The standards, statutes, studies and state data behind the Pennsylvania Transfer Framework, each one carrying what it supports and whether it has been checked at source.
Every source the Keystone Birth Collaborative has relied on, with what it supports and how far it can be pushed. One row per source, a stated relevance, and an explicit verification state, so a reader can tell a checked claim from an unchecked one without asking.
Verification states. VERIFIED means read at source by a person. SUMMARY means taken from a secondary summary and not yet read at source. OURS means the Collaborative built it. Last updated 3 October 2026.
76 sources in 9 sections. 55 checked at source.
| ID | Source | Supports | State |
|---|---|---|---|
| PA-01 | PA Department of Health, annual tables of occurrent live births by hospital, 2005 to 2026 | 56 hospitals stopped delivering; 121 to 75; 10 counties to 23 | OURS, built hospital by hospital |
| PA-02 | 28 Pa. Code Chapter 137, obstetrical services in hospitals | Does not contain the word hemorrhage; only blood reference is "immediate blood transfusion services as necessary," neither term defined; last substantially written 1980 to 1984 | VERIFIED |
| PA-03 | Joint Commission, 1 January 2026 standards disposition | Both maternal safety standards deleted, 13 elements of performance; annual hemorrhage drill and annual severe hypertension drill deleted with no replacement; disposition column reads "Deleted. N/A. N/A." | VERIFIED |
| PA-04 | Kozhimannil et al., JAMA 2018 | Births in a hospital with no obstetric unit rose 3.06 percentage points in the year after a rural county lost its unit, over four times the rise in out-of-hospital births | SUMMARY |
| PA-05 | PA DOH published birth tables, small-number floor | Floor of 25 births a year per hospital; births in units that closed fall below it and are invisible by construction | VERIFIED |
| ID | Source | Supports | State |
|---|---|---|---|
| TR-01 | MAWS, Indications for Discussion, Consultation, and Transfer of Care, Washington State, 2021 | The three-tier model: discuss, consult, transfer. §§ 2.1 to 2.4 definitions, §§ 3.3 to 3.5 intrapartum, postpartum, newborn | VERIFIED |
| TR-02 | MAWS, Planned Out-of-Hospital Birth Transport Guideline, 2011 | What the midwife does and what the hospital does at handoff, §§ 4.1 and 4.2 | VERIFIED |
| TR-03 | Home Birth Summit, Best Practice Guidelines: Transfer from Planned Home Birth to Hospital, 2020, CC BY 4.0 | Model practices; the three model transfer forms | VERIFIED |
| TR-04 | Smooth Transitions, Foundation for Health Care Quality, Washington | Hospitals enroll, each names a liaison, community midwives and hospital staff review transfers as colleagues; running since 2009 | SUMMARY |
| TR-05 | Vedam et al., Mapping Integration of Midwives across the United States, PLOS ONE 2018 | MISS score: Washington 61, Pennsylvania 26 | VERIFIED |
| TR-06 | Johnson and Daviss, BMJ 2005 | 12% of planned home births transferred; 5 of 6 before the birth; about 3% urgent | VERIFIED |
| ID | Source | Supports | State |
|---|---|---|---|
| HM-01 | Standard obstetric physiology, as summarized in PPH reviews | Uterine blood flow at term 500 to 600 mL/min, some sources to 750; 10 to 15 mL/min outside pregnancy | SUMMARY |
| HM-02 | ACOG, reVITALize and Practice Bulletin on Postpartum Hemorrhage | PPH defined as cumulative blood loss 1,000 mL or more, or loss with signs of hypovolemia, within 24 hours | SUMMARY |
| HM-03 | StatPearls, Postpartum Hemorrhage | Uterine atony causes 70 to 80% of PPH; usual cause in the first 4 hours | SUMMARY |
| HM-04 | WHO, Recommendations: Uterotonics for the Prevention of Postpartum Haemorrhage | Misoprostol on the Model List of Essential Medicines for PPH where oxytocin is unavailable or cannot be safely used; added for prevention 2011 | SUMMARY |
| HM-05 | Global Health Supply Chain, PPH medicines summary, 2019 | Misoprostol stable at room temperature, water-soluble, oral; oxytocin normally stored 2 to 8 degrees C and degrades at high temperature | SUMMARY |
| ID | Source | Supports | State |
|---|---|---|---|
| GS-01 | 42 Pa.C.S. § 8331 | Good Samaritan civil immunity, CPR | VERIFIED |
| GS-02 | 42 Pa.C.S. § 8331.2 | Good Samaritan civil immunity, AED use by any bystander | VERIFIED |
| GS-03 | Act 59 of 2014 | Epinephrine auto-injectors, trained school and entity personnel | VERIFIED |
| GS-04 | Act 139 of 2014 | Naloxone, any member of the public, standing order | VERIFIED |
| GS-05 | Stop the Bleed, American College of Surgeons and DHS | Public bleeding-control kits; bystander tourniquet and wound packing | SUMMARY |
| ID | Source | Supports | State |
|---|---|---|---|
| LG-01 | HB 2520 PN 3408, Medical Practice Act amendment | Defines "lay midwife"; four unlawful acts including administering any prescription medication; mandated consent contents; 4-year retention; religious-sect exemption on the consent requirement only; effective 60 days | VERIFIED, full text read |
| LG-02 | HB 2520 history | Memo 11 May 2026 "Lay Midwifery Informed Consent Notice"; referred Children and Youth 14 May; reported and re-referred to Professional Licensure 28 September 2026, 25-0; prime sponsor Rep. Arvind Venkat (D-30); session ends 30 November 2026 | VERIFIED |
| LG-03 | Act 14 of 2026 | Created the licensed CM category in Pennsylvania; Board of Medicine rulemaking pending | VERIFIED |
| LG-04 | MCARE Act, Act 13 of 2002 | Hospitals and birth centers report serious events to DOH and the Patient Safety Authority within 24 hours, no patient identifiers, PA-PSRS not public by facility | VERIFIED |
| LG-05 | Vital Statistics Law of 1953, 35 P.S. 450.201 to 450.214, and 28 Pa. Code Ch. 1 | Birth record authority; recognized certifiers include physician, CNM, midwife, other attendant, and the parent for an unattended birth | VERIFIED |
| LG-06 | Thompson v. Nason Hospital | Pennsylvania corporate negligence: nondelegable hospital duties for staffing, supervision, equipment, overall care | SUMMARY |
| LG-07 | 298 MD 2026, Commonwealth Court | The midwifery matter. KBC is not a party and takes no position. Reference only | NOT FOR CITATION IN KBC MATERIAL |
| ID | Source | Supports | State |
|---|---|---|---|
| CR-01 | NARM Candidate Information Bulletin, June 2025 | CPM: 55 births (10 observer, 20 assistant, 20 primary under supervision), 75 prenatal, 20 newborn, 40 postpartum exams | VERIFIED |
| CR-02 | ACGME Emergency Medicine Defined Key Index Procedure Minimums, effective 1 July 2028 | 10 vaginal deliveries, up to 3 simulated; 7 neonatal assessments, up to 2 simulated; no prenatal, postpartum or continuity requirement | VERIFIED |
| CR-03 | ACGME Obstetrics and Gynecology case log minimums | 200 spontaneous vaginal deliveries, 145 cesareans, 15 operative vaginal | VERIFIED |
| CR-07 | ACGME Program Requirements, Family Medicine, 2026 | Standard residency: minimum 20 vaginal deliveries (4.11.i.1.b, Core). Maternity-care option: 400 hours / four months on L&D and 80 deliveries performed or directly supervised (4.11.i.2, Core). Faculty requirement 2.7.d.2 | VERIFIED, read at source 30 Sept 2026 |
| CR-08 | ABFM 2026 Core Competencies and Procedures | Normal vaginal delivery and cesarean section appear among additional procedures programs are encouraged to provide, not the required core | VERIFIED, read at source 30 Sept 2026 |
| CR-09 | ABPS Family Medicine Obstetrics eligibility | 60 vaginal deliveries, 15 in the last 2 years; Surgical Qualification adds 70 cesareans as primary surgeon, 10 in the past 2 years, 12-month fellowship within 5 years, or 5 years ongoing practice; ALSO and NRP. Certification floor, not what every fellowship requires | VERIFIED |
| CR-04 | ACNM Definition of Midwifery and Scope of Practice, 2021; ACNM Core Competencies 2025; ACNM Standards | CNM scope, settings, training path, recertification | VERIFIED |
| CR-05 | AMCB certificant data | 14,802 AMCB-certified midwives; 14,662 (99.05%) CNMs and 140 (0.95%) CMs | VERIFIED |
| CR-06 | Kathleen Hindle, CNM, DNP, signed Role Sheet 3, 18 Sept 2026 | Correction of record: the graduate-degree training path is not universal; certificate-program CNMs practice today | OURS, signed |
| ID | Source | Supports | State |
|---|---|---|---|
| LB-01 | CAP Q-Probes, emergency department test turnaround time studies (see PMID 8418756, PMID 9341581) | Median ED hemoglobin turnaround ~25 min; half of labs report 90% within 50 min; clinician-stated goal 20 min | SUMMARY |
| LB-02 | PMC11484656, type and screen versus conventional crossmatch | 51.24 min to first transfusion vs 71.56 min | SUMMARY |
| LB-03 | A single academic center's published turnaround | 92 min for type and antibody screen. An example, not a benchmark | SUMMARY |
| LB-04 | AABB Standards | Pretransfusion specimen for a pregnant patient must be collected within 3 days | SUMMARY |
| ID | Source | Supports | State |
|---|---|---|---|
| KB-01 | Safe Passage summit audio corpus, 26 Sept 2026 | 21 recordings, about 19.5 hours. Every participant quotation in the framework | OURS |
| KB-02 | Signed role and seam pages | Role 1 (Abigail Iovine, 20 Sept), Role 3 (Kathleen Hindle, 18 Sept), SAGE five questions (Danielle Isbell), Seam 2, Seam 3 approval cards | OURS, signed |
| KB-03 | Table paper, photographed 28 Sept | CLAY three tiers; CREAM markup of the mothers' page; seam proposal annotations | OURS |
| KB-04 | Hospital lane, drafted from the room recording 15:33 to 15:35 | Bureaucratic accretion; provider-to-provider calling blocked; capacity follows reimbursement | OURS, awaiting signature |
| KB-05 | PA maternity closures file, 2005 to 2026 | County-by-county table behind PA-01 | OURS |
Extracted from the reference list of Birth Emergency Skills Training (Gruenberg), the standard BEST curriculum, and resolved against PubMed. Every entry below carries both a PMID and a DOI and was registry-verified. None of the book's own text is reproduced here; these are its cited primary sources.
| ID | Source | Why it is here | Status |
|---|---|---|---|
| BE-01 | Roush, R.E., The development of midwifery--male and female, yesterday and today, Journal of nurse-midwifery, 1979. PMID 376791, DOI 10.1016/0091-2182(79)90078-8 | VERIFIED | |
| BE-02 | Burst, H.V., The American College of Nurse-Midwives: a professional organization, Journal of nurse-midwifery, 1980. PMID 6898114, DOI 10.1016/0091-2182(80)90002-6 | VERIFIED | |
| BE-03 | Tom, S.A., The evolution of nurse-midwifery: 1900-1960, Journal of nurse-midwifery, 1982. PMID 7050320, DOI 10.1016/0091-2182(82)90164-1 | VERIFIED | |
| BE-04 | Rooks, J.P., Nurse-midwifery: the window is wide open, The American journal of nursing, 1990. PMID 2248314, DOI None | VERIFIED | |
| BE-05 | Menticoglou, S.M., Symphysiotomy for the trapped aftercoming parts of the breech: a review of the literature and a plea for its use, The Australian & New Zealand journal of obstetrics & gynaecology, 1990. PMID 2189391, DOI 10.1111/j.1479-828x.1990.tb03185.x | VERIFIED | |
| BE-06 | Rosenblatt, R.A., Interspecialty differences in the obstetric care of low-risk women, American journal of public health, 1997. PMID 9096532, DOI 10.2105/ajph.87.3.344 | VERIFIED | |
| BE-07 | Scoggin, J., The historical relationship of nurse-midwifery with medicine, Journal of nurse-midwifery, 1997. PMID 9037936, DOI 10.1016/s0091-2182(96)00068-7 | VERIFIED | |
| BE-08 | Bastian, H., Perinatal death associated with planned home birth in Australia: population based study, BMJ (Clinical research ed.), 1998. PMID 9694754, DOI 10.1136/bmj.317.7155.384 | VERIFIED | |
| BE-09 | Lewis, D.F., A randomized clinical trial of daily nonstress testing versus biophysical profile in the management of preterm premature rupture of membranes, American journal of obstetrics and gynecology, 1999. PMID 10601934, DOI 10.1016/s0002-9378(99)70395-9 | VERIFIED | |
| BE-10 | Chamberlain, G., ABC of labour care: obstetric emergencies, BMJ (Clinical research ed.), 1999. PMID 10323825, DOI 10.1136/bmj.318.7194.1342 | VERIFIED | |
| BE-11 | Simpson, K., Shoulder dystocia. Nursing interventions and risk-management strategies, MCN. The American journal of maternal child nursing, 1999. PMID 10565146, DOI 10.1097/00005721-199911000-00009 | VERIFIED | |
| BE-12 | Sandberg, E.C., The Zavanelli maneuver: 12 years of recorded experience, Obstetrics and gynecology, 1999. PMID 10389741, DOI 10.1016/s0029-7844(99)00355-5 | VERIFIED | |
| BE-13 | Baldwin, K.A., The midwifery solution to contemporary problems in American obstetrics, Journal of nurse-midwifery, 1999. PMID 10063228, DOI 10.1016/s0091-2182(98)00073-1 | VERIFIED | |
| BE-14 | Sullivan, N.H., CNMs/CMs as primary care providers: scope of practice issues, Journal of midwifery & women's health, 2000. PMID 11151458, DOI 10.1016/s1526-9523(00)00076-3 | VERIFIED | |
| BE-15 | Curet, M., Predictors of outcome in trauma during pregnancy: identification of patients who can be monitored for less than 6 hours, The Journal of trauma, 2000. PMID 10912853, DOI 10.1097/00005373-200007000-00003 | VERIFIED | |
| BE-16 | Dawley, K., The campaign to eliminate the midwife, The American journal of nursing, 2000. PMID 11059319, DOI None | VERIFIED | |
| BE-17 | Stone, S.E., The evolving scope of nurse-midwifery practice in the United States, Journal of midwifery & women's health, 2000. PMID 11151466, DOI 10.1016/s1526-9523(00)00084-2 | VERIFIED | |
| BE-18 | Boyer, M., Root cause analysis in perinatal care: health care professionals creating safer health care systems, The Journal of perinatal & neonatal nursing, 2001. PMID 12095006, DOI 10.1097/00005237-200106000-00006 | VERIFIED | |
| BE-19 | Bridges, E.J., Hemodynamic monitoring in high-risk obstetrics patients, I. Expected hemodynamic changes in pregnancy, Critical care nurse, 2003. PMID 12961783, DOI None | VERIFIED | |
| BE-20 | Ponkey, S.E., Persistent fetal occiput posterior position: obstetric outcomes, Obstetrics and gynecology, 2003. PMID 12738150, DOI 10.1016/s0029-7844(03)00068-1 | VERIFIED | |
| BE-21 | Rubeor, K., The role of risk management in maternal-child health, The Journal of perinatal & neonatal nursing, 2003. PMID 12822697, DOI 10.1097/00005237-200304000-00002 | VERIFIED | |
| BE-22 | Smith, G.C.S., Factors predisposing to perinatal death related to uterine rupture during attempted vaginal birth after caesarean section: retrospective cohort study, BMJ (Clinical research ed.), 2004. PMID 15262772, DOI 10.1136/bmj.38160.634352.55 | VERIFIED | |
| BE-23 | Alarab, M., Singleton vaginal breech delivery at term: still a safe option, Obstetrics and gynecology, 2004. PMID 15229021, DOI 10.1097/01.AOG.0000131628.62183.34 | VERIFIED | |
| BE-24 | Guise, Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section, BMJ (Clinical research ed.), 2004. PMID 15231616, DOI 10.1136/bmj.329.7456.19 | VERIFIED | |
| BE-25 | Snyder, L., Ethics manual: fifth edition, Annals of internal medicine, 2005. PMID 15809467, DOI 10.7326/0003-4819-142-7-200504050-00014 | VERIFIED | |
| BE-26 | Gurewitsch, E.D., Comparing McRoberts' and Rubin's maneuvers for initial management of shoulder dystocia: an objective evaluation, American journal of obstetrics and gynecology, 2006. PMID 16458671, DOI 10.1016/j.ajog.2005.07.019 | VERIFIED | |
| BE-27 | Cheng, Y.W., The association between persistent occiput posterior position and neonatal outcomes, Obstetrics and gynecology, 2006. PMID 16582120, DOI 10.1097/01.AOG.0000206217.07883.a2 | VERIFIED | |
| BE-28 | Vedam, S., Closing the theory-practice gap: intrapartum midwifery management of planned homebirths, Journal of midwifery & women's health, 2007. PMID 17467596, DOI 10.1016/j.jmwh.2007.02.013 | VERIFIED | |
| BE-29 | Peregrine, E., Impact on delivery outcome of ultrasonographic fetal head position prior to induction of labor, Obstetrics and gynecology, 2007. PMID 17329512, DOI 10.1097/01.AOG.0000255972.48257.83 | VERIFIED | |
| BE-30 | Bohren, M.A., Hofmeyr, G.J., Sakala, C., Fukuzawa, R.K., Continuous support for women during childbirth, Cochrane Database of Systematic Reviews, 2017. PMID 28681500, DOI 10.1002/14651858.CD003766.pub6 | The evidence base for the doula role page and glossary entry | VERIFIED |
VERIFIED means the Collaborative opened the source itself and confirmed the claim against it. SUMMARY means the finding is taken from an abstract or a secondary account and the full text has not been read. OURS means the Collaborative built the figure from primary data and the workings can be shared. Where a source could not be reached, the entry says so rather than going quiet.
A list that marks its own weak entries is more useful than one that does not. If an entry is wrong, or you know the source better than we do, the Collaborative would rather hear it.