Research shows that for a healthy, low risk pregnancy, a planned out of hospital birth is safe for the birthing person and the baby, and is even associated with lower rates of intervention, when compared to a planned hospital birth.¹ If you plan an out of hospital birth, your midwife will continue to assess if you are low risk. If your pregnancy or labour/birth becomes complicated, your midwife will recommend a hospital birth or transfer to hospital. 

If a transfer to hospital is required, transportation will be either by personal vehicle or ambulance. On the reverse side, you will find a list of reasons to transfer, and the most likely form of transportation. Your midwife will attempt to transfer you to the Civic Hospital, where we hold privileges, but sometimes the safest option is to transfer to the nearest hospital. If transfer is for the baby from the Ottawa Birth and Wellness Centre, the baby will be transported to CHEO.

If an urgent transfer is required, 911 will be called and paramedics will assist in the transfer. Your midwives will communicate with you throughout the transfer, so you know what to expect. At times, urgent care requires intense focus and there may not be time to explain what is happening. However, your midwives will debrief with you and your support people after the situation has stabilized. 

Reasons for transfer to hospital include, but are not limited to: 

In Labour

Non Urgent - likely transfer by personal vehicle

Most common - up to 30% 

• The birthing person chooses to move to hospital for an epidural
• Labour is not progressing normally
 

Less common

• Birthing person has abnormal vital signs or is ill (fever, flu, high blood pressure) 
• Meconium is noted (the baby’s first bowel movement) anytime after the water breaks

Urgent - transfer by ambulance

• Abnormal vaginal bleeding 
• Abnormal fetal heart rate
• Any medical emergency in the birthing person (shortness of breath, chest pain, etc.) 
• Lack of progress in the pushing stage 

Non Urgent - likely transfer by personal vehicle

• A tear that is too complicated for the midwife to repair (if bleeding is stable)

Urgent - transfer by ambulance

• Shoulder dystocia (difficulty delivering the baby’s shoulders)
• Abnormal fetal heart rate 
• Postpartum hemorrhage, if not resolved by midwives with usual methods
• Resuscitation of the baby 
• Retained placenta - when placenta is not delivered within 30 minutes after birth
• Abnormal vital signs of the baby/respiratory distress 

1. Eileen K. Hutton et al, 2016. Outcomes associated with planned place of birth among women with low risk pregnancies. Canadian Medical Association Journal. https://www.cmaj.ca/content/188/5/E80