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Community midwives detail screening, informed‑disclosure and documentation practices for planned home births
Summary
Midwives described the intake process for families considering planned home birth, highlighting transfer‑planning, informed‑disclosure forms (often required by CPM credentialing), documentation of declined tests, EMR variation, and screening for communication and trust.
At a working‑group meeting, community midwives outlined the interview and screening process they use when families seek planned home birth care. The presenters listed concrete items midwives routinely discuss during intake: transfer rates and emergency procedures, health history, obtaining existing medical records, prior disciplinary actions, professional training and education, and whether the midwife carries liability insurance.
Midwives said they use an informed‑disclosure document that explains who they are, their training, and the state legal status of community midwives; the document is typically signed by families when they choose to hire a midwife. One participant said, “the disclosure that Gingi refers to comes from the CPM credential,” noting that CPM credentialing requires certain elements in the disclosure; the group clarified that a CPM requirement is not the same as a CNM requirement.
The group emphasized both 'tangibles' (medical history, records, transfer plan) and 'intangibles' (the ability to build trust, communication style, and willingness to accept recommended medical care). Participants said variations in individual midwives’ personal scope of practice and routes of entry into midwifery create real differences in comfort with specific complications (for example, V‑backs, breech, twins) and in when to recommend transfer.
On documentation and charting, speakers said there is no single common electronic medical record among community midwives; some still use paper charts, complicating transfers, and providers rely on screenshots or printed pages to share records in urgent situations. The group reported that refusals of recommended testing (for example, STI testing, GBS testing, newborn procedures) are recorded in chart notes and that some refusals require a signed acknowledgment while others are simply documented, depending on practice.
Costs and insurance: members said most families choosing home birth have insurance but usually do not expect reimbursement; whether midwives carry professional liability insurance varies. The group flagged insurance, EMR compatibility, and documentation practices as topics that may need dedicated time at future meetings.
The working group paused the discussion on immediate postpartum transfers and agreed to continue it at the next meeting.
