Home Birth Transfer Rates: What the Data Shows
In the US MANA Stats registry, 22.9 percent of first-time parents who planned a home birth transferred to a hospital during labor, against 7.5 percent of parents with a previous birth.
On this page
Sources cited (5)
- ACOG 2025
- Birthplace in England Collaborative Group (England) 2011
- Rowe et al. 2013
- Cheyney et al. 2014
- Nethery et al. 2021
What percent of planned home births end in a hospital transfer?
ACOG estimates that 10 to 25 percent of planned out-of-hospital births involve a transfer to a hospital in labor or after birth [1]. In the US MANA Stats registry, 10.9 percent of planned home births involved a transfer during labor (1,850 of 16,924) [4]. In England's Birthplace study, 21.0 percent of planned home births did [2].
A transfer means going to a hospital for any health need of the parent or baby, in labor or after birth [1].
Rates are higher for first-time parents: 22.9 percent in the MANA Stats registry, 30.5 percent in Washington State and 45.0 percent in England's Birthplace study. For parents with a previous birth the range was 4.2 to 12.0 percent [2] [4] [5]. The studies do not count transfers the same way: Birthplace includes transfers after birth, and MANA Stats counts transfers during labor only, so the rates are not directly comparable.
| Study | Who and where | First-time parents | Parents with a previous birth | What counted as a transfer |
|---|---|---|---|---|
| MANA Stats [4] | Planned midwife-led home births at the onset of labor, US voluntary registry, 2004 to 2009 | 22.9 percent (864 of 3,770; 95% CI 21.6 to 24.2) | 7.5 percent (986 of 13,143; 95% CI 7.0 to 8.0) | Transfers during labor only. Transfers after birth are counted separately (1.5 percent of parents, 0.9 percent of newborns). Midwives chose whether to report, so some births may be missing |
| Nethery et al. [5] | 10,609 planned home and licensed birth center births, Washington State, 2015 to mid 2020 | 30.5 percent | 4.2 percent | Transfer during labor. Home and birth center births combined |
| Birthplace in England [2] | Low-risk planned home births, England, 2008 to 2010 | 45.0 percent (2,057 of 4,568) | 12.0 percent (1,472 of 12,256) | Transfer before or after delivery. Overall for planned home births, 21.0 percent |
Our page on first-time home births puts these numbers next to the outcome data, and the safety page covers the larger studies.
Why do parents transfer from a planned home birth?
Slow progress in labor is the most commonly reported reason. In MANA Stats, failure to progress was the largest share of transfers during labor, at 40.7 percent (752 of 1,850). The Washington State authors cite other studies that name slow labor progress as the most common reason for transfer among first-time parents [4] [5].
Other reasons recorded for transfers during labor in MANA Stats were desire for pain relief (15.2 percent), fetal distress or meconium, the baby's first stool passing before birth (10.0 percent), malpresentation (6.4 percent) and maternal exhaustion (5.3 percent), and more than one reason could be selected. These shares cover all parents, not only first-time parents [4].
Transfers also happen after birth. In MANA Stats, 1.5 percent of planned home births involved a transfer of the parent after birth and 0.9 percent a transfer of the newborn, and the authors describe both as infrequent [4].
In England, Birthplace researchers grouped the reasons into categories. They classed fetal distress, slow progress in the second stage of labor and bleeding before birth as potentially urgent, and slow progress in the first stage and requests for an epidural as non-urgent [3].
How urgent are transfers?
We did not find a US study that sorts transfers by urgency. In England's Birthplace study, researchers sorted the recorded reasons because urgency was not recorded: among first-time parents who planned a home birth, 10.3 percent transferred before birth for a potentially urgent reason, 13.6 percent for a non-urgent one and 19.1 percent for one they did not classify [3].
"Potentially urgent" is the researchers' sorting of the recorded reason for transfer. It does not describe what happened to a particular parent or baby, or how the transfer turned out. The authors wrote that within the potentially urgent group "some transfers will have been more urgent than others, some may have been emergencies", that the group "should not be considered as emergencies", and that "some transfers for reasons that we did not classify as potentially urgent may also have been urgent" [3].
The paper's abstract concludes: "Most transfers are not urgent and emergencies and adverse outcomes are uncommon, but urgent transfer is more likely for nulliparous women", meaning first-time parents. That conclusion covers transfers from home and from freestanding midwifery units together. Because 19.1 percent of first-time parents transferred for reasons the researchers did not classify, the figures above cannot say exactly what share of transfers were urgent [3].
For parents with a previous birth, 1.6 percent transferred before birth for a potentially urgent reason, 2.0 percent for a non-urgent reason and 7.3 percent for a reason that was not classified [3]. Transfers after birth for postpartum hemorrhage were another 1.2 percent of first-time parents and 0.7 percent of parents with a previous birth [3]. All of these percentages are shares of everyone who planned a home birth, not shares of the parents who transferred.
How long does a transfer take?
We did not find a US study of transfer times, so the figure is from England. In Birthplace, the median time from the decision to transfer to a first assessment in an obstetric unit was 49 minutes from home, and 42 minutes for potentially urgent transfers before birth. The authors say the effect on outcomes is unclear [3].
The authors write that transfers "commonly take up to 60 minutes from decision to transfer, to first assessment in an [obstetric unit], even for transfers for potentially urgent reasons". The 49 minutes includes time spent arranging transfer, waiting for the ambulance, travel and any wait before assessment. The study covered England from 2008 to 2010, so US timing may differ [3].
How often do planned home births end in a cesarean?
In Washington State, 11.4 percent of first-time parents planning a home or birth center birth had a cesarean, and 0.87 percent of parents with a previous birth did. The same cohort's transfer rates were 30.5 and 4.2 percent. In MANA Stats, the overall cesarean rate for planned home births was 5.2 percent [4] [5].
Both first-time figures, 11.4 percent cesarean and 30.5 percent transfer, are shares of all first-time parents in the cohort, so they do not show how many transfers ended in a cesarean [5].
What should I ask a midwife about transfers?
Ask your midwife how often her clients transfer, for first births and for later births, which hospital you would go to, and whether she has a written agreement with that hospital. Other things to ask are whether she stays with you at the hospital, whether she is credentialed there, and whether she can walk you through a recent transfer [1].
ACOG supports policies that "require clear communication by out-of-hospital birth attendants to their patients regarding transfer protocols, including prevalence, logistics, limitations, and scenarios in which a transfer may occur", and "recommends each out-of-hospital birth attendant have written transfer protocol agreements that are mutually agreed upon with the hospital(s) who would be receiving patients in the event of need for transfer" [1]. Our list of questions to ask a midwife has more.
To compare midwives who attend births near you, browse the directory or send the free matching form, and we'll share your request with a few local midwives and introduce you to those who are available.
Frequently asked questions
What is the transfer rate for planned home births?
ACOG estimates that 10 to 25 percent of planned out-of-hospital births involve a transfer of care to a hospital in labor or after birth, for any health need of the parent or baby. In the US MANA Stats registry, 10.9 percent of planned home births involved a transfer during labor, and in England's Birthplace study 21.0 percent involved a transfer. Rates are higher for first-time parents than for parents with a previous birth.
Do first-time parents transfer more often?
Yes, in all three studies. First-time parents transferred in 22.9 percent of planned home births in the US MANA Stats registry, 30.5 percent in a Washington State cohort of home and birth center births and 45.0 percent in Birthplace in England, which also counts transfers after birth. Parents with a previous birth transferred in 4.2 to 12.0 percent.
How urgent are home birth transfers?
We did not find a US study that sorts transfers by urgency. In England's Birthplace study, among all first-time parents who planned a home birth, 10.3 percent transferred before birth for a reason researchers judged potentially urgent, 13.6 percent for a non-urgent reason and 19.1 percent for a reason they did not classify. The authors say some of the potentially urgent group "may have been emergencies" but that the group "should not be considered as emergencies". It is a sorting of the recorded reason, not a count of emergencies or a measure of outcome.
How long does it take to get from home to a hospital in a transfer?
We did not find a US study of this. In England's Birthplace study the median time from the decision to transfer to a first assessment in an obstetric unit was 49 minutes from home, and 42 minutes for potentially urgent transfers before birth. The authors say the impact of these times on outcomes is unclear. The study did not cover US ambulance or hospital systems.
What should I ask a midwife about transfers?
Ask for her transfer rate for first births and later births, which hospital you would go to, whether she would stay with you and whether she has a written transfer agreement with the hospital. ACOG recommends written agreements and clear communication about transfer protocols. Browse the directory or send the free matching form.
Looking for a midwife? Find a home birth midwife near you by city or state, or request a free match.
Find a midwife with strong hospital relationships
Browse licensed midwives by state and ask each one about their transfer rate, hospital partners, and what transfers look like in practice.
Find midwives by state →- American College of Obstetricians and Gynecologists. Transfer Protocols for Out-of-Hospital Birth (approved by the Board of Directors November 2025). View source
- Birthplace in England Collaborative Group (England). Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ. 2011;343:d7400 (table 2). View source
- Rowe RE, Townend J, Brocklehurst P, et al. Duration and urgency of transfer in births planned at home and in freestanding midwifery units in England: secondary analysis of the Birthplace national prospective cohort study. BMC Pregnancy Childbirth. 2013;13:224. View source
- Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S. Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004 to 2009. J Midwifery Womens Health. 2014;59(1):17 to 27. View source
- Nethery E, Schummers L, Levine A, Caughey AB, Souter V, Gordon W. Birth outcomes for planned home and licensed freestanding birth center births in Washington State. Obstet Gynecol. 2021;138(5):693 to 702. View source
▶ How we research this content Editorial standards
Researched from primary sources: state statutes and board rules, Medicaid provider manuals and state Medicaid rules, and peer-reviewed research. Each claim links to its source in the References list.
Written by the Home Birth Partners editorial team, not by clinicians, and not clinically reviewed unless a named reviewer appears in the byline.
The "Last updated" date in the byline is the last time this guide's content changed.
Midwives and midwifery associations can suggest a correction. Anyone who spots an error or has a primary source we should add can email [email protected].