It is late evening and there is a definite chill in the air as I make the five-minute walk to my birth center from the nearby hospital. I wrap my arms around my torso in an effort to keep my body heat contained and I say a little prayer of thanks. I am thankful for many things. I’m thankful that I have a place to take my families when they need hospital-based care. I’m thankful that when we do have to make this trip, the mothers are treated with respect and compassion. I’m thankful that I am blessed to have excellent physician colleagues that I can call at any time to consult with. In order for me to provide excellent out-of-hospital care, all of these things are critical.
My birth center is a free-standing independent center staffed by certified nurse-midwives. We serve roughly 30 women each month, who come from a wide range of backgrounds. We are located in a mixed urban/suburban setting. Recently, we had a week that particularly highlighted the importance of our quality collaborative relationships.
We had a woman develop acute-onset preeclampsia. Fortunately, we caught it quickly and were able to get her in to see our collaborating OB immediately. Even though this woman risked out of our care, she received excellent care and gave birth vaginally to her healthy baby. The transition from our practice to the hospital was seamless and the mother was supported through the entire process by us and the doctor—we worked as a team. We were able to visit her in the hospital and she came to us for her postpartum care.
Another woman gave birth at the center to a 10-pound, direct OP baby. She had a partial third-degree laceration. We were able to easily call our nearby hospital and consult with the OB who was on call. Our client was escorted by us to the L&D unit, she had her repair done and we were able to then bring her right back to our center. During this entire process, a midwife was at her side, able to offer support.
A woman who had been in prodromal labor for a couple days, despite all of our midwifery-based interventions, became exhausted and stalled out at 6 cm. She requested a transfer to the hospital for pain relief. Again, we were able to call and speak with a physician and then escort her to L&D and help get her settled in. She received an epidural and was well supported by the hospital nurses. With position changes and the use of a birth ball, she gave birth vaginally to her healthy baby.
These are success stories, and I am so proud of both my staff and the staff that we work with at the hospital.
What makes me sad is that I know our situation is not the norm for out-of-hospital birth in our country. Despite our best efforts as midwives, providing high quality prenatal care, educating and empowering our clients and being ever vigilant in knowing normal and when to intervene, we will always have women who require the care of physicians and hospitals. The ability to facilitate that transfer of care in a timely, professional and compassionate manner should be the standard of care, not the exception.
When the other midwives and I first opened our birth center, the nearby hospital was unsure about this whole “birth center thing.” Slowly but surely we demonstrated our safe, excellent care and appropriate transfers. Whenever we did transfers, we made sure to make positive contact with all the hospital staff members. We reached out to them—the physicians, the nurses and the administration—and made ourselves available. Here are some important tips that we have learned:
- Put a human face to your practice; be visible and open for communication. It is easy for hospital-based providers and nurses to imagine all kinds of things about you when you are an abstract concept.
- Visit the hospital when you are not doing a transfer, but when you are fresh and well-rested.
- Demonstrate to them who you are and how you carry yourself. Be confident but humble. Ask them questions and their opinions; engage in conversation. The conversation doesn’t even have to be pregnancy- or birth-related. Oftentimes it is best to start off on other topics where common ground can be established.
- Be transparent. Maintain and make available your outcome statistics. Be open about what you do and what you don’t do.
Bring something to the table—what can you offer them? We refer our clients who choose an ultrasound to our collaborating physicians. This helps to build our relationship and frankly brings them some income. It is also beneficial in that our clients are able to meet the physicians so that in the event of transfers, the physicians are not complete strangers.
- Nurses are great to have on your side. Do what you can to facilitate a positive relationship with them. Speaking as a midwife who used to be an L&D nurse, they can make or break your situation.
- Follow up after transfers. Send a thank-you card.
In actuality, this is a process that takes time and commitment. We were persistent and consistent and did not give up. This determination has been well worth the effort. Today, it is a relationship that is collegial, professional and not taken for granted. It must be maintained and cultivated to continue to thrive. We still reach out, are still persistent and have been known to visit with chocolates. If we can do this, so can you. Again, it may not happen overnight or easily, but it can happen.