Possible Medical Interventions
Reasons for transfer to secondary care, during childbirth
As midwives, we provide care for births that carry no increased medical risk. About 30% of births can be fully guided by us, while in roughly 70% of cases there’s a reason to transfer care to the hospital.
The most common reason for a hospital transfer is the wish for pain relief.
🏥 The hospital’s obstetric team – also called the “second line” – consists of nurses, hospital midwives, and obstetricians.
Is it a problem if my care is transferred?
No, not at all. Of course, we find it a little sad when we have to transfer your care, because it means we can’t stay with you until your baby is born. But what matters most is that you have a positive birth experience and that both you and your baby stay healthy. Sometimes that means your care is best continued by the hospital team.
How does the transfer work?
We always make sure that the hospital team is fully informed about your pregnancy and how your labour has progressed so far. We also share your wishes and preferences, so that the transition goes smoothly and causes as little disruption for you as possible.
Why is it helpful to read about this — even if it may not happen?
You can never predict exactly how your labour will unfold. Parents who already know what might happen are often less surprised and more confident if a transfer becomes necessary — and tend to look back more positively on their birth experience.
The 9 most common reasons for hospital transfer during labour
Note: These are listed in the order in which they typically occur during labour. The wish for pain relief is by far the most common reason for transfer!
Your waters have broken, but contractions haven’t started after 24 hours
If contractions haven’t started after 24 hours, the risk of infection increases. In the hospital, both you and your baby will be monitored for signs of infection. If there are no concerns, you can choose to wait another 24–48 hours for labour to start naturally, or opt for an induction.
The baby’s heartbeat will be continuously monitored with a CTG. If infection is suspected, you’ll receive antibiotics via an IV. The birth itself can usually proceed normally.
After birth, your baby may be observed for 12–24 hours before going home. You and your partner stay together with your baby until discharge.
Your baby has passed meconium (poo) in the amniotic fluid
This can be a sign of stress in the baby and slightly increases the risk of breathing difficulties after birth (around 5 in 100 cases). A CTG will be started to assess your baby’s condition. If contractions haven’t yet begun, they’ll be started with a hormone (oxytocin) infusion. The heartbeat will be continuously monitored.
After birth, your baby may be monitored for 12–24 hours. You and your partner stay together in the hospital until you can all go home.
Slow progress in dilation (cervix not opening)
Sometimes dilation slows down or stops despite regular contractions. This can be caused by weak contractions, the baby’s position, or tension and stress. We’ll first try natural methods — position changes, relaxation, or a warm shower. If these don’t help, we’ll transfer you to the hospital.
In the hospital, medication (oxytocin) can be used to strengthen contractions or pain relief can be given to help you relax. If dilation still doesn’t reach 10 cm, a caesarean section may be needed.
Changes in the baby’s heart rate
We regularly monitor your baby’s heartbeat. If it changes, this can indicate stress, for example due to reduced oxygen or strong contractions. We’ll first try simple steps like changing position and breathing deeply. If that doesn’t help, you’ll be referred to the hospital.
There, you may receive extra oxygen or IV fluids, and medications to reduce contractions. Often this restores the baby’s heart rate. If not, a small blood sample from the baby’s scalp (microblood test) can give more information. If the baby needs to be born quickly, the obstetrician may use a vacuum or perform a caesarean section.
You want pain relief
If you request an epidural or remifentanil, we’ll transfer you to the hospital. A CTG will be performed first (for 30–45 minutes) to check your baby’s condition. The hospital team will then discuss the pain relief options with you so you can choose what feels right.
Pushing isn’t progressing (slow second stage)
If progress stalls while pushing, we’ll first try natural measures like changing positions, emptying your bladder, or giving you more time. If there’s still no progress, we’ll transfer you to the hospital.
The hospital team may give oxytocin to strengthen contractions. If the contractions are strong enough but the baby still doesn’t descend, the obstetrician may use a vacuum or perform a caesarean section.
Heavy bleeding (mother)
Some bleeding is normal, but heavy bleeding can happen due to tears, placenta problems, or a uterus that doesn’t contract well after birth. We’ll monitor the bleeding closely and give medication to help your uterus contract. If it doesn’t stop, we’ll transfer you to the hospital.
There, you’ll receive IV fluids and treatment to stop the bleeding — for example, manually removing the placenta or giving stronger medications.
The placenta isn’t delivered
Normally, the placenta detaches within an hour after birth. If not, we’ll first try stimulating the uterus through breastfeeding, medication, or abdominal massage. If this doesn’t work, you’ll be transferred to the hospital.
There, stronger medications will be given via IV and the uterus will be massaged again. If the placenta still doesn’t come out, it will be removed manually under light anesthesia (manual placenta removal). You’ll wake up shortly after, and can reunite with your baby within 30–40 minutes.
Severe or complex tearing
If the anal sphincter is (partially) torn, the repair needs to be done in the hospital by a specialist. This is sometimes done with local anesthesia, but often under light sedation in the operating room. During this time, your partner stays with your baby until you return.
Summary: Trust in your care team
Go into your birth with an open mind! It’s completely okay to have wishes and a birth plan, but also to adjust them if needed. Thought you wanted a home birth without pain relief, but change your mind? No problem — we’ll arrange it. The hospital team is wonderful and, just like us, wants you and your baby to have a safe and positive birth. They’ll explain everything and help you make the best decisions for you.
- Have trust: Most births progress without major complications.
- Preparation brings calm: Knowing what might happen makes it less stressful.
- Keep asking questions: If something is unclear, please ask — we’re happy to explain.
- We’ll see each other again! If you’re transferred, the hospital team takes over until after the birth. Once you and your baby go home, your care returns to us.
🤰🏻 Important to know:
The reasons for transfer described above will never all happen at once! And remember — even if something unexpected occurs, you are never alone. Trust yourself and trust us as your care team. Together, we’ll make sure you and your baby are in safe hands.