When a Home Birth Becomes a Hospital Birth

stacyYou did everything “right.” You took Bradley Method childbirth classes. You hired a doula. You hired a midwife to attend your birth. Your diet has been perfect. You rented the birth pool. You took all of the right supplements, attended prenatal yoga classes, had regular chiropractic care, and gained a good amount of weight — not too much, not too little, just right for you.

But birth isn’t just a series of checklists.

It’s good to pay attention to what contributes to a healthy pregnancy and birth, but it’s not a guarantee that the actual birth will perform like an item on a checklist.

Birth is complicated, often messy and surprising, and it’s best to remain flexible as you approach the due date.

Despite doing everything “right,” for some reason, things might not go as planned, and the blissful, ecstatic, empowering, or even orgasmic home birth you planned becomes the birth you didn’t plan. Your home birth becomes a hospital birth.

Is this such a bad thing? It doesn’t have to be. It can be a very good experience, even if it deviates from the original plan. As a midwife, I’ve seen the good, the bad, and the downright ugly hospital transfers. Fortunately, the ugly transfer experiences have been rare.

The Different Paradigms of Care

Midwives and obstetricians approach birth from different paradigms. So what is a different paradigm of birth and why does it complicate things? For one, midwives are trained to attend the 95% of births that occur without complication. The approach to labor is grounded in this very real statistic, but also has to do with the midwife’s training, which focused on continuous labor support and limited intervention.

A physician and/or surgeon is trained to handle the 5% of complicated births. In contrast to midwifery training, obstetrical training is grounded in staying ready for that rarer complication.

It’s important to note that midwives are trained to recognize when a complication arises and vigilantly keep an eye on a woman’s labor to ascertain if there is ever a need to transfer care to a hospital, where a physician/surgeon can take over the birth.

Sometimes the two types of training can clash. Most often obstetricians have never attended a home birth or observed a birth with a midwife in the primary care role, whether at home or at a birth center. Thus, their only experience with home birth moms is likely the mom who has transferred with a complication. They don’t see the other, larger population of women who have had healthy births at home or in a birth center with the midwife.

In their training, obstetricians see the more complicated side of childbirth. One physician I know spent her obstetrical rotation at a hospital serving a poor community that had limited access to prenatal care. Some of the mothers were addicts. The deliveries were complicated and the outcomes not always optimal. While this training and awareness is necessary and important, especially in emergency situations, it can color their responses to home birth transfers. They have seen what poor prenatal care and poor lifestyle choices can mean for a birth. The part of midwifery care that they may not understand is that midwives have already carefully screened their clients to be sure that the pregnancies are healthy and that home birth or birth center birth is a viable option for the mom. It’s also not uncommon for a midwife to transfer care during the pregnancy if the mother becomes high risk.

In my case, as a member of my local healthcare community, I do my best to educate the hospital staff, nurses and physicians alike, as to how a midwife practices. It can be hard to cast aside a person’s training experiences to learn about a different model of care, but with hard work and respectful dialogue, between the moms and midwives and the hospital staff, care providers in the obstetrical care setting can gain greater understanding of just “who these midwives really are.”

So what will a transfer birth look like?

The ability to transfer a mother is an important tool in the midwife’s toolbox. And a transfer hospital birth can turn out just as positive as the home birth might have been.

Depending on the hospital and staff, a midwife may shift into more of a doula role during the birth, helping the laboring mom make the best decisions and making sense of the medical events that often happen quickly with a transfer. The midwife can provide support to the family members who might be there as well. Sometimes the hospital will require the midwife to leave, but that is becoming a rarer exception. If that happens, the midwife will still provide some sort of postpartum care and support. During the transfer, the nurses and doctors are doing their job when they take over the birth – they know complicated birth best – and it’s important to remain grateful for both models of care.

The goal of every birth is a healthy mom and baby. Stay focused on navigating the transition with a positive attitude; it will help you feel better after the birth, whether your birth is a home birth, or a transfer hospital birth. Assert your needs, but don’t be confrontational. Be respectful. A combative attitude helps nobody and serves as an obstacle to good care. Your midwife will be there to help you process the unexpected transfer and transition in care. Midwifery care does not stop with the transfer; it simply follows the needs of the mother, no matter the birth setting or interventions.

Disappointment is Natural

You know you did everything right: you followed the latest nutritional guidelines, you exercised, you took a childbirth class, you prepared. But your birth didn’t happen at home like you planned; it happened at the hospital. The important thing is to remain grateful that you could rely upon a two-tiered system of care. The right provider used his/her skills to bring the birth to the final stretch. Yet, you have an overwhelming sense of disappointment.

Birth is an emotional event. It’s physical, it’s spiritual, and it’s a hormonal journey that sometimes bring tears, elation, sadness, joy, or a combination of all. If you’re feeling disappointed about the birth, find ways to express that disappointment. Write about it. Talk about it. Cry about it. Practice radical acceptance.

Your birth is just one step in the path into motherhood. Celebrate that you’ve become a mother and focus on the positive. Your birth happened just as it needed to happen.

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