Planned Home Birth ~ Emergency Transport &
The Interface Among Midwives, Nurses & Physicians

Adapted from publications by College of Midwives of British Columbia, Canada, 1997

3.0 PLANNED HOME B1RTH

EMERGENCY TRANSPORT TO HOSPITAL

In an emergency transfer from home to hospital during the intrapartum or immediate postpartum, clear organization, responsibilities, and teamwork are essential for a safe transport. Unless it is clearly quicker and safer to transport by private vehicle, emergency transport is normally assumed to take place by via Emergency Medical Transport (EMTs).

 3.1 Prior to Emergency

•      Upon setting up practice the community midwife is encouraged to contact the local Emergency Services to establish a professional relationship with their personnel. It is helpful for paramedics to be familiar with the community midwives practicing in their area and when possible, to be familiarized with the training, licensure status, scope of practice, skills sets and limitations of community-based midwifery services.

 3.2 Emergency Transport Initiated  

• The midwife contacts emergency services and provides clear directions to her client's home, and indicates the health status of mother and/or baby  ~ either a life-threatening or a stable emergency transport.  
  

• The midwife appraises the EMTs of the condition of the woman and/or her newborn, the need for resuscitative measures or IV therapy, and the suitability for transport of the woman and/or newborn to hospital.
  

•  While awaiting the arrival of the EMTs the midwife contacts the designated hospital personnel/ department regarding the ETA of the impending transport, the presenting emergency, strategies for stabilization, potential interventions required including surgery, and the care plan en route.
  

•  Hospital personnel make arrangements for emergency arrival, ensuring appropriate medical staff are on hand.
  

•  The midwife completes the intraparturm transfer records before transport whenever possible.

 3.3 Emergency Transport Underway

•  The midwife accompanies her client in the ambulance, if appropriate.
  

•  During transport, the midwife communicates by cellular phone with the physician, if possible.
  

• The midwife continues to provide emergency care to her client, unless it is more appropriate for the paramedic to assume care.
  

• The midwife and paramedic collaborate in providing care when appropriate (e.g., CPR, management of shoulder dystocia or breech delivery).  
  

• The midwife provides technical information relative to childbirth and neonatal care, such as the importance of keeping the newborn baby warm and dry and that O2, once begin, cannot safely discontinued without an appropriate weaning period, even if the baby appears pink.

 3.4 Arrival at the Hospital

 ·        The woman is admitted directly to the procedure / operating room.

 ·        The midwife provides appropriate antepartum, intrapartum, postpartum and transfer records and/or a verbal report.

 ·        Primary care is transferred to the physician, while the midwife continues to provided psychological support to the childbearing woman and her family and information to physicians and hospital personnel.  

3.5  Follow-up after mother/baby are stabilized, delivered or admitted to a special care unit

• The midwife charts pertinent information about the EMT transport and transfer of care to hospital personnel, noting names of all first-responders when possible.
  

• The midwife documents the status of mother / baby upon arrival, especially noting vital signs, FHTs,  whether or not the delivery has occurred, time of delivery after admission, status of the neonate at and following birth, neonatal skin color, admission to special care units, etc, paying special attention to information that may have legal implications for any of the parties.  
  

• The midwife expresses appreciation on behalf of herself and the family to paramedics and hospital personnel for their assistance during an emergency.  
  

• The midwife analyzes the background situation and emergency circumstances of the mother or baby's and when possible discusses the situation with medical personal in order to learn from each emergency transport for her own edification and to share information and insights with her peer review group with the hope that the incidence of emergent events will be reduced whenever possible.