What is your transfer rate?
Home to hospital
The plans are tender, intimate, and well thought out. Something changes, and a planned home birth has shape shifted into a hospital birth.
While the majority of transfers occur as non-emergent, acknowledging the most common transfer reasons can be uncomfortable for parents. It is helpful to keep in mind that the actual risk for each factor is low.
Why does transfer happen?
Pregnancy
Most practices do not include transfers of care during pregnancy prior to labor into their transfer statistics. While this inclusion isn’t required, it is helpful for families to know that there are important reasons to change place of birth plans during pregnancy from home birth to hospital birth.
These are most commonly: high blood pressure, uncontrolled gestational diabetes, or post term (over 42 weeks) and associated events.
Labor
This is the most commonly reported statistic for transfers. Once labor is established, a transfer may occur for very slow or no progress, maternal exhaustion/request, thick meconium, signs of infection, or concerning fetal heart rate.
After the birth
What occurs after a birth is most often, but not always, included in the transfer rate. The most common reasons are: severe postpartum hemorrhage, preeclampsia signs/symptoms, and newborn complications.
How often does a transfer happen?
The overall transfer rate ranges from 9.9% to 31.9% (Blix et al). It is important to note that prenatal or antepartum rates of transfer are NOT included in this statistic. Further, birth records do not capture transfers. They are self-reported by providers/practices. This means we don’t know the actual transfer rate of each region, state, nor the U.S. overall.
What factors influence a transfer rate? As we can see, factual reporting is a significant factor. In real time, transfers occur for many factors such as patient request, fetal intolerance, high risk diagnosis developments, and other concerns which may not develop until well after birth. Providers must be transparent about their transfer rates, timing, and reasons.
What is your transfer rate??
For 2021, the transfer rate including prenatal transfers was 22%. The transfer rate for intrapartum and postpartum periods only was 14%.
This is quite a low transfer rate considering: 1) Rewilding’s first full year in practice, as well as 2) purposefully low client volume, will impact the percentage by a reverse of small sample fallacy.
In short, the Rewilding transfer rate represents a win regardless of the number. Why?— because successful transfers are based on maternal-fetal need and client decision. When the experiences of safety, support, and respect are paramount, focus on an arbitrary number devalues the outcomes and family experience.
At the end of the day, I would rather have a 50% transfer rate than a single loss/injury due to refusal to transfer when clinically necessary.
