| Description |
Background: The number of women choosing to give birth in the community (either at home or in a birth center) rather than in the hospital setting is increasing due to personal preference, previous birth trauma, and the COVID-19 pandemic (Monteblanco, 2021). About one in ten women involved in a community birth, while in labor or postpartum, will medically need to or desire transfer to a hospital for delivery or postpartum care (Vedam et al., 2014). These transfers of care can be challenging for community midwives and providers and negatively impact the safety and satisfaction of the experience (Vedam et al., 2014). Evidence demonstrates that education and collaboration among professionals involved in birth transfers promote safety, satisfaction, and smooth transfers of care (ACNM, 2011). Methods: We conducted a quality improvement project in conjunction with The Utah Women and Newborn's Quality Collaborative (UWNQC) Out-of-Hospital Birth (OOH) Committee to assess the need for community-to-hospital birth transfer training in Utah and investigate birth transfer challenges unique to providers in rural areas of Utah. Next, we developed outlines, storyboards, and scripts for education modules designed for community midwives, emergency medical services, and hospital providers. We followed a human centered design approach to guide training module content and process development. We queried community midwives, facilitated a discussion group, and presented the interprofessional education (IPE) module outlines and storyboards to stakeholders, who then evaluated them for feasibility, usability, and acceptability. Results: Most community midwives expressed the need for community-to-hospital transfer training as "very important"; only two (33.3%) reported previous participation in any kind of birth transfers IPE training. Four participants (80%) reported miscommunication, distrust of community midwives, and misconceptions of midwives as significant challenges to birth setting transfers. Rural providers expressed that transferring care early in the labor course-due to long travel distances to a nearby hospital-often results in feelings of "being dismissed or their concerns not taken seriously." UWNQC Committee members who evaluated the training modules reported they met committee goals and expectations, assessed the storyboards and scripts to be "very valuable," and expressed intent to adopt the curriculum and continue work towards production. Conclusions: This quality improvement project met its goal to assess the need for community- to-hospital birth transfer training in Utah, investigate the unique considerations for providers in rural areas of Utah, and develop content outlines and storyboards for IPE modules. Ongoing interest and support from stakeholders will be paramount for continued project development, production, and sustainability. This work has the potential to spread to other contexts and provider types, including doulas, nurses, and pediatricians. The next steps include completing the storyboards and scripts for remaining modules, emergency medical services (EMS), and hospital provider specific tracks; assisting with a grant application to secure funding for production; beta- testing and evaluating change in provider self-efficacy. Further study and evaluation are needed to understand the change in provider perspectives, communication practices, and sense of collegiality among providers involved in birth setting transfers. |
