Incident Report Forms for Members
of the California College of Midwives

Purpose of Incident Report: -- to memorialize in writing any unusual event at the time of its occurrence by a person who was a direct personal witness

Form: Published by CCM with sequential inventory control numbers. Individual forms are one page with a yellow self coping sheet attached. Fill out in ballpoint pen in blue or black ink. Keep the carbon and mail original to the administrator/ CCM.

The forms provided for this are numbered and should contain the names of all individuals who were present at the time of the incident and a non-judgmental description of events/circumstances ("just the facts, mam"). Identifying initials may be used for physicians or hospital staff to preserve their anonymity. However, the record of events constructed should be able to be  verified in a court of law should that come to pass.

The form is confidential property of the CCM (would require a court order for discovery). They may be used anonymously for research purposes.

Examples of "Incidents":

1. Events or circumstances that might result in litigation or accusations by a regulatory agency against the midwife at a later date, including conversations in which a client family indicates they may file suit or a doctor or hospital employee threatens to "report" the midwife the "authorities"

2. Events or circumstances observed in the course of interacting with medical providers or institutions in which the midwife was a direct observer of substandard care or harmful practices -- for example, errors in medical or nursing care, use of unsterile equipment or septic technique, failure to obtain parental consent before performing invasive procedures (episiotomy, neonatal intubation for meconium), retaliation against homebirth parents by angry hospital staff or attending physician in which the parents were subjected to derogatory accusations (child abuse, etc), subjected to unwanted and medically unnecessary procedures or refused care that was wanted or medically necessary (for instance a doctor who refuses to provide pain medication/local anesthesia during procedures or refuses to deliver a precipitous breech thus forcing the midwife or nurse to "catch" the baby instead).

3. Any other unusual occurrence that might useful to have a written record for later use.

Non-judgmental Language:  Please make every attempt to simply describe the events, without labeling or negative characterizations, and record exact quotes or paraphrases as precisely as possible. When some qualification is necessary, please choose your words carefully. For example if the nurse was incredibly rude to a homebirth mother after transport, one would characterize that in the neutral term of "Nurse's remarks were disrespectful to mother" and then if you can remember what she said quote or paraphrase the nurse "Only a crazy person or hippie would try to have their baby at home", etc. The same principles would be applied to the physician. For instance,  after an emergency CS with stillbirth 10 hours after hospital admission of a mother not in labor, one doctor informed the father that his baby had died and that it was the father's fault for having chosen a midwife and said "If you had been under the care of an obstetrician this wouldn't have happened". Of course, the family had been under the care of an obstetrician  - him!

Incident reports are especially helpful under circumstances of emergency transfer of care in which there is either a bad outcome or threats by physicians or hospital staff to "turn you in". Particularly with mortality or any permanent disability subsequent to midwife or home-based birth care the hospital or doctor may try to cover themselves by pointing the finger at the midwife, making it appear that what she did (or failed to do) caused the bad outcome when in fact we, as direct observers of medical or nursing care, noted either a failure to respond (would not believe information provided by the midwife) or a vast over-reaction which resulted in a cascade of complications. In any event, you as a practitioner are best served by having your chart be in apply-pie order and memorializing the events by filing an incident report in a timely fashion (within 7 days if possible).