Connecticut midwifery working group seeks smoother hospital transfers for home births

A Connecticut midwifery working group met virtually to discuss ways to make transfers from planned home births to hospitals safer and less traumatic for families. Participants included community midwives, hospital-based midwives and obstetricians, representatives of the Connecticut Department of Public Health and health foundations, and hospital-system staff. The group approved its previous meeting minutes and spent the bulk of the session collecting firsthand accounts and concrete recommendations for improving transfer workflows.

The Department of Public Health’s policy director, Miriam Miller, said she helped lead “the governor’s maternal health proposal that led to the new licensure category for birth centers,” and that she was in the meeting primarily to listen and learn. Several hospital clinicians described a recurring dynamic of mutual distrust: hospital staff are often anxious about liability and receiving transfers they perceive as arriving late or without adequate information, while families and community providers sometimes fear judgment when they arrive.

Hospital and community speakers converged on several practical fixes. Norwalk Hospital provider Sarah Church said, “I really appreciate when we get the transfers and we have records and we get warm handoff. I think that really makes that transition a lot easier,” noting that a direct, structured provider-to-provider report (for example an SBAR: Situation, Background, Assessment, Recommendation) speeds care and reduces confusion. Participants emphasized that transfers are usually non-urgent, but delays often result from poor advance communication, missing records, EMS handoffs that are not coordinated to obstetric workflows, and hospital logistics once the patient arrives.

Speakers recommended several immediate actions the working group can pursue: (1) inventory what home-birth registration data are already captured and whether those fields (planned vs unplanned birth, attendant type, transfer events) can be aggregated across the state; (2) promote direct provider-to-provider calls and a standard SBAR format for transfers; (3) expand simulation drills and joint debriefs that include midwives, EMS and labor-and-delivery teams (participants noted models such as Step Up Together); and (4) plan targeted outreach to obstetric leaders and hospital administrators at a May roundtable to build relationships and clarify local referral/transfer workflows.

Several hospital clinicians described a growing problem they called “dual care,” where patients maintain prenatal contact with a hospital practice for testing or records but plan to birth outside the hospital and then present for care only if complications occur. Hospital providers said that pattern can strain capacity and damage trust when it results in late transfers. The working group discussed ways to reduce those tensions through clearer expectations, documentation and patient education.

Participants also flagged data limitations. While the meeting included a suggestion to revise minutes wording to reflect that registration forms currently include fields for planned home birth and attendant type, attendees agreed that it is not yet clear how well those items are recorded or aggregated for quality improvement. DPH staff offered to investigate what the state already collects and whether additional refinements are needed.

The session closed with agreement to continue the conversation in May and to pursue the practical steps above: a short review of DPH data capture, outreach to hospital leadership, and expanded use of drills and debriefs between community midwives, EMS and hospitals. The group approved the prior meeting minutes by voice vote before moving on to the substantive discussion.