When it comes to a planned home birth, a key aspect to your birth plan is a plan for what you’ll do in the event of a hospital transfer. 

Of course no one wants this to happen, but part of an educated and informed approach to home birth is understanding the signs that it is time to go to the hospital.

  • Many times, a hospital transfer during a home birth will be non-emergency.  In this case the hospital transfer will be done in your personal car, and for you and baby’s safety it’s best to continue the birth in a hospital setting
  • In other cases, hospital transfer during home birth can be more of an emergency situation.  In this case, you’d be transported by ambulance to get you (or baby) the medical assistance needed ASAP
  • Lastly, it’s good to know reasons your baby might need to be transferred to the hospital after your home birth too

Today we’re going to take a look at all of the signs it’s time to go to the hospital during a home birth– sudden emergency or not. 

The unknown will be erased and you’ll be better able to visualize and plan for every possible home birth outcome by knowing the common and signs and reasons that it’s time to head to the hospital.

1. Slow or stalled progress during labor

The most common reason for hospital transfers in women who are having their first birth is slow or stalled progress during labor.  This might occur during any stage of the labor process from early, active, to pushing. 

Reasons that stalled or very slow labor progress may warrant a hospital transfer are:

  • Very long and slow active labor may pose a safety threat to mom and baby that can be better monitored in a hospital setting where intervention can be provided immediately
  • Very long labors can leave momma wanting or in need of medication to help her rest or cope with the duration of the labor
  • Stalled labors during active or pushing phases may need to be augmented with medication in a hospital setting (ie: Pitocin).  Or they might result in the need for an assisted delivery (ie: a C-Section) in order to keep momma and baby safe

Typically, a hospital transfer for this reason is considered non-emergency.  You will go to the hospital in your personal car and your midwife will follow.

2. Meconium in your amniotic fluid

The presence of meconium (baby’s first poop) in your amniotic fluid is the second most common cause for hospital transfer during home births.  In mommas having their second birth or other subsequent births at home this is the most likely reason you would need a transfer.

Basically, if baby has already had a bowel movement (either prior to or during labor) there is a risk of baby inhaling the meconium when they take their first breath.  This increases their risk of infection and can make it difficult for them to fully inflate their lungs.  Additionally, the fact that baby pooped in utero can be an indication that baby is or was under stress, though this is not always the case.

For these reasons, if your water breaks and meconium is present it is safest to continue with the labor and birth in a hospital setting.  The hospital is better equipped to monitor baby and provide intervention swiftly after birth should it be necessary.  The hospital will also have a pediatrician or pediatric team present at the birth as an added precaution.

What if there’s no time to get to the hospital?

If you are pushing and birth is imminent when the presence of meconium in the amniotic fluid is discovered, your midwife will be trained in how to handle this scenario.  She will be ready and attempt to suction baby’s airways before they take their first breath. 

Remember that the presence of meconium doesn’t mean your baby will definitely suffer consequences.  Just that there is an increased risk.

3. Baby’s positioning

You and your birth team should know baby’s position prior to birth.  In fact, it’s a pretty important factor in determining if you are a candidate for home birth as your due date approaches.  This is because breech babies, or babies that are “sunny side up” do present a higher risk or need for birth assistance. 

However, if during labor it suddenly becomes known that your baby is no longer in the ideal birth position (or, more rarely, if there are unknown multiples!) you will be encouraged to transfer to a hospital.

Again, in the event that there is no time to go to the hospital, your midwife is likely well trained on how to deliver babies presenting atypically.

4. High blood pressure or fever in the birthing momma

High blood pressure during home birth

High blood pressure in the birthing momma is associated with a number of increased risks to mom and baby.  If your blood pressure goes above a certain number (which you should discuss with your midwife prior to labor) it is much safer to progress with your labor in a hospital.  This is because of access to monitoring, labs for blood work, medication, IVs, etc.

Fever during home birth

If the birthing momma presents a fever, it means there is an infection present.  This needs to be treated promptly in a hospital setting.  The presence of a fever also means that baby and momma will need closer monitoring. They may also benefit from potential access to interventions and supports that only a hospital can provide.

5. Excessive bleeding during labor or after birth

Excessive bleeding during home birth labor

Bleeding that is heavy in volume during labor warrant an emergency transfer by ambulance to the hospital during birth.  This is because heavy bleeding during labor is most often associated with a placental abruption. 

A placental abruption is when then the placenta detaches from the uterine wall.  It is a serious concern because this can block off air and nutrient supply to the baby.  The heavy bleeding and significant blood loss is also a medical threat to momma.

Excessive bleeding after a home birth

After a normal vaginal birth, women can expect to lose about 500 ml of blood.  In about 1-5% of pregnancies women may experience significant blood loss after delivering their placenta.  This is known as a postpartum hemorrhage (source).

Postpartum hemorrhage occurs when the uterine muscles do not contract vigorously enough to stop blood vessels from continued bleeding after the placenta is delivered.  The good news is that even if you do experience a postpartum hemorrhage most midwives carry anti-hemorrhaging medications and are well trained and versed in handling this complication.

While the likelihood of experiencing this is pretty low in general (and your midwife can likely deal with it in your home), it may be reason for an emergency trip to the hospital immediately after delivery.

6. Cord Prolapse

Cord prolapse is a very rare phenomenon where the umbilical cord falls below baby’s head.  If this does happen, it causes a lack of blood flow to your baby.  To ensure baby’s safety in the event of a cord prolapse a C-section will be necessary.

If you experience a cord prolapse you will need to be transported quickly to the hospital via ambulance.  Your midwife will know how to hold baby’s head off of the cord to allow blood to continuously flow while you are waiting for the ambulance and on your way to the hospital. 

7. Severe tearing after birth

Severe tearing after birth is another reason you may need to head to the hospital after your home birth.  Midwives are equipped and able to handle minimal tearing, but in the rare case of 3rd or 4th degree tearing you will need greater medical assistance. 

Luckily, the procedure is most often outpatient and can be completed quickly to get you back to your baby ASAP.

8. Abnormal fetal heart rate during labor

Throughout your home birth your midwife will be monitoring baby intermittently.  If anything seems to be atypical, unusual, or abnormal your midwife will likely err on the side of caution and recommend a hospital transfer.

This is because in a hospital setting there will be more advanced monitoring devices and access to intervention and medical support should they be needed.

9. Baby showing signs of difficulty transitioning to life outside the womb

Immediately following your baby’s birth they will be evaluated for how well they are transitioning to life outside of the womb.  In some cases, there might be immediate red flags regarding baby’s ability to thrive.  In other cases, red flags might begin to appear hours after birth.

Some examples of signs that your baby isn’t transitioning well included difficulty breathing, labored breathing, and unstable body temperature.  If your baby is having acute issues immediately follow birth, your midwife will be knowledgeable on how to help them transition successfully.  She can suction, provide oxygen, and use vigorous rubbing to help with immediate transitions.  In rare cases, she may need to use CPR or resuscitation.

These difficulties with transitioning, depending on the severity, may mean a hospital transfer is important for baby’s safety.  They might need special monitoring or medical support to ensure they continue to thrive.  If momma is considered stable, she will often be able to accompany her baby.

10. Momma wanting to go to the hospital for any reason

Lastly, if at any point during your home birth labor you feel like you want to transfer to the hospital, speak up! Your midwife and birthing team will be completely supportive. 

Whether it’s because of anxiety, want for medication, just a gut feeling, or ANY other reason don’t feel shy or nervous about having these needs met.  This is your birth, and there is no right or wrong way for your birth story to unfold.

Use these signs that it’s time to go to the hospital to write your home birth plan

Now that you know all of the reasons you (or baby) might need to transfer to the hospital during your home birth, you are ready to write a more informed home birth plan.

You can also take these 10 reasons you might go to the hospital during your home birth to have more informed discussions and ask all the right questions to your midwife. Pin the article for later and pull it up at your next midwifery appointment!

Find out what her experience in emergency situations and with hospital transfers has been. Ask what she’ll be equipped to handle in your home birth setting and when she’ll personally recommend a transfer.

Have you had a hospital transfer during a previous planned home birth? Share your story with our community by chiming in below!

Additional sources:

Reasons to Transfer into the Hospital

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