What Happens If We Need to Transfer to the Hospital During a Home Birth?

This was the question I most needed answered before I could get comfortable with home birth. What happens if something goes wrong and we need a hospital?

The short version: there's a plan for that, and it's not a backup. It's part of the plan.

How often do home births transfer to a hospital?

More often than most people expect, and usually for unremarkable reasons. In the Birthplace in England study, about 45 percent of first-time mothers planning a home birth were transferred during labor or right after. For women who had given birth before, it was 12 percent.

That 45 percent sounds alarming until you look at why. Most transfers happen because labor stalls, mom is worn out after many hours, or she decides she wants an epidural. True emergencies are rare, and an experienced midwife is trained to spot warning signs before they become emergencies.

If this is your first baby, go in knowing a transfer is a real possibility. It doesn't mean anything failed.

What should the transfer plan include?

Your midwife will walk you through it before labor. If she doesn't bring it up, ask. Get specifics:

• What would make her recommend a transfer.
• Which hospital you'd go to and how long it takes to get there.
• Whether you'd drive or call an ambulance, and in which situations.
• Who goes with your wife, and what the midwife does once you arrive.

The American College of Obstetricians and Gynecologists treats a hospital transfer arrangement as a requirement for anyone planning a home birth. On this point the home birth midwives and the obstetricians agree.

On your end, keep a bag packed by the door, know the route, and keep the car fueled in the last few weeks. It's the same prep you'd do for a planned hospital birth, and having it done means one less thing to think about.

What does a midwife handle at home before transferring?

A lot. Qualified home birth midwives carry oxygen, IV fluids, medication to control bleeding, and equipment to help a newborn breathe. Many complications get managed right there.

One dad in our survey described a birth with a stuck shoulder and heavy bleeding afterward. He said he was panicking inside and genuinely afraid. But the midwives stayed calm and focused, got the baby breathing, and took care of his wife. "Seeing the midwives respond with such confidence, experience, and urgency gave me reassurance," he wrote. "My little family was in good hands."

I share that because it's the moment partners fear most, and it's also exactly what midwives train for. For the bigger picture on risk, see what the research says about home birth safety.

What's my job if we have to transfer?

Stay steady and stay on her side.

The hardest part of a transfer for many couples is emotional. She may have pictured this birth at home for months. When the plan changes, the most prepared partner in the room can turn into an obstacle if he can't let the plan go. Your job isn't to protect the plan. Your job is to protect her, and sometimes those are different things.

At the hospital, you become her advocate. One mom in our survey had her birth plan mostly go out the window after a transfer. What she remembered was that her husband "fought for me." He made sure the staff stuck to what still applied, and he cut off anyone trying to talk to her during contractions.

That's what advocacy looks like. You know what matters to her. You can carry that into a room full of strangers so she doesn't have to.

Chapter 3 of the book covers transfer plans in more detail, and Chapter 10 includes stories from families whose births didn't go as planned.