A Little on Homebirth Transfer Rates
Rebecca Newell
4/17/20242 min read
One of the biggest questions people have when it comes to homebirth is ‘what if there’s an emergency and I need to go to hospital?’ or I often hear ‘my partner won’t let me have a homebirth because it could go wrong’.
So let’s look at the figures of homebirth transfer rates. The figures below have been taken from a global research study, containing data from 215,257 women.
The total proportion of transfer from home to hospital varied from 9.9% to 31.9% across the studies.
For first time mums transfer rate ranged from 23.4% to 45.4%,
For those who had given birth before, it varied from 5.8% to 12.0%
But let’s taker closer look and see how many of these transfers included actual emergencies.
Non Emergency
The most common indication for transfer was labour dystocia or the slowing of labour, between 5.1% to 9.8% (we will look at this later)
Foetal distress varied from 1.0% to 3.6%,
Postpartum haemorrhage from 0% to 0.2%
Respiratory problems in the infant from 0.3% to 1.4%.
Emergency
The proportion of emergency transfers varied from 0% to 5.4%.
What do they mean by Emergency?
The meaning of emergency varied from study to study for example in one study just ‘being transferred to hospital in an ambulance before or after the birth’ was classed as an emergency.
Other reasons in other studies included breech presentation, meconium in the water and failure to progress.
When did these transfers take place?
During labour and before birth of baby between 8.4% to 24.1%.
After the birth* between 1.7% and 7.3%
*Important to note after the birth in has been classed as anywhere between 2 hours and 5 days. This significantly distorts the statistics, and one could also make the case that the actual transfer rate might be lower when considering the safety of home birth.
Research also found that the studies conducted in places where home births were well-integrated into the national or regional healthcare system showed a higher transfer rate, compared to studies in settings with independent midwives. Hmm.
Could this be linked to the fact that the biggest reason for transfer is slowing of labour?
Could it be that the guidelines and policies the NHS midwives must follow are influencing birthers to transfer if they are ‘taking too long’? We know that independent midwives have the autonomy to watch and wait.
Sources: Transfer to hospital in planned home births: a systematic review | BMC Pregnancy and Childbirth (biomedcentral.com)