"Things just aren't going the way we hoped..." {Tampa Bay Doula}

"...I think it’s time that we transfer your care.”

If you are planning an out of hospital birth, these are words you hoped you’d never hear, or thought wouldn't ever apply to your birth. I mean come on--you've eaten right, done all your prenatal yoga, read the latest Ina May book, and attended that 12 week long childbirth education class! You’ve done everything possible to prevent having to leave your intended birthing location. However, birth is unpredictable. As you and your labor partner prepare to transfer into uncharted waters, you’re feeling uneasy and wish that you would have hired a doula.

The National Birth Center Study II surveyed 15,574 women who planned a great experience with a birth center: 84% gave birth in the center; 4.5% were referred to a hospital before being admitted to the birth center; 11.9% transferred to the hospital during labor; 2.2% had their babies after transfer; 2.0% transferred after giving birth.  Of these births, 82% of in-labor transfers were first-time moms. Most transfers were non-emergency with the most common reason being prolonged labor.  The majority of emergency transfers were for non-reassuring fetal heart rate patterns or postpartum hemorrhage.  Out of 1,851 women who transferred to hospitals during labor, 54% had a vaginal birth, 38% had a cesarean birth and 8% had a forceps or vacuum-assisted vaginal birth.

Though a transfer of care can happen even before labor begins, transferring in the midst of it can be a bit of a shock to the system, leaving you feeling a wide range of emotions and unsure what to make of it all.  It’s overwhelming and happening so fast.  You just need a minute to wrap your head around it all…

In the event of a transfer, many times your midwife may be unable to transfer with you and stay for the duration of labor as an advocate for your experience. They have to respectfully transfer care to a new care provider. This is not the fault of the midwives, but simply the corner that our local birth climate has them backed into.  A doula, when usually hired in mid pregnancy, can go along on whatever journey the birth may take. Her job always remains the same – to provide emotional, informational, and physical support, be your advocate, witness on the journey, and to help slow down the moments of chaos.

But what happens when you didn’t think to hire a doula?

Maybe it was because you were having a homebirth or birth center birth, your midwife or OB suggested that you didn’t need one, you and your partner wanted it to be just the two of you, or it simply wasn’t something in the budget. But what happens then? Most doulas require you to hire before labor begins to establish a relationship and ensure that they are available for you. For families who decide during the course of labor that they really do want and need that extra support, a Transfer Doula is an option that may make all the difference.

What does a transfer doula do?

A transfer doula makes herself readily available in the event of a transfer from a birth center or home birth when the laboring mom and partner need a support person to transfer with them. She will remain with them for the entire birth process, providing:

            •           Unconditional emotional & physical support

            •           Help understanding their options for care

            •           Immediate postpartum care, including initial breastfeeding support.

            •           One postpartum visit within the first week

            •           Additional community resources such as mom groups, breastfeeding and Cesarean support groups

The biggest difference between a birth doula hired prior to labor and a transfer doula is that she makes herself available at the last minute to meet with a client with whom she never scheduled prenatal appointments and supports them during a very intense situation. When a transfer happens, a doula can bring optimism, encouragement, and knowledgeable support for her client during the change of environment. 

There are many other scenarios in which a transfer doula can be of service.  You can even think of it as the “Damn, we changed our mind” doula when you just want extra support in any birthing situation.

Inspired by my own birth experience, I found this small, mostly untraveled road of transfer doula work.  I was in a situation that called for a transfer from the birth center to the hospital, and I never once thought we would need a doula because we had an out-of-hospital midwife that could be there with us.  My husband and I wanted an intimate experience, but when the situation shifted we wished there would have been an option for us to call someone last minute. We wished something like this transfer doula service had been made available to us, but it wasn’t. We ended up feeling very alone, unsure, and scared walking into a place we never wanted to be in the first place.  As a newer birth doula trying to find my own place in the community, I attended the birth of a family I hadn't met ahead of time. It turned into a necessary non-emergent birth center transfer, and after a few interventions and rest, a mom who was told she had a 95% chance of a Cesarean had a vaginal, mostly unmedicated birth.  It was such a powerful experience to bear witness to. 

In the event that a hospital transfer turns into a Cesarean… I know from my own experience that this mama will need extra love and support. There’s not a more awful feeling than coming out of the operating room feeling alone and like a failure, especially when you had a very different birth plan in mind.  I have been on that side of the fence, and have known many others that have had similar experiences. If I could go back, I would have asked for a doula. I needed that extra support and so did my husband. Birth is highly unpredictable, and there is no wrong way to birth your baby, but it is wrong to feel abandoned and unsupported--especially when support and care exists and is simply waiting for your call. 

You can read my birth story and journey here.

And if you are interested in learning more about Transfer Doula services or working with me throughout your pregnancy and birth, I can be contacted at 727.417.7240 or via email at Melissa@barefootbirth.com. If you are a homebirth midwife or a birthing center I am happy to present an inservice for your staff to familiarize you all with this new service. 

Special thanks to Lee Anne at Remarkable Photography & the Swain family for sharing their own transfer story here in photos.