About 90% of the time, there are warning signs that occur before a problem develops that allow plenty of time for good decision-making and non-urgent transport to the hospital in your own car. Midwives are extensively trained in recognizing the warning signs that tell us that labor has become abnormal. Not every problem requires a trip to the hospital – oftentimes a change in your position or hydration solves the problem. Issues requiring a hospital transfer most often happen during labor, but can sometimes come up in the first few hours after the birth as well. The most common reasons for transferring to the hospital during labor include:
- maternal exhaustion and/or request for pain relief (this is more common in first labors)
- the cervix isn’t dilating properly (often due to the baby’s head being turned in an uneven or unfavorable position)
- the baby’s heartbeat has become what is called “non-reassuring,” meaning that the baby is stressed for some reason
There is a small percentage of emergencies that require a call to 911 and urgent transport to the hospital. In very rare cases, a serious problem can occur that has no warnings signs at all, such as a placental abruption or blood clot in the lung. In these extremely unusual situations, you or your baby would need immediate care or equipment that would not be available in the home. Being in the hospital is no guarantee that you or your baby’s life would be saved either—often there is nothing that can be done in these situations—but emergency personnel and equipment are more likely to be available there. It is important for families considering homebirth to be willing to accept these risks.
In the period right after the baby is born, there may be problems with either you or your baby that could require a trip to the hospital. You may have trouble with heavy bleeding or delivering the placenta. Licensed midwives are able to administer various medications at home that are meant to stop excessive bleeding. Sometimes more extensive measures must be taken, and a small percentage of clients require a hospital transport. These issues are more likely to be urgent transfers. The most common problem with newborn babies is breathing difficulty, and a few babies need to go to the hospital within the first few hours after birth for evaluation by a pediatrician.