What Is a Midwife Backup Plan and Why It Matters
A midwife's backup plan is the arrangement she has if you need a hospital: which hospital she transfers to, how that handoff is supposed to work, and whether a physician is part of the plan. Ask what she has in writing for a hospital transfer before you hire, so your midwife backup plan is on paper, not only described on a call.
A midwife's backup plan is the arrangement she has if you need a hospital: which hospital she transfers to, how that handoff is supposed to work, and whether a physician is part of the plan. Ask what she has in writing for a hospital transfer before you hire, so your midwife backup plan is on paper, not only described on a call.
On this page
Sources cited (4)
- American College of Obstetricians and Gynecologists, Transfer Protocols for Out-
- Anderson and Gilkison. The Cost of Home Birth in the United States. Internationa
- American College of Obstetricians and Gynecologists, Committee Opinion 697, Plan
- North American Registry of Midwives, CPM Practice Documents.
What is a midwife backup plan supposed to include?
Start with the hospital she uses if you transfer, and whether she has a written plan for that handoff.
ACOG's November 2025 position statement on transfer protocols recommends that each out-of-hospital birth attendant have written transfer protocol agreements that are mutually agreed upon with the hospital or hospitals that would receive patients if a transfer is needed [1]. That statement also supports policies that require clear communication by out-of-hospital birth attendants to their patients about transfer protocols, including prevalence, logistics, limitations and scenarios in which a transfer may occur [1]. For certified professional midwives, NARM requires written practice guidelines, including transfer and transport plans. That is a CPM requirement, not a count of how many U.S. home birth midwives have a written plan [4].
State licensing rules for consultation, collaboration and transfer differ, and some states have no midwifery license at all. Ask what applies where you live, rather than assuming a national template.
What should I ask before I hire?
Ask her to name the hospital and, if there is a consulting or receiving physician, to name that person too. Ask how long those arrangements have been in place, and whether you can review the written transfer protocol.
Ask what happens to her role after a transfer, because hospital policy and her credential decide whether she can stay with you as a clinician, as a support person, or not at all. Ask whether postpartum visits with her still happen if you transfer.
Ask how often her own clients transfer, and for what reasons. Published transfer figures are collected on our home birth transfer rate page. Her own answer matters more than a national average, because practices and counties differ.
ACOG Committee Opinion 697, reaffirmed in 2026, names access to safe and timely transport to nearby hospitals as a factor associated with safer planned home birth, and it does not set a national drive-time number [3]. Ask which hospital she uses and how she plans the trip from your address. Do not treat any mileage figure on a website as a medical standard.
What does a transfer cost?
A midwife's fee and a hospital bill are separate. Ask, in writing, whether any part of her fee is refunded if you transfer, and ask your health plan what you would pay if you arrived at the hospital during labor. Nationally, a 2021 survey of 129 U.S. practices found an average midwife fee of $4,650, a median of $4,400, and fees from $2,000 to $9,921 [2]. Those figures are for the midwife's package, not for a hospital stay. The home birth midwife cost guide has the national survey tables.
How do I put this together when I interview?
Bring the hospital name, the written protocol and the refund rule to the same conversation in which you ask about her license, her service area and whether she has room around your due date. Our pages on what to expect at a midwife interview and questions to ask a midwife have a longer list.
You can browse the directory or get a free midwife match, then ask each midwife about her backup plan directly.
Frequently asked questions
What is a midwife backup plan?
A midwife's backup plan is the arrangement she has if you need a hospital: which hospital she transfers to, how that handoff is supposed to work, and whether a physician is part of the plan. Ask what she has in writing for a hospital transfer before you hire.
Does every midwife have a written backup plan?
Not automatically. ACOG's November 2025 transfer position statement recommends a written transfer protocol agreed with the receiving hospital, and some states require documentation as part of midwifery licensing. Ask what she has in writing and what your state requires.
Will my midwife stay with me if I transfer?
Only if the hospital allows it and her credential lets her continue as a clinician, as a support person, or at all. Ask her what usually happens in her practice, and ask whether she still does postpartum visits after a transfer.
Does a backup plan add to the midwife's fee?
The 2021 survey figures on this page are for the midwife's fee, not for a hospital stay. Ask whether any part of her fee is refunded if you transfer, and ask your health plan what a hospital admission would cost you.
How far away should the backup hospital be?
ACOG Committee Opinion 697, reaffirmed in 2026, names access to safe and timely transport as important, and it does not set a national mileage or drive-time limit. Ask which hospital she uses and how she plans the trip from your address.
Bottom line: A backup plan is only as good as the relationships and protocols behind it. Before you hire, check that the backup physician actually knows your midwife, that the hospital is close enough for an emergency, and that you understand what a transfer would cost you. Ask to see the written transfer protocol. If something reads as vague, keep interviewing until you find a practice whose backup plan makes sense for where you live.
Looking for a midwife? Find a home birth midwife near you by city or state, or request a free match.
- American College of Obstetricians and Gynecologists, Transfer Protocols for Out-of-Hospital Birth, position statement approved November 2025. View source
- Anderson and Gilkison. The Cost of Home Birth in the United States. International Journal of Environmental Research and Public Health, 2021 (survey of 129 midwifery practices in 49 states). View source
- American College of Obstetricians and Gynecologists, Committee Opinion 697, Planned Home Birth, reaffirmed 2026. View source
- North American Registry of Midwives, CPM Practice Documents. 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].