Why you might need to be transferred to hospital
Even when you have successfully booked a home birth, circumstances might
arise which lead to a change of plan, so that your care during pregnancy,
or even during labour, is transferred to hospital.
In pregnancy about 15 in every 100 women are advised to switch to hospital
care. In labour, about 3 in 10 women having their first baby are transferred
to hospital, but far fewer second or subsequent births are transferred.
Not all of the reasons listed below are absolute reasons for hospital
birth, but it is important that your carers feel confident in their skills
for this kind of birth in a home setting, and complications like these
may mean that they recommend a change of plan.
In pregnancy
- Pregnancy-induced hypertension (pre-eclampsia)
- A pregnancy that has gone well beyond due date
- A low-lying placenta. If your placenta completely or partially covered
the cervix, a Caesarean delivery would be the only safe way to deliver
your baby
- Twins or a multiple birth
- The baby is not in a good, head-down position. For example, your baby
may be breech, (though a breech baby might turn to a head-down position
at the last moment)
- A previous Caesarean birth
In labour
- A labour that begins before you are 37 weeks pregnant (your baby may
need special care)
- The baby showing signs of distress: meconium-stained
liquor or the pattern of the heartbeat could indicate this
- Absence of progress in labour. However, a labour that is progressing
slowly is not in itself a problem. Although it is tiring, it does not
or mean that the baby or mother is at risk. If mother or baby are becoming
distressed, however, a move to hospital may be suggested so that labour
can be artificially accelerated
- Bleeding in labour
- A mother who feels she needs more pain
relief than can be offered at home, for example an epidural
In the end, it may be you who decides to go to the hospital. Even after
making all the preparations to give birth at home, you are still free
to change your mind at any time, even when you are in labour. You don’t
have to make a final decision early on in pregnancy - take your time to
read and think about it.
What if…?
Unfortunately, complications can happen with a homebirth and it's
important to realise that things maybe won't go as you planned.It is reassuring
however to realise that:
- Research shows home births to be as safe, if not safer, than hospital
births. The Winterton Report which looked at over 100 pregnancy and
birth issues concluded "There is no convincing or compelling evidence
that hospitals give a better guarantee of the safety of the majority
of mothers and babies. It is possible, but not proven, that the contrary
may be the case."
- Community midwives are experienced and trained to look for abnormalities
in labour. They will closely monitor your blood pressure, pulse and
temperature along with the baby's heartbeat which will detect the majority
of problems very early on.
Although there are few true emergencies during labour and birth, some
conditions that may require transfer to hospital include;
- Meconium stained liquor - Greenish black colour to your waters
indicates the baby has passed meconium which could mean he is in distress.
He could also suffer respiratory problems if he inhales the meconium.
However, half of babies born at term pass meconium and an experienced
midwife will not automatically assume that a transfer is necessary.
- Bleeding - it's quite normal to experience some bleeding in
labour but occasionally it can be a sign of placental abruption, where
the placenta starts to come away from the uterus. This can be extremely
dangerous for both mother and baby.
- Foetal distress and maternal exhaustion - although not an emergency
in itself, if your labour becomes very prolonged with little progress
you will become exhausted and your baby may become distressed causing
his pulse to increase. At this stage a transfer would be recommended.
- Post Partum Haemorrhage (PPH) - this is excessive bleeding
after the birth and is usually caused by the womb not contracting properly,
leaving a raw area to continue bleeding. PPH after a home birth is not
very common as they often occur following intervention to speed up labour
which doesn't happen at home births. However, your midwife carries the
same drugs which would be used in hospital to stop the bleeding. If
after giving you these drugs you are still bleeding then she will call
an ambulance to transfer.
- Retained placenta - if some of your placenta does not come
away then you will need to be transferred.
- Baby resuscitation - Midwives carry special resuscitation equipment
and are trained to deal with this situation. If after a minute your
baby is still not breathing the midwife will keep him oxygenated with
a special mask and bag and in most cases he will breathe within two
to three minutes, after which time an ambulance would be called.
- Cord prolapse - this rare but dangerous situation is when the
umbilical cord comes out from the uterus in front of the baby's head
which can cut off the baby's oxygen supply. It always calls for a caesarean
and should it happen at home you will be asked to kneel on all fours
with your head lower than your body and your bottom stuck in the air.
She may hold the baby's head up to further take pressure from the cord
while waiting for the ambulance and may even remain like this throughout
the journey until you reach hospital.
While you may not want to transfer to hospital, most midwives would only
recommend it if they really felt it necessary. If however, you still have
doubts, the Brighton Homebirth Support Group suggest asking yourself the
following questions:
- What are the indications for transfer?
- What are the benefits of a transfer?
- Are there any risks involved in going to hospital?
- Are there any alternative treatments?
- What will happen if nothing is done?
Current statistics show that 16 per cent of homebirths are transferred
to hospital and 40 per cent of first time mums having a home birth will
deliver in hospital.
Where to next?
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