Home-birth advocates and hospital clinicians urge standardized transfer forms, drills and provider-to-provider handoffs

Cara, co-chair and home birth midwife, opened a roundtable on improving home-birth to hospital transfers by reading a set of reflections that called for stronger provider-to-provider relationships, cultural competency training, clearer transfer pathways and better documentation to help families and clinicians during transfers.

Participants said hospitals currently vary in how they handle transfers and debriefs. An unidentified hospital clinician who spoke from Yale New Haven Hospital said formal provider debriefs generally occur only after a sentinel event — “a very poor outcome either for mom or baby” — and that institutions maintain different lists and thresholds for those events. The clinician added that debriefs can be requested by nurses or charge staff but that including outside providers such as community midwives often depends on hospital affiliation and risk-management policies.

Roundtable speakers urged expanding routine debriefs and running joint drills to build working relationships and improve documentation. “Doing drills with doulas and a simulated patient is the absolutely most helpful perspective to have,” one participant said, describing exercises that include handoff communication, documentation and clinical care in high-fidelity simulations.

Speakers also discussed transfer statistics and how stress differs by transfer type. One participant summarized the literature as showing roughly 9–12% of planned community births transfer to hospital, with emergent transfers under about 2%. Several hospital clinicians explained why non-emergent transfers can be especially stressful for receiving teams: arriving patients may lack complete documentation or may escalate to urgent conditions, and receiving clinicians must rapidly re-assess and document for licensure and liability reasons.

To reduce uncertainty, the group recommended direct provider-to-provider sign-outs and a standard transfer form that could be uploaded into any electronic health record (EHR). Dante and other participants noted existing model transfer forms used in other states and said a statewide standard — ideally accepted by the Department of Public Health and compatible with major EHRs — could reduce redundant assessments and improve continuity.

Amy, who described her work with a national training program, outlined the Step Up Together program that pairs community midwives with hospital champions to run full transfer drills, create standardized documentation practices and address transport and hospital delays. Amy said the program is free for participating facilities, runs across a five-month cohort and includes high-fidelity drills and a community debrief to build trust and clarify procedures.

The co-chairs also noted the conversation will continue in follow-up sessions with obstetricians, pediatricians and administrators and that the reflections will be included in a public annual report. A participant raised whether unifying midwifery licensure (for example, CPM and CNM pathways) would help families identify midwives who meet consistent standards; co-chairs said the group is already discussing ways to increase transparency about training and accountability.

The meeting concluded with organizers thanking participants, announcing a summer pause and saying the roundtable series would resume in September.