Consultations & Transfers of Care in BORN

Recording Consultations & Transfers of Care in the BIS Infographic (PDF, 490 KB) (Published July 2022)

Recording consultations and transfers of care (TOC) in the BORN Information System (BIS) can be challenging. Below is a segment of our new infographic that provides our top tips and reminders. Click on the image to view the full infographic (PDF, 490 KB) or click the link above.

View Recording Consultations & Transfers of Care in the BIS infographic transcript.

 Snippet of the consultations and transfers of care infographic which provides direction on how to record a consultations/transfer of care in the BIS.

 

Consultations & Transfers of Care FAQ

More questions about consultations and TOC? We have answers! Review the FAQs below or search for your specific question. Midwives are welcome to request new questions to be added to our FAQ by emailing research@aom.on.ca. 

Where do I record a consultation/TOC in the BIS?

Every encounter in the BIS has a specific time-period associated with it. Consultations/TOC should be organized based on the time in which they occurred. The BIS time periods are as follows:

  • Antenatal General: During pregnancy including early labour, prior to active labour.
  • Labour & Birth: From onset of active labour to approximately 1-hour post-birth. 
  • Postpartum Maternal: Approximately 1-hour post-birth to discharge from midwifery care.
  • Birth Child: Within approximately the first hour of birth.
  • Postpartum Child: From approximately 1-hour post-birth to discharge from midwifery care.

Take care to not duplicate the same consultation/TOC across multiple encounters. 

If you are not sure which encounter/time-period your consultation/TOC falls under, choose the encounter in which the clinical indication that necessitated the consultation/TOC occurred. For example, a PPH that occurred within the first hour after birth, but circumstances arose that delayed the consultation/TOC until 2 hours postpartum should still be recorded in the Labour & Birth encounter.

Induction/Cervical Ripening

Induction of labour and cervical ripening related consultations/TOC are exceptions to the time periods. Although induction and cervical ripening occur before active labour begins, they are integral to the process of labour and birth and therefore consultations/TOC related to induction and/or cervical ripening should be recorded in the Labour & Birth encounter. To learn more about this exception, review the below response to “Where do I record a consultation/TOC related to induction of labour and/or cervical ripening in the BIS?”.

What do I select as the reason for a consultation/TOC in the BIS?

When selecting the reason for a consultation/TOC, always select the clinical indication or medical condition that justified the need for a consultation/TOC. 

Do not select the clinical intervention that occurred after the consultation/TOC.

For example, a consultation for abnormal fetal heart rate may ultimately result in a TOC and a cesarean section, but the reason for this consultation/TOC is based on the original clinical indication (i.e., abnormal fetal heart rate) not the resulting intervention to manage the complication. This is because the trajectory of the client’s care was not certain when the need for a consultation/TOC was determined, and indeed a different intervention (or no intervention) could have been used depending on the clinical circumstances and the physician’s discretion. Additionally, the fact that the client had a cesarean section is captured elsewhere in the BIS (like all other clinical interventions) and does not need to be duplicated in this section. 

See the below snippet of our consultations and transfers of care infographic for examples on what to select.

What to select examples from consultations and TOC infographic

Footnote 3: The examples displayed here will not be applicable to all midwives. Scope of practice may vary; midwives should assess their own knowledge, skills, and judgement to determine when it is appropriate to consult or transfer care.

Where do I record a consultation/TOC related to induction of labour and/or cervical ripening in the BIS?

Induction or cervical ripening related consultations/TOC are an exception to the defined time periods for BIS encounters. Although induction and cervical ripening occur before active labour begins, they are integral to the process of labour and birth and therefore consultations/TOC related to induction and/or cervical ripening should be recorded in the Labour & Birth encounter. 

There are several reasons for this exception including:

  • A client receiving an induction is prepared for imminent active labour and thus induction is a component of the labour & birth experience.
  • Induction related data is collected only in the Labour & Birth encounter, and thus data on consultations/TOC should be consistent with the data that has already been entered in the encounter.

When selecting the reason for a consultation/TOC related to induction the primary clinical indication that necessitated the induction should be selected, for example select pre-labour rupture of membranes (PROM) or postdates (≥41 weeks). There is no option in the BIS to select “induction” or "cervical ripening" as the reason for the consultation/TOC.

Where do I record a consultation/TOC related to PPROM or PROM in the BIS?

The encounter in which consultation/TOC data is recorded related to PPROM or PROM would depend on whether labour is initiated directly after the rupture of membranes. 

For preterm pre-labour rupture of membranes (PPROM), these consultations/TOC should be recorded in the Antenatal General encounter since they occur before active labour and typically do not result in imminent labour and birth.

Consultations/TOC related to PROM may be recorded in the Antenatal General encounter if PROM does not result in immediate progress toward labour (ex. Induction). 

For clients where PROM is used as the clinical indication to justify induction of labour and a consultation/TOC is required to perform this induction, this consultation/TOC should be recorded in the Labour & Birth encounter.

Should I select multiple reasons for a consultation/TOC?

It is best practice to select a single primary reason for a consultation/TOC. However, if there was another reason that was crucial to necessitate a consultation/TOC, this may be selected as well. Midwives should avoid selecting more than two reasons for a consultation/TOC.

As a reminder, midwives should select clinical indications/complications as the reason for a consultation/TOC, not clinical interventions. For more information visit the above response to the question: “What do I select as the reason for a consultation/TOC in the BIS?”. 

It is important to keep in mind the many details of a client’s clinical scenario should already be captured in other areas of the BIS and therefore do not need to be listed in detail in the midwifery tab as reasons for consultations/TOC. 

When is it appropriate to record a consultation for an epidural during labour?

Although the BIS requires midwives to record all consultations with physicians during a course of care, a consultation during labour with an anesthetist for a routine epidural does not typically need to be recorded as a consultation. 

If an anesthetist is called to place an epidural for a client during labour but there is no involvement of any other physician in this process, then the epidural would not be considered a reason for a consultation. This will be the case for most routine epidurals where the client does not have a clinical condition or complication of complex, obscure, or serious nature.

If a midwife is required by their hospital to first consult with an obstetrician or a physician other than the anesthetist to access an epidural during labour for a client (either due to hospital protocol and/or due to the complex, obscure or serious nature of the client’s condition), then the epidural would be considered a reason for a consultation. To record this epidural in the BIS, select “Pain Management-Epidural” as the reason for the consultation/TOC.

The available list of reasons for a consultation/TOC in the BIS does not include my client’s specific case. How do I record this properly?

When looking through the available reasons for a consultation/TOC, be sure to open each drop-down list and read the options carefully. Since the list of options for the Antenatal General and Labour & Birth encounters are quite extensive, it is possible the option you are looking for is difficult to locate but can be found in one of available drop-down lists.

Note: The AOM has recommended to BORN to include a search bar within this section in the Antenatal General and Labour & Birth encounters in the BIS to reduce time spent searching for the reason for a consultation/TOC. This request is with BORN and if approved may appear in the April 2023 BIS update. The AOM has also made several recommendations to BORN to improve the number of items that automatically pre-populate (‘flow over’) into the Midwifery tab when they are entered in other areas of the encounter. 

If the option you are looking for does not exist, select the most appropriate “other” option. There are many specific “other” options within the drop-down lists of both the Antenatal General and Labour & Birth encounters. The more specific the data entered in the BIS, the better quality it will be. Always attempt to select the most specific “other” if available. For example, if your client has a mental health concern that required a consultation/TOC during pregnancy, but this concern is not listed as an option in the BIS, select “Mental Health Concerns – Other” as the reason for the consultation/TOC in the Antenatal General encounter.

The BIS contains several “other” options that fall within specific categories of complications. The below table lists all the “other” options that are available in each encounter in the order they appear.

Encounter

Specific Other Options

General Other Options

Antenatal General

  • Mental Health Concerns – Other
  • Pre-existing Health Condition – Autoimmune – Other
  • Pre-existing Health Condition – Cardiovascular – Other
  • Pre-existing Health Condition – Endocrine – Other
  • Pre-existing Health Condition – Cardiovascular – Other
  • Pre-existing Health Condition – Gastrourinary – Other
  • Pre-existing Health Condition – Haematology – Other
  • Pre-existing Health Condition – Neurology – Other
  • Pre-existing Health Condition – Pulmonary – Other
  • Complications of Pregnancy – Fetal – Other
  • Complications of Pregnancy – Maternal – Other
  • Complications of Pregnancy – Placental – Other
  • Infection in Pregnancy – Other Infections
  • Medication Exposure – Other
  • Medication Exposure – Other prescription
  • Other Maternal condition or complication, specify:
  • Other Fetal condition(s), specify:
  • Other, specify:

 

Labour & Birth

  • Lacerations – Other
  • Labour and Birth Complications – Other
  • Complications of Pregnancy – Fetal – Other
  • Complications of Pregnancy – Maternal – Other
  • Complications of Pregnancy – Placental – Other
  • Infection in Pregnancy – Other Infections
  • Medication Exposure in Pregnancy – Other
  • Medication Exposure in Pregnancy – Other prescription
  • Mental Health Concerns – Other
  • Pre-existing Health Condition – Autoimmune – Other
  • Pre-existing Health Condition – Cardiovascular – Other
  • Pre-existing Health Condition – Endocrine – Other
  • Pre-existing Health Condition – Cardiovascular – Other
  • Pre-existing Health Condition – Gastrourinary – Other
  • Pre-existing Health Condition – Haematology – Other
  • Pre-existing Health Condition – Neurology – Other
  • Pre-existing Health Condition – Pulmonary – Other
  • Other condition or complication, specify:
  • Other Fetal condition(s), specify:
  • Other, specify:

 

Postpartum Mother

 

None.

  • Postpartum – Other maternal medical conditions
  • Other, specify:

Birth Child

  • Neonatal Birth Complication – Birth injury – Other

 

  • Other, specify:

Postpartum Child

  • Neonatal Birth Complication – Birth injury – Other

 

  • Other, specify:

How do I determine my scope of practice now that the consultations/TOC standard has been rescinded by the CMO?

Midwives must assess their own knowledge, skills, and judgement to provide care within the legislative scope of practice. This scope of practice may vary from midwife to midwife based on factors such as experience, training, and practice settings. Midwives should refer to the CMO's Scope of Practice document (PDF, 1 MB) (along with its included decision tree (PDF, 207 KB)) and the AOM’s FAQ on Scope of Practice to understand what is changing and what it might mean for their scope of practice now and in the future.

How do I record consultations/TOC that may be considered shared care with a physician?

Although there are circumstances in which a midwife and a physician may engage in collaborative care, the CMO no longer acknowledges the concept of “shared care”.  At any given time, there can only be one most responsible care provider (MRP), and thus care cannot be equally “shared” amongst a midwife and a physician.

If the midwife remains the MRP but is involving a physician to collaborate in a client’s care by seeking guidance or support on a particular concern, this is a consultation. 

If the physician becomes the MRP (i.e., is now primarily responsible for managing the client’s care), and the midwife continues collaborating on certain aspects of care that are within midwifery scope, this a transfer of care.

For more information on scope of practice as it relates to consultations/TOC review the AOM's FAQ on Scope of Practice