If a high-risk situation or complication arises during prenatal care, there may be time for the midwife & client to attempt to arrange alternative options and a transfer of care to a supportive health care provider. However, if an high-risk emergency situation or any other issue arises in which the midwife feels that the required care is outside of her services, time may be short and urgency may be felt by both midwife and client. During prenatal care, the labor, birth or postpartum if a situation arises in which the midwife feels the need to do an emergency transport and/or transfer care of a client and/or her baby to the care of a health care provider or medical facility and the client refuses to allow transport, these are steps that should be taken to ensure that the client's rights and safety are protected as well as those of the attending midwife and her birth attendants during a problem situation. At no time should a midwife abandon her client while in her care, but make all efforts to assist the client in obtaining necessary medical attention.

The midwife must inform the parents of the risks and complications and follow any set protocols regarding the specific problem.

The midwife should notify the client's health care provider, if available, or the nearby medical facility about the complication and refusal by the client to transport. Documentation needs to be completed regarding all actions taken in the client's medical records.

The midwife should call the emergency medical services (EMS) and inform client of the risk of refusal to transport and refusal of treatment.

If the client still refuses transport when EMS arrives, she should stay with the client and continue to provide care.

The midwife must have the client sign a disclaimer.

MoonDragon's Birthing Guidelines: Transfer Criteria

MoonDragon's Client Forms: Medical Treatment Disclaimer Form

MoonDragon's Client Forms: Transport Form

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Variations of Pregnancy Guidelines

Variations of Labor & Delivery Guidelines

Variations of Postpartum Guidelines