Home birth is undoubtedly safe for mothers and babies, however, sometimes transfer becomes necessary.
The Birthplace Study (2011) found that 36-45% of first time mums and 9-13% of multiparous mums transferred from home or birth centre to obstetric unit during or shortly after birth. Many of these transfers were for additional pain relief or non emergencies.
This transfer rate is undoubtedly high, so we should ask why it is high and what we can do to reduce it. These aren’t just questions for academics, expectant families should consider them and also give some thought to what they may do in the situation that transfer becomes necessary or desirable.
Seeing as request for further pain relief is one of the most common reasons for transfer, preparing for coping at home is important. Use of water for labour has been found to be very effective as pain relief and has no associated risks. Hypnosis for birth also lowers the request for pharmacological pain relief, as does hiring a doula.
Some of the reasons that a transfer in labour or shortly after birth might be advised by a midwife are:
- Meconium in the waters
- Maternal haemorrhage
- Sustained changes in foetal heart rate
- Slow progress
You may find it helpful to research these things and make your own informed decisions about whether you would agree to transfer for these reasons.
What happens if I do transfer to hospital?
There may be some variations from one area to another, but some of the things to expect are as follows.
Your midwife or, if you do not have a midwife with you at home, your birth supporter will call an ambulance. Within minutes, an emergency response vehicle with a paramedic will usually arrive. Depending on the reason for transfer, there will probably be nothing for this paramedic to do, they may have never attended a labouring woman before and may not understand what women need (i.e. respectful quiet). You may wish for your birth supporter to continue protecting your birth space at this time by keeping the paramedic at a distance.
An ambulance will arrive shortly afterwards, usually within 20 minutes. This may feel like a very long wait. Try to keep calm and focus on your labour, let others worry about gathering up anything you want to take with you. You may have a bag already packed, or a box of birth things, or you may need them to pack something quickly. It may help to have a list prepared for them to refer to. Your midwife may spend this time writing notes.
When the ambulance arrives your partner may be told they have to ride in the front with the driver, this is not true, however, you can keep your partner with you in the back of the ambulance. Your midwife will ride with you and there will also be a paramedic in the back. You can either lie down or remain seated, whichever is more comfortable for you. A blood pressure cuff may be put on your arm and a pulse monitor clipped to your finger.
The driver may fire up the siren and lights and drive to the hospital very quickly. This does not necessarily reflect the nature of your transfer, for instance if you are going in for pain relief, however it may be standard protocol with home birth transfers which have been called in as 999 status.
When you arrive at hospital, the staff will be waiting for you. You may be offered a wheelchair but if you prefer to walk that is your choice.
You will be shown to a delivery room, you may ask for lights to be dimmed and bare minimum staff to be present. The admitting midwife will want to examine you and there will be a hand over with the midwife accompanying you from home. Unless you have an independent midwife, the home birth midwife will leave at this point, an independent midwife will stay with you and continue to advise and support you, though she cannot perform any clinical checks on you for insurance reasons. If you have a doula she will able to remain with you.
It is likely that an obstetric registrar or consultant will also wish to examine you and if you require an epidural or spinal block an anaesthetist will also come to your room to talk to you before administering the pain relief. You will be advised to have a cannula fitted, though this is optional and may be something you wish to decline at this time as they can be fitted very quickly in an emergency if necessary. This can be a very busy and confusing time in labour. It is important to have an advocate with you to answer as many questions as possible on your behalf. You have the right to refuse examinations if you wish.
No matter what reason you have transferred for, you are still in control of what happens, you can accept or decline any procedures or interventions, you can make your birth your own.
Written by Holly, mum of 2 who has transferred in to hospital from a planned home birth.