Transcript: Recording Consultations & Transfers of Care in the BIS Infographic

View infographic


A request for clinical assessment and advice from a physician or a nurse practitioner.

Transfer of care (T-O-C) 

The transfer of responsibility from a midwife to a physician as the most responsible provider (M-R-P) for part, or all, of the duration of the client’s care. When a T-O-C occurs, the physician becomes the M-R-P.


Only record consultations and T-O-C that occurred with a physician or a nurse practitioner.1
A midwife may engage in collaborative care with a physician, but there can only be one M-R-P at any given time.
A routine epidural2 would not be considered a consult if there is no involvement of any physician other than the anesthesiologist.

Where to record

Below are some examples of consultations/T-O-C that may occur in each encounter.3

Antenatal General: during pregnancy including early labour prior to active labour.

              Examples: GDM, PPROM

Labour & Birth: from onset of active labour to approximately 1-hour post-birth.

              Examples: 4th degree tear, PPH

Postpartum Birthing Parent4: approximately 10 hours post-birth to discharge from midwifery care.

              Examples: Incision infection, mastitis

Birth Child: within approximately the first hour of birth.

              Examples: birth injury. Meconium aspiration

Postpartum Child: from approximately 1 hour post-birth to discharge from midwifery care.

              Examples: hyperbilirubinemia, weight loss > 10%

What about induction?

Although inductions occur before active labour, they are integral to the process of labour and birth and any consult/TOC related to them should be recorded in the Labour & Birth Encounter.

What to select

Always select the primary clinical indication/complication as the reason for a consultation/T-O-C regardless the clinical intervention.3








Breech at 38 weeks




Presentation other than cephalic at 38 weeks


PROM at 40 weeks




Complications of Pregnancy – Maternal – Prelabour rupture of membranes (PROM)


Postpartum hemorrhage


Manual removal of placenta


Labour and Birth Complications – Postpartum hemorrhage


More questions?

General B-I-S F-A-Q

Consults/T-O-C F-A-Q

Midwives Scope of Practice F-A-Q



1Consults with other health care professions (ex. Massage therapist, naturopathic doctor etc.) should not be recorded. Midwife-to-midwife consults and T-O-C do happen but are not yet recorded in the BIS. A place to record midwife-to-midwife consults/T-O-C may in included in future BIS updates.

2A routine epidural is performed or clients that do not have complex, obscure or serious clinical complication; clients of this nature may require a consult/T-O-C. Click here for more guidance on recording epidurals.

3The 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.

4The encounter is entitled “Postpartum Maternal” in BORN. In attempt to maintain gender inclusive language, the A-O-M has chosen to refer to this encounter as “Postpartum Birthing Parent” for the purposes of this infographic.