27/06/2025
Perfect explanation of “What is your transfer rate?”
Let's talk about the age old question you are asked at a consultation...
"What is your transfer rate?"
That can be a loaded question and really ask yourself what it means before asking the question. Do you mean emergency transfers where you had to call an ambulance? Do you mean a transfer where you as a provider had to make a call because of factors that led to mom/baby being safer in a hospital setting? Do you mean to include all of those couples who choose, on their own, to go in and get rest, epidural, or other interventions for whatever reasons?
You have to take into consideration that there is a team dynamic making decisions in the moment with a variety of details that play into the decision making for non-emergency transfers. It is usually a discussion and more than one thing that would spur the discussion to begin with - like not just exhaustion, but maybe they can't keep food down either (sometimes IV fluids are necessary and sometimes they aren't going to make a huge difference in the situation), or maybe on top of exhaustion, the mom starts to get low grade fever, or what if the baby's heart tones are now not reassuring after changing positions and doing all the things to get them to come back down...
Transfer from home or birth center is never just black and white - and my prayer would be that when a potential client asks this question, they ask in more detail to understand that not all of the time (and certainly most of the time) it isn't the midwife just stating a decision, but it is due to the fact that the midwife is honoring the mother's decision and autonomy with informed decision making.
How many first time moms does the midwife take - then see if a transfer rate is impacted by that alone because those births take a lot of patience, watching, and education beforehand (prenatally) for clients to understand that "maternal exhaustion" is the #1 reason they would transfer from home to hospital. But, midwives and practices teach, educate, talk about, and prepare the best way possible before birth to not be in that statistic.
Sometimes transfers are warranted.
Most of the time transfers would be non-emergent.
Most of the time transfers are a team discussion and decision.
Usually transfers are handled professionally and smoothly.
Oftentimes, midwives who have had a client, transfer for whatever reason, continue to do postpartum care for mom and well visits for baby.
Transfer is not a bad word. It shouldn't be used to detour a person from consulting with a practice. There are appropriate transfers from community birth to hospital birth. Ask questions, have discussions, and make an informed decision.
Is there a transfer of care antepartum (during prenatal period)
Is there a transfer of care intrapartum (during labor & birth)
Is there a transfer of care postpartum (after baby and placenta born)
"While 'home birth complications' can sound intimidating, it’s important to remember that midwives are skilled at recognizing and managing challenges long before they become emergencies. Most issues can be addressed at home, but if a higher level of care is needed, we have the training and resources to make transfers smooth and safe." and... "When a transfer happens, remember, it’s not a failure. It’s a brave, wise choice to use available tools for the best interests of mom and baby. And we’re there every step of the way, ensuring families feel supported, heard, and cared for." - Carolyn Denning, CNM, MSN
HomeBirthSummit.com states:
Transfer Guidelines Focused on Mother and Infant Safety
"When healthy mothers plan a home birth, they are most often cared for and monitored by skilled midwives. Infrequently, the mother or infant requires transfer from the home or birth center to the hospital to access specialized procedures or care. Good communication and coordination between providers during these transfers minimizes the potential for negative impact on outcomes. As the safety of the mother and infant is always of the highest priority, it is important to have detailed guidelines used by all health care providers involved in such transfers."
So, what is written here is a lot - and hopefully helps some couples understand the nuances of what goes into a decision making event that would cause a transfer to happen in a birthing situation.
What have you learned about transferring from community to hospital? I would love to see your input and wisdom, so we can all learn together!