CREATING BEST PRACTICES in COLORADO FOR transfers across levels of care during pregnancy and birth

JOIN the CSTC

Coalition meetings will resume in January 2024 and will happen via Zoom on the second Wednesdays at 12pm.

OUR PROCESS

Part I

Identify appropriate stakeholders to join the coalition and ensure inclusivity across stakeholder groups. See our participant list here.

Part II

Develop consensus for multidisciplinary guidelines related to safe transfers of care. See our Consensus Transfer Guidelines from Planned Community Birth to Hospital here.

Part III

This phase will begin in January 2024.

Implement quality improvement Pilot Projects in partnership with multi-disciplinary stakeholders based on the consensus guidelines.

Components will include:

developing transfer forms and surveys
putting a plan in place for ongoing multidisciplinary relationship-building
developing educational materials and forums to support uptake of the guidelines and tools

our motivation

The coalition was started to bring together multidisciplinary perinatal care stakeholders to ensure safe transfers from community to hospital during pregnancy and birth. Laws passed in 2021 require licensed providers and facilities to have plans and procedures for these transfers (see below). Models and best practices have been developed in other states. This is the effort to develop such standards in Colorado.

WHAT is THE LAW?

12-30-118 Acceptance of transfers from home and birthing centers

(1) A person regulated under this title 12 who regularly provides health-care services related to labor and delivery shall:

(a) Be able to identify when to transmit and receive patient information, and transfer and receive patients, across the facility's levels of care; and

(b) Coordinate with other providers to effectuate services across the facility's levels of care in a way that prevents patients losing access to care.

(2) This section does not prohibit health-care providers from billing for health-care services rendered.

(3) The acceptance of a transferred pregnant person does not establish an employment or consultation relationship between the accepting health-care provider and the transferring health-care provider or establish grounds for vicarious liability.

25-3-126. Health facilities - requirements related to labor and childbirth - rules - definitions

(1) except as provided in subsection (2) of this section, on and after january 1, 2022, a health facility that provides services related to labor and childbirth shall demonstrate to the department, in the form and manner determined by the department by rule, that the health facility has a policy that:

(a) allows every birthing person to have a companion or doula with the person during birth in addition to a partner or spouse;

(b) prioritizes newborns bonding with their families in order to facilitate the physiologic postpartum process;

(c) will not exclude from care any person experiencing physiologic birth or interrupt the process of physiologic birth without the informed consent of the birthing person;

(d) details the facility's process related to receiving a pregnant person's patient information from any provider regulated under title 12 who has provided care for the pregnant person; and

(e) establishes a process to transfer and receive pregnant persons across the facility's levels of care within the facility's capacity and capability.

(2) for labor and childbirth services provided to a birthing person who is in custody, a health facility shall demonstrate to the department, in the form and manner determined by the department by rule, that the health facility has a policy that:

(a) prioritizes newborns bonding with their families in order to facilitate the physiologic postpartum process, unless: (i) the parent or legal guardian of the newborn consents to medical treatment; (ii) the newborn is released to a legal guardian; or (iii) the birthing person is released from labor and delivery; and

(b) will not exclude from care any person experiencing physiologic birth or interrupt the process of physiologic birth without the informed consent of the birthing person.

(3) as used in this section:

(a) "doula" means a person who provides physical, emotional, and informational support to a pregnant person before, during, and after pregnancy.

(b) "physiologic birth" means labor and birth powered by the innate human capacity of a pregnant person and the pregnant person's fetus, which includes endogenous hormone systems.

(c) "physiologic postpartum process" means the biologic process that happens to both the newborn and birthing person after delivery due to endogenous hormone systems.