🔴 Hospital Transfers 🔴

A word about Homebirth to Hospital Transfers

Something most homebirthers try to avoid for obvious reasons.

They are also something often feared hugely.

For lots of reasons.

Previous trauma is a BIG reason.

Change of plans towards a chain of events not desired is another.

Disappointment, defeat, fear and a sense of failure often come to the surface. Naturally.

BUT. A homebirth transfer with midwives that you trust is always done for ACTUAL concerns rather than for reasons of policy and guideline.

IT IS HOMEBIRTH MIDWIFERY WORKING IMPECCABLY

We will ALWAYS to the best of our ability discuss with you what our concerns are and let you decide on whether to transfer or not.

We will answer your questions, and address your worries.

Occasionally, things need to happen quickly if there is a real emergency.

IME, this is usually crystal clear to you as usually your gut is telling you something is off, sometimes it’s obvious (bleeding/fetal distress/baby needing help transitioning after birth) and we know each other well, so our tone of voice and facial expression gives away that things are urgent.

So what actually happens?

Well, usually concerns become apparent over time. We then have time to discuss best course of action for YOU.

If the decision to transfer is made, things usually happen relatively speedily.

One of us (usually two of us are in attendance) calls for an ambulance via 999.

We usually step out of the room for that.

The other person/midwife will help prepare for transfer with you.

Getting you out of the pool, dry and dressed appropriately.

Stabilised in other ways if possible.

Delegate what to get together so you have some stuff in hospital (sometimes this is not very effective as our priorities are not *clean nighties* at that point usually....hence a packed hospital bag can come in handy).

We may seem busy writing more stuff in our notes.....this is really important for a swift transfer of care once in the hospital.

This part often feels quite stressful.....both for you and us.

Then, usually in a matter of minutes, an ambulance arrives.....this often changes the tone somewhat, depending on crew.

I have dealt with amazing, sensitive, kind and efficient crews, but also with some that were unaware of appropriate behaviour around birthing persons.

Generally, they are super efficient, will likely do a set of obs (BP, oxygen sats, pulse) and often start an IV access/Venflon for fluids for us if necessary/appropriate.

Then, we go.

Either walking to the ambulance may be completely doable, OR a maneuverable collapsible chair to get you out of the house is used, which then helps to get you onto the stretcher in the ambulance.

Depending on how well or unwell you are, you likely will stay with your tiny one if already born.

Usually babies are just fine coming with you in the ambulance, on occasion though, if transfer is extremely urgent, or you are very unstable, a second ambulance may come for the baby, OR another person brings the baby to the hospital in a car seat (though this is IMO inappropriate).

The ride in the ambulance is usually somewhat uncomfortable, a little scary with lots of apprehension, or maybe even a huge relief!

You will be strapped onto a stretcher, either on your side or semi recumbent or sitting.

One of us WILL COME WITH YOU.

We might write some notes in the ambulance (though I get so car sick in them a CAN NOT DO IT!) and we try to keep you calm by chatting and hopefully keeping you comfortable.

Then, we arrive.....it’s usually a swift journey.

Again, getting to the labour ward is often a little awkward and uncomfortable as generally, we have to pass some members of the general public which is not super when you are labouring or you have just birthed and you feel scared/worried and very vulnerable.

Then, labour ward.

Reception is generally very friendly, often a little jarring as new relationships have to be forged quickly.

We will give a verbal handover to tell staff what has been happening up to then.

Depending on the situation, things may move quite quickly, bloods may be drawn, doctors may come in to assess.

This is the time when things feel often feel most out of control and disorienting.

Things might be going down a different path you were hoping they would, and the hospital staff don’t know you well and might also not be used to women claiming their autonomy and power.

We will help you navigate this situation to the best of our ability and with as much integrity and support for you as we can.

We don’t have the ability to speak FOR you, neither can we act as your midwives at that point, BUT WE CAN STILL HAVE YOUR BACK

I hope this makes the possibility of a transfer a little less scary, and while this is specific to how I would practice as an IM, I’m pretty sure it is similar to NHS midwifery transfers.

P.S: on occasion a transfer by car can be appropriate or preferred by the birthing person. A transfer for a long labour, for extra pain relief for example, or even for suturing can often be done by own car if preferred.

Did you have a transfer? How was it for you?