Some midwives have a challenge finding good collaborating doctors for referrals. There are many practices that go out of business purely from that relationship ending and not having another doctor be an option. Some states require a written collaboration with a doctor for a midwife to practice (please check your specific rules and scope). Building that rapport and relationship takes time. Some doctors are used to working with midwives. Many I speak with don’t really know what a midwife is or even what a collaboration looks like. Each has different expectations of what the word collaboration means. I stress keeping supervision and collaboration as very different terms when discussing your relationship.
Supervision is when employment or direct “watching” of a midwife occurs from a doctor. That can include chart auditing, regular meetings to discuss all patient’s assessments and management plan, and being completely responsible/liable for midwife’s care. Collaboration is what most midwives are used to in their independent businesses. This relationship can be informal or in writing. I have a memorandum of understanding that I and the doctor would sign to have clear expectations of each person’s scope, availability, and expectations from each other. Each doctor had different requirements for expectations. Some only wanted to be called when a concern arise that needed co-management or transfer of care. Some doctors wanted routine labs, ultrasounds, and testing performed on all patients before agreement to consult and collaborate would be signed.
It wasn’t legally required in my state, but I wanted it for safety and professional courtesy to patients so they knew what professional collaborations I had in place. I was fortunate that a few of the collaborating doctors had known me for years prior to becoming a midwife (few of the benefits being a Labor and Delivery Nurse prior to completing midwifery school). Others, I set up meetings with local Obstetricians before starting practice, showing my resume, statistics, and certifications. I wanted to learn which hospitals and doctors were best options in area to send patients to if referral was needed. It was good to have transport discussion ahead of time, create policies for practice that were reviewed by doctors in area, and know local resources that did labs and additional testing I may need to provide high quality care.
It is great to have your initial collaboration write a formal signed letter that can be given to other potential collaborating doctors discussing their experience with your past collaborative relationship. Anything you can do to show your standards and professionalism will only help your cause long term. Midwives create strong long term practices with creating these amazing resource pools including a list of great collaborating doctors in area. Talk with local Pediatricians, Family Practice Physicians, and hospitals. You will be surprised how many doctors not doing deliveries will send patients your way looking for a home birth when this collaboration is established.
Communication is vital among community resources including Obstetricians. If a women is needing more urgent medical care, it is much nicer to send her to doctor’s office by transfer of care versus triage visit just to get them into another care provider’s office. Create standards on both ends of the care team, so patients will have a smoother transition from your care towards other providers within medical community. Midwives care for babies first month of life. Wouldn’t it be lovely to have a smooth transition for babies to next provider with a prior arranged collaboration in place?