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Collaborative Care


Collaboration Outside the Hospital

If you are planning or considering an out-of-hospital birth, it is important to understand the differences between collaborative agreements, consulting physicians, referrals, and transfer of care.  It is even more important that you understand the roles and responsibilities of each care provider and their subsequent “agreements”.   These terms are interpreted, applied, and upheld  in many different ways. 


  • Collaborative Agreement: A collaborative agreement can be between a midwife and a physician or a midwife and a hospital.  The nature of this agreement implies that the two work seamlessly together, backing one another up, and equally share responsibility in care provided.  There is no guarantee that this is the case in every “collaborative” relationship, so investigating what exactly the agreement entails with both parties involved is important.  


  • Consulting Physician: If a midwife has a consulting physician, it means there is someone she can call if she determines there is need to do so.  In this scenario, the midwife holds the responsibility to properly assess, and refer clients for consultation or referral.  Whether or not she does so is at her discretion.  


  • Referral: A referral happens any time your midwife refers you to a physician or CNM for a second opinion.  A referral may or may not result in transfer of your care to another provider.


  • Transfer of Care:  A transfer of care takes place when care is transferred from one care provider to another.  Transfers can occur during the course of prenatal care if red flags arise.  Other times transfers occur during labor, but can still be considered non-emergency.  And finally, transfers occur in the case of emergencies.  Please visit the link provided to learn more about transfer of care protocols, timelines, and how they impact safety.   


For Further Reading...

What is a Collaborative Care Model?

When Ideals Fail: CNMs and Collaboration