Every family dreams about the day of their baby’s arrival into the world. Months of attention to nutrition, exercise, relaxation, and prenatal bonding reach their culmination in the birth journey. The birthing mother feels a great force stirring within her and turns inward, surrendering to her body’s magic. Her labor is unique, and there is a wisdom in the rushing waves and the quiet plateaus alike. Those of us honored to support her as she brings her child into the world are humbled, and trust the rhythms of labor.

When I ask clients in prenatal visits to share their fears and worries with us, the most common answer I hear is, “I really don’t want to go to the hospital.” Families choose homebirth for all kinds of reasons, but almost all are hoping to minimize interference in the birth process. They are making the choice to birth in a setting where they will not be pressured into routine interventions. They want privacy and serenity. They have chosen care providers who will listen to them and honor them as the decision-makers for themselves and their baby.

Yet no amount of preparation or trust in the birth process can completely eliminate the possibility of hospital transfer. Midwives are the experts in normal birth. There are many variations of normal, but sometimes the hospital is the safest place to be for mother or baby.

What does a hospital transfer from a planned homebirth look like? It depends, but here are a few things to know:

  • Most transfers are not emergencies. The most common reason for transfer is lack of progress in labor – not according to an arbitrary time limit, but after many techniques have been tried to move the labor along and the mother is becoming exhausted. In most cases, the baby is doing well at the time of transfer.
  • Rarely, a woman is transported after birth for excessive bleeding or a retained placenta.
  • Newborns who are not breathing well may be transported for assessment in the hospital.
  • Most transfers are by private vehicle driven by the woman’s partner or family member. Urgent transfers may be done by ambulance.
  • The midwife accompanies or follows the family to the hospital and remains with them continuously whenever possible. The midwife helps the family navigate the unexpected situation and support them in advocating for their rights in the hospital.
  • The family still has the right to informed choice in their care.
  • Most hospitals in our area are respectful to families transferring from a planned homebirth, and may even assign a sympathetic nurse.
  • The midwife continues postpartum care after a hospital birth and may even offer extra visits to a hospitalized mother or baby.

It’s natural for a family planning a homebirth to be anxious about common hospital procedures such as IVs, epidurals, and cesarean birth. But they can be a godsend when truly needed. We go to the hospital when we need to use some of the tools they have there. A routine IV may be unwanted in labor, but an IV given to a mother who is dehydrated and exhausted is a blessing.

Changing plans mid-labor or just after birth can feel scary and disruptive. But the work of birth is largely spiritual, as we open not only our bodies, but also the deepest parts of our being to bring our babies into the world. This work continues at the hospital. If the mother is laboring, in most cases the lights can be dimmed and relaxation techniques can continue as she tunes in to her body with the help of her support team.

Babies are experiencing the transfer too (even before birth), so it’s important to calmly tell baby what is going to happen. Mother can turn inward and talk to the baby; her partner can remind the baby that he or she is loved and safe. If the mother has epidural anesthesia and is not feeling her labor, she can still watch the monitor and breathe deeply down to her baby during the contractions. In case of a cesarean, talking to the baby before and after the birth is especially important. Mother and baby may experience more separation than they expected after a homebirth, but often the parents can touch or even hold baby in the operating room. The golden hours of bonding skin-to-skin can begin whenever mother and baby are reunited – even after a long NICU stay. No matter when it happens, the first day at home should be treated as day zero, with mother and baby cuddling in bed without interruption.

California midwives are working toward a more integrated system, in which hospital transfers can be smooth and stress is minimized. Everyone shares the same goals: a healthy mother and baby. When families are treated with respect and receive good care from all involved, an unplanned hospital birth can still be a joyous experience. Still, it is common to experience grief at the loss of the birth the family envisioned, and these feelings should be heard and honored by all supporting them.

Remember that going to the hospital is not a failure: it is the courageous sacrifice of your own wishes for the sake of your child. That’s the essence of parenthood.

Rachel Kiene, LM, CPM
Birthstream Midwifery Service