Wednesday, June 6, 2012

The hospital is "only" 12 minutes away

When clients at an out-of-hospital birth center ask their midwives, "What would happen if there were an emergency," they are greeted with the calming notion that, "The hospital is only 12 minutes away."  Women are often reassured that a short ambulance ride somehow means that care is close enough to feel comfortable when embarking upon out-of-hospital birth.

When you stop and think about this, there is so much more to responding in the event of an emergency than the length of the ride from one driveway to another.  What conveniently is not discussed is

  • The time it takes for a decision to be made to transfer, when concerns are in fact recognized
  • The time it takes for a mom's request to transfer to be taken seriously instead of "buying more time" with stall tactics
  • The time it takes for the ambulance to be called
  • The time or day and day of the week and how that impacts traffic flow
  • The time it takes for the ambulance to drive to the birth center
  • The time it takes  for EMTs to assess the situation and respond accordingly
  • The time it takes to load 
  • The time it takes to stabilize a baby who isn't breathing for transfer
  • Insert Drive Time Here (12 minutes)
  • The time it takes for the hospital staff to assess the patient in need and make a plan for moving forward, sometimes having no records on hand
  • The time it takes for strangers to fill out paperwork
  • The time it takes for new care to effectively take shape with a resolution achieved  
  • EMTs do excellent work, but they are not an RNICU or labor and delivery team.  

Wouldn't it be more accurate to consider the broader scope of transfer time as "Care to Care" transfer, meaning the time it takes from request or concern to the time it takes to get the help you need?  Let's look at three different real-life transfer events that happened from the Greenhouse Birth Center to Sparrow Hospital in the Lansing area last year.

Client #1 ~ "Non-Emergency" transfer: Mom in pain requests transfer after pushing without
                     progress for 2+ hours.  Baby's heart rate is variable. Midwives stall because she
                     is "so close" but eventually discuss transfer and call an ambulance.

Client #2 ~ "Urgent: transfer:  Mom has been pushing for 4+ hours with no progress.  
                      Baby's heart rate starts to be concerning. 

Client #3 ~ "Emergency" transfer: Baby born without a heartbeat, immediate resuscitation 

Table: Transfer Time from Birth Center to Hospital
for Three Different Families

Stage of Transfer Process

Type of Scenario

mom in excruciating pain requests transfer
baby’s heart rate in labor is concerning
baby is delivered with no heartbeat
Transfer Requested or Serious Concern Noted until Ambulance Called
30 minutes
(initial requests to transfer discounted)
Not Available
4 minutes
(from delivery until ambulance called)
Ambulance Called until Ambulance Arrives at Birth Center
3 minutes
2 minutes
2 minutes
Ambulance Arrives at Birth Center until Ambulance Departs for Hospital
5 minutes
8 minutes
16 minutes
(attempting to resuscitate baby)
Ambulance Departs for Hospital until Ambulance Arrives at Hospital
12 minutes
(no lights or siren)
9 minutes
(lights & siren)
11 minutes
(lights & siren)
Ambulance Arrives at Hospital until
Care is Effectively Transferred
60+ minutes
(epidural given and mom resting)

15 minutes
(pain meds given and evaluations in progress)

14 minutes
(RNICU team still resuscitating)

Care to Care
approx 2 hours
34 minutes

41 minutes
(baby has a heartbeat, prognosis grim)

In the most emergent scenario (third column), you're looking at 41 minutes from the time a baby is born without a heartbeat to the time he has been "resuscitated".  41 MINUTES!  How does a baby have any chance at survival after 41 minutes without a breath?  Furthermore, how does a baby have any chance at survival after 12 minutes without a breath, even if the claims made were true?

Purposefully minimizing the estimated time it takes to effectively transfer a mom or baby in crisis is abhorrent.  Midwives who practice out-of-hospital birth need to be frank with clients about the fact that emergencies do come up in an instant that require immediate medical attention, and that when they do, there is little that can be done to avert it.  By proximity alone, you're putting yourself at risk.  I would have appreciated a frank conversation about this instead of being told that, 'They know what to look for and how to get help in plenty of time, that the hospital is only 12 minutes away and the ambulance is across the street."    


  1. I hope the GBC will now report more accurate transfer times to all of their clients!

  2. Don't bet on it SWH^

    This is the single most important factor, and it's usually ignored. No matter how awesome your MW is, not being where the help is can kill. Add in clueless or negligent MWs and its a recipe for disaster.

    This chart also assumes a nice urban or suburban area, with quick response times, adequate ambulance coverage, a fully staffed hospital/NICU and light traffic. This is not the case for a large amounts of women, who live in rural, exurban, or inner city neighborhoods, where those things aren't a given. I know from our house, the hospital is 16 min, but that hospital does not have 24/7 OB, or a high level NICU. You would need to be flown to Portland, an hour away.