Transferring from a homebirth to hospital

For many women, the chance of needing to transfer from a planned homebirth to hospital during labour is quite scary, and is enough to deter them from even planning a homebirth.

There are many and varied reasons for transferring from a planned homebirth to hospital, and you'll be pleased to hear that most fo those reasons actually come about during the pregnancy and well before labour starts.  This could be for reasons such as :

  • High blood pressure
  • Baby is in the breech (bottom-first) position
  • You have certain medical conditions such as a heart condition or epilepsy
  • There have been concerns about baby's growth or the health of baby during pregnancy

By and large, having started labour at home as a low-risk woman carrying a healthy baby, the chance of needing to transfer to hospital is very low.  The statistics on this vary, depending on whether we look at first-time Mums or women who have previously given birth.  The chance of needing to transfer to hospital during labour as a first-time Mum is slightly higher than that of a woman who has previously given birth.  However, the most common reason for transfer in a first-time Mum is not an emergency reason: it is simply for a labour that has gone on for a while, the woman is tired and is requesting pain relief.  This is not an emergency situation and transport to hospital would most likely be by car.  In your own time. 

The other reasons that women sometimes need to transfer are for after-birth issues such as a placenta that is not coming away or losing too much blood after the birth.  It is rare for babies to become distressed in a home birth when the pregnancy has been well and healthy, the baby has grown well and is healthy and the labour is normal and has not been stimulated artificially with drugs and medications.

What precautions do midwives take?

There are many things that homebirth midwives do to make a potential transfer safe for mother and baby.

  1. Homebirth midwives usually make a back-up booking into the local hospital, with your permission.  This means that if a transfer to hospital is needed, the necessary information (test results, ultrasound reports, health history and so on) is on file at the hospital.
  2. Homebirth midwives carry with them medication for excessive bleeding after birth and resuscitation equipment for baby.
  3. Eligible midwives work collaboratively with obstetricians, streamlining any possible transfer situations and ensuring that if medical care is needed, it is available from a doctor whom you have met previously.
  4. Your midwife may take you on a personalised tour of the birth unit so that you are able to view the rooms and ask any questions you may have.  This means that if a transfer is needed, you would be moving to a place that you have seen before.
  5. Your midwife will talk with you about any risk factors and s/he will work with you to minimsie their potential impact on your birth and baby

Overall, women who plan to birth at home have a small chance of needing to transfer to the hospital after labour has started,  Despite this, women who need to transfer usually rate their experience as being positive, even though it was not the experience that they had initially hoped for.  Evidence supports that women who plan to birth at home experience a smaller chance of complications and interventions when  compared with women who had planned all along to birth in hospital.

Melissa Maimann is an endorsed eligible midwife in private practice in Sydney.  One of the first eligible midwives in Australia, Melissa now offers a range of care options for women including private midwifery care, antenatal shared care and birth support.  Visit Melissa's website to learn more about her services.