Friday Fallacies: The Hospital Is Just Minutes Away

Anytime you come across someone defending homebirth, you’re going to hear that you can always transfer in case of an emergency. It comes up in almost every thread where someone mentions qualms — be it their own, their partner’s or their mother-in-law’s — about giving birth at home.
etc., etc., etc. This sentiment is all over the internet.
The problem with birth, however, is that when things go wrong, they go very, very wrong. And it can happen quickly. Cord accidents, uterine rupture, placental abruption, hemorrhage…all can occur in a matter of minutes, and all can be deadly.

There are plenty of problems with the “The hospital is only minutes away!” platitude with which all these women are comforting their worried family members.

One is the idea that being “ten minutes” from a hospital means that you can go from realizing there’s a problem to having the baby out and alive in ten minutes. This scenario is certainly realistic. IF YOU’RE ALREADY IN THE HOSPITAL. The hospital where I volunteer as a doula can perform a stat c-section in eight minutes.

If you’re having a homebirth, however, it simply isn’t going to happen. Let’s assume you got lucky and managed to hire a midwife who is not only competent enough to recognize a serious emergent situation and recommend a transfer in a timely fashion, but has a relationship with a hospital where they trust her judgement (read: this is a CNM). This midwife must also have accurate and complete records and bring the chart with her to the hospital. Now, this seems like a no-brainer, but ask these women or any number of L&D nurses that I know, and you will learn that it is sadly uncommon. But I digress.

You will have to get to the ER somehow. If you’ve called EMS, it will probably take them a minimum ten minutes to get to your house, five to ten minutes to grab you, load you in and get the hell out, and another ten minutes to get to the ER. Hopefully the paramedics have called in to let them know what to expect and the OBs are racing to the ER to meet you. If you don’t call an ambulance, it might take less time to get to the hospital (or not, seeing that your laboring body probably isn’t moving too quickly), but you don’t have the call ahead or stabilization the paramedics could provide.

Once you’ve arrived, an entire team flocks to you, hooking up monitors and placing IVs, all while trying to get the appropriate details. Since you’ve had all your care at home, the hospital has no records; if you had been laboring in the hospital, the history and physical notes, progress notes, labs (you’re going to need your blood typed and crossed for surgery), and IV sites WOULD ALREADY BE DONE. If you are dehydrated from laboring for an extended period of time or from an attempt to induce your labor using castor oil, they will have a hard time inserting the IV, which could cost precious minutes. They will use a portable ultrasound to check the baby unless the head (or body, as in the Lucian Kolberstein and Henry Bizzell cases) is out, in which case they will attempt to get the baby out or head straight for the OR. Even the very best and most efficient team is going to take an additional ten minutes after you show up in the ER to have you prepped and in the OR for an emergency cesarean, and that’s with rapid intubation and general anesthesia. The BEST CASE scenario is 30-45 minutes, not the eight it would take if you were already there.

Now, this scenario only applies if you happen to live in an area with a large teaching hospital and on-call OBs 24/7. What happens when the closest hospital is a smaller community hospital? More than likely, the only doctor there is going to be an ER doctor, not an obstetrician. The OB will have to be called in, as an ER doctor isn’t going to perform a cesarean unless you are dead and your baby is still alive, and may live up to 30 minutes away from the hospital. If the ER doctor is able to deliver your baby — which he hasn’t done since med school — he or she may be the only doctor at the hospital, so the focus will be split between you and your child. He or she may not have intubated an neonate since med school, either. He or she may not be required to have a neonatal resuscitation certification. By the time the OB and pediatrician arrive, an hour may have passed since your midwife first realized you were in desperate need of a transfer.

Do you want to go for an hour without breathing? What makes you think your baby does?