"The Very Best That It Could Be and a Lot Better Than I Would Have Imagined": Birthing People's Experiences of Transfer From Community to Hospital.

Abstract

Background: Community births (those in homes or freestanding birth centers) are increasing in the US, although they still represent a small percentage of total births. Research shows that community births can offer positive outcomes for low-risk individuals, such as fewer interventions and greater satisfaction. However, when perinatal complications arise, transfer to hospital can result in negative care outcomes and experiences. Effective integration of care and respectful communication between community and hospital providers during transfers are crucial for improving quality care measures. This study aimed to investigate the experiences and outcomes of individuals transferring from community settings to an urban US hospital with established transfer guidelines.

Methods: This multi-method study, utilizing descriptive statistics and a grounded theory approach, explores the outcomes and experiences of individuals transferring from planned home or birth center births to hospital care for intrapartum management from August 2019 to August 2020. We included participants who were 18 or older, English-speaking, and had experienced a live birth following transfer from home or birth center to hospital. Quantitative outcomes were obtained through chart review. Qualitative interviews were conducted within 6 weeks post-birth, recorded, transcribed, and analyzed using constant comparative analysis.

Results: A total of 82 individuals transferred during the study period, with 23 participating in qualitative interviews, we identified 5 major themes: seamless transfer, teamwork, respectful care, changing expectations, and a complex relationship with autonomy and decision-making. Participants valued smooth communication, midwife-to-midwife transfer of care, and the balance between autonomy and reliance on provider recommendations during transfers.

Discussion: Understanding the experiences of those who transfer from community settings to hospitals is crucial for improving perinatal care. With established guidelines for transfer in place to facilitate collaboration across care providers and birth settings, transfers can be managed effectively, resulting in respectful experiences of care with positive health outcomes.