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

By Jill Snelson, CPM

By Jill Snelson, CPM

One of the most important conversations I have with families considering home birth is also one of the conversations people sometimes don't want to have:

What happens if we need the hospital?

My answer is simple: then we use the hospital.

Choosing home birth does not require pretending hospitals aren't valuable. Hospitals have resources that I do not have in your living room. There are situations in which those resources become necessary, and part of responsible home birth care is knowing when we have reached that point.

Most transfers are not dramatic emergencies.

When people picture a home birth transfer, they often picture flashing lights and chaos. That can happen, and true emergencies require emergency transport. But many transfers are much less dramatic.

Maybe labor has gone on for a very long time and despite everything we have tried, there simply isn't adequate progress. Maybe exhaustion has reached a point where pain relief and therapeutic rest would be beneficial. Maybe there is a change in fetal heart tones that I want monitored more continuously. Maybe maternal blood pressure is becoming concerning. Maybe something about the clinical picture tells me that we need resources that are not available at home.

One of my goals is to recognize those situations before they become emergencies whenever possible. One of my favorite phrases is that I am proactive, not reactive. I would much rather sit beside you and say, “I don't think we should continue laboring at home. I think it's time to go in,” while everyone is stable than wait until the decision becomes urgent.

What actually happens when we decide to transfer?

When hospital care becomes the appropriate next step, I explain what I am seeing, why I am recommending transfer, and what I expect to happen next.

For a non-emergency transfer, the family will usually travel to the hospital by private vehicle. I call the receiving hospital and give a clinical report so the team knows who is coming and why. Relevant records are sent so they have the information they need to continue your care.

Once you arrive at the hospital, the hospital provider assumes responsibility for your medical care. Depending on the circumstances and logistics surrounding the transfer, I may be able to accompany you or meet you there in a supportive role, although that cannot always be guaranteed. I do my very best to make sure I am with you as much as possible though out the entire process.

If the situation is emergent, the process looks different. EMS is called, immediate care continues while we await transport, and the priority is getting mother or baby to the appropriate level of care as quickly as possible. I advocate to stay with mom and/or baby in the ambulance so that continuity of care is maintained and you are not left with people you do not know.

That is why talking about transfer before labor matters. Professional guidance around out-of-hospital birth also emphasizes having a plan for safe and timely hospital transfer when it becomes necessary.

Transfer does not mean that home birth “failed.”

This matters to me. A transfer is not a failure, it’s a successful transfer!

A transfer is not a moral judgment on your body. It does not mean you weren't strong enough, didn't labor correctly, or somehow failed at natural birth.

It also doesn't automatically mean something catastrophic has happened.

Sometimes the safest birth plan changes because the clinical situation changes.

Our goal was never simply to remain at home at all costs. Our goal was to support a healthy mother and baby while honoring physiologic birth in an appropriate setting.

Sometimes home remains that appropriate setting all the way through birth. Sometimes it doesn't. Recognizing that difference is part of good midwifery care.

What happens to my postpartum care afterward?

A hospital transfer does not necessarily end our relationship. If your care was transferred during labor or immediately postpartum and there are no complications that require continued management by another provider, I can typically resume routine postpartum care after you are discharged home. That means checking on your recovery, helping with breastfeeding, evaluating baby, answering questions, and walking with you through the early postpartum weeks just as we had planned.

And sometimes we also talk through the birth itself. Giving you space to debrief and process is a deeply important part of the overall scenario. Transfers can bring complicated emotions, even when everyone is healthy and the transfer was clearly the right decision. There is space for that conversation too.

Home birth and hospital birth do not need to be opposing teams. The hospital is there when we need hospital-level resources. I am deeply grateful for those resources when my clients need them.

My responsibility as your midwife is to support normal birth well, recognize when something is no longer normal, and be willing to change the plan when the safety of you or your baby requires it.

That is not abandoning the home birth plan. That is the home birth plan working exactly as it should.