A midwife is at a client’s home as the primary care provider for a planned home birth. At 15 minutes postpartum, the client’s bleeding begins to increase and the midwife’s assessment is that the client requires another level of care to manage the haemorrhage. After a discussion with the client, the midwife calls for an ambulance and calls the hospital to notify them of their impending arrival. The paramedics arrive within 10 minutes and begin the process of transfer to hospital.
What does the midwife need to know in order to manage this situation?
Transitions in care occur when there is a transfer of responsibility and accountability for the client’s care between a midwife and another care provider. During a transition in care, also known as a transfer of care, midwives should always know who is accountable and ensure this accountability is communicated to the client and to other members of the care team. A well-structured handover of accountability requires effective communication and supports continuity of care.
In this scenario, if the client is stable and alert, the midwife should be clear with them prior to the transport to hospital who will be accountable for their care. The midwife should explain to the client that when their care is formally transferred to the physician in the receiving hospital, the midwife will no longer be their most responsible provider (MRP). It is important to manage the client’s expectations regarding their care and explain the limitations of the midwifery role after the transfer of accountability takes place.
The midwife is also responsible for communicating this accountability to the other health care providers involved in the client’s care including the attending paramedics, and the nurses and the physicians at the hospital. College standards require that midwives confirm with the receiving physician that they are MRP once the transfer occurs and to ensure this is documented in the client’s record.
In their role as a care provider who is not the client’s MRP, College standards require that the midwife works together with the MRP to provide care that is in the best interest of the client. This involves working with the care team after the transfer of care, to come to a clear understanding about what role the midwife will play in this client’s care.
The following Professional Standards apply to midwives:
- 26. Collaborate with the MRP, after a transfer of care, to provide care that is in the best interest of the client.
- 28. Consult with or transfer care to another care provider when the care a client requires is beyond the midwifery scope of practice or exceeds your competence, unless not providing care could result in imminent harm.
- 29. Provide complete and accurate client information to the consultant at the time of consultation or transfer of care.
- 30. Ensure that clients and health care providers know who the most responsible provider throughout the client’s care is, including when there are delegations, consultations, and transfers of care.
The following Record Keeping Standards apply to midwives
A midwife is responsible for documenting all care they provide to a client according to the following:
- Every transfer of, and discharge from care as well as the reason for the transfer or discharge.