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?

38 thoughts on “Friday Fallacies: The Hospital Is Just Minutes Away

  1. Well the I was told in my midwife interview that yes the hospital is only “5 minutes away”. It took about 20 minutes to get there. It took me 5 minutes to get in the truck. When I got to the hospital, St. Charles, the OB was not there yet, and I had to wait for him until the nurses could do anything. My midwives did not bring any records. She could not even tell the OB when my due date was. I ended up telling the doctor everything about me while writhing in pain trying to breath. The hospital was told I had no prenatal workups or labs. I had them at the same hospital, but I guess the midwives forgot that. I actually felt bad for the OB. He gets put in this situation where he doesn’t know you and the midwives offer no info either. It is almost safer for the OB to just do a C-section so he doesn’t get blamed for a botched delivery.

  2. our hospital was exactly 3 minutes away . when sh^% hit the fan it took over 30 minutes to get me dressed and down stairs to transport. by the time we reached the car, i needed to push. when i delivered her, she had already passed- and a midwife is NOT prepared to resuscitate a dead baby. they don’t even carry epi ! by the time the ambulance arrived (12 minutes) there was no hope….

  3. On a normal day, I could have walked to the hospital where I transferred to from my homebirth in under 10 minutes. But when in labor, after prolonged pushing, we decided to transfer. Between pushing contractions, I walked down three flughts of stairs, somehow climbed in the car, my husband drove, and it was 30 minutes before we were in labor and delivery in a room. I was transferring as a precaution, not as an emergent situation!

    This post makes a good point.

  4. Take it from someone who had to watch the seconds tick by helplessly.

    a) As pointed out, Midwives most often do not have enough knowledge to catch a risk factor before it is an emergency. BUT if they do . . .

    b) The birth center I used was a 4 minute drive from the hospital normally. In an emergency you can count on at least 5xs that.

    In an emergency, seconds can mean the difference between recovering . . . permanent injury and . . . death.

  5. According to Google Maps, I live 3.3 miles from the hospital – an 8 minute drive if you are going the speed limit. I felt pretty confident about this when I was planning a homebirth.

    When my son was born not breathing, the midwives attempted to revive him by stimulating the cord, turning him on his stomach and rubbing his back, and after that failed – they attempted CPR which they did not know how to administer! After 6 minutes of this, they called 911. It took less than 6 minutes for the EMT’s to arrive. Within 7 minutes of them arriving Shahzad was transferred. Fifteen minutes later, I was transported in a separate ambulance. It took me about 5 minutes to get to the hospital ER. When I arrived I was told that attempts to revive my son had failed and I was immediately surrounded by doctors and the hospital chaplain.

    It doesn’t matter if you live across the street from a hospital. By the time the transfer occurs and resuscitation is started, your baby could already be brain dead and even worse, you as the mom could be in serious condition. I have no doubt that if the EMTs/Doctors had been able to revive Shahzad, he would have had serious brain injury.

    Fortunately, my overall health was fine. I did not have any blood loss and the only thing the OB needed to do for me was deliver my placenta. It took roughly an hour for them to get me into a room to begin that procedure.

    Again, I want to reiterate – it doesn’t matter if you live across the street from the hospital. If your midwives do not know what they are doing, or if there is a serious problem, chances are you and your baby will not make it to the hospital in time. Preventable deaths will occur and sadly, you as the mom may have to return home with empty arms just as I did.

    • I am so sorry, Margarita. So sorry. I had to transfer too, and I was sooo lucky that everything turned out ok for me, but it terrifies me to think how close I really came to your situation.

      I am just so sorry.

      • Thank you Rachel! I am happy for you and glad things turned out good. Hopefully this blog and these stories of negative outcomes will get people to realize that this is serious. Time is precious. Too precious when you’re baby is born not breathing.

  6. I lived 5 mins drive from the hospital where I had my first baby. Even on a good day, I would allow 20 minutes to get to my antenatal appointments.

    Getting from house to car, traffic bottlenecks, finding a park (even the emergency and pickup bays were often full), waddling down the corridors to find the right area (and get this, L&D was in a secure, hidden area not on ground floor). You cant just turn up at the front door and see a nurse midwife or obstetrician.

    … It all takes time. It takes more time when you are heavily pregnant and more time again when you are in labour.

  7. Absolutely. We lived 10 minutes from a great hospital with J’s homebirth, and was still a distance much too far when it all went to hell.

    Also, the idiot midwife who delivered J. did not know how to GET to that hospital. She knew it was close, but never even bothered to google map the damn route. Giving her directions after my baby was rushed off in an ambulance was a lot of fun. So please, don’t take it for granted that because a midwife assures you that the hospital is such an easy ride that she has any idea at all what she is talking about at all.

  8. I used to work as a 911 operator in a large Southwestern city. Every time I hear the “we’re only XXX minutes from the hospital” I cringe.

    Yeah, you may be XX minutes from the hospital. But that is on a good day, with no road hazards like rush hour traffic, ice/snow/rain, an accident that is tying up traffic (how RUDE of them to do that at a time like this!!), etc.

    Trained paramedics busting their tails to load and go take at least 5 minutes to get someone ready to transport, BTW. They aren’t emotionally involved in the situation at hand and can keep cooler heads. Now, it’s possible that a few amateurs can load and go faster than that, but is it likely? Based on what the prior commenters stated here, what do you think?

    And what if you really need to step on it to get to the hospital, like in the case of hemorrhage? Ambulances can radio ahead, turn on the flashing lights and floor it. Try that with a Prius or minivan and get back to me on how successful you are.

    (Oh, if you are planning on waiting for the ambulance….don’t assume that the nearest fire station will be the ones to respond. They may be tied up with a diabetic having a bad reaction, or someone having a heart attack, or…get this….dealing with a fire. I know, how RUDE of them NOT to sit around on standby waiting to see if you need them for your blessed event. The closest paramedics who are available when you call may be 10 minutes or more away. That’s gonna seem like an eternity if you need them there now.)

  9. the hospital was 3 minutes away…but by the time the Shit hit the fan, it ended p taking 30 minutes just to get me dressed and to the car–where i promptly needed to push. When Aquila came out she had already passed .without Epi and an intubabtion kit my midwife was unable to revive her (no midwives carry those things…)by the time the ambulance arrived (12 minutes after birth) it was too late by far…. i never knew how far away the hospital really was.

  10. After my first miscarriage, I suffered a severe postpartum hemorrhage at home where I lost 2 liters of blood. By the time I realized how serious my situation was and called 911, I was put on hold for 4 minutes before I could speak to an operator. It took 10 minutes before the fire dept came and then another 15 min before the ambulance and paramedics arrived. After that, it took 10 minutes to load me onto the rig and then another 5 to secure a second IV before the ambulance left the driveway. It was an entire hour after I dialed 911 before we actually got to the hospital. This experience really opened my eyes… I was in shock and nearly died before we even made it to the hospital.

  11. Yes, let’s assume all midwives are incompetant, that the situation at the hospital is always perfect, that all laboring women already have IV’s placed, blah blah blah. Let’s fear monger and ignore all of the available information and research and disempower women and end up in a world where we all have scheduled sections just in case we are one of those women who may have had an issue arise. Or how about we just accept that sometimes horrific things happen no matter where we are. How about we actually find out the credentials of the people we are trusting our lives, and our infants lives, to. How about we support each other and encourage each other to make informed choices with cool heads and all of the available information??

    • Carrie, that’s what the whole article is about. Making informed decisions. It is not okay for midwives to advertise that they are 3 minutes from a hospital without disclosing that in an emergency you need to count on that being at least 30 minutes of severe bleeding, asphyxiation etc.

      I do not find being misled for someone else’s agenda empowering at all. In fact I have never felt so violated or victimized.

      I am so tired of the “that happens in a hospital too” line. Trying to spread fear about hospitals is Fear Monger. I guess it is just okay, if it is for your cause and not against it?

      Hospital takes all the high risks and all the emergencies. Midwives are suppose to be taking only the healthiest and those with very lowest risk level. Deaths and Injuries should not be occurring in that situation.

      This article did not say you can’t have a homebirth. It says “Hey, if that is what you’re choosing KNOW this correct information.”

      That information would have saved my son a lot of pain, struggle and hardship. Please respect that.

    • The point is that women are force-fed platitudes like this one instead of being told the unvarnished truth. Imagine their shock and dismay when all the things they are told turn out to be falsehoods. For instance, “trust birth, your body was made to birth, and nothing will go wrong” And if something does go wrong, they are fed another set of platitudes, the old schtick that their baby would have died in the hospital anyway. Why not tell women the truth and let them base their decisions of facts instead of wishful thinking?

  12. According to Google maps, my hospital was six minutes away. I remember checking multiple times because it reassured me to think how close it was. It was more like 20-30 minutes from the moment we decided to transfer, before I was actually in a L&D room. And this was late at night with minimal traffic and the hospital didn’t seem very busy.

    Now, I was only transferring for pain relief, but I can’t imagine it would have been much quicker if it was an emergency. It probably would have been longer had I needed a c-section since they would’ve needed to prep for that.

  13. By the way Carrie why do you think doctors don’t want to do home births? Because regardless of their “credentials” they know that being close to the bells and whistles is safer. It’s not just about the person’s credentials, it’s also about having the right equipment that can’t necessarily be carried in a little bag. (like, newborn resuscitation/PROPER suctioning equipment for meconium, a sterile OR set, anesthesia, all medication for PPH, IV equipment, I could go on). Interestingly the more “credentials” you have, the more training you have, the more you are humbled by how rapidly a seemingly normal delivery can go, and the more you realize back up is important.

  14. Carrie: I’m sorry, but I didn’t see anyone advocating that everyone have a c-section. Also, in a lot of places, it’s nearly impossible to get the accurate backgrounds and records of midwives. There’s no obligation for them to report and disclose. In addition, the ‘bad things happen in hospitals’ argument wears thin. Of course they do. The difference? They’re equipped to handle emergencies. Your house is not. Trying to say that those minutes in between home and hospital don’t matter and that the outcome would be the same either way is just simply not true in most cases.

  15. Carrie, your comment had nothing to do with the post. It is in no way fearmongering to realistically look at the time it will take to transfer. You are attempting to use the word “disempower” to deflect the conversation. You know horrific things do happen in all kinds of places, but they are more likely to happen in a home birth with a CPM, than in a hospital with an OB/GYN, period.

  16. “Or how about we just accept that sometimes horrific things happen no matter where we are.”

    So Margarita, Liz P and other women like them should just accept that their babies died? They should be at peace with their dead children? Not question the system that led to their children’s deaths, and attempt to prevent such tragedies from ever happening again? How dare you! What kind of moral grounding do you have, anyway? Is your need for empowerment more important than a child’s life?

    I pray you never experience a loss like theirs. I pray you continue to live with your misinformed head still firmly stuck where the sun don’t shine.

  17. Carrie, if you would have us all empowered with all the available information, could you please get MANA to release their homebirth stats? While you’re at it, you could ask Oregon Health Licensing Agency why they haven’t gotten back to me about their investigation into the midwife malpractice I suffered (as my midwives keep happily practicing away, their clients oblivious to the fact that they all but destroyed my pelvic floor, and my torso is held together by mesh now).

    Who’s spreading information women NEED to make informed decisions? Blogs like this one. So Carrie, what I really want to know is this: What have you got against giving women the full story about homebirth … hmmm?

  18. not “torso,” but “much of my lower torso,” that is. Geez, I get so angry at people who would keep vital information from pregnant women I can’t see straight, let alone type.

  19. The largest risk of a homebirth is DELAYED RESPONSE TIME. It doesn’t matter how far you are from a hospital – there is no NICU in the bedroom of your home. Having said that, it is rare that a baby needs that level of intervention and a skilled, experienced CNM who practices conservatively will recognize the problem and arrange for a transport before it becomes a life/death situation for the baby and/or the mom.

  20. Carrie:
    “Or how about we just accept that sometimes horrific things happen no matter where we are”

    No, we don’t. We stopped accepting that during the last century. That’s what obstetrics is all about. Reducing the incidence of “horrific things.”

    Exactly why is the “horrific” acceptable to you, Carrie?

  21. Carrie,

    To be truely educated in a subject, you need to know the bad as well as the good. The down-side of HB is transfer time. You are not educated if you fail to see how this is a problem.

    But like most in your cult, your head in bury in the sand.

  22. I will happily accept that “sometimes horrific things happen wherever you are” if you accept that the chance of a horrific thing happening is many, many, many times less in a hospital with operating rooms, high tech equipment, and trained staff ready to jump in and save you.

    In the hospital, a troubled labor can be remedied with drugs or a timely emergency c-section. At home, a baby loses oxygen and dies. Only one of these is a horrific thing. The other one is a mildly stressful thing at the moment but has no lasting consequences.

  23. While I feel for both sides I can honestly see the attarction to homebirth: While Hospital birth may feel safer from a mortality rate in regards to the unexpected…It causes just as many problems as it solves. I am the mother of 6 children, 3 I have in my home…and 3 I hold in my heart.

    My daughter was stillborn and beacause of *Hospital Policy* Because I could still legally walk into a clinic and abort her…I wasn’t allowed to see her or hold her or say goodbye…. Had I known this I would have had her at home ( as clearly there was no risk to her in having a home birth.)

    Because I have a complicated medical history my labors have always been carefully monitored inductions…. the firt 2 I could see having definate necessary merit, though the reason for my son’s induction was never clearly explained to me except I was 4cm dialated so it was decided I would be induced and I was to go along with the plan…The contractions were brutal and so again I was forced into an epidural I really didn’t want out of sheer necessity….my Son was exposed to Meconium ( though didn’t asperate ) at birth, and I wound up with an infection from the epidural that almost went to my brain that I had to be rehospatlized for. Thnakfully I made it…but If I’d had my son at home none of that would have happened! Losing a baby is the MOST HORRIFIC thing a Parent can go thru…and I’ve done it 3 times…but…as screwed up as this might sound to some of you. I could handle losing another baby a hell of a lot better than my kids could ever have handled losing me. Neither system is perfect…. whatever you did make an INFORMED decision.

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