Home Birth Hospital Transfer Rates

d.cubed · June 2010

My husband and I are in the process of interviewing midwives. After taking a hospital tour yesterday at a very "natural friendly" hospital in Berkeley, I determined that home birth still feels right for me.

The one thing holding me back from just deciding, "Yes, we are doing a home birth!" is the transfer rate. Most of the midwives that we've interviewed have 15-25% hospital transfer rates. Considering that we would have to pay $5,000 out of pocket to have a home birth, I wonder if these transfer rates are high?

christina627 · June 2010

I'm not sure what the transfer rates for my MW were. Her rate is $2,200 I think for all prenatal, birth, and pp care combined. If you transfer care before the birth you aren't required to pay all of it. We technically transferred care the day before my son was born, but our midwife was there the whole time and did our pp care, so we paid everything still even though she said we didn't need to.

pinksweetpea2 · June 2010

Yes, they are high. My MW transfer rate was 5% and her c-section rate was 2%.

Also, $5000 sounds like a lot to me- what does that include? I live in a high COL area and I paid $3000 for prenatal, birth (with three MWs attending) and postnatal care, bought a birth kit for about $100 and rented an aqua doula for $250. I had all of my prenatal testing done before I switched to a homebirth, but I doubt that would have added up to $1,500.

christina627 · June 2010

I looked it up and my MW's transfer rates are 7%.

iris427 · June 2010

I think those rates sound high too. Are there other HB midwives you could look into?

Germanwife2b · June 2010

When I was learning about my MWs' practice, they told me that their stats were about a 10-14% transfer rate for 1st time moms and 7% or less for repeat moms. My MWs do 70% home births and 30% BC births and these are the stats combined. They also said transfers were usually due to maternal exhaustion, rupture of membranes for >24 hours or maternal request and very, very rarely do they ever have an emergent transfer. I think they told me that their c/s rate was <10%.

flyer23 · June 2010

Mine had a transfer rate of about 3%. Around half of the transfers ultimately resulted in a c-section.

d.cubed · June 2010

Thanks, ladies! These transfer rates felt high to me too!

I was also pretty stunned by how expensive it is around here to do the home birth! I was expecting around $3,000, but every midwife I've talked to (and I've talked to about 9) quotes between $4,500 - $5,000! Home birth midwives are pretty in demand, so I guess they can raise their prices!

pinksweetpea2 · June 2010

Germanwife2b:
rupture of membranes for >24 hours

See, this might be where you find one of the differences in percentages. My MW doesn't transfer for this reason- she just keeps the internals to a minimum.

I can't really can't understand why homebirth MW would have such a policy. The risk of infection doesn't come from the water being broken for more than 24 hours- it comes from too many people sticking their hands where they don't belong. My water was broken for my entire 40 hour labor. Transfering was never considered, but my MW did deny one of my requests to be checked because she didn't want to risk introducing bacteria.

strangebird · June 2010

d.squaredII:
Thanks, ladies! These transfer rates felt high to me too!
I was also pretty stunned by how expensive it is around here to do the home birth! I was expecting around $3,000, but every midwife I've talked to (and I've talked to about 9) quotes between $4,500 - $5,000! Home birth midwives are pretty in demand, so I guess they can raise their prices!

Couldn't this be due to location? You live in one of the most expensive areas of the United States. A lot of us are weighing in from rural areas and states like Michigan, Illinois, and Missouri, which are notoriously less expensive than California.

That said, the highest price midwife we encountered near Chicago was $3500, so I think you're being overcharged, but, again, I wonder if that is the going rate in SF. I've been there several times and if I only learned one thing it was that everything was more expensive in San Francisco.

LindseyJW · June 2010

i think that's HUGELY high. the practice i went with was 6 or 7% for hospital transfers. that included all moms though, and first timers have a higher transfer rate.

it also only includes those who transfer during labor. does your rate include only those moms, or those moms who have to be transferred to OB care prior to labor due to complications or post-term babies?

does your rate include all moms or just first timers? even with just first timers, i think that is a very high rate. at my practice, i think the first timer transfer rate was closer to 8 or 9%.

my current midwife has a 1% transfer rate.

CTri17 · June 2010

pinksweetpea2:
Yes, they are high. My MW transfer rate was 5% and her c-section rate was 2%.

Also, $5000 sounds like a lot to me- what does that include? I live in a high COL area and I paid $3000 for prenatal, birth (with three MWs attending) and postnatal care, bought a birth kit for about $100 and rented an aqua doula for $250. I had all of my prenatal testing done before I switched to a homebirth, but I doubt that would have added up to $1,500.

yeah this!

My MW has only had 5 people transfer(out of about 300), 2 of those were post birth just because she wanted to be safe and they were just fine . 1 Was a lady that didn't want to continue laboring at home. And 2 were because the mom's placentas weren't releasing and she wanted to be safe.

That ALSO sound like a lot for the HB MW, ours and we live in a HCOL area was $2200 and included all pre-natal, the birth, and 1 day, 2 day, 1 week, 2 weeks, 4 weeks and 6 weeks post partum mom/baby check ups.

Then we payed $150 for the pool and maybe $25 for supplies (the rest was included in her $2200).

d.cubed · June 2010

In terms of price, it is definitely a combination of 1. San Francisco (i.e. we pay more for everything around here) and 2. Demand. People LOVE home births around here, so these midwives are in high demand. I am taking two weeks to interview midwives (already had many, many phone interviews) and am having 5 face-to-face interviews. Already 2 of them have taken other clients for my due date!

It sounds like what I would get is similar to what others get in the rest of the country:

1-3 hour long visits in your home:Every 4 weeks until 22 weeks (gestational age)Every 3 weeks until 28 weeksEvery 2 weeks until 36 weeksEvery week thereafter until the birth5 post-partum visits I'll ask them to get more specific about the different transfer rates, but, yeah it does feel high to me too.

Lurker216 · June 2010

My midwife has about a 6% transfer rate. Most midwives I've spoken with have about a 10% transfer rate, generally for exhaustion/maternal request.

Mine charges $5,200 for all prenatal, birth, and postnatal care. She is a little more than most other midwives in my area but that's because she does all prenatals as home visits so I never have to travel to her. We are getting a discounted rate of $4,000 for paying in full before 36 weeks.

d.cubed · June 2010

Oh, and in terms of internal exams - they do not perform them at all, if I request that. I agree re: infection.

CTri17 · June 2010

d.squaredII:
Already 2 of them have taken other clients for my due date!

so what, ask them if it matters. There is only a 4% chance that you will give birth on your due date (though, I did, there was another friend of ours that was using our midwife that had the same EDD as me and she had her LO 13 days late)

And the fact that she comes to your home I'm sure definitely jacks the price up. We did all of our prenatals (except for the one at 34 weeks, which is the home visit) at her office.

duncanpowers · June 2010

I would ask specifically why they end up transferring so many patients to the hospital, and if that percentage includes the number of patients they have to transfer to OB care prior to birth due to pre-e, GD, and other complications. Also ask what their time limitation is on laboring at home, because if they're following hospital protocol, that could be some of it. I was watching one baby show on TV where the mw insisted the patient transfer after 24 hours, even though if you are not strep positive, you can be ruptured in your own home for up to 72 hours without developing additional complications. Because they're in such high demand where you are, they may have many more guidelines that are designed to weed out based on time.

d.cubed · June 2010

CTri17:
d.squaredII:
Already 2 of them have taken other clients for my due date!

so what, ask them if it matters. There is only a 4% chance that you will give birth on your due date (though, I did, there was another friend of ours that was using our midwife that had the same EDD as me and she had her LO 13 days late)
And the fact that she comes to your home I'm sure definitely jacks the price up. We did all of our prenatals (except for the one at 34 weeks, which is the home visit) at her office.

I meant "around" my due date. Most of them seem to only take 2-4 clients a month.

All of the home birth midwives here come to your home. There is only one that has an office to go to. And her price is the same as the others!

ScottiesLilHottie · June 2010

15 - 25% is very high for a homebirth midwife. My midwife's transfer rate is 5% and I don't think I'd be comfortable with a care provider who's transfer rate was over 10%.

ErinMSB · June 2010

I've only interviewed one HB MW so far. Her transfer rate is 12-14% with a c-section rate of 2-3%. The most common reasons for transfers were maternal request, exhaustion/long labor, and ruptured membranes for more than 24 hours (she said this was her policy, but that it's ultimately the mom's decision). HTH.

Kathzoo · June 2010

Transfer rate around here is 25%, and of those, 75% are for pain medication or labor augmentation (pitocin). 1 in 4 ends in C section.

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