Most pregnant people who plan to deliver at Magnolia Birth House go on to have their babies at the birth center. In fact, about 85 percent of clients remain low risk and have uncomplicated births.
What happens to the other 15 percent? During the course of pregnancy, birth, or postpartum, something changes that means the birthing parent is no longer in the low-risk category. According to our protocols, home and birth center birth are not appropriate for people with any elevated risks, making a hospital birth the best option.
In the natural birthing community, there is sometimes a notion that transferring to the hospital equals failure. But that’s not true at all. Transferring simply means that the hospital has become the safest place for you and your baby. You may be wondering, “What are the reasons for a transfer from the birth center to the hospital?” or “What happens if I transfer during labor or postpartum?” Read on for the answers to those and other questions.
What Are the Reasons for a Transfer From the Birth Center to the Hospital?
Antepartum Transfers
Antepartum means before childbirth, so this means switching to planned hospital birth, usually late in pregnancy, rather than continuing with the plan to give birth at the birth center. Common reasons for this type of transfer include elevated blood pressure or gestational diabetes that requires medication management.
Another common scenario is going past your due date. Birth center laws in Florida do not allow us to care for folks who go past 42 weeks. Therefore, if you get to 40 weeks and four days, you will begin having biophysical profile (BPP) testing, which is a special type of ultrasound that evaluates the baby and scores their health in utero. If the score is not at a certain level, the baby will need to come out sooner rather than later. In addition, if a client hits the 42-week mark and doesn’t go into labor, despite trying natural induction methods, they will have to go to the hospital for a medical induction.
Intrapartum Transfers
Intrapartum refers to the process of childbirth, so this means a transfer during labor. Here are some of the most common reasons for an intrapartum transfer.
Exhaustion. This sometimes happens when the birthing parent experiences prodromal labor and/or a long early labor phase. In this scenario, clients may choose to transfer to the hospital for pain management, such as an epidural. To help labor progress, Pitocin may be a good option in order to still have a pelvic birth.
Pre-labor rupture of membranes. If your water breaks before contractions begin, this is called prelabour rupture of membranes, or PROM. Many birthing parents will be in active labor within 12 hours of their water breaking, but if you are not, Florida birth center law requires us to consult with a physician for more time or a hospital transfer. This is because PROM presents a risk of infection.
Moderate to heavy meconium in the amniotic fluid. Amniotic fluid should be clear, but light meconium is acceptable at the birth center. If a client’s water breaks and we see thick yellow, green, or brown meconium, the hospital becomes the safest environment for birth. This is because there’s a risk of the baby aspirating or becoming sick. A hospital with a neonatal intensive care unit (NICU) is equipped to handle aspiration and perform deep suction if it’s necessary.
Vulnerable fetal heart tones. During labor, the baby’s heart rate should be between 120-160 beats per minute, and we monitor the heart tones intermittently with a handheld Doppler. If the heart rate is above or below the normal range for a prolonged time, the baby could be in distress. Depending on the situation, this can be an emergency that requires an ambulance.
Postpartum Transfers
After the birth of the baby, there are also several possible reasons why a birthing parent or the baby might need hospital care. The most frequent scenario for the parent is postpartum hemorrhage, while other common reasons include a tear that is more than a second degree or a placenta that is retained for more than an hour.
When it comes to the baby, reasons for non-emergency postpartum transfers could be a baby who’s smaller than expected or a newborn who’s not regulating temperature or sugar well. Emergency reasons are a baby who has difficulty breathing or non-reassuring heart tones in the immediate postpartum.
What Happens If I Transfer to the Hospital During Labor or Postpartum?
Transfer from birth center to hospital
Most transfers are not emergencies, and families travel in their own cars to North Shore Medical Center, which is the hospital where our medical director has privileges. In the near future, we hope that our certified nurse midwives (CNMs) at Magnolia can get privileges at North Shore. When that happens, if your birth is attended by a CNM, she will be able to accompany you into the hospital and continue as part of your care team.
In an emergency transfer situation, we will call 911. The birthing parent — and the baby if he or she is already born — will travel by ambulance to Jackson North Medical Center, the hospital that’s closest to the birth center.
Whether a transfer is an emergency or not, the Magnolia team will always call the hospital before arrival and give the hospital staff a breakdown of what’s going on and the status of the person being transferred. We will either fax the health records or provide the client with a hard copy to take with them.
What Does Postpartum Care Look Like After a Transfer?
After birth, we offer every transferred client a home visit between 7-10 days. We also do a telehealth visit at three weeks postpartum and a final postpartum appointment between six and eight weeks after birth.
In addition, all clients, whether they transfer to the hospital or not, receive one lactation visit with an International Board-Certified Lactation Consultant (IBCLC). This never expires, so clients can schedule an appointment six months after their birth, for example, if they start experiencing breastfeeding troubles.
What Else Should I Know About a Transfer From the Birth Center to the Hospital?
Sometimes things don’t go according to plan, but we encourage all of our clients to keep an open mind and remember that the hospital might become the safest place to give birth. Here are four suggestions to mentally prepare for the possibility of transferring to the hospital.
Pack a Just-in-Case Hospital Bag
Since you are planning to leave your home for the birth center, you will already have a bag packed. However, consider packing a separate bag with a few items you would need in the event of a transfer. This could be an extra change of clothes for you and the baby and overnight toiletries.
Prepare a Hospital Birth Plan
While you probably have discussed your birth preferences with the Magnolia team, it’s important to create a section in your birth plan that addresses your preferences for standard hospital practices. Think about routine newborn procedures, cord clamping and cutting, and skin-to-skin time. Also, make notes about what you want if you need a C-section.
Hire a Doula
No matter where you give birth, it’s helpful to have a support person who is focused on your emotional well-being and can advocate for your informed choices. A professional doula offers this type of support and continuity of care, serving as the perfect complement to midwifery care during a transfer. North Shore is allowing doulas during the pandemic, so your doula, if you’ve hired one, can join you at the hospital. Jackson North, however, is not allowing doulas, but talk with your doula during pregnancy about the possibility of virtual support during postpartum time.
Consider Your Finances
When it comes to costs for prenatal visits, birth services, and postpartum care, we can’t bill until the baby has been born. In some cases, a client may be eligible for a refund from the birth center if they transfer to the hospital, while other times, a client may have a balance owed to Magnolia. There are so many variables — policy limits, deductibles, and co-insurance.
To learn more about midwifery care at Magnolia, fill out our form to set up a free consultation.
