The short answer: A transfer simply means your care moves to the hospital, because you or your baby could use more help, or because you'd like something home can't offer, like an epidural. Common reasons include a long, slow labor, being exhausted or wanting more pain relief. Your midwife plans the route with you months ahead and usually comes along.
By Sybille Mom of two · first birth in a hospital, second at home · Education only, not medical advice
"But what if something goes wrong?" It's the first question almost every mom asks when she thinks about a home birth. And it's a good one.
Here's what I've learned: feeling calm isn't only about candles and quiet. It's also about knowing someone skilled is watching, and that there's a plan. Once you know your plan, it gets much easier to stop rehearsing "what ifs" at 3 a.m. and get back to the important stuff, like sleeping and snacks.
The plan starts at your very first visit
A good home birth midwife talks about the hospital long before labor: which one, how long it takes to get there, how you'd travel, and what would make her recommend going. ACOG, the organization of US obstetricians, encourages women planning a home birth to have their provider make transfer arrangements with a nearby hospital before labor begins, and to have a quick, reliable way to get there. The American College of Nurse-Midwives describes planned home birth as part of a supportive, connected system, with a clear way to transfer to the hospital if it's needed.
So a transfer isn't an improvised moment. It's a plan you made together, sitting on your sofa, months earlier.
What I loved was knowing how experienced my midwives were. I trusted that they would know if I needed to transfer, so I didn't have to worry about it. I could just do my thing and feel comfortable at home, and if there was a sign, I knew they'd notice right away. That was my experience with my midwives, and it's a big part of why choosing someone you trust matters so much.
Why a transfer might happen
A transfer can happen during labor or after the birth. Common reasons include a labor that's moving slowly, being exhausted, or wanting more pain relief, like an epidural.
Sometimes your midwife notices something she'd like a doctor to look at more closely. Sometimes it's after the birth, when you or your baby need a check that's easier at the hospital. And if this is your first baby, it's extra worth talking through with your midwife ahead of time.
If you ask for an epidural, that isn't giving up. That's you listening to your body, and it's a perfectly good reason to go.
What a transfer usually looks like
Every midwife does it a little differently, so ask yours. Often it looks something like this:
- She tells you what she's noticing and what she recommends, so you can decide together.
- She calls ahead to the hospital, so they know you're coming.
- You travel by car or by ambulance, whichever your midwife recommends.
- She comes with you or meets you there, and shares your notes with the hospital team.
- The hospital team takes over your care. Depending on her license, your midwife may keep caring for you there, or stay with you as support.
The hospital team is there for exactly these moments, and I'm so grateful they exist.
Bring your calm with you
My first birth taught me how much it matters to feel included in what's happening. So if you ever transfer, bring your voice along. Ask what's happening and why. Ask for a minute to talk it over. Ask for your partner to stay close. Dim the lights if you can, and put your breathing music back on. Your birth is still your birth, wherever it happens.
A small "just in case" bag
- ID and your insurance card
- A copy of your birth preferences, with a short "if plans change" page
- Phone charger and headphones
- Something comfortable to wear home, for you and the baby
- A car seat installed in the car (you'll need it either way)
- Snacks for your partner. Trust me on this one. 🍪
Questions to ask your midwife about transfer
- Which hospital would we go to, and how long does the drive take?
- What would make you recommend going? Is there anything that would mean planning a hospital birth from the start?
- When would we drive ourselves, and when would you call an ambulance?
- Do you come with me, and will you stay?
- How often do your clients transfer, especially first-time moms, and why?
- What's included in your fee if we transfer, and what would be billed separately?
Every pregnancy is different, so talk it through with an experienced midwife and your care provider. They know you, and they're the right people to help you plan.
Questions moms ask
Does my midwife come with me if I transfer?
Many home birth midwives travel with you or meet you at the hospital and share your notes with the team there. Whether she can keep caring for you at the hospital depends on her license and the hospital, so ask her at your first visit.
Will I have to go by ambulance?
Not always. Depending on the situation, families may travel by car with their midwife or by ambulance. Your midwife will tell you what she'd recommend and when, so it's a great thing to talk about ahead of time.
Can I still have my birth preferences at the hospital?
Yes, you can bring them and share them. Things might change depending on why you're there, but asking for dim lights, your music, your partner close by and time to make decisions is always okay.
Does a hospital transfer cost extra?
Often it does, because hospital, doctor and ambulance services are usually billed separately from a midwife's package. For example, one midwife's practice lists physician, hospital and ambulance charges as not included. Ask your midwife and your insurance company what would be covered.
Is it a failure if I transfer?
Not at all. A transfer means you and your team made a good decision together, with your baby at the center. That's exactly what a plan is for.
