Best Practice Guidelines for Home Birth to Hospital Transfer

Sidenote:  I have had five children in 2007, 2009, 2010, 2013, and 2015. I've had two induced hospital births (once by medical need, once by choice), a hospital transfer during home birth, and two successful home births. After being treated just like another number, I knew there had to be more to birth than pushing a baby out and going home. Unfortunately, there is a lack of support across the board. Whether you decide to have an epidural or go pain med free, women should have access to the information to make informed choices(Avery's birth story. Hallie's birth story. Ellia's birth story.)



As a home birth family, we know the importance of collaboration between a home birth team and hospital staff. In order for smooth transition, good communication between mothers, midwife, and hospital staff is needed. With our third child, I decided to transfer to the hospital due to maternal exhaustion. He was a vaginal breech birth and the labor was exhausting. There were issues with communication from the EMTs up to the hospital staff. Avery's birth was vaginal, but NOT peaceful and we were not respected. Two years later, we were able to have a peaceful home birth with our fourth child.

Home birth is a very safe option for low risk pregnancies. Some people still see it as a very old fashioned option. We chose home birth because we desired a setting in which I could birth without unnecessary interventions. While my first pregnancy was complicated, my last three pregnancies have been completely healthy and uncomplicated. The need for medical intervention did not arise. We received midwife led prenatal care by our Certified Nurse Midwife. You can read more about safety outcomes of home birth as studied by the Midwives Alliance of North America. One of the best conclusions of this study is showing the cesarean rate of 5.2%, vs. the national average of 32.8% according to the current information available on the CDC website. How many of those c-sections are unnecessary?

The Home Birth Consensus Summit has generated a set of guidelines that are designed for the clear collaboration of home birth team and hospital staff. This is such an important process to have in place, because sometimes hospital staff isn't aware of the prenatal care that midwives provide. Believe me, I do know this to be true from our transfer experience.

While I'm not going to be able to post the entire text of the guidelines on my blog, I wanted to share the twofold purpose of the guidelines:

1. To highlight core elements to be included when developing documents and policies related to 
transfer from home to hospital. 
2. To promote the highest quality of care for women and families across birth settings via 
respectful inter-professional collaboration, ongoing communication, and the provision of 
compassionate family-centered care.

*Read the entire text of the Best Practice Guidelines.

Some of the guidelines include allowing a woman to let her midwife remain present in the hospital setting for support, if she so chooses. When possible, allow the mother and newborn to stay together after admission and during hospital care. Also, hospital staff and providers should be sensitive to the psychosocial needs of the woman that result from the change of birth setting.

Again, those are just a few highlights of the Best Practice Guidelines. I absolutely cannot stress enough that birth cannot be just viewed from a medical standpoint. Please understand that as a mom of four and a birth advocate, I know that prenatal care is important and that medical issues arise during pregnancy. But in the United States and several other countries, we have gotten away from the needs of a mother. We have gotten away from our most basic primal instincts. Bonding. Love. Breastfeeding. Birth is more than just a medical procedure.

According to the CDC, the number of planned out of hospital births has been on the rise for several years now. An out of hospital birth means at a birth center or a home birth. This number is predicted to continue to climb. As more women are opening up to alternative birth choices, it is imperative that these guidelines are put in place across the board. You can read more about these statistics at the CDC website.

Have you had a home birth? What are your birth experiences?

Comments

  1. Hi Farrah. My husband was born at home by accident. His mother went into contractions due to gestational diabetes. He was underweight at birth. I purposed to have a natural birth to first child... ended up with epidural because, you guessed it, I was in the hospital.

    Second time around, we planned better. We used a birth center and I had a natural water birth. I labored at home for about 3 hrs and then I had Gabriel within 25 minutes of arrive at the center. It was the experience I wanted. It was beautiful.

    Thank you for talking about natural birth. I'm considering training as a doula decades from now. =)

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  2. This is such an important topic. I'm a labor nurse at a high-risk hospital & when we receive HB transfers no one seems to know what to do or say to support the family or recognizes the difficulty of the transfer on them. I've had all 3 of my children at home. The 3rd however was planned for a hospital w/a CNM (this was covered 100% by insurance & we didn't have the money for our beloved midwife). Upon arrival to the hospital we were told the CNM wouldn't be coming for our birth and the staff Dr. would deliver. My husband & sister-in-law felt uncomfortable w/the comments they were hearing while I was being checked in triage & we were all confusef as thr CNM had just told me a few days before that she would be available. The Dr. insinuated we were being selfish expecting her to come in on Father's Day as she works all the time & deserves a break. Even though I was 5-6cm w/a bulging bag non of us felt comfortable and chose to make the 30min drive home. My husband & I welcomed our son on our own but even 2yrs later I remember the lack of serenity w/that birth as compared w/the others where we were guided, assisted & supported by someone we trusted. Healthcare professionals need to recognize the emotional influence they have, that taking good care of someone goes beyond tasks & skill.

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  3. Phoebe: Would you be willing to share some of your comment publicly? The Home Birth Summit (the authors of the statement) are putting together a power point presentation and would like to - with your permission - share some of your comment. Please feel free to contact me privately to discuss if you'd like: jeanette (at) birthswell (dot) com. Thanks!

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  4. I have no first hand experience with home birth. All 3 of mine were induced hospital births. That was the right decision for me, as I wanted the pain relief available.

    Of course, now that I am done having babies, I would like to attempt a home labor. Still not comfortable, personally, with a home birth, but laboring at home would be much calmer and more desirable than a semi-busy hospital setting. Who knows, maybe I can talk the hubs into one more, and maybe by then I'll have worked up the courage to attempt a home birth. After all, Tylenol should help the pain, right? ;)

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