"Transfer of care" means that circumstances have dictated that a different kind of care is necessary in order for the safety of you and your baby to be maintained. The necessity for a transfer of care can happen for a host of different reasons, and can happen during prenatal care, during labor, or the postpartum period. In addition, each transfer can have a varying level of severity ranging from mother requested transfers, to midwife detected red flags, to full-blown emergencies. It is important to know every detail of how a potential transfer will take place, and how risk factors will be assessed and monitored.
A Quick Note About Assessments...
Why are you talking about assessments, I thought this was the Transfer of Care page? Great question. The truth is a midwife cannot effectively transfer and have safety in mind if she does not value assessments that would indicate a need to do so. Therefore, a midwife who dismisses assessments as unnecessary, or who carries a philosophy that birth is always normal or a variation thereof, is one that is marching down a dangerous road. You would be wise to find another midwife.
Your midwife is responsible for assessing your risk factors, and monitoring for “red flags” before, during, and after your baby arrives. This is critically important in terms of safety, particularly those planning an out-of-hospital* birth. It is not enough to trust that your midwife knows what to look for and when you need help, even if she verbally says she does. Detailed conversations about what variations warrant consultation, referral, and transfer of care is absolutely necessary. Ask your midwife for a written copy of her collaborative agreement, consulting contract, and risking-out criteria**.
Many states have public health code that helps to define the terms of transfer of care, risk factors, and collaborative care relationships. Michigan does not have these relationships and roles defined by law. The definitions named here are in general terms. Some states mandate that midwives working in the out-of-hospital sector have physician back up. To what extent varies by state. It is essential for parents to understand that when considering a midwife who practices outside the structure of a hospital, there are few, if any professional ground rules
Furthermore, Michigan has no guidelines or requirements for relationships between midwives, doctors, and hospitals. Some midwives have excellent relationships with physicians and hospitals. Others have a reputation to the contrary, and to the detriment of safety for mothers and babies. To ensure the relationship is hospitable between hospital and/or physician and the midwife you are considering, a call or meeting with both parties is warranted.
For Further Reading:
Any parent considering an out-of-hospital birth must ask themselves, "What would happen if there were an emergency?" Often when midwives are asked this question, a common response is, "The hospital is only 12 minutes away." Women are casually reassured that a short ambulance ride somehow means that care is close enough to feel comfortable when embarking upon out-of-hospital birth. There is so much more to responding in the event of an emergency than the length of the ride from one driveway to another. For real life examples and for further consideration, please read "The Hospital is "Only" 12 Minutes Away".
What We're Seeking: Safety Protocols for Out-of-Hospital Birth and Transfer of Care
The Delicate Relationship Between Assessments and Safety
Routine Care During Pregnancy
* Out-of-hospital birth refers to birth that takes place in a home or a freestanding birth center
* *Risking-Out refers to the practice of having defined criteria for which clients will be referred for consultation or transfer of care. Proper risking-out criteria would help a care provider assess and monitor for low risk status. If at any time, a pregnancy or labor presents risk factors contrary to low risk, the client should be referred for consultation or transfer of care. Adhering to clear risking-out criteria demonstrates an appreciation for the fact that not every mother or pregnancy is a good candidate for OOH birth for safety reasons. Not all midwives share this appreciation.