When to Birth in or Transfer to a Hospital

A homebirth is normally a wonderful, safe experience for everyone involved, but there are some times when hospital treatment is necessary. The choice of birth location is up to you, your partner, and your caregiver. Here are some circumstances where you may want to put your faith in the hospital and your fate into the hands of doctors.

Those who have a classical (T-cut) Cesarean scar are at a very high risk of uterine rupture which has severe results if immediate care was not received. A repeat C-secion should be scheduled on or after the mother's due date.

If your baby is in a transverse position with his back facing the cervix, he can only be born by C-section.

If you have an incompetent cervix you may need a cerclage, which must be done in the hospital. Some methods have little impact on your ability to birth vaginally while some require a C-section. If you have a cerclage it is best that you birth in the hospital.

A misshapen cervix may mean that a Cesarean delivery is necessary if it prevents the baby from descending.

In a footling or complete breech, where the baby's feet are pointing down, birth by C-section may be safer for the child but carries increased risks for the mother.

Multiple pregnancy, especially if you are carrying triplets or quadruplets, can be a reason to birth in the hospital, depending on the circumstances.

Low amniotic fluid may be a reason to deliver in the hospital depending on the severity of its effects on the child.

Certain fetal abnormalities need immediate treatment after birth, so depending on the severity, this can be a reason to plan a homebirth.

Having previously had severe postpartum hemorrhage that may recur is a reason to consider birthing in a hospital.

Teen mothers delivering a second child may feel safer in the hospital because of the higher chance of stillbirth that some studies have suggest may exist.

Having had many complicated pregnancies and deliveries that required intervention and had poor outcomes may make the hospital a better choice.

You may not want to birth at home if you have low or high platelet levels.

If you have an STD, you need treatment such as antibiotics during pregnancy to reduce your risk of infecting the infant. The infant may still contract the illness and need treatmentment immediately after birth, so you should birth in a hospital or at least have an in-depth discussion with your doctor before planning a homebirth.

If you are Rh- and your child is Rh+, you will need special prenatal and postpartum care. If the infant is suspected to be severely affected you will need to birth in the hospital, so one must discuss the choice with their doctor.

If you are at risk of birth complications and live a great distance from a hospital, it is better to birth there just iin case.

If your baby repeatedly measures small (under 5lbs) or very large (over 10lbs) on ultrasound scans and palpitations, he may be better off being born in the hospital.

Preterm birth that occurs before 35 weeks or 36-37 weeks if you and/or your midwife feel uncomfortable delivering at home that early will require a stay in the NICU for the baby.

Severe preeclampsia may be a reason to birth in the hospital, especially if there isn't one near your home.

You should transfer if you hear a fetal heartrate that persists in being irregular for quite a while, especially if it occurs along with thick meconium in the waters.

For diabetes patients, if blood sugar levels droop dangerously, one should consider transferring.

If the mother begins to seizure or go into shock, or if postpartum bleeding cannot be controlled, hospital transfer is crucial.

If the baby is limp, lifeless, cold, and gray, you should dial 911 immediately while the midwife attempts to resuscitate the infant.

Placenta previa and placental abruption in most cases will require a delivery by Cesarean.

You should transfer to the hospital if you desire pain medication or are too fatigued to continue handling the labor, much less pushing out the child.

If the baby becomes stuck and cannot be dislodged, you will need to transfer to the hospital.

Cord prolapse, while more common with breech babies, is very rare and occurs when the water breaks and pulls the umbilical cord into the birth canal, presenting before the baby. This can cause the cord to become compressed and decrease oxygen supply to the baby. The mother needs to lie with her butt in the air, keeping as little weight on the cord as possible. Someone should dial 911 immediately, and a Cesarean will be performed immediately upon her arrival to the hospital.

If you decide to birth in the hospital, you can increase your chances of a safe delivery by hearing what your doctors have to say but insisting that your wishes be respected. Do not allow yourself to be bullied, coerced, or manipulated into consenting to intervention that you do not feel is necessary. You must continue to trust your instincts and intuition even in the hospital. Do not let them forbid you from birthing in the position that feels right to you or restrict your movement. This is still your birth, and you should be the one in charge! Moreover, keep a vigilant watch over your newborn. You are still the parent, and the best way to prevent your child from unnecessary intervention is to stay with him at all times and be persistent in your oppositions. Whether you wish to receive an epidural, have a C-section, vaccinate your child, or circumcise him, is all completely up to you. Stand up for yourself!

Angela Horn, "You can't have a homebirth, because..." Home Birth Reference. URL: http://www.homebirth.org.uk/
Robin Elise Weiss, "The Incompetent Cervix." About.com. URL: http://pregnancy.about.com/cs/incompetentcervix/a/aaincomp.htm
Natan Haratz-Rubinstein, "Low Amniotic Fluid." Babycenter. URL: http://www.babycenter.com/refcap/pregnancy/pregcomplications/1199460.html#2
Unknown, "STDs and pregnancy." Center for Disease Control. URL: http://www.cdc.gov/STD/STDFact-STDs&Pregnancy.htm
Robin Elise Weiss, "Rh Factor in Pregnancy." About.com. URL: http://pregnancy.about.com/cs/rhfactor/a/aa050601a.htm
Jennifer VanderLaan, "Labor Challenges." Birthing Naturally. URL: http://www.birthingnaturally.net/birth/challenges/emergencies.html