title: Critical congenital heart disease screening practices among licensed midwives in washington state.
abstract: BACKGROUND
  Since 2011, pulse oximetry screening for critical congenital heart disease (CCHD) has been recommended for newborns. Initial implementation guidelines focused on in-hospital births. Recent publications affirm the importance of universal screening, including for out-of-hospital births. No published data describe CCHD screening rates for out-of-hospital births.
  
  
  METHODS
  Licensed midwives in Washington state were surveyed regarding their current CCHD screening practices, volume of births attended annually, and typical newborn follow-up practices. For those who indicated they were screening, additional information was obtained about equipment used, timing of screening, and rationale for voluntarily initiating screening. For those who indicated that they were not screening, information regarding barriers to implementation was solicited.
  
  
  RESULTS
  Of the 61 midwives in our sample, 98% indicated they were aware of published guidelines recommending universal newborn screening for CCHD utilizing pulse oximetry. Furthermore, 52% indicated that they were screening for CCHD currently. Ten percent stated they do not intend to screen, whereas the remaining respondents indicated that they plan to screen in the future. The primary barriers to screening were the cost of pulse oximetry equipment and inadequate training in screening technique and interpretation.
  
  
  CONCLUSIONS
  Although voluntary implementation of CCHD screening by licensed midwives in Washington is increasing, it lags behind the implementation rates reported for in-hospital births.
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Evers
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Vernon
authors.forename: Amy H
authors.initials: AH
authors.lastname: Schultz
mesh_terms: D001291:Attitude of Health Personnel; D001364:Awareness; D036861:Delivery, Obstetric; D005260:Female; D019983:Guideline Adherence; D017048:Health Care Costs; D006330:Heart Defects, Congenital / Q000175:diagnosis; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D033182:Intention; D008880:Midwifery; D015997:Neonatal Screening / Q000379:methods*; D009721:Nurse Midwives; D010092:Oximetry / Q000191:economics; D036801:Parturition; D011181:Postnatal Care; D057184:Practice Patterns, Nurses'; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014861:Washington
keywords: Washington; congenital/diagnosis; heart defects; home birth; infant/newborn; midwifery; neonatal screening; oximetry