In certain circumstances the midwife will advise that transfer to hospital is necessary. This journey is always made by ambulance and a midwife will accompany you. By this means heavy traffic can easily be negotiated and good communication links with medical staff maintained in the event of a difficulty. Your partner can accompany you or may follow in his or her own car; this makes it easier to get home again.
We will aim to stay with you until your baby is born but your care will usually be handed over to a hospital midwife with us providing a supportive role.
In the unlikely event that you are not willing to accept the advice we give you and you decline transfer to hospital, we will inform the delivery suite co-ordinator, obstetric registrar (senior doctor) and the on call Supervisor of Midwives and will continue to care for you at home. The second midwife may be called earlier to provide support.
However, it must be appreciated that the midwife does not have access to the more sophisticated equipment and medical expertise that is available in the hospital.
Circumstances in which transfer to hospital would be recommended
• If you or anyone in your household has confirmed or suspected Covid-19
This is to minimise exposure to the virus for our staff and caseload and to arrange the recommended monitoring for you and your baby.
• Labour starting before 37 weeks or after 42 weeks of pregnancy.
Before 37 weeks it is recommended that a paediatrician is on hand for the delivery. After 42 weeks it is advised that you have closer monitoring during labour as the baby is slightly more at risk.
• If labour has not started within 24 hours of the waters breaking you are advised to have labour induced in hospital. Your home birth team midwife will discuss this with you.
• If the ‘waters’ are brown/green (MECONIUM) when they break.
This indicates that the baby had opened his/her bowels, which may be a sign of distress and in most circumstances recommend transfer into hospital where the baby’s heart rate can be monitored continuously and a paediatrician can be present at the birth.
• Abnormalities in the baby’s heart rate.
Both a very fast and a very slow heart rate can be a sign of distress. If this was to occur and persist and the birth is not imminent and simple management such as change of position or drinking do not resolve this, you will be advised to transfer to hospital for closer monitoring and/or a paediatrician to be present at the birth.
• Excessive blood loss
Some bleeding during labour and after birth is completely normal, however if you are bleeding heavily at any point we would advise you to transfer to hospital where there are more staff and equipment to manage the bleeding.
• Raised blood pressure.
Some change in blood pressure is expected during labour, you are working hard and your blood pressure will rise. However, there is a limit to what is considered normal and if the midwife has concerns she will recommend that you are transferred in to hospital.
Occasionally labour may be prolonged or difficult to cope with despite good support and good preparation for the birth. Entonox is offered as a safe method of pain relief. However, if you need stronger pain relief you may choose to transfer to hospital where additional help is available for example giving drugs that increase the efficiency of the contractions and/or epidural anaesthesia.
• No progress or slow/prolonged 1st /2nd stage of labour.
Sometimes the length of labour itself becomes a concern. We would expect that some progress, however small, is made. We will discuss this with you and your partner if it occurs in your labour.
• Retained Placenta.
Sometimes the placenta does not deliver in the normal way and transfer to hospital is necessary for removal.
• For perineal suturing.
If we are not able to make you comfortable or the tear is more complex you will need to transfer to hospital for stitching.
• Unwell baby.
If there are any concerns regarding the baby’s well being after the birth you will be advised to transfer to hospital for assessment, observation and/or treatment by the paediatrician, as appropriate. Reasons for this may include baby’s that do not respond well after birth, waters significantly stained with meconium or signs of infection.