Homebirth and Collaborating With Midwives

How I Practice Video Series 
Jennifer Tessmer-Tuck, MD, FACOG
Minneapolis, MN

Recently we have seen an increase in the number of women who are attempting homebirth. Many of these women are attended by certified professional midwives or birth attendants who do not have hospital admitting privileges so when difficulties arise during labor or delivery, they were often seeking care with us late and often when they had complications. We really wish for an opportunity to intervene sooner on these patients because the safety of the mother and the baby were really our first priority.

We have an ob-gyn hospitalist on site 24 hours a day, seven days a week and we have a practice that is collaborative with a certified nurse midwife partner so we decided to reach out to the homebirth community and offer them the opportunity to transfer directly to the certified nurse midwife service. So the homebirth community has the contact information for our certified nurse midwife on call; she reaches out to her and we arrange for transfer of the patient.  When the patient and the provider present to the hospital, they are met by the ob-gyn hospitalist and the CNM who assess the patient together and make the decision of whether or not she is appropriate to continue care with the CNM service. Even when we have patients we feel need transferred to the ob-gyn hospitalist, we often continue to have the CNM involved in the care. This seems to be very appealing to the homebirth provider and to her patient and the CNM is able to help us transition the patient to the hospital environment.  What we ask of the homebirth transferring provider is that she come with all of her prenatal records in hand and be prepared to do a handoff to the team. The three of us meet together, review their records – and sometimes we find that the records are different than what we’re used to so we prepared a handoff form that allows the homebirth provider to itemize things that are the most important to us (laboratory studies, ultrasound results, documentation of the progress of labor). This opportunity for midwife-to-midwife transfer is unique in our community and has been very appealing to homebirth providers and their patients. We have found that once they know that we have a collaborative environment and not a competitive environment, they are more open to reaching out to us sooner and we’ve seen more transfers even during the course of prenatal care. This safe, compassionate, and collaborative environment has been very important to us in offering patient safety for mom and the baby. This is how I practice. 

American Congress of Obstetricians and Gynecologists
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