Home birth transfer to hospital
Most women who plan a home birth have thought about this and then put it down again, because there is nowhere obvious to take the thought. This page is what actually happens, how often, and which parts of it you still get a say in.
How often it happens
More often than most people expect, and the number depends almost entirely on whether this is your first baby.
45% and 12%
In the Birthplace in England study, which followed nearly 80,000 births, 45% of women having their first baby at home moved to hospital during labour or just after the birth. For women who had given birth before, it was 12%.
Birthplace in England Collaborative Group, National Perinatal Epidemiology Unit, University of Oxford. Key findings.
Rates elsewhere land in a similar range. A systematic review of planned home births across several countries put transfer between roughly 9% and 32%, with the same first-baby pattern underneath it.
Blix E, Kumle M, Kjærgaard H, Øian P, Lindgren HE. Transfer to hospital in planned home births: a systematic review. BMC Pregnancy and Childbirth, 2014. Full text.
If you are having your first baby at home, transfer is close to a coin toss. Worth knowing, and worth deciding a few things around before the day.
Why it usually happens
The common reasons are slow ones. In the systematic review above, the single largest category was labour that was not progressing, at around 5% to 10% of all planned home births. Wanting stronger pain relief than is available at home is another. So is a placenta that takes longer than it should, or a tear that needs better light and better anaesthetic than a bedroom can offer.
Emergencies are the smaller part. Across the studies, roughly 4% of transfers were classified as urgent, which works out at well under 1% of planned home births overall.
Two of the commonest reasons have nothing wrong with them at all: you can run out of energy, and you can change your mind. Both are reasons enough on their own.
What the transfer itself looks like
Your midwife decides with you, calls the hospital ahead, and calls an ambulance if one is needed. The hospital knows you are coming and, in most cases, has somewhere for you to go when you arrive.
How you travel depends on where you are up to. If birth is not imminent and everything is stable, some services will take you by car. If you are close to pushing, or anything is urgent, it is an ambulance. Your midwife normally comes with you. If she is a privately practising midwife, whether she can keep caring for you inside the hospital depends on her arrangement with that hospital, and it is worth asking her about it now rather than then.
If you are in Australia, how home birth and transfer work here is covered separately, including the publicly funded programmes and the professional indemnity insurance change due at the end of 2026.
49 minutes
The average time from the decision to transfer to being assessed at the obstetric unit, for planned home births in England. Half of that is usually spent still at home, getting ready to move.
Rowe RE, Townend J, Brocklehurst P, et al. Duration and urgency of transfer in births planned at home and in freestanding midwifery units in England. BMC Pregnancy and Childbirth, 2013. Full text.
The handover
Most women describe the journey itself as manageable. What stays with them is the first ten minutes after they walked in.
You arrive in a room of people who have never met you, in the middle of a contraction, and within a few minutes you are being asked to make decisions about monitoring, about pain relief, about your baby. Your midwife gives a clinical handover. Nobody hands over what you wanted, because there is no established way to do that.
So the questions get asked at the worst possible time, or they do not get asked at all and something happens by default.
The gap is in the paperwork, and paperwork can be sorted out in advance.
What you can decide now
Nearly everything that gets decided in a hurry on arrival can be thought about calmly at thirty-four weeks:
- who rides in the ambulance, and who follows in the car
- who answers questions when you would rather not talk
- how you want to be asked for consent when there is very little time
- what order you want pain relief offered in, and what you would rather not be offered
- what happens in the first minutes after birth — the cord, skin to skin, who goes with the baby
- vitamin K, hepatitis B, the first feed
- what you want if it becomes an unplanned caesarean
- who is allowed in the room, and who is not
None of that is a guarantee. Circumstances overrule a plan, and a plan written in advance is not consent given in advance. It does mean the room already knows the answer to most of what it would otherwise stop and ask you.
Birth Bridge is a free tool for working through exactly those decisions. It asks you about sixty of them, one at a time, in whatever order suits you, and turns your answers into three printed documents: one written for the hospital staff, one for the people beside you, and one to keep. Everything stays in your browser. There is no account and nothing is uploaded.
What to have ready
A bag packed at around thirty-six weeks, sitting somewhere someone else can find it, and your plan printed and in the top of it. Printed matters. A phone gets locked, goes flat, or ends up in a car park, and a piece of paper can be handed to a midwife who is not looking at you yet.
Birth Bridge does not give medical advice, and nothing here is a substitute for your own midwife or doctor. The figures on this page are linked to the studies they come from so you can read them yourself. Go through anything you write down with your midwife before you rely on it.