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Downloadable Guidelines Documents for Midwifery Practices

MAWS Indications for Discussion, Consultation and Transfer of Care in an Out-of-Hospital Midwifery Practice (April 2008) - PDF

MAWS Planned Out-of-Hospital Transport Guidelines (Updated Feb 2011) - PDF

MAWS Clinical Guideline for Vaginal Birth After Cesarean (VBAC) in the Out-of-Hospital Setting - PDF


The MAWS Planned Out-of-Hospital Birth Transport Guidelines were developed by Licensed Midwives and have been reviewed and approved by members of the Statewide Perinatal Advisory Committee (PAC), the Midwives’ Association of Washington State (MAWS), and the Physician-Licensed Midwife Work Group. The task force that lead to the creation of this document was appointed in 2004 to study and improve the process of transferring women and their babies from a planned out-of-hospital birthing locations to an acute-care hospital when a higher level of care became necessary. The task force is a cooperative effort of obstetrician–gynecologist physician leaders and licensed midwifery leaders, as well as those with expertise in public health and policy.

As part of the next phase of this project, midwives and physicians across the state have begun to meet with the goal of forging more intentional relationships to improve communication and client care. Several hospitals have been identified as locations at which to begin piloting this important work.

The Guidelines speaks to an underlying and mutual interest in the health and safety of mother and baby in the event of a transfer from an out-of-hospital birth setting to a hospital birth setting. When complications develop during labor or in the immediate postpartum period, access to a higher level facility with appropriate medical technology is an essential component in the achievement of good outcomes for mother and baby. Read More: (PDF)

 

The MAWS Indications for Discussion, Consultation and Transfer of Care in an Out-of-Hospital Midwifery Practice are referred to in the MAWS Planned Out-of-Hospital Birth Transport Guidelines because Licensed Midwives in WA state are required by law to consult with a physician regarding their client's care when there are significant deviations from normal during the pregnancy, labor, or postpartum period (RCW 18.50.010).

Licensed Midwifery as defined in RCW 18.50, is an autonomous profession. Licensed midwives work interdependently with one another and with other health care practitioners to promote the optimal health and safety of low-risk mothers and babies during the normal childbearing cycle.

Licensed midwives engage in an ongoing screening process that begins during the initial visit and continues through the completion of care in the postpartum period. In providing primary maternity care, licensed midwives take into account their client's own informed choices, the state laws and regulations, the standards for practice and core competencies for basic midwifery care provided by their professional organizations, the midwifery and medical literature, the settings in which they practice, the collaborative relationships they have with other health care practitioners and area hospitals, and their clinical judgment, expertise, and philosophy of care.

During pregnancy, labor, or postpartum, risk factors or complications can develop. This document provides a list of conditions that a licensed midwife may encounter in practice for which discussion, consultation, or transfer of care is indicated. The list is representative but not exhaustive. Other circumstances may arise where the licensed midwife believes discussion, consultation, or transfer of care to be necessary.

Professional members of the Midwives' Association of Washington State (MAWS) discuss, consult, and/or transfer care of their clients according to this document and in accordance with the MAWS document Position Statement: Shared Decision-Making. In addition, new clinical procedures may be undertaken in accordance with the MAWS document Mechanism for Introducing Expanded Clinical Procedures into Midwifery Practice. MAWS members should discuss the scope and limitations of midwifery care with clients and refer to these documents as necessary.

This document should be used as a screening tool to distinguish between low-risk and higher-risk maternal and newborn clients. Its purpose is to enhance safety and promote licensed midwives' accountability to their clients, to one another, to other health care practitioners, and to the general public. Read More (PDF)

 

MAWS Clinical Guideline for Vaginal Birth After Cesarean (VBAC) in the Out-of-Hospital Setting - The Midwives' Association of Washington State (MAWS) recognizes that appropriately screened women with a history of cesarean section must be able to exercise their right to access safe and satisfying vaginal birth after cesarean (VBAC) options. It is also the position of MAWS that women have the right to competent and evidence-based care in the setting and with the care provider of their choice.  Because of the dwindling availability of VBAC options in the hospital setting, the demand for out-of-hospital VBAC has increased. In an effort to respond responsibly to this growing demand, MAWS has a formal Position Statement on Vaginal Birth After Cesarean and has created an evidence-based Clinical Guideline for VBAC in an Out-of-Hospital Setting. Which is intended to guide midwives, improve communication with physician and hospital staff and optimize clinical outcomes for mothers and babies.