In pursuit of excellence: quality assurance, documentation, and peer review by home birth CNMs.

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.