemphisYalad Birth & Wellness Center, Athens