Unpacking the Transfer Rate at NBBC


The road to preparing for your natural childbirth at the birth center is long.  Between childbirth education and breastfeeding classes, infant care preparation, regular exercise, finding a doula— so much is invested in your success at the birth center.   
As midwives, we are often asked: What is your transfer rate at Natural Beginning?  About 30% of our clients who opt for the birth center midway through pregnancy transfer to the hospital setting.   
One half of our transfers include women whose pregnancy becomes high risk in the second half of her pregnancy.  Women risk out” of the birth center for reasons like breech presentation, gestational diabetes requiring medication, high blood pressure and pre-eclampsia.   Our high risk mamas are still cared for by midwives and physicians in our unique collaborative care model.  Each provider at the practice of OBGYN North and Natural Beginning Birth Center is a woman who practices evidence based obstetrics, opting for intervention only when medically necessary.  Every physician and midwife is invested in the safety of you and your baby; but we also care about your experience in birth.     
The other half of transfers occur after a mama is admitted to the birth center during her labor.  We know that your first labor almost always takes the longest, as your body has never opened in this way before.  In fact, 90% of our transfers from the birth center while in labor are first time moms.  The average time spent in latent labor is 12-24 hours, which can be exhausting.  If labor is prolonged and a level of exhaustion is reached, your body may stop contracting effectively, which means your cervix stops changing.  At this point, other tools appropriately used at the hospital may be used to help your body rest, then resume the momentum of labor. As midwives, we are working hard to help your body rest between contractions to avoid this exhaustion.  We encourage rest during early stages of labor and staying well nourished and hydrated during the active phase.  Low intervention methods to help restore exhausted mamas may include IV hydration and nitrous oxide.  Other typical reasons for transfer in labor may be thick meconium stained fluid, a non reassuring fetal tracing, or if your bag of water breaks and active labor has not begun within 24 hours  
The vast majority of our transfers in labor are non emergent. This is because only low risk, healthy women with healthy pregnancies use the birthing center. As a practice, we are vigilant throughout your prenatal care to ensure only the healthiest moms and babies are using the birth center.  If transfers are emergent, the birth center is in very close proximity to the hospital and our collaborating physicians.   
We are proud to report that last year, 96% of our moms admitted to the birth center in labor ultimately had vaginal births either at the birth center or at North Austin Medical Center.  Every midwife at Natural Beginning Birth center is a credentialed provider at North Austin Medical Center. This seamless transfer and continuation of care means more vaginal deliveries and better outcomes!  
Check out our 2016 stats , unpacked  
139 women were admitted to the birth center in 2016.  6 had C sections.  4% of women admitted to the birth center had C sections, 96% had vaginal deliveries.   
Of the 165 women who planned for the birth center, 52 transferred to North Austin Medical Center (31%).  Of this transfer number 1/2  (16%) of women became high risk before labor began.  50% of this high risk group had C sections and 50% had vaginal births.  
The remaining half were transferred in labor 15%. The most common reason for transfer was arrest of dilation / maternal exhaustion.  77% of these women went on to get epidurals, rest, labor down, and have a vaginal delivery.  Of those vaginal births in-hospital, 65% were attended by their midwife.  The remaining vaginal deliveries were vacuum or forceps vaginal deliveries (19%) , or a birth attended by a physician from OBGYN North (16%).   
Of the women who planned to use the Natural Beginning Birth Center (ALL comers), only 11.5% had C sections, significantly less than the national average of 32%.  Interestingly, the overall practice of OBGYN North had a 12% primary C section rate.  
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See how our outcomes compare with the National Birth Center Study.   
click on this link for a user friendly explanation of the studys results:  
http://www.birthcenters.org/?page=nbcsii#transfers  

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