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What is an Effective Transfer Policy?

In some states, midwives are bound to discuss a transfer plan with their clients. In effect, this transfer plan should cover the basics of where the woman chooses to go and how she chooses to get there and what information she will take with her. Ideally, all midwives will discuss this information and ideally, all providers will do what they are supposed to do, which is give effective, professional care when asked. There are problems with our system, however, that produce places where transfers go well and polite and in other places produce transfers where women are treated badly, threatened with CPS reports, manipulated, physically or verbally abused and even coerced into cesareans because the incoming hospital will not “allow” them to continue laboring. While these are obviously violations of all known ethics and some laws such as EMTALA, it still continues to occur.

BirthAction encourages women to reach out to both midwives and the local hospitals to help engender more favorable conditions and discuss the accessibility of professional care in case of transfer, while understanding that this is impossible in some cases. However, we do believe that as more women come forward, report such care to hospitals, medical boards, nursing boards and accrediting agencies for hospitals, then perhaps we can begin to have discussions on what is professional care and why even women who have chosen out of hospital birth might need to access it and therefore, be treated well.

After all, it is in the best interests of everyone that a mother and baby be treated well and reach the best possible outcome. If homebirth transfers become so arduous and fear-ridden, then women and midwives might avoid transfer for very valid fears of repercussions on all sides. We need to work against that and we need hospital providers to see that this is in their own best interests.

Some effective transfer policy desires would be obvious:

-Providers will not insult or berate women arriving at the hospital for their choices, their baby’s current condition and/or other markers such as size, length of labor, etc. Discussions as appropriate should occur after treatment has been initiated and labor and birth have occurred and even then should be of professionals speaking to adults.
-Records should be provided without repercussion, as informational statements of care, not potential liability for providers to use against one another.
-Midwives should be considered professionals in the process of transfer, not locked out, ignored or reported for the fact of their attendance at labor.

In short, we should create Safe Harbor situations wherein care can be escalated as needed, as in other civilized countries that have out of hospital birth.

Have you contacted your hospital about their transfer policies? Let us know!

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