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Advisory council urged to replace Elmar after researchers find data unusable for quality improvement
Summary
Speakers at the Medical Board of California Midwifery Advisory Council meeting said the current licensed‑midwife annual reporting tool (Elmar/LMAR) produces data that researchers judged not usable for quality improvement or research and recommended adopting an alternative registry designed for community births.
Rosanna Davis, president of the California Association of Licensed Midwives, told the Midwifery Advisory Council that researchers commissioned by CALM concluded the state's Elmar tool "was not usable for quality improvement and or research." She said CALM is exploring options instead of overhauling the current system.
The comment followed a longer presentation at the meeting that reviewed the Elmar (licensed midwife annual report) and its statutory purpose. The advisory council's chair, Madelyn Weisner, summarized staff and researcher findings and said the Elmar as currently implemented fails to produce verifiable, research‑grade data and risks double counting or producing inconsistent denominators for common outcomes.
Why this matters: Council members and midwifery stakeholders rely on a valid statewide data set to monitor patient safety, understand practice trends and defend midwifery scope in policy debates. Presenters said the Elmar's current structure — mixed denominators, inconsistent definitions of onset and outcomes, and no sentinel‑event narrative field — produces unreliable figures that have already been weaponized in policy disputes.
Presenters noted key problems identified by researchers: opaque or inconsistent question language, denominators that shift between births and neonates, and lack of fields that capture multifactorial clinical decision‑making or narrative context for mortality and morbidity. The researchers recommended that, rather than attempting piecemeal repairs, the council consider permitting submission to a community‑birth registry or other purpose‑built systems as an alternative.
Council members and several public commenters supported pursuing a legislative or regulatory pathway that would allow licensed midwives to submit required annual data to a validated community‑birth registry (examples discussed included the Community Birth Data Registry, PDR and MANA statistics platforms) and have that submission meet the statutory Elmar requirement.
Madelyn Weisner said she would assemble a task force to develop a concrete proposal to bring to the council and to the full Medical Board of California, and several MAC members volunteered to work on the effort.
The meeting record includes repeated cautions from speakers that the Elmar has been used in prior policy fights and that any replacement approach should both improve research value and protect midwife and patient privacy.
The council did not take final action on the report at this meeting; members directed staff to form a working group to draft options for the MAC to consider and, if appropriate, present to the board.
