Transferring to a Hospital: Why it Happens
It’s one of the biggest questions prospective clients ask us: what happens if there’s an emergency and I have to transfer to a hospital? What we tell them reassures them: only about one in 10 of our clients transfer to the hospital in labor, and most of the time, it is not for an emergency but because the mom has had a long labor and would like medical pain relief so she can get some rest.
The good news here is that most of the clients who transfer to the hospital in labor – we transfer to Morton Plant in Clearwater – continue to labor and have a vaginal birth with no complications. Only about 3% have a cesarean birth. Morton Plant is one of just a few hospitals in the Tampa Bay area whose obstetricians offer the option of a Gentle Cesarean, a more family-centered approach to a cesarean birth.
Keeping in mind that every birth is unique, and that decisions are made on a case-by-case basis, there are a few other situations where clients would be transferred in labor, including:
High blood pressure: This is a common sign of preeclampsia which occurs in 5-8% of pregnant women. For the safety of both mother and baby, high blood pressure and preeclampsia need to be carefully monitored in a hospital setting in the event a cesarean birth is required, so a client with these symptoms would be transferred.
No contractions after the water breaks: Every now and then (unlike what we see in the movies), a pregnant woman’s water breaks but contractions don’t kick in, or the contractions don’t cause appropriate cervical change. Once the water is broken, there’s an increased risk of infection. That’s why state law requires that birth centers facilitate a hospital transfer for clients whose water has broken but who aren’t in active labor and showing cervical changes within 24 hours after the water breaks. Our Certified Nurse-Midwives can suggest non-medical ways to encourage contractions, including herbs, homeopathy and acupressure, but if none of them work, they will recommend a transfer. Clients who are transferred in this situation will likely be induced with an artificial hormone, such as Pitocin, but many clients have had successful vaginal births even with a few unexpected interventions.
Concerns about the baby’s heart rate: It is normal for the baby’s heart rate to fluctuate a bit during a contraction, but if the heart rate remains consistently fast or slow in between contractions, it could be a sign that the baby is in distress and wants out soon. For baby’s safety, the midwife would recommend a transfer.
Baby has turned breech: Most babies get into a head-down position somewhere around the 34th week of pregnancy and stay there throughout labor. But once in a while, a baby decides to turn bottom-down, or breech, in labor. For safety reasons, breech babies cannot be born at a birth center, so the client would have to transfer to a hospital, most likely for a cesarean birth.
Once a baby is born, there are two situations where a client or her baby would be transferred to the hospital:
Postpartum hemorrhage: About 4% of new mothers experience severe bleeding in the immediate postpartum period, making it one of the most common complications of labor and potentially one of the most dangerous. At Breath of Life, we administer a small dose of Pitocin (synthetic Oxytocin) immediately after birth to help reduce this risk. In all cases, our midwives carefully calculate a mother’s blood loss after birth. There is a systematic way to treat blood loss, including with several stabilizing medications that we have right here at the birth center. If the blood loss is significant, or if the interventions are not working, then a transfer would be appropriate.
Baby needs help breathing: All of our midwives and birth assistants are certified in neonatal resuscitation, and we have oxygen right here at the birth center, so quick action can be taken to help a baby who may be having a difficult time adjusting to life outside the womb. When a baby is transferred to the hospital, it is usually the mom’s husband or partner who goes with the baby while mom stays at the birth center to be looked after for a few more hours.
Most of the women who come to our birth center in labor stay here to have their babies. But the reality is that birth is inherently unpredictable, and inevitably, a small percentage of clients will need to transfer. What those moms need most is reassurance that they did all they could to stay low-risk and have a natural birth, and to understand that sometimes things happen in labor that are completely out of our control, such as a baby’s erratic heart rate or a mom’s blood pressure spiking in labor.
Transferring to a hospital isn’t a “failure” by any means. It is a courageous decision by a woman in labor who recognizes that sometimes we need to call on tools beyond what Mother Nature provides to bring our babies into the world safely and in good health.