How prepared will your midwife be? And how fast could you get to hospital? Get the lowdown on what happens if things aren’t as straightforward as you’d hoped.
1. Hospital transfers aren’t normally emergencies
Actually, the most common reason (32.4% of transfers to hospital) for home birth plans not to work out is because you’re tired and things are progressing really slowly (NICE, 2014). The other reason (5.1% of transfers) is that you might decide you want an epidural (NICE, 2014). So if you hear about people deciding to go to hospital after planning a home birth, you’ll understand why.
2. Transfers to hospital happen quickly
Transfers to hospital usually take less than an hour from making the decision to arriving (Rowe et al, 2013). Ask your own midwife how long it takes locally. So if you do need to change your home birth plans, it will all be sorted quickly.
3. If there is an emergency, the hospital will know
If you or your baby is showing signs of significant distress, your midwife will call an ambulance (NICE, 2014). They’ll tell the hospital it’s an emergency so staff will be ready and waiting for you. That means you and your baby will get the treatment you both need quickly.
4. A home birth doesn’t mean you can’t have interventions when necessary
If your midwife is concerned about you or your baby during labour, she will arrange your transfer to hospital for assessment. Sometimes, that assessment will lead to a decision to have an assisted birth (with forceps or ventouse) or a caesarean birth (NICE, 2014).
5. If the baby has the cord wrapped around its neck, the process is the same as in hospital
Just as if you were in hospital, your midwife will be monitoring your baby’s heartbeat throughout labour. If there are signs that your baby needs help, you’ll be transferred to hospital.
Over a third of babies are born with the umbilical cord around their necks so it’s a perfectly normal part of labour (Peesay, 2012). The cord’s usually loose enough to be unlooped and your birth plan will progress normally. If your baby isn’t coping well after the birth, the midwife will arrange transfer for both of you to hospital.
6. Midwives can deal with blood loss/postpartum haemorrhage
Midwives are trained to deal with complications that come up wherever you are. They’ll have the same equipment at home as they would have on a midwife-led unit (MLU). So if you do haemorrhage, the midwife will give you a drug to contract your uterus, and will massage your tummy to stem bleeding until an ambulance arrives (NICE, 2014).
7. For the rare occasion it’s needed, midwives bring some resuscitation equipment for babies
Most babies who are poorly will already be in hospital. Otherwise, it will become clear during labour that the woman and baby need to go into hospital. So it’s unusual for babies born at home to need resuscitation, although some newborns do need to be encouraged to breathe.
Your midwife gets annual training in these techniques, and will follow the same process as she would use in hospital:
- keeping the umbilical cord intact so the baby gets oxygen from the placenta
- keeping the baby warm and dry
- making sure the airway is open
- giving the baby five or more puffs of air
- chest compressions.
(Resuscitation Council (UK), 2015)
The midwives will also call a paramedic to bring the baby to hospital.
8. Some women and babies go to hospital after the birth
A few women have a complication after they give birth that means it’s a good idea to go to hospital. Complications might include a retained placenta, needing a lot of stitches, or concerns about the baby. If there are complications, the midwife will arrange a transfer to hospital (NICE, 2014).
This page was last reviewed in March 2018.
Our support line offers practical and emotional support in all areas of pregnancy and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about labour and life with a new baby. We also run local NCT home birth support groups: call 0300 330 0770 or email firstname.lastname@example.org to find one near you.
The Home Birth Reference Site provides information and opinions about having your baby at home, for parents who think that it might be the right choice for them, and for health professionals looking for resources.
Which? and Birth ChoiceUK have developed a tool to help you find out what your choices are for giving birth in your area. This tool combines your preferences with research evidence to show the local options most suited to you.
Rowe RE, Townend J, Brocklehurst P, Knight M, Macfarlane A, McCourt C, Newburn M, Redshaw M, Sandall J, Silverton L, Hollowell J. (2013) Duration and urgency of transfer in births planned at home and in freestanding midwifery units in England: secondary analysis of the birthplace national prospective cohort study. BMC Pregnancy and Childbirth. 13(1):224. Available at: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-… [Accessed 5th October 2018].
NICE (2014) CG190 Intrapartum care for healthy women and babies. Available at: https://www.nice.org.uk/guidance/cg190/ [Accessed 5th October 2018].
Resuscitation Council (UK) (2015) Resuscitation and support of transition of babies at birth. Available at: https://www.resus.org.uk/resuscitation-guidelines/resuscitation-and-sup… [Accessed 2nd November 2018].
Peesay M. (2012) Cord around the neck syndrome, BMC Pregnancy Childbirth. 12(Suppl 1):A6. Available at: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-… [Accessed 5th October 2018].