Experiences of Women Planning a Home Birth Who Require Intrapartum Transfer to Hospital: A Metasynthesis of the Qualitative Literature

Abstract

Recent evidence supports the safety of planned home birth for low-risk women when professional midwifery care and adequate collaborative arrangements for referral and transfer are in place. The purpose of this article is to synthesize the qualitative literature on the experiences of women planning a home birth, who are subsequently transferred from home to hospital. A metasynthesis approach was selected because it aims to create a rich understanding of women’s experiences of transfer by synthesizing and interpreting qualitative data. Three categories were synthesized: “communication, connection, and continuity,” “making the transition,” and “making sense of events.” Quality and clarity of communication, feeling connected to the backup hospital, and continuity of midwifery carer helps make the transfer process as seamless as possible for women. Arriving at the hospital is a time of vulnerability and fear, and retaining the care of a known midwife is reassuring. New caregivers must also be sensitive to women’s need to be reassured and accepted. The reasons for transfer need to be clearly communicated both at the time of transfer and in more detail during the postpartum period. Women need to talk through their experience and to acknowledge their feelings of disappointment in order to move forward in the next phase of their lives. Continuity of carer enables this to be done by a known caregiver in a sensitive and individualized manner. Further qualitative research to examine home birth transfer issues, specifically in the Australian context, is currently being planned as part of the Birthplace in Australia project.