1. OOH Transport Considerations
Cassaundra Jah, CPM, LM, IBCLC

2. Fulfillment of…
NM apprenticeship class requirement "NMMA course replacing NICU and high risk prenatal care observations" (0.0 CEU for the state)
NMMA CEU 1.5hour (if NOT being taken for NM apprenticeship)

3. Course Completion Requirements
Course is NOT completed until instructor has received document which includes:
Documentation of client education on transports
Documentation of client refusal to transport
Write transport steps
Transport locations in area student plans to practice within
Including direct numbers to L&D or best department for above locations
Transport Documentation to be provided to receiving entity
Note if student is using electronic charting she must provide a sample of transport documentation via her chart using the electronic system she will be using at most of the births she attends

4. Homebirth Summit Transport Guidelines
In the prenatal period, the midwife provides information to the woman about hospital care and procedures that may be necessary and documents that a plan has been developed with the woman for hospital transfer should the need arise. (Note next bullet removed)
The midwife notifies the receiving provider or hospital of the incoming transfer, reason for transfer, brief relevant clinical history, planned mode of transport, and expected time of arrival.
The midwife continues to provide routine or urgent care en route in coordination with any emergency services personnel and addresses the psychosocial needs of the woman during the change of birth setting.

5. Homebirth Summit Transport Guidelines con't
Upon arrival at the hospital, the midwife provides a verbal report, including details on current health status and need for urgent care. The midwife also provides a legible copy of relevant prenatal and labor medical records.
The midwife may continue in a primary role as appropriate to her scope of practice and privileges at the hospital. Otherwise the midwife transfers clinical responsibility to the hospital provider.
The midwife promotes good communication by ensuring that the woman understands the hospital provider’s plan of care and the hospital provider understands the woman’s need for information regarding care options.
If the woman chooses, the midwife may remain to provide continuity and support.

6. Before a Transport Happens
Educate clients about transports
Informed Decisions
Labs
What happens during one
Where to transport
How long you will stay with them
Length of time to transport
Know your transport numbers i.e. % maternal, % neonatal
Your role during a transport and once transfer of care is complete
Latest research on morbidity

7. Refusing to Transfer See two samples
Best legal documentation is in client's own hand, also lets midwife know how client is interpreting education
Think about what your personal limits are.

8. You are the Midwife, Act Like it and Take Responsibility

9. Code Switching
Code switching refers to the ability to change your speech to be best met by your audience.
EX: teen speaking with friends vs parents or teachers
When you transport being able to code switch to professional and medical language is vitally important in terms of being well received and viewed by the medical model as professionals within obstetrics who deserve respect
This serves you, your client, and the midwifery community at large

10. Dress Appropriately This is another form of code switching
Medical community as with all communities tend to respond with those who seem most like themselves – being their kind of professional will ease transports
If you don't wear scrubs and/or closed toed shoes to births have an extra set in your vehicle and change before arriving.
Suggestion: wear scrub pants to births and keep scrub top in car. If needed keep closed toed shoes in your vehicle as well.

11. Charting Transfers Chart everything
Sometimes it is easier to make a running line item list with times
Chart all medical events, changes in status, vitals and observations as obtained
Record everyone's names including EMTs, receiving nurse/staff, midwife/doctor

12. Transferring the Chart
Reason why this class requires you practice sending your electronic chart
Open Maternal and Infant Transfer paper chart from Homebirth Summit
Open MANA info Transfer Gathering Form

13. Trauma Happens Midwife Client Infant (NICU)
My cell phone number will NEVER change. You can call me any time

14. Debrief
Debrief with all midwives, students/assistants present at the birth within 48 hours of the transport
Remember hindsight is 20/20 – be gentle with yourself and others
Recommended that you do a peer review on all transports

15. Follow Up with Receiving Entities
Good Experience
Follow up with a thank you
Bad Experience
Consider advising client to include the important points in the hospital evaluation that they will receive in the mail
Document each experience that could be improved and forward these notes via , fax, or a phone call to the most appropriate person

16. What’s my role at the hospital?
Facilitating communication with staff
Letting clients know they have a choice when staff presents care plan as law
How can you help the nurse?
What can you learn from the doctor?