What About Home Birth Complications and Hospital Transfers?
Choosing to give birth at home is a deeply personal decision, often driven by the desire for a natural, low-intervention experience in a familiar and comfortable environment. One component of making this choice is understanding the safety and risk factors of home birth.
As a certified nurse-midwife, I’ve guided countless families through home births, always prioritizing the health and safety of both mother and baby. While we strive for a seamless, physiologic birth at home, we also ensure families understand potential home birth complications and how we navigate transfers when additional care is needed.
Let’s explore home birth complications, what transfers look like, and how we navigate them to ensure the safety and well-being of both mom and baby.
Home Birth Complications: Knowing When Transfer of Care Is Necessary
First, it’s important to remember that home birth is safest and most appropriate for healthy, low-risk pregnancies. Following this guideline minimizes the chances of significant home birth complications.
Second, as certified nurse-midwives, we’re expertly trained in physiologic birth and able to recognize when a transfer might be the wisest choice, either for mother or baby, and our priority is always the health and safety of both. If complications arise, transferring care is a proactive step to access additional resources and support.
While the risk of transfer is low, it can become necessary at various stages of care: pregnancy, labor, or the postpartum period. Here are the most common causes of transfer at each stage:
Antepartum Transfers: Complications During Pregnancy
Though we don’t expect issues to arise during pregnancy — and they rarely do — we carefully monitor your progress and note any development that might warrant additional care. For instance, if your anatomy ultrasound shows that baby might require extra medical attention after birth, we can transfer your care to a hospital system equipped to meet that need. Or, we might make a similar shift if a condition develops that would increase mom’s risk during labor or birth.
It’s important to note that as midwives, we don’t unilaterally make such decisions on behalf of our clients. Rather, we start a conversation when the need arises and move forward in full collaboration with the client, ensuring both mom and baby receive the support they need.
Intrapartum Transfers: Complications During Labor
While most home births progress beautifully, some births can last longer than expected and require additional support. One of the most common reasons for transferring during labor is prolonged labor that leaves mom exhausted and needing extra tools. In these cases, we accompany mom to the hospital to continue supporting her as she gets the additional resources she needs.
Less often, we may see signs that mom or baby isn’t tolerating labor well. If a home birth complication like this occurs, we don’t wait until the situation becomes serious; we accompany mom to the hospital for appropriate care right away.
It’s important to note that home birth transfers are rarely emergencies. Midwives are trained to recognize “yellow flags” — early signs that something isn’t progressing well. This allows us to act calmly and decisively, ensuring a smooth transition before an emergency develops.
Postpartum Transfers: Complications After Birth
A postpartum transfer can become necessary for either mother or baby. For mom, this might be due to extensive bleeding or a severe tear requiring hospital-level repair. For newborns, transfers might occur when a baby needs extra support during the transition from intrauterine to extrauterine life.
While it’s normal for newborns to need a little time to transition to the outside world, some babies take longer to stabilize. As midwives, we’re trained in what’s normal and what isn’t, and we recognize when a newborn requires additional care or monitoring.
How Do We Handle Home Birth Transfers?
One of the biggest misconceptions about home birth complications is the idea that they always involve dramatic, emergency scenarios. In reality, most transfers are calm and deliberate.
As home birth midwives, we bring a wealth of tools and training to every birth. Our birth bags are stocked with effective herbal treatments, medications for managing bleeding, oxygen, and even IV supplies. If a transfer becomes necessary, we don’t just send families off — we go with them. We stay by their side, advocating for their preferences and providing continuity of care in a vulnerable moment.
Transfer Rates and Expectations
While little data exists in the form of high-quality, national-level studies, we do have some statistics on home birth transfer rates from the community of home birth providers. Nationally, about 10–15% of home births involve transfer to a hospital. At our practice, we’re proud to have rates that align closely with these averages, often even lower. Here’s a breakdown of our transfer statistics:
Antepartum transfers: 9%
Intrapartum transfers: ~10%
Postpartum transfers: 3%
Newborn transfers: 1%
One of the most striking statistics regarding hospital versus home birth complications is the data on C-sections. The current national average for cesarean sections has reached over 30% — nearly one-third of all births. Planned home births, however, have a far lower rate. At Haven, for example, we see a 6% cesarean rate.
Why Choose Home Birth?
Despite the low possibility of transfer, many families choose home birth because of its unique benefits. Birth is a natural, physiological process, and for many, being in the familiar environment of home allows mothers to relax and release during labor. Midwives are experts in supporting this natural process, providing individualized care that respects a family’s goals and needs.
The low complication rates, especially the low C-section rate, and the opportunity to have as little interference as possible in the natural birth process are strong draws for many women. That said, it’s essential to choose the birth setting that feels safest for you. While home birth is a wonderful and safe option for low-risk pregnancies, hospital births offer benefits as well. The key is to choose the setting that aligns with your goals and makes you feel calm, safe, and cared for.
Hospital Transfers and Home Birth Complications: Final Thoughts
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.
The key to a successful home birth — whether or not a transfer is needed — is having a team you trust. At Haven, we take pride in being that team, providing personalized, compassionate care that supports families every step of the way.
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
Carolyn Denning, a midwife at Haven Birth and Wellness, grew up in the suburbs of Detroit and earned a degree in Human Physiology from Michigan State University. Her passion for supporting women through pregnancy led her to midwifery, starting as a doula while completing her nursing degree. She gained valuable experience as a Pediatric Emergency and Labor and Delivery nurse at Vanderbilt.
Carolyn and her husband, Dustin, served as missionaries in South Africa, where she supported pregnant women and experienced her own transformative home birth. She is a proud mother of two girls, Levy and Josie, and enjoys traveling, exploring nature, and learning about different cultures.
Disclaimer: The content on the Haven Birth and Wellness website is created and/or reviewed by qualified Certified Nurse Midwives and healthcare professionals. We strive to provide accurate and detailed information for our readers. However, this blog is intended for informational purposes only and should not be considered a substitute for professional medical advice. Your own healthcare provider is best equipped to understand your unique situation and medical history. Always consult with your healthcare provider before making any decisions that may affect your health.