Ep 173. All About Homebirth Transfers

Let's take a deep dive together and chat about all things home birth transfers. We'll discuss FAQs like the most common reasons for transfers, the midwife's role, and coping emotionally when birth doesn’t go as planned. Whether you’ve transferred in labor before, or are planning a home birth and want to understand transfers better, this episode offers essential insights and support.


01:09 Today's Topic: Home Birth Transfers
02:21 Personal Anecdotes on Disappointment
07:55 Diving into Home Birth Transfers
09:00 Common Reasons for Non-Emergent Transfers
12:26 Handling Emergencies and Complications
18:24 Importance of Communication and Trust
21:52 Questions from Listeners
30:16 Discussing the Role of Midwives in Hospital Transfers
31:02 Coordinating with Hospitals During Transfers
32:10 Navigating Hospital Transfers During COVID-19
33:05 Preparing for Hospital Transfers: What to Expect
34:44 Understanding Hospital Policies and Staff Interactions
36:57 Balancing Birth Plans and Necessary Interventions
39:50 Managing Expectations and Emotional Processing
45:16 Processing Birth Experiences and Moving Forward
50:03 Preparing for Future Births After a Transfer
55:21 Conclusion and Community Support

Links We Chat About:

How Midwives Handle Complications at Homebirths

Processing Birth Disappointment: Ep 74

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Transcript

0:00

Welcome to at Home with Kelly and Tiffany, where we share powerful tools, exciting education, and relatable views about holistic health, physiological birth, and thriving in the female body. We are home birth midwives in sunny San Diego. Passionate about the alternatives that give women control and confidence in health, in birth and in life. We've poured a lot of love into creating very in depth and high value offerings. A monthly membership, a physiological birth course, and holistic guides for the women who really want to dive all the way in. But this podcast. We want to bring zero cost information about health and natural birth and make these important topics accessible always. Your support of the show is also zero cost and means everything to us. When you leave a review, share an episode and join our newsletter. It really helps us keep this space open, ad free and full of honest, valuable conversations. Now let's dive into today's show.

Kelly: 1:09

Welcome back to the podcast ladies. I am Kelly.

Tiffany: 1:14

And I'm Tiffany.

Kelly: 1:15

And we are here as you can see in the subject of our podcast today, a really important, really commonly asked topic in general. All about home birth transfers. So we are home birth midwives in San Diego. Who we help women have babies at home, but certainly there are situations where transfers occur. We get a lot of questions, especially on Instagram about this topic. So we knew this was one of the top ones that we wanted to bring back when we brought back the podcast to answer a lot of those questions that we commonly get asked.

Tiffany: 1:50

And I'm excited to bring this information into like a deeper dive. So women who are curious about this as they're considering home birth for themselves, but also for women who have experienced home birth transfers. That seems to be sometimes one of the most impactful ways that we have this discussion is validating and processing that. That peace for women who plan to have a home birth and had to transfer for some reason, it can feel there can be so many emotions tied up in that. So before we dive in, our icebreaker for today, Kelly is sharing a recent disappointment of your own. And how you've been processing that, because I think that we often are pointing the finger towards processing disappointment in birth, processing, disappointment in how pregnancy was managed, processing, you know, some, some piece of. Pregnancy, birth postpartum. That just felt overwhelming and I was realizing that actually that's a muscle processing Disappointment is like a muscle that we flex throughout our entire lives and could be so helpful for women to consider that even before they get pregnant, how they process disappointment and how they move through something not going as planned. Give an example in your life of. It could be so minuscule too. It doesn't have to be like some big dramatic thing, but what's a, what's a piece of disappointment in your own life that you've processed recently?

Kelly: 3:23

There, it was funny but I feel like there's many that I could pull from, and that's just like the way life is sometimes, right? Where you're like, oh man, I've had to pivot a lot, or, you know, restructure what I thought was gonna happen a lot. The most recent one, just I've been on this dive, trying to sort out what we're doing next is, I created this landscape project for our backyard and I was like, this is it. Like we're really trying to redo it. A lot of it we're doing ourselves or as we're able to. But I created this kind of vision. And I was like, this is what's gonna really like, make such a sweet backyard space for all of us to be in and enjoy, you know, company, all of that. and it was like, this is the story of my life. Also, it was wildly more expensive than I anticipated, including getting quotes from multiple people, like our go-to guy who's like below the radar on all the things, all the way through companies who are like, we'll give you a percentage, you know, here's our sale. So it was just wildly more expensive than I thought and I was like. Okay, well you know what, then I, we can wait. I, we don't have to do it right now. How about we wait and we save up for it? Like I'm very patient when it comes to that stuff. We've lived in our house for a while. A lot of stuff still isn't done.'cause I'm like, I'm just not there yet, or I haven't found the right thing for that yet. Like, I can be patient that's like kind of added to the list of things that were like, well, maybe we should wait and save for that, that my husband was like, let's put these like in order of what we actually really care about. So anyway, we started pivoting and like kind of re we threw away that old plan basically, and we're like, let's start with something completely different and what else can we do to make this what we want it to be? But actually within a more grab-able. You know, nearer timeline for us. And so, yeah, it was just, it was a bit of like wanting something really badly and being like, but this is what this is, this is gonna make it perfect. And then realizing that's just sort of the vision that I had. There are other things that are going to. know, take up the space, make it comfortable for everybody and beautiful and all of that. So that's been like the recent thing, just because that's been on my, like if, I don't know if you're on Pinterest, but if you are and you follow me per my personal account somehow it's all landscaping ideas right now.

Tiffany: 5:38

I, you are giving me PTSD from my landscaping era.

Kelly: 5:43

Yep.

Tiffany: 5:43

I remember the time where I was like, okay, so while you're saying that, it's making me realize that sometimes the hardest piece to process is the vision of what it you thought it was gonna be. And my problem sometimes with being disappointed with something is that my, the reality cannot catch up to the vision. I cannot make the two pieces come together. And I did not do the work it took in order to get my vision to reality. Soon enough,

Kelly: 6:16

Mm.

Tiffany: 6:17

didn't do the research. I needed to affirm my vision is reasonable, and instead I thought what I was being like kind of modest and rather simple with the plan. Turns out I. It's not reasonable. I can't afford a$25,000 deck, even though I think that's the simplest way to fix the front yard is have this really cutesy deck. It's gonna cost$25,000 at best because lumber prices are insane right now. Now my entire vision has to pivot because. I didn't budget it right, and now I'm just, and all I can think about is the deck that never was, I spent too long on the vision and not enough time on the planning. And it reminds me it reminds me a little bit of the time where I swore I don't know where I was at mentally. I swore I was having a boy the second time, my second pregnancy. And we went to go get the gender reveal ultrasound early, and it's a girl again, and I, I love her. She's wonderful. There's nothing wrong with having two girls, but because I decided in my head that it was gonna be a boy this time I cried at the ultrasound and my husband's like laughing at me like, there's a 50 50 chance here, lady. Like, what? I'm not sure how you got so wrapped up in that. There's another example of the vision got away

Kelly: 7:51

Yep,

Tiffany: 7:52

from reality. Oh my gosh. Okay, well let's ju let's jump into home birth transfers.'cause I know there's a lot of information that we wanna share. On this topic, I asked Instagram, Hey, what are your questions about this? And we got some, we got a really good spread of them. But just to start out, just to provide some context for what we're talking about here, like there's, there we would have to talk about this. Topic for three or four hours in order to completely cover the scope of why would you need to transfer? What are the nuances of transfer? What if you're, what kind of recommendations would your midwife make? What might be going on in your labor, et cetera, et cetera. So. I know that we don't have time for that three hour podcast. We do have a ton of that level of information in our childbirth education course, so women who are thinking, I need a lot more of this type of processing. There's so much more in depth there, but just a general overview of why women might transfer from home to the hospital. Hospital. Can you give some examples, Kelly, of like, I mean, I, I think I wanna reiterate right off the bat that. 90% of our transfers are non-emergent, maybe even more than 90% of our transfers. We have a very small amount of women who transfer to begin with, so it's a very, very small number of women who are gonna have an emergent transport. Most of what we're gonna talk about today is non-emergent. There's a couple of different pieces there of being cautionary, risking out, and we'll talk about some of those. Things and we can get, we can talk a, we'll talk a little bit about the emergent transfer because I know that that's something that women, you know, wanna hear about. But let's just assume most of what we're talking about is non-emergent. Can you give some examples of what some of those transfer reasons would be?

Kelly: 9:49

Yeah, so obviously there's, there's transfers that can happen technically, like a transfer of care while still pregnant, right? Like you are no longer in this umbrella of low risk pregnancy, low risk mom, low risk baby situation. And so that can come up. Even potentially earlier than towards the end of pregnancy, right? Something can flag on an ultrasound and that gets more information where like, hey, actually the safest place for you to have your baby is actually the hospital, right? Or as you get closer, like here in California, we have a couple laws that oversee what we can do, like a planned breach birth or multiples, right? And so. There are some pieces or, you know, risking out in terms of timing, having your baby before 37 weeks or after 42. Again, those are California things. There's other states that kind of follow that. So there's, there's some of those pieces that like we are very, you know, quick to discuss leading up to even at the very beginning of pregnancy, right? But in labor itself. You are correct. The most common reason that we see women transfer is for a very, very long labor. And so we have been working on it for many hours. We are doing all of the things, we are sometimes doing nothing also to like let things just be and rest and you know calm down the nervous system and all of that. And so all of the many things that we can do at home. Over those many days. Mom in particular, we, we don't really ever make that call because again, it's non emergent. But if mom is like, no, I'm, I'm ready. I need a nap. I just need an epidural. I need to go to sleep and wake up and have like the resolve to actually have this baby. That is a great use of resource for that particular situation. Right? And so that's probably the most, the most common one that we see. There's obviously some other things that can come up during labor itself. If there we're dealing with heart tones for the baby that are just non-res reassuring in some way, particularly high, particularly low, in a particular way to contractions themselves, kind of giving us, like to think of a heartbeat of a baby as like telling us a story. That's the way that the baby can communicate with us. And so we use that information to say, what is the baby telling us? And so oftentimes that's not a. gosh, we listened to this once. This is a, an emergency, we need to leave right now. Again, it's a storytelling, Hey, this is what we're hearing with your baby's heartbeat. Let's try these things. Let's see how this, you know, goes over this next chunk of time. As of right now, it's not an eem. You know, we're not concerned. We don't need to do anything right now, but we just need to say like this out loud. Here's what we're hearing. Here's the story that's kind of being told. Those would be like kind of the top two flagged things of. More non-emergent situations. Of course, again, like you said, there's plenty of potential complications and emergencies that arise. Most of the time those are dealt with at home really well, right? And we can manage those at home without needing to transfer. Of course, there are so times where we say, Hey, we're doing all of the things. We're keeping things as stable as possible, but just isn't the right place for you or for baby, for whatever reason. Mm-hmm.

Tiffany: 13:06

just level of exhaustion is impacting her pulse or her temperature, or, her blood pressure, right? We've had a couple situations in pregnancy where the blood pressure or in labor where the blood pressured is kind of like a piece of concern. There's a couple of things that midwives do transfer for that we don't generally, and that is meconium present at labor. That is, that by itself is not a reason for our pra. We don't, our practice doesn't transfer just for that reason. We would be looking for other signs of fetal distress to accompany that sign. And then your water broken for too long. Without labor starting or without labor progressing. I mean, of course there can be some other factors in there that complicate that situation, but we don't transfer just because x amount of time has passed. After your la your water's broken, the concern there is infection. So then we're looking for signs of infection. We would transfer for signs of infection. So there's, there's a couple of like nuances even in what. What would be recommended, and there are some questions here today from our followers about agreeing or challenging the midwife's

Kelly: 14:18

Mm-hmm.

Tiffany: 14:19

for, for transferring you. So we can get into that a little bit too. And some reasons for emergent transfers. You know, like Kelly, you said, fetal distress. Like sometimes the heart rate is doing a thing and we're like, Hmm, this could potentially be a problem for later. Let's get you into a setting where this can be handled better. Usually there's other pieces that are going on with that, right? Sometimes there's a really obvious, your baby is not okay. This is not normal. We need to get you in for more monitoring. So that could be a piece of it. Postpartum hemorrhage is on the list, except we've not transferred for postpartum hemorrhage specifically in our practice. We've had severe transfers, or we've had severe hemorrhages, and we've had we've given the option to women, Hey, you're kind of on the, you're on the borderline here. These are the things that you can do to recover really well and will continue to monitor you. Or you could go in for blood products if you want to, but I guess the hemorrhage that was not able to be controlled at home. You, you, you automatically would call 9 1 1 once you realize that it's not gonna get under control at home. So that's a thing. The internet think shoulder dystocia is a reason for transfer and it's not number one because you do not have time. For your emergency personnel to come and not know how to handle so shoulder dystocia and get you to a hospital shoulder dystocia always has to be resolved at home. You need a midwife who is trained in that, those resolution things, and that's something to talk about. With your midwife, how does she handle shoulder dystocia? The baby always comes out at home. Sometimes you need to transfer because the baby was stuck for too long and needs further monitoring or more assessment or potentially more help, you know, as a result of shoulder dystocia. Along with. Postpartum hemorrhage. An emergent reason would be placenta abruption or suspected uterine rupture. We have not had that happen in our practice but it is a possibility. I think that that's important for women to talk about with their care providers. Like, hey. This is a risk. Do I have extra risk factors? How would you handle this situation? Along with blood pressure would be, you know, other really un reassuring signs with the mom if she keeps passing out, if she seems like she's potentially having a seizure, if she you know, is not okay for any reason at all, even if she just is like vomiting so much that she can't get a grip on. On labor that would be a reason to transfer. And then lastly on my list is a severe tear, which we have transferred. We did have one transfer for severe tearing. There's just only so much that a home birth midwife can do with the equipment and training that she has. There is absolutely a time and place for a trained surgeon to put your pelvic floor and vagina back together.

Kelly: 17:20

That one in particular, I remember being like the, the, even the provider who we transferred into was like, oh, this is, this is extensive. Right? And so being like, yes, our assessment of that was correct. Right? We can do a lot at home. But it was like validating in that particular way. I will say, we'll link in our show notes also some, some spaces to go check more into some of these things, like how do we manage hemorrhage at home? All of that. It's not like we're like, oh, you're just bleeding too much. Let's call an ambulance and hope that they get here in time. Like, we've done all we can do, and we kind of like wipe our hands and walk away. We're just continuing to work or continuing to breathe for the baby to help, you know stabilize your bleeding. All of the things. While we are en route to go do some of these transfer things. So I think that's just a helpful piece as you consider transfers in general because it's, it's not like, oh, just because we can't finish this at home just'cause we can't re resolve this completely at home doesn't mean that your midwife isn't continuing to keep you safe in that kind of interim time.

Tiffany: 18:23

Yep. And how midwives handle complications is a completely different discussion than home birth transfers. So go get some education on those pieces. We have an excellent blog post for that. Midwives are equipped for emergencies, and you need to know how your midwife is equipped for yours and be on the same page. That's also kind of a nod to a couple of episodes ago where, dads like to be involved in that conversation too. So much so that we have safety conversations, conversations about safety in birth with our clients throughout the entire pregnancy, and we leave that discussion open. We're really transparent about our capabilities and our background and our comfort level, and I think that's important to understand about your midwife because every midwife kind of goes about assessing risk and their responsibility with it a little bit differently. But we especially discuss emergencies that can happen at birth, at the home visit, that 36, 37 week visit where we ask everyone who's going to be at the birth to be present because they need, the whole entire team needs to be a part of that conversation. We don't have time to explain to you what we're doing if we're trying to handle an emergency. You just need to know, yes, we talked about this, my midwives. Have a plan for it. And I think that's a huge piece for women to not shy away from, not feel afraid to talk about with their care provider. And then Kelly, I'm just thinking right now that like I've heard you chime in on this quite a few times, but I. You should have these discussions with your obstetrician. Also, I think we assume if you're giving birth in a hospital with all the equipment and all the lifesaving devices and stuff, that you're just going to be like, well, if something bad happens, just handle it and I'll trust you to handle it. But if we're giving birth at home with a provider who's trained in to handle the same exact types of complications, we wanna know exactly. How they're prepared to handle it, what their perspective is, what the philosophy is for preserving physiology, how you're gonna be respected and treated, what the protocol is. And those discussions need to be happening with every care provider in every setting. I.

Kelly: 20:40

I, I think obviously as midwives we're just like, put under more scrutiny for whatever. I mean, there's like lots of cultural re there's just that's again a whole different conversation, but. You deserve that information matter where you're having your baby. And then that is part of making that informed decision of are you the right provider for me? Is this the right birth location for me? Those two things, provider and birth location, are going to impact your birth experience so much that yes, you absolutely should be asking, Hey, how do you guys handle shoulder dystocia? Oh, that's interesting. That sounds completely philosophically different than the midwife I just interviewed with. Interesting. I'm gonna bank that, you know, as I make my decisions. Kind of thing.'Cause it, does matter. And again, you deserve, you deserve the information and deserve to be a part of a part of it too.

Tiffany: 21:27

Absolutely, and there's plans that are in place for transfers. In fact, it's a part of California law that we have a written plan of. Where we're going to transfer, who we're gonna transfer to the types of working relationships we may or may not have in our community. And that needs to be disclosed to every single client. So women should be looking for that too. Okay. Let's jump into some of these questions because it's gonna provide a lot of context. We kind of did just like this overview of, of potential transfer situations. I wanna start out saying those of you who are listening or who are. Who are afraid of potentially having to have a transfer from home to the hospital? If you trust your care provider and if you trust the plan that was made, and if you. Participated really well in preventative care in your pregnancy. A transfer is a best and wise use of resources. It is not a failure. It is not plan B necessarily. It is not everything has to go out the window and everything that you wanted about your birth is ruined now. It is just a good. Use of resources.

Kelly: 22:51

I think that's just such a helpful reminder because we've had a couple. Transfer situations where, you know, we go in and the discussion of like failed home birth is, you know, mentioned or I've seen it charted before, maybe not said out loud and I'm like, I wanna rip my hair out because I'm like, this is. Part of what keeps home birth safe is that we are not so dug in the ground. All of us that we're saying it is home birth at all costs. I don't care what the outcome is, we're staying home. Right? That is not the philosophy. And so understanding what actually keeps home birth safe is recognizing a provider and mom, family relationship that is trustworthy enough to say, Hey, here's. this collective experience we're having. Here's the safest place to allow this to kind of un unfold and, you know, move forward. So that is always one of those things that just digs under my skin, that idea of something that's failed because it's completely not a failure, it's just, needing to move forward in a different way. Right.

Tiffany: 23:58

Yeah. And I think another thing that is worth sharing is the midwife has her own process of. Her role in your transfer, and it is something that greatly pains us even when it's completely necessary. We have spent hours and hours discussing and processing without you. It's not your responsibility as the woman or the client to be a part of that processing for us. But I'm thinking of the times that we have transferred and my, my greatest concern, of course, is safety. I want everybody to be safe when it comes down to should we transfer, should we not? But very, very, very close second, because we take. The, because we take the birth process and the experience so seriously, really close to safety for me is was it necessary? Was it absolutely necessary? Was there anything else that we could have done? Looking back, I'm so critical of are we sure we needed to transfer? Are we certain we needed to transfer because. I understand that there's a lot of midwives out there who would just, they always default to better safe than, sorry, better safe than sorry, and are very quick to transfer any time risk comes up. I do not, I don't identify with that. I do not want to, I don't want to be better safe than, sorry, I mean in the real context of things that I do, but I think it's so, I think there's so. To the safety discussion, then get you to higher level care if anything comes up.

Kelly: 25:43

Yeah, and honestly the you know, everyone's gonna practice differently. Understanding, you know, and asking good questions as you're interviewing midwives is gonna be important. But that is a huge sign to me of like. In some situations, I'm not gonna blanket everybody who has that mentality, but like of burnout also, of just like, oh man, I did everything. Okay, let's just like move. Let's just get this, keep this moving. Right? And that is a huge problem just with maternity care in general. Hey, just like, get on this, let's just keep this moving. Okay. We've started this thing and just like, I don't really care how it finishes, like please just, just go. And again, I'm not saying that every. Midwife feels that way or anything, but it's just a helpful piece. Seeing it from this side as a provider, but also from the other side as a mom. witnessing all of the different kind of nuances there. And it really does matter how your midwife is going to manage some of these things. So it matters. Again, coming back to selecting the right care provider for you which. in with a lot of research and responsibility and question asking of your own as well. But again, that responsibility is worth it. It's worth kind of digging into and, and asking some of those questions.

Tiffany: 26:53

Totally. Okay, Kelly, so how far in advance do we know that a transfer is happening? That is our first question.

Kelly: 27:02

I mean, it is, it runs the gamut, right? There may be, there's very rarely but could be a situation where we are saying. Oh, was so normal or like was well contained within this little normal sphere and now something just got chucked out of it so far that there's no way we can bring that back into normal. It happens so quickly. We need to go like as quickly as possible. Of course that can happen. The most common thing is that it might ping in our own brains. Wow. She's been at this for a really long time. We're really working. I'm throwing everything I can a few times at this, you know, using all of the different tools that I have, and you kind of see. Well, let's, I'm not gonna put this out there to her, right? But like, let's just kinda see where this potentially goes. Right? And so that idea may be kind of wormed in there, not in saying, I think you're gonna transfer so I'm just gonna stop doing stuff.'cause that's where we're eventually going. But we see things kind of play out over time, usually. And so similar with like vitals or something, right? If we can't get things to stabilize, we are thinking. Hey, probably eventually this is going to happen. So there's no actual timeline that we have to say like, oh, we knew it an hour. We knew for sure an hour ago, and now we're, now we're just finally talking about it. We, as midwives and as a team, have resolved to be very communicative. So the second we see something is sort of out of normal, we will say, Hey, we're noticing this thing. We're telling you now we're gonna work on this thing. To bring that back into normal it on its own, it's not an issue. But we also don't wanna see other things start to kind of like follow that thing that's out of normal. Right? And so that conversation maybe had a day before you have your baby, maybe have the 30 minutes before, right? But we don't, we never shy away from that. We don't ever wanna keep parents in the dark about something that's going on with their labor because she may say, Hey, that's actually, you know, that's a problem for me. I wanna go. And then that's an entirely different conversation than us clinically deciding to go.

Tiffany: 29:04

Yep. And I think our clients know that they can always make the decision to go. They can always say, I want to go, but. Unless it's a A, unless there's something clinically going on, we usually tell women, Hey, we are not entertaining the I want to transfer discussion, or Can't I just get an epidural or I'm done until you are getting up, putting pants on, grabbing your bag. Telling your husband, no, seriously, I'm getting in the car right now. And that's a completely different scenario and situation than actually talking about do you need to go in for something? Therapeutics, I think sometimes women think, you know, are thinking through that too. And then dads are like we always make sure to tell dads if we're acting normal and cool and relaxed and. Smiling sometimes and nodding our head and quietly leaving the room and giving you guys space. And then everything's normal and fine. We're not secretly gathering information. And then going to discuss, isn't this absolutely. Terrible. What a train wreck this is gonna be and not tell you. I think everyone's always like, is everything okay? Is everything all right? Yes. Assume everything's fine and everything's okay. Un unless we have some piece of information that we'll share with you. And it doesn't always mean, Hey, this is bad. This just means like, oh, this is what I'm noticing. Here's how we're gonna monitor that. Here's what this could mean. Here's what we're gonna do to try to prevent that from happening, right? I mean, the communication piece is huge. So women wanna know what midwife's role in a transfer do we go with women to the hospital? How do we work with the staff and that kind of thing.

Kelly: 31:02

Yeah. I mean, one of our, one of my favorite things about the setup that we have doing this together, and your midwife will have somebody there with her, right? Usually depending on where you're at in your labor and all of that. Is the fact that we get to kind of like tag team some of the big issues, right? And so one of us, whoever's kind of primary that during that birth will. Call the hospital, discuss the situation. We actually, from our electronic health records, can download all of your information, the labor, you know, stuff so far, and fax that over very quickly so that they have it before you even get there. They know who you are, they have a grid for it. They're getting some of your information before you get there. They are saying, yes, we are ready for this. Transfer. We've had some conversations that have been beautiful. Oh gosh, I'm sure she just really doesn't even wanna be here. We're gonna try to make this as, you know, best as possible. We've had other conversations saying, I can't believe that this is happening, and she's probably gonna have a c-section when we get here. And I'm like is, should, is this where we need to transfer? Like, what should we do about that? And so. Yeah, so there's a, there's a, it's not on the mom to like, call and say, Hey, this is what's going on. We call, we move forward with that idea of transfer one of us. So COVID messed everything up, right? Where we couldn't go at all and we didn't really have a ton of transfers, but that just sucked so bad to be like, okay, good luck. Right? And I don't know what exactly is gonna happen. And I, and I can't be there to like, hold your hand and say that things are gonna be okay. so, but what we, what we. Desire to do what the goal is, is that one of us will go right. Mom and dad usually are just driving themselves. If they're in an ambulance, obviously we're coming in a different car and usually what we're doing is gathering stuff to bring to them, right? Your clothes, your phone charger, all of that good stuff. And then one of us will stay home and actually clean up, right? Because your birth tub may be out. You probably don't wanna come home from your hospital birth to see your blown up birth tub sitting there and think about. You know, even more just the work you have to do, the what didn't happen, all of that. So one of us will stay home clean up. One of us usually will go with depending on the situation, right? And so. We're not the care provider though when we get there, we are always your care provider, but within that spectrum, we now are more so like doulas, right? And so we don't, we can give some clinical feedback, all of that, but we then are handing your clinical care over. And so that's generally speaking what that kind of transition looks like.

Tiffany: 33:25

And so women wanna know what what's the situation if they've never had prenatal care with a hospital-based provider, or what if their midwife doesn't work closely with the transferring ob? How does that work?

Kelly: 33:39

Yeah, so we ha we've transferred to obs that we have never met before. We've transferred in situations where I've been like, actually, I've never even been to this hospital. You live in a different area of town that I, you know, am not super familiar with anymore. And so again, we can download all of your records, all of your lab work, your ultrasounds. All of that and be able to share that with them basically instantly so that they have the information that they need so they can see, yes, you have been getting prenatal care. Look, your GBS negative, here's what your, you know, gestational diabetes screening tools looked like. All of those things can kind of get your, your background. They can also get it if you've said, I've declined everything in my pregnancy and here I am. Right. So they can get that information just so they understand. of who is in front of them. We like to give context too, right? So like over the phone can say the things that we want to, but really they're just kind of coming after some of that clinical data, which is very easy to share. And then that all of a sudden gives you like a history that they have access to too.

Tiffany: 34:41

Yep. So it usually goes pretty smoothly. I mean, in our community, especially with the, some of the emer emergent pieces and labor actually happening, the hospital has to receive the transfer. And so sometimes they like that, sometimes they don't. And

Kelly: 34:58

Yes.

Tiffany: 34:59

that's just what we're dealing with.

Kelly: 35:02

There are certain hospitals around here that are kind of known for being, you know, more willing, more kind, more gentle with transfers. And so you can kind of assess that in your own community. Ask your doula, ask your midwife. That's mostly just like what word on the street has been basically, oh, I had this good experience here. I had this bad experience here, kind of thing. And granted, we don't know who's on call. We don't know the nursing staff that day. We can't guarantee like, oh, you will be, you know, received Well. Amazingly enough, most of our transfers have actually been received quite well with a, with a sense of. This wasn't where you wanted to have your baby, but you're here now. So like, let's try to make this the best that we can. But also, you're not here anymore for this like low risk completely hands-off experience. Usually if you're going in, it's for, it's for something, right? And so there's not, not that you, you still absolutely have a say. You should say yes or no. You should have informed consent over all the things. It's just most likely gonna look a little bit different in terms of what you're desiring because you're going in. For something usually.

Tiffany: 36:09

Yeah, so you, there's a thing in our community, and I guess it will vary in many different ones. Even if you see an OB during your entire pregnancy and you're under their care and you're under midwifery care, they will not accept a transfer in labor for anything it is against their malpractice coverage or you know, something like that. And so that's important to know.'cause I think a lot of women think, oh, here's my backup plan. If this doesn't work out, I'll still get this great doctor and try to have this really great. Experience, but they're not allowed. Maybe they're the hospitalist that day, maybe they're already on rotation on l and d that day, and they end up being there to receive your care. But in our community, that is not something that we can ever guarantee or promise women.

Kelly: 36:56

Yeah.

Tiffany: 36:57

So once we get to the hospital, Kelly, what does how do women, you said we're going in for a reason, right? I think that's the, I think that's the ticket that. That need, we need to reframe what we're doing here because we had a lot of questions on Instagram about how do we preserve the birth plan, how do we try to keep interventions as little as possible? How do you know tho those, those kinds of discussions? And I don't mean to be little, that concept at all. We can still have as much, we can still try to protect physiology and the experience and try to have the best experience ever, but we're going in for interventions. That's what we're doing. There's going to be interventions. So how do we work with our clients on the balance there or on that spectrum of advocating for yourself, still trying to have the best experience yet going for the things that we're going for.

Kelly: 37:52

Yeah, I, I think you nailed it when we're, we're trying to preserve physiology as much as possible, right? We're, we're going into a thing that most likely is going to disturb that a little bit, but that doesn't mean like everything is completely railroaded now. An emphasis on really going slowly through these things as much as your safety, you know, situation allows for, right? Like if you're going in for. Man, my, my labor is just stalled and the contractions aren't doing a thing anymore. And we've done everything and yeah, I am gonna need some Pitocin. We can go in and we can slowly start that. We don't have to, we don't have to ramp up just because you've been in labor for a long time, right? We can slowly start that and remind your body, this is what we were doing before, is what we can do. We can kind of allow your hormones a second to kind of catch up to what we're trying to encourage your body to do. Then. Same thing with like an if you're going in for an epidural, right? Yet, no, that wasn't what you originally anticipated, right? But you can still make that a really connected experience. Yes. It's gonna come along with like, okay, well now I'm gonna have a catheter. Now I'm gonna have this like monitoring. But one of my favorite things to encourage moms to do who have an epidural, right, is if you're not, you could be still be feeling that like tightness. If you're not feeling anything and you're like, this is really disorienting, look over at the monitor. It'll show you when you're starting to, and you can hold your belly and you can do your nice deep breaths, and you can use that time to just talk to your baby, right? Connect with them and then enjoy the rest in between. Right? And so there's like some pieces that you can still say, Hey, I, I still have some control here. And just because you say yes to one thing doesn't mean you're saying yes. everything. But again, that reframing of Yeah, yeah. We're, we're here for a reason is a really helpful shift. You are always still in charge, but still recognizing, yeah, this is this, these are the reasons that this stuff even exists. It's not just for every birth and whatever, like this is a really good usage of these kinds of interventions and tools that they have.

Tiffany: 39:49

Yeah. And then for non-emergent transfers, which is going to be the huge majority of what we end up dealing with, there's, there's not, it doesn't automatically mean you're gonna have a C-section or you're going to have the, this worst case scenario thing happen. At your birth. We usually still have time on our side. We usually still have stable vitals on our side. That's why we went when we went. We usually have still lots of capabilities, and so that's an important part of the discussion is timing the transfer in a way that still gives you lots of options so that it's not an emergency, so that it's not something where we have to make decisions quickly and push it. But what would you say to women about. That C-section rate. I think the, I think women are afraid that transferring into the hospital means automatically they're gonna end up with a C-section.

Kelly: 40:43

Yeah, I mean that has happened for a couple clients of ours. That's like kind of how that story went and we can see how a very small amount of women actually. Really do at the end of the day, really need C-sections versus how many are actually getting them right. And so to recognize, oh, I'm so thankful for this because this is the situation where like this was actually needed. Right? Versus most of our moms are going in. Again, the most common reason for transfer is wanting that epidural, wanting to take a nap. Not kidding, right? Going in, getting the epidural, setting yourself up with like a peanut ball or with a bunch of pillows, right? And just sleeping for a little bit. Most of our clients are waking up and saying. Or, or their provider is saying like, oh wow, a lot has changed while you were sleeping. It's time to push your baby out. It's a, a very common, not saying that's everybody's experience, but it's really common. If that is the reason for transfer, to allow your body just to be like, man, I needed that and then I. To wake up and say, okay, we're like making progress, we're moving forward. We're kind of ready to have a baby, or we need a little bit more support to do that. But now I feel revitalized and can actually be involved in this conversation and be an active participant. I think that's a huge part of, of that. So I'm not exactly sure what the real stat is in terms of a home birth transfer turning into a cesarean, but for ours it's very low. Just because of, you know, I. A million different situations, but that in particular is a very common thread that we have, we've seen happen.

Tiffany: 42:18

Yeah, I'm thinking of a transfer that we had where it was emergent, four heart tones, really unstable heart tones. We had been in labor for quite a while and it was taking so long. And then once I started hearing heart tones become destabilized, then I was listening a whole lot more frequently and it was seemingly. Getting worse and worse. And so I called 9 1 1 and I'm telling everybody in the whole, during the whole transfer and the whole team, oh, we're just going to the hospital for a C-section, that's what we're doing. And then we get to the hospital and the provider's feeling just like really generous and like we do have a little bit more time and they're not rushing her back to a C-section, they're gonna let her labor for a little bit. And I'm like. This is really interesting. This is the opposite of what I came here for, but at least. But at least the ORs down the hall now instead of an ambulance ride away. Right. And so I'm just waiting and waiting and waiting for the OB to make the call to go do the C-section and finally they do. And I'm so relieved as the provider'cause I'm like, that's what we needed. We needed. We needed to cut this baby out immediately. Which of course is never on our, never, never a part of our plan, right? Not a part of our repertoire is please cut the baby out. And later the mom was having such a hard time processing that she ended up at the C-section. It just was mentally more than she ever. She just really didn't think that that could happen to her, or she felt like it was the worst thing that could happen to her in her birth. And she was, just asking over and over again, was it needed, could I have had more time? And while I was helping her process it, I was like. Yes. I thought if I could perform a c-section on you at home before we even called 9 1 1, if I can do that safely, I would've taken your baby out then. So it's, so mostly I'm demonstrating this, that there can be what was happening clinically. There can be processing the event as the first person that that's happening to, and then there can be years and years of. Trying to wrap your head around shifting from that vision, understanding reality, what was needed, questioning that, and even in a situation that to me, looked really appropriate for that high level of intervention for the mom, can still feel really disorienting, really disappointing. Really upsetting and just even processing with someone who was there and was your care provider and right. Like there's so many supportive pieces there. And still, it took a really long time during our postpartum, postpartum year together, and I'm not sure if she ever really finally arrived to, I accept that this happened. But let's talk about that a little bit. Kelly. Let's talk about processing the experience, processing the event. How do women even begin to process, no matter what happened to them, no matter what the, what the situation was with the transfer? How do women begin to wrap their head around that happening to them?

Kelly: 45:36

Yeah, I mean it's, it's hard because no matter, no matter what in birth, there's gonna be something that happens where you're like, oh, that was surprising or potentially disappointing. Pointing. Right? And so working through, no matter what your birth looked like, because for some people they may look from the outside and say, oh, well you had a vaginal birth. It all went straightforward, except for the fact that like, you just didn't get to do it at home. What are you complaining about? Right? But again, that idea, even that we were talking about the beginning, right? This vision that you have created, like it, it feels very, I mean, birth is so personal and so. Meaningful and impactful that like, of course, no matter what, even if you had your baby very straightforward and it was at home, right? There's still things that you're unpacking and processing. And so being able to say with a trusted person, whether that is your midwife, that is your friend who understands your heart for what you wanted, whether that is your spouse, who was like, dude, I went through that too, and I understand where you're coming from, not necessarily just anybody because you get a lot of, well, just be thankful of that. Like fill in the blank, right. But being able to actually say like, here's what I'm feeling. I'm so happy on this hand that my baby's here. I love my baby so much. Or maybe you're still like, I'm still trying to bond with this baby. Everything that happened kind of impacted that, you know, particular feeling and you're saying, this is not what I expected, but I have this baby and I am thankful that they are here. I'm getting to know them. Falling in love with them, all of that. But on the other hand, that sucked. I hated that that happened. I hated that I did all of this work that I spent all of this time. I did all I like, paid all this money, you know, all of it. And then I didn't get what I wanted. And everybody says, Hey, get a doula. Look at the percentage rate is so much lower. Hey, get a midwife. These stats are so much better. Right? And I did all their things. Right, right. And so then you're like, what's wrong with me? And that's a lot of processing that a lot of women do and kind of come back to of like. What hap what was wrong with me that this happened? Of course, the answer is nothing. Right? Of course the answer is just like birth. We're, we don't live in a perfect world, like things are fallen and broken and so things do happen. But being able to start to reframe some of those pieces of not shoving them down, but saying, where can I find, like where in my labor was I really strong? What am I proud of? From, you know from that experience, what situation was I in where I was like, man, this is hard, but I'm still gonna do it. Right. Starting over time to reframe some of those things, you may need to do that with a therapist. You may need to do that. We'll link in on a show notes, some ways that we recommend kind of processing some of those things. But. Actually doing the work and saying, I'm gonna, I'm gonna talk about this. I'm gonna journal about it. I'm gonna, you know, I'm gonna meet it rather than shoving it down. And recognizing also that time will make you kind of go up and down. Sometimes you'll be like, that was great, or at least I'm okay with it. And then there's gonna be times where you're like, that I'm dry heaving and I'm so sad, you know, about, you know, a particular outcome or a particular situation. And so, eventually you may never get to the place where you're like, I am okay with that. You may always be like that. That was terrible. Wish that didn't happen. You can accept that it happened and say, man, bummer. Right? Like such a huge bummer that that happened. You may never get to the place. And that, I just wanna say that too, just to encourage women that if you still feel like, gosh, five years later and that still kind of sucks. Yeah. It's. It is, it, it's because that sucked. And I'm sorry that you went through that. But we can still take some of those pieces and move forward healthily and wisely with that, where you can say, yes, everything. Ha oh, you know, everything happens for a reason or whatever. You, you know, kind of platitude you wanna say, but you can say, I can do, I can use this for good. This helped me become the mother that I am. This helped me become the woman that I am because I had to walk through some of that disappointment and grief. Through that.

Tiffany: 49:18

Right, and like I, I mean I've, I've probably shared on the show before, it took me four years to get to a place where I accepted my own cesarean. And that wasn't even an emergency situation. That was just, I hated that it happened and what that meant for who I was as a person and a mom, and. The disadvantages. I felt that that brought our entire everything. And it's be, I I, it took me so long because I was stuck. I didn't know how to move forward. And so I think your advice on continuing to process, getting help, talking to somebody who is trained in helping women process birth trauma and birth disappointment is hugely important. And then allow yourself the space to, have some more processing of that if you decide to have another baby and that you're different now, you're different because of that experience. You're, you're bringing your history into another pregnancy. You know now what can happen. The home birth picture is less idyllic to you, and it can be a really beautiful place to find yourself more rooted in the concept of. The transformation and the challenge and overcoming and victory in some of those spaces that is not completely outcome based and that there's some, there's some freedom in that and being able to ex to, to process and experience birth in that way. But like you said, Kelly, like being, being gracious with yourself, giving yourself some time, not being afraid to look at resources. Totally. Okay. If you want to try to have another home birth. And you wanna do it with a different team, potentially, you'll, you absolutely loved everything about these people, but you just can't do it. There's pieces of it. You just need to be different. And so you're gonna hire a different midwife this time, or maybe you need to do, maybe you need to have a doover with that exact team. Maybe the, maybe there's something important about. You know, navigating that piece again, and there's other things that you wanna bring, you know, some change in and differences to, and everybody's gonna kinda like navigate that a little bit differently.

Kelly: 51:40

Yeah, we've had, we've had clients who have chosen to have a different team the next time, and I've never once taken that personally because I'm like, I get it. And, and we have a good relationship, you know, whatever. Like, but you need something new. You need to write a new story, you want a different doula, you want, you know, just something completely different. Great. And then we've had the experience where we get to do a, you know, plan another home birth with a client who transferred and get to do that again. And it is, it's one of the more exhilarating experiences to just be on that side and be like, oh man, like to watch that unfold. So much of the pregnancy is usually. Processing that and saying, oh, I'm exci. I wanna get my hope. I do wanna get my hopes up a bit. I'm afraid of that feeling of, you know, feeling knocked down again if things don't go the way that I want them to. But like, I can still be excited about this idea that I really still want to happen in my life. And you know, it's the same thing, like when we have feedback. Clients who come to us, most of the pregnancy, we're like, we're not really treating this differently except we're doing a lot of emotional processing for. What birth can be like, what we would like it to be like, how we're gonna, how we manage disappointment, all of those things. So much, so much, so much of it is emotional processing that happens. And if you're not completely in the space of like, yes, I, so ready to get my hopes up, I wanna be with that same team. Like, we're going for this, whatever. But you're still just like, I'm pregnant again. I know that home birth would be really great. I'm still terrified. I'm working through a lot. It is okay to say. I'm stepping back into this relationship. I, I have a lot to work on this pregnancy. I have a lot of, you know, surrender and places to get through and to do that together is a really sweet thing that, that we get to do. And we get to witness that transformation too. I.

Tiffany: 53:31

Yeah, and for the woman who's listening who, who just wants to hear about home birth transfer, but has not had, is, is still preparing and waiting for her own birth, and is just looking for context on how to be prepared for something like this. There's a degree in which like to match with your personality and how you like to be prepared and feel safe to continue to do some research in this area. There's a degree in which safety can be talked about that is not fear-based. There's a way that being prepared can, can be done without expecting something to go wrong. Right? And so leaning into some of those pieces of having education, having information. Understanding different birth settings and what they have to offer. Having some type of, you know, exercise in self-advocacy, even if you don't have to do it with your current care provider in your, you know, in the birth setting that you've chosen. There's so many things that can change and, and are somewhat unpredictable with birth, and we don't have control over all of those pieces. And so it is okay to some degree to, play around with some of those ideas and educational pieces, and it's one of the things that we're passionate about discussing. Obviously we, we want women to be prepared and we think that women who have the most information are gonna be able to make the best decisions for themselves, even if it's a decision that they weren't prepared for. They can still use that. That advocacy muscle of how to make an informed decision about something that you don't know anything about, it is completely possible. We teach a lot of that in our childbirth. Education course. You can grab the link in the show notes. We still have that 10% off code for you guys too. And I think we'll wrap up this discussion now and see you guys in our next episode. But this is giving me a lot of ideas for future things that we need to bring onto the podcast and continue to discuss.

Kelly: 55:37

Absolutely great conversation and just like the, the foundation of it, that's the piece that I love, is that now hopefully women as you're listening, can say. Oh, that piqued my interest. I'm gonna go research that thing. Oh, I'm gonna go have that conversation. Oh, I'm gonna go ask that question. That is exactly what we want to be here for. So hopefully that gives you lots of food for thought and we will catch you next week.

56:00

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