2.2 Best Practice Guidelines for Transfer

Now that you have learned that conflict is rooted in ambiguity of intention, information, purpose, expectations, understanding, direction, relationship, and/or role, take a minute to think about Geeta's home birth transfer. At this point in her story, there is the potential for either conflict or effective collaboration to arise. Review the Best Practice Guidelines for Transfer from Home to Hospital (22), with attention to when conflict could occur.

Following the 2011 Home Birth Summit, a multidisciplinary group of delegates formed a Collaboration Task Force that included leaders with expertise in obstetrics, family medicine, midwifery, nursing, health administration, public health, pediatrics, law, risk management, health policy, and ethics, as well as consumer rights and childbirth education. They developed these guidelines to reduce systems errors or conflict when care is transferred from a community setting to a hospital. Here are excerpts from the guidelines that outline best practices for the home birth attendant and the receiving hospital staff. 

Model Practices for the Midwife (22)

  • In the prenatal period, the primary provider (midwife or physician) provides information to the childbearing family about hospital care and procedures that may be necessary if transfer occurs. A plan for hospital transfer is developed with the client and documented.

  • The primary provider assesses the status of the client, fetus, and newborn throughout the maternity care cycle to determine if a transfer will be necessary.

  • The primary provider notifies the receiving hospital staff of the incoming transfer, reason for transfer, brief relevant clinical history, planned mode of transport, and expected time of arrival.

  • The primary provider continues to provide routine or urgent care en route in coordination with any emergency services personnel, and addresses the psychosocial needs of the client during the change of birth setting.

  • Upon arrival at the hospital, the primary provider presents a verbal report, including details on current health status and/or need for urgent care. The provider also presents a legible copy of relevant prenatal and labor records of progress and course of care prior to admission.

  • The primary provider may continue in a primary role, as appropriate to their scope of practice and privileges in the hospital, and the clinical need for expertise. Otherwise, they transfer clinical responsibilities to the receiving hospital provider.

  • The primary provider promotes good communication by ensuring that the childbearing family understands the consultant provider’s plan of care, and the hospital providers and staff understand the family’s need for information regarding care options.

  • If the client chooses, the primary provider may remain to provide continuity and support even if the primary care role is transferred to the consultant.

Model Practices for the Hospital Provider and Staff (22)

  • Hospital providers and staff must be sensitive to the psychosocial needs of the pregnant person that result from the change of birth setting.

  • Hospital providers and staff should communicate directly with the primary provider to obtain clinical information.

  • Timely access to maternity and newborn care providers may be best accomplished by direct admission to the labor and delivery or pediatric unit.

  • Whenever possible, the birth parent and their newborn are kept together during transfer and after admission to the hospital.

  • Hospital providers and staff participate in a person-centered decision making process with the birth parent to create an ongoing plan of care that incorporates the values, beliefs, and preferences of the birth parent.

  • If a birth parent chooses, hospital personnel should try to  accommodate the presence of the primary midwife as well as the birth parent’s primary support person during assessment and procedures.

  • The hospital providers and the primary provider coordinate follow-up care for the birth parent and the newborn; care often reverts to the primary provider upon discharge.

  • Relevant medical records, such as a discharge summary, are sent to the referring primary provider.