When discussing maternal-fetal transport, it is important to review the Emergency Medical Treatment and Active Labor Act (EMTALA) regulations as they relate to appropriate transfers. EMTALA originated in 1985 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA; 1985), to protect patients during an emergency regardless of their ability to pay for care or insurance status. The law requires that all patients, including those in labor, be assessed, stabilized, and treated at the hospital where they present regardless of their ability to pay for care or insurance status. EMTALA (U.S. Department of Health and Human Services & Centers for Medicare & Medicaid Services, 2003, 2009) requires that hospitals perform a medical screening exam (MSE) for anyone who presents with an emergency medical condition (EMC). The goal for the patient who presents is to either be stabilized and treated or transferred to a facility that can better meet the medical needs of the patient based
on her individual clinical situation. Pregnant women who present with contractions and/or who may be in labor are considered unstable. Caregivers must consider many factors in their decision regarding when it is appropriate to transfer a pregnant woman to another facility. A pregnant woman who is having contractions is not considered to be having an EMC if it is determined that there is adequate time to safely transfer her before she gives birth or if the transfer will not pose a threat to the safety of the patient. Caregivers must evaluate whether the woman and her fetus will be better served at a higher level of care. This is not always a straightforward or clear clinical judgment. A woman who appears stable prior to transport may become unstable during the transport. Unanticipated birth could occur prior to arrival at the receiving facility. Transfer might also be feasible based on the patient’s request.