Understanding Birth Center Eligibility and Transfers from Birth Center to Hospital

Lots of families have questions about birth center eligibility and transfer from the birth center to the hospital. Here are answers to the most common questions. Ask your midwife or doctor if you want to talk more about your specific situation.

Who is eligible to give birth in the birth center?

One of the most important ways to maintain safety in the birth center is to follow guidelines that ensure only people with low-risk pregnancies give birth there. Your midwife or doctor will talk to you about eligibility for birth center care during your pregnancy. When you are in labor, your midwife will do a thorough evaluation of your eligibility before you are admitted to the center. In order to labor at the birth center, you must:

  • be healthy, with no pre-existing or pregnancy-related illnesses like diabetes, high blood pressure,
    heart disease, or other serious conditions
  • have no history of prior cesarean birth or certain other types of uterine surgery
  • go into labor at term (between 37 weeks and 41 weeks 6 days)
  • have a baby in the head-down position
  • have normal vital signs (heart rate, temperature, blood pressure)
  • have signs of fetal wellbeing, including normal fetal movement and heart rate
  • be in active labor within 24 hours of your water breaking
  • complete required classes to ensure that you and your partner or support person are prepared for unmedicated labor, early home discharge, and postpartum mother-baby care.

What happens if I’m not eligible for birth center care?

We will continue your prenatal visits and classes and plan for a hospital birth, and you can see the midwives, the physicians, or both during the remainder of your pregnancy. In most cases, you will still be able to have the midwives care for you in labor in the hospital, if that is your preference. In some cases (more serious problems or the need for cesarean or assisted vaginal birth, or if it’s simply your preference), the physician will take care of you during your birth. Either way, the full team and community at Baby and Company are behind you.

What situations can lead to transfer during labor?

After admission, your midwife will continue to monitor and assess any risk factors to make sure continued care in the birth center is right for you. They will watch your vital signs, fetal heart rate, coping and pain management, and other factors and may make a recommendation to transfer based on the results. Unless it is an emergency, they will usually try to resolve the problem first, without transferring.

The most common reasons for transfer are slow labor progress, exhaustion, or need for pain management. Less common reasons include fever, concerns about fetal wellbeing, or high blood pressure.

How often do people transfer from the birth center to the hospital? Is it always an emergency?

Out of every 100 people admitted to the birth center, about 17 will transfer to the hospital before birth, and 83 will deliver as planned at the birth center. The vast majority of transfers in labor are not emergencies – in more than 90% of transfers, the mother and fetus are medically stable at the time of transport, and in most cases they go to the hospital in their own car. Your midwife will go with you to the hospital and will usually continue your care there. When the situation is not stable, the midwife will come with you in the ambulance and work together with the emergency response team and the hospital-based team to provide treatment and help you deliver your baby.

What’s involved in a transfer during labor?

More than 70% of people who transfer in labor from Baby and Company to the hospital end up having vaginal births.When the decision is made to transfer, we will make sure you’ve gathered your belongings and have everything you need to go to the hospital. We will make sure that your partner and loved ones are aware of the process and know where to go to meet you. Before leaving, we will check on you and your baby’s vital signs and escort you out the door. We will be there for you as you get settled into your hospital room and make sure your birth records and other information are available to the full team at the hospital. You will go through a streamlined hospital admission process, and in most cases the midwife will continue your care, collaborating with the physician and other hospital team members as needed.

What situations can lead to transfer to the hospital after delivery? How often does it occur? Are these transfers always an emergency?

Out of every 100 mothers who give birth in the birth center, about 94 will be discharged home and 6 will need hospital-based care for postpartum recovery, including about 2 who will need urgent transfer. The most common reasons for postpartum transfer are need for surgical assistance with laceration repair, excessive bleeding, or problems delivering the placenta.

Out of every 100 babies born at the birth center, about 88 will be discharged home and about 12 will require hospital-based care for 24-48 hours or longer. This includes about 1 or 2 babies who are transported urgently. The most common reasons for newborn hospital admission are concerns related to jaundice or breathing difficulties.

Even though most postpartum mother and/or baby transfers are not urgent, an ambulance is typically used for transport so that a midwife can provide ongoing care and communicate directly with the hospital-based team. Whenever possible, both mother and baby will be transported and admitted to the hospital, so they can stay together after birth.

What’s involved in a transfer of a mom or newborn after birth?

If you and your baby are leaving the center for postpartum care, we will ensure that you both are transported together, when this is safely possible. You and your baby’s safety are our top priority. For most transfers, your baby will need to be securely fastened into a car seat. This means you’ll put a diaper and clothes on your little one before leaving. We will make sure you have all your belongings, will check vital signs on you and your baby, and will make your birth and newborn records available to the full team at the hospital. A midwife or a nurse will go with you to the hospital to be sure that you are safe and settled into your hospital room.

Will transfer ruin my birth plan?

Transfer from the birth center to the hospital is the best plan when you or your baby need closer observation, medical attention, or surgical care. If you are hoping for a birth center birth and want to avoid interventions, going to the hospital may feel disappointing. While you will likely have additional interventions, such as an intravenous (IV) line and continuous fetal monitoring, your team will work hard to support your birth plan and preferences. They will support you to use movement and position changes as much as possible, and help you personalize a plan of care that is appropriate for your medical condition. More than 70% of people transferred to the hospital in labor end up having vaginal births, and about 85% report high satisfaction with their care even though they transferred.

Want to learn more about birth center and hospital birth? Enroll in a free Birth Choices class at Baby and Company.

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