Reasons for transfer to hospital
By Kidspot Team |
Giving birth to a baby is usually a normal process for up to 85% of women and that most babies are born on time and healthy. This means the majority of women have an excellent chance of having their baby where they plan to. Even in the instance of the mother's or baby's health deviating slightly from the norm, a competent caregiver with the basic equipment in a chosen place of birth can usually deal with these circumstances safely and effectively. However, occasionally more serious complications arise (for the woman or her baby), meaning the birthplace originally chosen cannot provide the sophisticated intensive care facilities required to deal with their unexpected ill health.

When planning to have your baby at home the reasons for transfer to hospital are usually health conditions that vary from the norm, requiring monitoring or medical attention.

Reasons for transfer vary from hospital to hospital and homebirth practitioner to homebirth practitioner, so it is important to ask your caregiver(s) about the possible situations that could mean you (or your baby) would need transfer.

As a general guide, some of the more common reasons for transfer include:

Illness for the mother:


If the woman has a pre-existing health condition, or becomes unwell during the pregnancy, she will often need specialist medical attention in a larger hospital delivery suite. Sometimes the baby will be unwell as a consequence and will also need specialist treatment. Reasons can include heart disease, kidney disease, epilepsy, diabetes requiring large doses of insulin, cholestasis, heavy bleeding during middle to late pregnancy and very high blood pressure.

Premature labour:


If you start labouring before 36 to 37 weeks of the pregnancy, then you will probably need to give birth in a delivery suite. Babies born at around 36 weeks gestation generally have no complications but the caregiver's concern is that sometimes the dating of a pregnancy is not truly accurate and that the baby could look and behave more like a 35 week old baby (or less), possibly having breathing difficulties at birth. If you paln to go to a smaller hospital they may have an earlier 'cut off' point depending on the sophistication of their newborn care nursery facilities.

Breech baby:


If your baby is breech (or in another unusual position such as a brow presentation or transverse lie) you will most probably be advised to have your baby in a delivery suite or possibly have a Caesarean birth.

Twins, triplets or more:


Women having more than one baby are generally advised to have their babies in a major delivery suite (with access to advanced intensive care facilities if the babies are premature). Some homebirth midwives will attend women with twins, if all appears to be going well, but this is often not recommended. Smaller hospitals usually accept twins if they are uncomplicated and not too premature, but may transfer triplets or more.

Induction and augmentation:


If your labour needs to be induced, or the contractions during labour weaken or slow (needing augmentation), you will need to be transferred to a hospital delivery suite. Some hospitals will facilitate induction with prostaglandins, then allowing the woman to go back home until the labour starts if all is well.

Labour complications:


If complications arise during the labour for either the mother or the baby then transfer from your home would be recommended. These can include fetal distress, heavy bleeding, cord prolapse or if you need an assisted delivery with forceps or a ventouse.

Epidural:


If you need or want an epidural you will need to go to the hospital delivery suite. Midwives can only administer gas to their patients but not controlled narcotics.

Illness for the baby:


If the baby is expected to be unwell, or it is apparent that they are unwell soon after they are born, they will need to be transferred to a large maternity or childrens' hospital for medical attention in an intensive care unit for babies. Many smaller hospitals can deal with minor health complications but would need to transfer the baby to a larger hospital for major complications.

Private hospitals or smaller public or rural hospitals


When planning to have your baby in the delivery suite of a private hospital, a smaller public hospital or a small rural hospital any decisions involving the transfer you or your baby are usually based on the level of intensive care facilities available at your chosen birthplace (for either the mother or the baby).

Most private, smaller and rural hospitals are able to deal with the majority of emergency situations and any common variations from the 'norm'. However, occasionally you or your baby may need to transfer to a major public hospital with advanced intensive care facilities. (Bear in mind that is quite rare for the woman to be that unwell to require transfer.)

If the woman does experience a life-threatening complication (such as extremely high blood pressure) she may need to be transferred for specialist care in an intensive care unit at a major general or maternity public hospital. Most private hospitals, smaller public hospitals and even some larger maternity hospitals are not equipped to care for a woman this seriously ill.

This may involve the woman being airlifted, or taken by road ambulance, to a major metropolitan hospital or a major rural centre for her care. If the baby has been born, your caregivers will usually try and facilitate the transfer of the baby with the mother, to be close by (that is if the baby(s) are well enough to travel). Be aware that if the mother and baby(s) need to be separated, you and your partner (or support person) could be faced with difficult decisions regarding whether to stay with the baby(s) or go with the woman.

If your baby(s) is seriously ill or very premature (to the point where they need to have a ventilator machine to help them to breathe), they will need to transfer to a major maternity or children's hospital with the staff and equipment to care for them.

For babies with major health complications that require emergency surgery, they will need to be taken to a major children's hospital that has the staff to perform the appropriate surgery required and care for the child as they recover. Again, transfer of the mother (and partner) with the baby is facilitated as much as possible, depending on how well the mother is. Sometimes the partner or support person will need to make a choice about whether to stay with the woman or go with the baby.

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