Clinical Transfer of Care - Learning Expectations

NARM defines a Transport as “transfer of care during labor to another primary caregiver prior to the birth of the baby. In the case of transfer the student must remain with the client through the birth (if possible) and continue to be present through the immediate postpartum period. The supervising preceptor must be present until transfer of care has occurred.”

Learning Opportunities

Transfer of care is an important skill. NARM Registered Preceptors should help students learn how to transfer clients in accordance with the Homebirth Consensus Summit Guidelines, including:

• Notifying 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.
• Providing routine or urgent care en route in coordination with any emergency services personnel and addressing the psychosocial needs of the woman during the change of birth setting.
• Upon arrival, providing a verbal report, including details on current health status and need for care, providing a legible copy of relevant prenatal and labor medical records.
• Providing 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, remaining to provide continuity and support.

NARM strongly encourages preceptors to remain present through the immediate postpartum period, however it is understood that the student no longer requires preceptor supervision once transfer of care is complete. Hospital transfers are a valuable learning experience for student midwives. Remaining as support for a client who has transferred to the hospital provides continuity of care for the client, an opportunity for the student to assume an independent primary support role in the hospital setting, and can foster understanding and collegial relationships between the midwifery and medical community. This should be noted in the preceptor/student contract.

The NARM Registered Preceptors should, as part of their emergency care plan, disclose to clients their practice’s policy regarding student participation during hospital transfers. If the preceptors in the practice generally do not remain when transfer of care is complete, choosing instead to leave the student to continue to provide support for the client, this should be disclosed to the client in the emergency care plan. The client should ideally be supported throughout labor, birth, and immediate postpartum, regardless of whether the baby is born by vaginal or cesarean birth. Often, the midwife is unable to attend the client in the operating room, but the midwife’s presence in the recovery or postpartum unit can be beneficial as the client establishes breastfeeding after a challenging birth. Midwives and students are encouraged to remain to provide support, as needed.