What if I transfer?

published 20th Jan 2023

Home Birth Transfer

Let me just preface this with this: Sometimes a transfer means birth has gone right.

Most of us hope to never transfer. But, there are rare instances when a baby or mumma do need some help. Transferring in a timely manner and getting crucial assistance is a real and valid reason for medical technology. That’s what it’s there for!

Women do not need medical help during a physiological birth. But if birth cannot progress physiologically, or an emergency occurs, then transfer is the right call for the health of mumma and baby.

You may obviously grieve your homebirth, grieve that you needed surgery or assistance, but that doesn’t mean it was wrong or unnecessary. Transfer *can* be the right thing for *that* birth.

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When can transfer occur?

Transfer can occur at any stage in pregnancy, birth and postpartum.

Sometimes women need help conceiving and they see a doctor for tests.

Sometimes women have a miscarriage that they would like an ultrasound to check on, or need help with the bleeding.

Sometimes women have hyperemesis (HG) in pregnancy, requiring vital IV fluids, or have anaemia and need an iron transfusion.
Sometimes unexpected health problems, accidents, or preterm birth occur.

Sometimes things happen during birth, through no fault of your own. 

Sometimes, you may experience retained placenta, or a baby with health issues, or you may experience postpartum depression and seek assistance.

While the desire may be to do a completely  “wild” or unassisted pregnancy/birth/postpartum, sometimes there is a need for assistance. Please don’t feel shame or failure for receiving necessary or lifesaving care. And don’t judge others for making the best decision for them at that time. Personally, I prefer the term “self directed” pregnancy/birth - as you are always in charge of choosing the birth path and options best for you at any time, even if that includes assistance. You are not “losing” a wild label and no longer part of the homebirth community, or being shunted through the system, adhering to outdated guidelines. You are birthing as a holistic woman.

Historical, structural, financial, and systemic issues presently undermine physiological birth. Unfortunately we have lost a lot of the wisdom once found in the older motherly women and midwives, and unless we stay 100% out of it, we are funnelled into a system biased against pregnant women and physiological birth. Homebirth is frowned upon and self knowledge is laughed at.

 A lot of women don’t have resources or finances available to learn to do their own doppler, or hire a midwife for a couple of tests or to do a couple of sutures. Going to a doctor for something necessary but that could have been done outside a hospital really sucks. Do your best to educate yourself and do what you can at home, but don’t feel bad if you have to utilise medical resources to ensure you and baby are both healthy and safe physically and mentally

True emergencies

I’m not going to go into detail on each of these, just provide a list for your research. Some of my other articles do cover physiological birth, and how to resolve these emergencies at home, if possible. It’s up to you to identify these scenarios in labour and what you can realistically handle. It should always be you (the mother) who has the final say on whether you transfer or not.

Transfer in pregnancy

• Pre-eclampsia 

• Premature birth

• Ruptured membranes prior to 36w

• Bleeding

Transfer In labour 

• Cord prolapse without imminent birth

• Unresolvable fetal transverse position

• Breech (ONLY if you do not feel comfortable - breech can definitely be birthed at home)

• Fetal tachycardia or bradycardia. 

• Bleeding beyond normal amounts (bleeding can occur from dilation and a low placenta - however a placental abruption can be deadly)

• Uterine rupture

• Unresolvable shoulder dystocia (once dystocia starts, it really needs to be resolved asap otherwise baby will be brain damaged - this will require assistance, but they would have to resolve it at your house, and transfer baby to get specialised care)

Transfer postpartum

• Non-responsive baby who isn’t reviving

• A baby that needs specialised care after a resolved event that caused a lack of oxygen (prolonged dystocia, breech, prolapse)

• Mother who has significant haemorrhage that isn’t managed with home remedies.

• Baby having obvious congenital issues, heart rate or breathing issues

• True retained placenta

• 2nd/3rd/4th degree tear (to clarify about the tear - you don't have to transfer for 2nd degree. But there were some discussions in a UC group where the mothers had not transferred and the tears turned out to be deeper than first thought, and didn't heal well. They regret not getting them stitched. So even if you got them assessed, and chose not to suture, at least you would have the information to decide accurately.) 

Can you avoid transfer?

Sometimes transfer is 100% necessary. But sometimes, truthfully, it could have been avoided. I see a lot of scenarios where a little bit of knowledge could have helped. E.g in one birth they transferred for the placenta because it wasn’t coming out on its own - only to find out something so simple: they didn’t know they could push it out once it had detached. That’s not to say that just because you’ve never given birth at home before that you’ll need to transfer - it just means you may need to be more diligent on educating yourself on some topics. During home labour and freebirth transfers, MOST transfers are for maternal exhaustion, not for emergencies.
If you transferred and you feel in retrospect that you didn’t *need* to, that’s okay. Don’t beat yourself up. You made the best decision at the time with the information you had.

I also hear many stories of transferring postpartum “just to get baby checked over”. Unfortunately, now you’ll most likely be stuck in hospital for hours while they want to do a myriad of tests and you’re bleeding and unable to rest or bond with baby properly. You may also get CPS called on you for declining care in pregnancy or postpartum. I do not recommend. Trust your motherly intuition. You were happy to do an unassisted pregnancy and a freebirth. Don’t second-guess yourself at the end. You can trust yourself to know if something is not right with bubba. Most babies will be healthy and not need assistance. If you want the birth certificate, it’s not worth the hassle a few hours after birth. Wait and do it when baby is a few weeks old and you have had time to rest and connect as a family. If you want the PKU and hearing tests…then you can do them at 1-2 weeks, but before 6 months old.

There are a few ways to help avoid transfer if possible:

Education to prevent transfer

Obviously research in pregnancy - start with our FAQs!

But, don’t dismiss being able to research after birth too. Sometimes you don’t know what you don’t know until a scenario pops up. Do you have time to research and stay home? Sometimes something happens in labour or birth that may need assistance but isn’t an emergency, e.g. tearing. Tears should be seen and sutured within 6 hours, but that gives you 5 hours to assess them yourself and decide if it’s only 1st degree and stay home, or yes, you want to transfer. So, pull out your copy of Home Birth on Your Own Terms. Call a midwife friend. Google. Come back to this website. Look up whatever topic you have questions on. Make a plan.

Accessing Assistance at home
Depending on what is happening, can you get someone to come to you instead of transferring? There are many women in your community with skills and knowledge that you can reach out to. And women all around the world! No matter what time zone you’re in, someone should be awake. You can of course, always access emergency ambulance services too.

I DO NOT recommend posting urgent questions in Facebook groups. You do not know or trust the women. You don’t know their background or where they got the information they’re telling you. Some Facebook groups have trolls and saboteurs - as much as the admins do a great job of trying to prevent them, anyone can lie on the internet. (Some have been known to call CPS on birthers too!) If you have time, you can remove your location from your profile, and post non-urgent questions on Facebook - considering carefully their answers. However, for emergencies, I recommend lining up some help in advance. Some women will do pro bono work, and others may ask for payment for being “on call” (even virtually - this is still their valuable time and expertise). This can range from $50 to a few thousand dollars depending on the package.

• Doula

• Birthkeeper

• Virtual midwife

• Friend

• Midwife 

• Family member (mother, aunt who is a nurse, etc - though be wary, many family members are anti-free birth and their concern for you can outweigh their ability to be professional)

Sometimes you can get a midwife to come to your home after birth and do suturing, birth certificate information, newborn checks, and other postpartum care. Australia, UK, and America have different homebirth programs that you may be eligible for. If “baby came too fast” to access their care during labour, maybe you can still access their afterbirth care.

Support in labour
Whoever you have present during your labour should trust you 100% to know your body and baby. You should trust them too. You want to be able to believe them if they say something is wrong, just as you want to be believed.

If the person present during your labour is also the person who will be transferring with you, they may need to be prepped on the ways they can advocate for you and protect you and baby. For example, if you're admitted during a postpartum hemhorrage, baby does NOT need to also be admitted as a patient. Father/partner can retain custody and keep them safe near you to feed, but not lose control by having baby whisked away to NICU or having to sign baby out AMA which can look bad with CPS. If they were never admitted, there’s less that can go wrong.

You can call someone else to attend you in hospital if that is a better choice or you need extra support. Private midwives sometimes have admitting rights. Maybe your doula was running late for your homebirth but they’re actually well trained in supporting cesearean births as well. Maybe your husband has people-pleasing syndrome but you know your mum will stand up for you. Make the calls you have to, to get the best birth you can, wherever you birth. You can never have too many people on your side.

Advocacy and autonomy

No matter where you birth you are entitled to autonomy and informed consent. Just because a hospital policy requires that their staff do something, does not mean you need to accept. You never have to consent to fingers in your vagina to be admitted to hospital. You don’t have to consent to a cesarean or episiotomy. Now obviously if you are at the hospital for an emergency there are some things you may decide to consent to that you otherwise would not. This is where your BRAINS acronym comes in.
B - Benefits
R - Risks
A - Alternatives (my favourite!)
I - Intuition
N - Nothing
S - Space (to discuss it)

And to help you maintain autonomy, it is helpful to have someone advocating for you. This is no slight on on you - you’re a strong woman with a voice! But sometimes you are exhausted, pumped with medication, foggy, and/or focused on baby. You don’t see the Dr approaching with the episiotomy scissors or trying to cut the cord 10 seconds after birth, or you may not hear the coercion in pulling the “dead baby card” to gain consent for procedures you have already declined. Having someone with you to say “Stop! Ask her first.” or “Stop! She said no.” can be incredibly helpful. Choose a doula, private midwife, or birth partner that is confident to speak up, and knows your birth plan. Although, they don’t *have* to know your birth plan, (it really does help if they have some knowledge of what an episiotomy is) - they just have to make sure EVERYTHING  is run past you first). Obstetric abuse is a disgusting practice and the prevention of which should be taken seriously.

Transferring to hospital at any time in pregnancy, labour, or birth is a challenging decision and requires a profound shift in expectations. You’re making a physical and physiological journey out of your comfort zone. There are physical, emotional, and social obstacles to navigate. Unfortunately this is not usually recognised by hospital staff, so whatever you can do, and whoever you can have present, to manage communication and collaboration may help you gain a better experience. You will be working with people whose paradigm is one of conflicting views on safety and risk to your own. You need the right support for your wellbeing.

"While a "do nothing" approach should be the default, a birth may require interventions.

If you are present and helping, you should focus on reinforcing the woman as the decisionmaker about interventions and how they are carried out"  - Rachel Reed, Reclaiming Childbirth as a Rite of Passage

"The whole point of woman-centered birth is the knowledge that a woman is the birth power source.  She may need, and deserve help, but in essence,  she always has, and will have the power "- Heather McCue 

Preparing for transfer

• Pack a transfer “box” (It’s NOT setting yourself up for failure to pack a bag, but some feel that it brings the wrong energy into your birth space. So put all the postpartum things you need together near your bed. After birth, you can use them conveniently OR your birth partner can whisk them into a bag to rush to the hospital.)

• Which hospital? (Know in advance which hospital you will be likely transferred to and what facilities they have there for little babies - then you can tell support people where to meet you, or know what the likely policy and attitudes are of the staff)

• Ambulance cover (You should have this all the time, but definitely have this before birth. Will save you a LOT of money, particularly if you get shunted between hospitals or life-flighted anywhere.)

• Fears of transfer - (it's okay to have fears, it’s OKAY to research cesareans, it’s okay to make a hospital birth plan,  - better to have the knowledge and never need it than need the knowledge and not have it. It’s okay to have a different mindset/comfort level/time to call it than another freebirther. Focus on your own fears and your own decisions. Every birth, baby, and woman is unique.