My experience of transferring from home birth to hospital

by Mel Rimmer

Mel's first baby, Thomas, was born by caesarean section after she transferred from a home birth, for failure to progress in the second stage.

Mel's second baby, Eleanor June, was born at home on Saturday 15th January 2000, weighing 8lb 5.5oz, after a 7 hour labour. Eleanor's birth story is online.

What happened at Thomas's birth?

I planned a homebirth, and had a lovely experience at home although we transferred to hospital after 4 hours in second stage, since the baby's head was not moving at all. I ended up with a caesarean (low transverse), and a healthy beautiful 7lb12oz boy. He had been posterior and his head was deflexed, which was presumably the reason for lack of progress, despite (believe me) vigorous pushing in every imaginable position.

I'm not bitter about the section - I think we probably tried everything we could have, and waited long enough to be sure things just weren't going to happen at home. Nevertheless, it wasn't the birth I had hoped for, and I wanted to avoid it happening again.

Were you prepared for the possibility of transferring if your first home birth didn't go according to plan?

I could have done with thinking more about the possibility of transfer, and preparing myself more for it. I would certainly have benefited from finding out a lot more about caesareans, because I was terrified and in the dark when it happened to me - which I hated. Two of the feelings I was precisely trying to avoid. In the effort to feel positive during pregnancy, I kept telling myself "It won't happen to me".

In the event, I only remembered some advice from a friend who had had two sections, one with a general and one with a spinal. She said "If you have a section, have local anaesthesia." I was so scared I would have loved to have been "put under", but I remembered what she said and just had the epidural topped up, and I'm very glad I did.

How do you feel about having transferred?

I was interested to read the abstract from the Dutch study on your site which said that the experience of birth wasn't affected by transferring to hospital. I think that would surely depend on how you measured it, and also on the reason from transfer.

For example, I was glad to have a healthy baby, and I was convinced that the transfer and the section were necessary, under the circumstances. It was a pity I couldn't have had the baby at home, but I wasn't absolutely devastated about it. Would the researchers in that study have concluded my experience of birth was unaffected? Possibly.

But just imagine if I had had the baby at home. Have you ever heard a home birth mother who said "Oh well, I'm glad I've got a healthy baby and I'm not devastated"? No, they're much more likely to say things like "It was amazing, a transcendent experience. I'm so glad we did it this way. I'll definitely do it like this again next time."

So I would say, absolutely, my birth experience was affected negatively by transferring in. I don't need therapy to get me over the disappointment and bitterness. But there was an effect, and it was negative. Now, if I thought the transfer was unnecessary - that would be a different story altogether.

And surely if you need to transfer in, then by definition you probably need some intervention. In my case, a section. Not a transcendent experience - more like a really, really horrible experience, mitigated only by the belief that it was necessary to save my baby's life (and my own). Any intervention isn't nice. No-one has forceps for fun. If they did, you'd be able to buy them in Ann Summers shops.

NB: Ann Summers shops are a UK chain selling 'marital aids'!

Presumably people who already planned a home birth are even more anti-intervention than those who planned a hospital birth. I just can't believe that finding that transfer didn't affect the birth experience!

Note from Angela: I found the Netherlands study puzzling too. I wonder if it has to do with the fact that childbirth care is so different there. Apparently it is common for women and their midwives to stay at home in the early stages of labour, and to only decide the final place of birth on the day when they have seen how the labour is progressing. For more details, see Beatrijs Smulder's article about midwifery and home birth in the Netherlands.

I agree. I think the systems are so different there that it's not easy to make a comparison. I find it amazing that differences in set-up between e.g. USA, Netherlands, and UK, make such a difference in outcomes (and I mean women's experiences, not just mortality rates).

Compare the system in the Netherlands, where around 30% of babies are born at home, to the UK or USA. Here, you have to make a big commitment to book a home birth, and may have had to fight hard to make that booking. Maybe when you have to transfer after making that mental commitment, and having fought for a home birth, transferring is more disappointing, and feels more like a 'failure', than it would otherwise.

You're absolutely right. When I pushed Eleanor out one of my first thoughts was "That showed them!", as if the only point was to put one in the eye of the obstetrician etc. In a way, it's a shame that it had to be a battle. The conflict overshadowed the whole pregnancy and labour. On the other hand, I can't help thinking that next time I'm going to have to do something even more outrageous - I couldn't imagine having a baby with the blessing of the medical establishment ;-)

What advice would you give to other mothers planning home birth? Should you dwell on the possibility of transfer?

It's so hard to draw the line between being really positive ("I'm definitely going to have this baby at home") and being unrealistic ("I'm not even going to contemplate what would happen if I had to transfer"). I know a lot of women become quite superstitious when they're pregnant, even if they're not normally. It sometimes feels as if packing a hospital bag, just in case, is tantamount to admitting defeat, or inviting disaster.

At the time she wrote this, Mel was still pregnant with her second baby:

You're planning a home birth after caesarean for your second baby. Have you found this difficult to arrange?

I haven't actually had any opposition to booking a home VBAC (vaginal birth after caesarean), as such, but I haven't had a lot of support, either. My midwife has recently taken a turn for the better, having spoken to an independent midwife who said that she'd done home VBACs and they were no trouble at all.

I've had to see the obstetrician, which I didn't have to with my first planned home birth. I was expecting him to try to talk me out of it, and took my partner for moral support, but actually he was quite nice. I get the impression that his idea of a high risk mother is one who takes methadone throughout her pregnancy, not a nice mum who had done her research and wanted a home VBAC (that's me, by the way!). So my advice is get an ob. from Liverpool or some other inner-city area, whose standards of "high risk" would make your eyes pop out!

I still have to see the director of midwives, and I don't know if she'll try to scare me. I think I can be scarier! And I have to see the ob. again when I'm 36 weeks. Except I'm 36 weeks about Christmas day, and the ob. is having a nice long holiday over Christmas and the New Year, so the appointment is actually more like 38-39 weeks. With luck, I may have delivered by then. So my second piece of advice is to have a due date towards the end of January, preferably on the turn of the Millennium, and the ob. will be too busy partying it up to try and scare you when you're nearly due!

By Mel Rimmer

Mel's second baby, Eleanor, and her third baby, Samuel, were borth born at home.

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