Home birth transfer means being transferred from home to hospital, either during labour or after birth, when a home birth was planned.

Recently on Instagram I saw a post that said, ‘home birth transfer is not a failure’. It resonated with me, as someone who had planned a home birth and ultimately ended up choosing to transfer in (read my birth story here). I never truly saw my home birth transfer as a failure – I made informed decisions at the time with the information I had and how I was feeling. Sure, I had the odd brain-gremlin afterwards, wondering if I could have ‘tried harder’ to have the home birth I wanted – but I never felt like a failure.

I would like to acknowledge that for some women a home birth transfer will be distressing – this could be down to the reason for and management of the transfer or the treatment they receive during the transfer or on arrival at the hospital. The Practicing Midwife have published an article recently about safe and compassionate home birth transfer highlighting the importance of communication and antenatal conversations around possible reasons for transfers, having a known midwife who is trusted by the woman or birthing person and ensuring that the transfer itself is done with privacy, dignity and emotional support – both during and after. 

Home birth is safe

We have heard of people being told they shouldn’t plan a home birth for their first baby ‘just in case’, or they’re ‘brave’ for planning a home birth, or to get ready for their ‘inevitable transfer’ – the last comment speaking to a belief that a home birth transfer is a failure. But you know what? Women and birthing people don’t ‘fail’ at birth (the system can and does fail us, but that’s a blog for another time!).

We have current, good quality research from the Lancet to show that home birth is a safe option for women and babies. It leads to less intervention for women and birthing people and is as safe as hospital birth for babies. This is true for both those classed as ‘low’ and ‘high’ risk. Although the risk of adverse outcomes is slightly higher for those in the ‘high’ risk category, the chance of there not being a poor outcome is significantly more likely. We know that women and birthing people who plan to give birth in hospital are more likely to experience interventions (that may not be necessary) than those who plan to give birth at home. We know that even just planning to birth at home reduces the likelihood of several interventions, even if ultimately the birth does not occur at home. According to the research from the Lancet, women with uncomplicated pregnancies who plan to give birth at home reduce their chance of having a caesarean section by 40%. For women with more complicated pregnancies who planned a home birth, research from the UK showed that 74% had a straightforward vaginal birth compared to just 51% who planned a hospital birth. Where you choose to birth has a significant impact on how you ultimately end up giving birth.

The culture of birth in the UK

In general there is a big misconception that giving birth at home is unsafe and that giving birth in hospital is inherently safe. We live in a culture that says that birth should happen in the hospital. Better to be close to the hospital ‘just in case’; a culture that sees home birth as a bit ‘out there’. So, whilst the research shows us home birth is indeed safe, society doesn’t quite believe it. And paradoxically we rarely question the safety of going into hospital to have our babies, despite knowing that our chance of interventions is increased just by being in the building. The NHS has just published the latest maternity statistics for 2023 -2024 showing a caesarean section rate (both planned and unplanned) of over 40%. This figure has been increasing year on year with no improvement in outcomes for women and babies and yet most people still choose to give birth in hospital because it is perceived to be safer. Something is evidently wrong and I’ll give you a clue: it’s not women and birthing people’s bodies, no matter what the media may have you believe. 

Interventions aren’t ‘bad’ per se

This is the bit where I do a small disclaimer – sometimes interventions are necessary. Sometimes they save lives. This is not a blog about interventions (eg caesareans) or hospitals being bad. Some women and birthing people will absolutely need to give birth in hospital. I’m grateful that we have hospitals and doctors who can do caesarean sections and instrumental births. I’m grateful for anaesthetists who can provide women and birthing people with pain relief. We live in a country where we have access to all this medical expertise and we absolutely should not take that for granted. But, and it is a big but, we do overuse the interventions in childbirth. Our medical system doesn’t trust the bodies of women and birthing people. It doesn’t trust birth. If the physiology of birth was understood, respected and protected by all working in maternity services, then perhaps we would see interventions only being used when truly necessary.

Why I would plan a home birth again

I have a strong belief that had I agreed to an induction of labour at 37 weeks, as is recommended by NICE for a DCDA twin pregnancy, I would have ended up with a caesarean birth (of course I can never truly know – but I do know that the odds would not have been in my favour). My babies did not choose to come for another 4 weeks (deepest apologies to my pelvis for that), my labour started spontaneously and I didn’t choose to go to hospital until I was very much in established labour (thank you to Natasha for persuading me gently to get back in the pool for several more hours!). I still had almost all the interventions under the sun, but I didn’t have a caesarean which I personally was very keen to avoid. My choices were mine to make and someone else in a similar situation might make completely different ones. If I have another baby, I would plan a home birth again because I know that this is likely to result in me having a straightforward vaginal birth. I would be given another ‘high risk’ label in future pregnancies because I had a postpartum haemorrhage, but that haemorrhage was from the episiotomy required for the forceps birth I had. Planning to birth at home automatically would reduce the likelihood of me having another instrumental birth and another episiotomy. Were I to choose mainstream maternity care, I would be encouraged to birth in the hospital because of this risk factor, even though I would be more likely to experience the interventions that could lead to a postpartum haemorrhage…is it making sense to you?! 

Home birth transfer is not a failure

Instead of seeing a home birth transfer as a failure, I believe we should acknowledge how great it is that someone made a choice to give birth at home and when they chose or needed to, there was a hospital and medical staff available to support them. How can it be a failure if women and birthing people are truly being supported to make decisions that feel right to them? How can it be a failure if the midwife recognised that an emergency was unfolding and more help was needed? What if we saw the availability of the hospital, if and when needed or chosen, as a gift? I’d hope that anyone who transfers to hospital during a planned home birth never feels like a failure – whatever the reason for transfer.

Interested in home birth? Want to chat about your options? Get in touch to book a free, no-strings attached chat. Head over to our birth stories page to read about some beautiful births.