Connecticut working group urges standardized transfer procedures and better hospital handoffs for planned home births

At a recent meeting of a Connecticut midwifery working group, hospital- and community-based clinicians urged faster, clearer communication and standardized handoff tools to improve transfers from planned home births to hospitals.

The group, convened to discuss five questions shared with hospital nurse-midwives and community midwives, focused on how transfer experiences shape views of home birth and on specific steps to make transfers safer and less adversarial. Chair called the meeting to order, the group approved amended April minutes and then turned to the main discussion.

Lucinda, a nurse midwife speaking from years of hospital and community experience, described long-standing negativity and bias toward midwifery in hospital settings and said that cultural change is needed. “When you’re in a hospital setting, there’s a lot of noise in your ears,” Lucinda said, adding that that noise includes “negativity, the racism, the ignorance, the gossiping at the front desk about patients who do come in.” She urged training that respects home-birth practices and better collaboration so families are treated with “respect and dignity.”

Michelle, who identified herself as a practicing midwife and educator, recounted the emotional toll of difficult transfers and a recent tragic case: “The baby arrived deceased,” she said, describing a transfer after a failed breech birth that involved police and conflicting accounts between the family and the midwife. Michelle used the example to stress that confusion over provider training and roles can harm families and complicate recourse.

Richard reported that the Department of Social Services had increased Medicaid reimbursement for birth centers, an administrative change he said will help keep the Danbury birth center operating. He connected reimbursement to sustaining training sites and argued that stable payment is central to expanding community birth and, ultimately, to any licensing or regulatory pathway needed to secure payer coverage.

Speakers who run transfer drills and readiness exercises described practical elements that improve outcomes. Amy, who works on transfer drills nationally, said midwife-to-midwife transfers are “ideal” and noted that many transfers still result in vaginal births: “The majority, you know, 75 percent or so of home birth transfers have vaginal births,” she said, arguing that shared rehearsals, templates and long-term relationships between community and hospital teams make a difference.

Across the meeting participants offered a set of recurring recommendations: establish early communication channels so the transferring midwife can reach the appropriate receiving clinician; adopt a standardized transfer checklist or template (SBAR-like) that is used consistently; create equitable debriefing practices after transfers that avoid blame and promote shared learning; and expand opportunities for students and residents to observe community births to reduce fear and unfamiliarity.

Several speakers also emphasized the importance of recognizing and addressing bias among hospital staff and described concrete operational fixes — shared on-call schedules, direct phone contact for the clinician who will receive a transfer, and agreed-upon documentation pathways — that reduce delays and confusion when patients arrive by EMS or self-present.

The working group agreed to consider drafting or reviewing existing standardized transfer materials, to explore pilot communication processes with hospitals, and to convene a follow-up meeting to develop next steps. The Chair closed the meeting after participants expressed interest in continuing the conversation.

What’s next: the group plans to review shared transfer templates and discuss a possible follow-up meeting focused on CNM (certified nurse midwife) perspectives and practical implementation steps.