What Happens If a Home Birth Needs to Transfer to a Hospital?

Written by Igel Cudiera
Published October 1, 2026

A home birth transfer to a hospital means that labor, birth, or the hours after birth move from your home to a hospital. It can happen during labor (an intrapartum transfer), after the birth for you (a postpartum transfer), or for your newborn. This guide walks through what actually happens, step by step, so you know what to expect and what to plan before labor.

If you are still deciding where to give birth, our article comparing home birth and hospital birth covers safety research and outcomes in depth. This article focuses on the transfer itself.

When Does a Home Birth Need to Transfer to a Hospital?

A transfer happens when your midwife, or you, decide that the care you need is better provided in a hospital. That can be because labor is not progressing, because a finding in you or your baby needs closer monitoring or treatment, or simply because you want something that is only available in a hospital, such as an epidural.

Planning for a possible transfer is built into every well-planned home birth. The American College of Obstetricians and Gynecologists (ACOG) reports that the risk of needing transport to a hospital during labor is 23% to 37% for people having their first baby and 4% to 9% for people who have given birth before. ACOG's 2025 statement on transfer protocols estimates that 10% to 25% of planned out-of-hospital births involve a transfer during or after labor. The difference between first and later births is large, which is why parity (whether this is your first birth) matters so much when you think about your own likelihood of transfer.

Is Every Home Birth Transfer an Emergency?

No. Most transfers happen because labor needs something home cannot offer, not because of a sudden crisis. In a systematic review of planned home births in Western countries, emergency transfers ranged from 0% to 5.4% of women planning a home birth, while total transfers were considerably higher.

It helps to think of three levels:

• Non-urgent transfer. Labor is slow, you are exhausted, or you want an epidural. There is time to get dressed, gather your bag, and travel by car.
• Urgent transfer. A finding needs hospital assessment soon, such as rising blood pressure or a change in your baby's heart rate pattern. Depending on the situation and the distance, your midwife may recommend a car or call an ambulance.
• Emergency transfer. Something needs hospital care immediately, such as heavy bleeding or a baby who needs help breathing. Your midwife calls 911 and begins emergency care while help is on the way.

Your midwife decides which level applies, explains why, and keeps reassessing, because a non-urgent situation can become urgent and an urgent one can settle.

What Happens When Your Midwife Recommends a Hospital Transfer?

The Home Birth Summit's best-practice transfer guidelines, endorsed by ACOG and the American College of Nurse-Midwives, describe what a well-coordinated transfer includes. The exact steps vary by practice and hospital, but a planned transfer generally looks like this.

The midwife assesses the situation

Throughout labor and after the birth, your midwife monitors you and your baby. When something falls outside normal limits, or when you ask to go, your midwife explains what they are seeing, what the options are, and what they recommend. In a non-urgent situation, you have time to ask questions and decide together.

The receiving hospital is contacted

Your midwife calls the hospital before you leave. The guidelines describe this call as covering the reason for transfer, a brief relevant history, the planned mode of transport, and your expected arrival time. That call lets the labor and delivery team prepare. The guidelines also note that timely access to hospital care may be best achieved by admitting you directly to labor and delivery (or, for a newborn, to the pediatric unit).

Transportation is arranged

A non-urgent transfer is often made by private car. Ask your midwife in advance who drives, who rides with you, and whether they travel with you or meet you there. For an urgent or emergency transfer, your midwife calls 911. The guidelines describe the midwife continuing care en route, alongside emergency medical services, and supporting you emotionally through the change of setting.

Your records and clinical information go with you

On arrival, the midwife gives the hospital team a verbal report on your current condition and any need for urgent care, along with a copy of your relevant prenatal and labor records: lab results, ultrasound reports, and a summary of labor so far. This means the hospital team does not have to start from nothing, and you do not have to recall details in the middle of labor.

Care is handed off to the hospital team

What happens next depends on your midwife's hospital privileges and the hospital's policies. Some community midwives can continue as your clinical provider in the hospital. More often, clinical responsibility passes to the hospital team, and your midwife can stay in a support role if you want and the hospital allows it.

What Are Common Reasons for Hospital Transfer During Home Birth?

ACOG lists the most common reasons for transport during labor as lack of progress, nonreassuring fetal status, need for pain relief, high blood pressure, bleeding, and the baby being in a difficult position. Grouped by who they concern, reasons your midwife may recommend a transfer include:

Reasons related to labor or to you:

• Labor that is not progressing, or a very long labor
• Exhaustion, or wanting an epidural or other pain relief not available at home
• High blood pressure or other concerning findings in your vital signs
• Bleeding during labor, or heavier than expected bleeding after the birth
• A placenta that does not deliver as expected

Reasons related to your baby:

• A heart rate pattern that needs continuous monitoring
• A baby in a position that makes birth at home difficult
• A newborn who needs help with breathing or needs further evaluation after birth

None of these automatically means a transfer. Your midwife weighs the finding, how you and your baby are doing overall, and how much time there is. How often each reason occurs is covered in our home birth and hospital birth comparison.

What Happens When You Arrive at the Hospital?

Once you arrive, the hospital team assesses you and your baby, usually in the labor and delivery unit. Expect some or all of the following:

• Assessment. A nurse and physician or hospital midwife review your midwife's report and records, check your vital signs, and assess your labor.
• Monitoring. Depending on the reason for transfer, the hospital may monitor your baby's heart rate continuously.
• Discussion of options. The team explains what they recommend and why, whether that is an epidural, medication to strengthen contractions, closer observation, or other treatment.
• Ongoing decisions. You remain part of the decisions. The best-practice guidelines call on hospital staff to use shared decision-making and to build a plan that reflects your values and preferences.

ACOG also states that when a transfer from home occurs, the receiving clinicians should maintain a nonjudgmental attitude toward you and the people with you. If a physician needs to become involved, our article on when a midwife brings in an OB-GYN explains how that relationship works.

Will My Midwife Stay With Me During the Hospital Transfer?

It depends on the practice and the hospital. Under the best-practice guidelines, a community midwife may continue as your primary clinician if they have privileges at that hospital. If not, they hand clinical care to the hospital team, and they may stay to support you, in line with hospital policy, if you want continuity with someone you know.

Practices differ, so ask directly before labor: Will you come to the hospital with me? Will you stay after the handoff? What will your role be? Holistic Midwifery New York offers both home birth and planned hospital birth with a midwife, and our midwives can walk you through exactly how a transfer would work in your situation during a consultation.

What Happens to the Birth Plan After a Hospital Transfer?

Your birth plan changes setting, but it does not disappear. The reason for transfer shapes what is possible. If you transferred for an epidural after a long labor, much of your plan may still apply. If you transferred for a concern about your baby, the priority becomes addressing that concern, and some preferences may need to wait.

Informed decision-making continues in the hospital. You can ask what each recommendation is for, what the alternatives are, and what happens if you wait. Whenever possible, the guidelines say, a parent and newborn should be kept together during the transfer and after admission.

Does a Hospital Transfer Mean the Home Birth Plan Failed?

No. Planning for a possible transfer is part of planning a home birth. ACOG describes timely transfer and an existing arrangement with a hospital as a requirement for considering home birth at all, which means the transfer pathway is part of the plan from the start.

Some parents feel disappointment or grief after a transfer. Others feel relief. Mixed feelings are understandable. It can help to talk through the birth afterward with your midwife, and the best-practice guidelines encourage a debrief that includes the family and the providers involved.

After the Transfer: Postpartum and Newborn Care

Transfer can also happen after the baby is born, for you or for your newborn. After a hospital stay, care can return to your midwife: the guidelines describe the hospital and midwife coordinating follow-up, with care reverting to the midwife after discharge and a discharge summary sent back to them. Ask how your midwife handles postpartum care after a transfer, including home visits and newborn checks.

How to Prepare for a Possible Hospital Transfer Before Labor

Transfer planning starts during pregnancy. The guidelines expect the midwife to explain hospital care and document a transfer plan with you, and ACOG's 2025 statement supports clear communication about transfer logistics, limitations, and scenarios. Your prenatal visits are the time to work through it. A practical checklist:

• Know the receiving hospital. Its name, address, which entrance to use, and where labor and delivery is.
• Know the route. Realistic travel time at different times of day, and where to park.
• Understand transport options. When a car is fine and when your midwife would call 911.
• Ask how records travel. Keep copies of key results, and know what your midwife will bring.
• Decide who comes with you. Your partner, doula, or support person, and who stays with older children or pets.
• Keep a short contact list. Your midwife, your backup support person, and your childcare.
• Pack a small bag. ID, insurance card, phone charger, and a few essentials. Our home birth supplies checklist covers what to gather for the birth itself.
• Discuss what happens if labor changes. Including what you would want if an epidural becomes an option.
• Learn the hospital's procedures. For example, visitor rules and how they handle incoming transfers.
• Understand your midwife's transfer protocol. Including their collaborating physician or hospital.

Questions to Ask Your Midwife About Hospital Transfer

• Which hospital would I transfer to, and why that one?
• Who is your collaborating physician or hospital, and what does that relationship cover?
• Do you have a written transfer agreement with the hospital?
• How do you decide between a car and an ambulance?
• What do you tell the hospital when you call, and what records do you bring?
• Will you come with me, and what is your role once we arrive?
• What happens if my baby needs to transfer after birth but I do not?
• How many of your clients transfer, and how many of those were urgent?
• How do you follow up with me after a transfer?

For a broader interview list, see our questions to ask when choosing a midwife.

Home Birth Transfer in New York: What to Know

A few New York specifics shape how transfer works here:

• Licensed midwives can attend births at home. The New York State Education Department lists clients' homes among the settings where licensed midwives practice. Certified Nurse-Midwives and Certified Midwives hold the same New York license.
• Every licensed midwife must have a collaborative relationship. Under New York Education Law §6951, it must be with a board-certified OB-GYN, a physician with obstetric privileges, or a hospital that provides obstetric services, and it must include plans for emergency obstetric coverage. Midwives must make information about these relationships available to their patients, so you can ask.
• Hospitals must evaluate people in labor. Under the federal Emergency Medical Treatment and Labor Act (EMTALA), hospitals that participate in Medicare and offer emergency services must provide a medical screening exam for an emergency medical condition, including active labor, regardless of ability to pay, and provide stabilizing treatment.
• A transfer can add hospital and physician charges. Our guides to how insurance handles a hospital transfer and Medicaid coverage for a home birth explain what to check with your plan.

For how home birth works more generally in New York, see what a planned home birth involves.

This article is general educational information about planned home birth and hospital transfer. It is not medical advice and does not replace individualized care from your midwife or physician. Every pregnancy and labor is different. If you think you or your baby need urgent care, call 911.

Sources

• American College of Obstetricians and Gynecologists. Planned Home Birth, Committee Opinion No. 697 (2017, reaffirmed 2026).
• American College of Obstetricians and Gynecologists. Transfer Protocols for Out-of-Hospital Birth, Position Statement (December 2025).
• Home Birth Summit Collaboration Task Force. Best Practice Guidelines: Transfer from Planned Home Birth to Hospital (updated 2020).
• 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;14:179.
• New York State Senate. Education Law §6951.
• New York State Education Department, Office of the Professions. Midwifery: Questions and Answers.
• Centers for Medicare & Medicaid Services. Emergency Medical Treatment & Labor Act (EMTALA).