OOH Transport Considerations Cassaundra Jah, CPM, LM, IBCLC

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)

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

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.

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.

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

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.

You are the Midwife, Act Like it and Take Responsibility

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

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.

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

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

Trauma Happens Midwife Client Infant (NICU) My cell phone number will NEVER change. You can call me any time. 808.283.5373

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

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 email, fax, or a phone call to the most appropriate person

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?