Birth centre transfer to the labour ward
Far more Australian women transfer out of a birth centre or a midwifery group practice than out of a home birth, and most of them were never told how likely it was. The move itself is usually a short one, and the change in your care at the other end can be considerable.
How often it happens
1 in 4 to 1 in 3
For a first baby, transfer from a midwifery unit to obstetric care runs at roughly a quarter to well over a third. For women who have given birth before it is far lower, in the range of one in twenty to one in seven.
Ranges drawn from studies of transfer from midwifery units, including the Birthplace in England programme. Rowe et al, 2013. Australian services publish their own figures and they vary; ask yours.
Ask your birth centre what its own transfer rate is for someone in your situation. It is a routine question and they will have the number.
Co-located and freestanding are different experiences
Most Australian birth centres sit inside or beside a hospital. Transfer is a walk or a short trolley ride down a corridor, sometimes only to a different room on the same floor. There is no ambulance and no drive, and the whole thing can be over in a few minutes.
That closeness makes it easy to underestimate. The walk takes two minutes; what happens at the other end can reshape the whole birth, and people arrive unprepared for it.
A freestanding unit, away from a hospital site, is closer to a home birth transfer: a decision, a phone call ahead, and a journey.
What actually changes
The reasons for moving are mostly unremarkable. Labour that slows, wanting an epidural, fluid that needs watching, a placenta that takes its time, a tear needing better light and repair. Urgent transfers are the smaller share.
What changes when you arrive is usually some combination of these:
- Monitoring. Continuous monitoring is often the first thing to change, and it limits how far you can move.
- The room. Bath, mat, beanbag and dim lighting are frequently left behind. Ask what you can bring with you, because the answer is often more than you would think.
- Who is in charge. An obstetric team takes clinical responsibility. In a midwifery group practice your own midwife normally continues alongside them. Ask whether yours does.
- The pace of questions. You start being asked to make decisions, several of them, in quick succession, while contracting.
Midwifery group practice
An Australian midwifery group practice usually means a small team, often around four midwives, with a named primary midwife carrying you through pregnancy, labour and the weeks afterwards. Caseload care of that kind is associated with better outcomes for first-time mothers, including more spontaneous labour and fewer elective caesareans.
Tracy SK, Hartz D, Hall B, et al. Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia. Full text.
On transfer, that means somebody in the room already knows you. She can say what you wanted without having to ask you mid-contraction, and she can do that far better if it is written down.
Birth Bridge is a free tool for writing that down before the day. It works through about sixty decisions at your own pace and prints three documents: a clinical directive laid out the way a ward reads, a brief for your partner and support people, and a copy to keep. Set the region to Australia for Australian wording and guidance. No account, and nothing you type leaves your browser.
If you are planning a home birth instead
Most of this applies, with an ambulance and a longer journey in place of the corridor. How home birth works in Australia is covered here.
Birth Bridge does not give medical advice and is not connected to any hospital or health service. Transfer rates, facilities and models of care differ between services, so use the figures here as a reason to ask your own birth centre rather than as a prediction. Go through anything you write down with your midwife.