ABSTRACT
This chapter explores the dilemma of decision-making in the context of transferring a woman from a midwifery center in the community to a higher level care facility, commonly a hospital providing a medical model of care. It explains the non-emergent transfer decision to demonstrate ideal decision-making tools and common pitfalls in this collaborative model. Such a decision is packed with expectations and potential disappointments for both the woman and the midwife. As a result, the tension that exists between the medical and midwifery models, values and expectations becomes heightened during a transfer decision as different models of care collide when the rejection of the mainstream is suddenly what is needed. Factors impacting midwifery decision-making can be divided into three domains: the midwife, the woman and the environment. High and middle income countries generally have strong, stable healthcare systems although they are often highly medicalised, with interventions frequently occurring. In low income countries the situation is more complicated.
