09/07/2026
ASK THE MIDWIVES - When Something Goes Wrong
But what happens if something goes wrong?
If youâre thinking about having a baby at home or in a birth center, this is not a rude question. Itâs not a negative question, and itâs definitely not a question weâre afraid of. Honestly, we think itâs one of the most important questions you can ask a community birth provider.
What happens if something goes wrong?
We love normal birth. We trust physiology. We have spent years learning how to protect the normal process of labor and birth without constantly interfering with it. But trusting birth has never meant pretending birth is incapable of becoming complicated. It can.
And thereâs something really important to say right at the beginning of this conversation: complications arenât unique to home birth.
Mothers hemorrhage in hospitals. Babies sometimes need help breathing in hospitals. Shoulder dystocia happens in hospitals. Fetal heart rate concerns happen in hospitals. Emergencies happen with midwives, family physicians, and obstetricians. Sometimes everybody does everything right and something still goes wrong because pregnancy and birth, like the rest of life and medicine, donât come with guarantees.
And sometimes the care itself can change the risk picture.
Every intervention has potential benefits, and many interventions are incredibly valuable when theyâre actually needed. We are very grateful that cesareans, anesthesia, medications, induction and augmentation, continuous monitoring, operative delivery, blood products, and advanced neonatal care exist. We absolutely want those things available when the benefit outweighs the risk.
But interventions can have risks and downstream effects too. One intervention can sometimes lead to another. Medications can change labor or affect how mama or baby responds. Restrictions on movement, eating, drinking, positioning, or time can influence how labor unfolds. Protocols designed to safely care for large populations donât always fit every individual person perfectly.
That isnât because hospitals are bad or obstetricians and nurses donât care about the families they serve. We know some wonderful hospital providers, and we are incredibly grateful for them when our families need their expertise and resources.
Itâs because every birth setting has strengths, limitations, benefits, and risks.
Community birth has limitations that we are very honest about. We donât have an operating room in the next room, a blood bank down the hall, or an anesthesiologist standing by.
Hospitals have tremendous resources for emergencies and high-risk pregnancies. They also operate within systems that may involve shift changes, multiple providers, institutional protocols, time constraints, and caregivers who may be meeting a mother for the first time while sheâs already in labor.
Neither setting makes risk disappear.
And relationship matters too.
Knowing someone doesnât stop a hemorrhage or resolve a shoulder dystocia. Thatâs where clinical skill, preparation, medications, equipment, and sometimes hospital resources matter tremendously. But knowing our families can help us recognize when something is different for this mama. It makes it easier for someone to tell us, âSomething doesnât feel right.â We already know her history, what is normal for her, what frightens her, how she communicates, what matters to her, and how she makes decisions.
Feeling heard, respected, and safe enough to speak up matters in maternity care too.
So the question really shouldnât be, âWhich place makes birth risk-free?â
THERE ISNâT ONE! Anyone who promises you an outcome is overestimating their power and ability to control birth.
A better question is: What are the benefits and risks of each setting for this particular mama and this particular baby? What resources are available? What matters to this family? And what plan gives us the best balance of physiology, preparation, appropriate intervention, and access to higher-level care when itâs needed?
For healthy, appropriately screened families choosing community birth, a big part of our job is recognizing when things are starting to move away from normal.
The reassuring part is that birth doesnât usually go from âeverything is perfectly normalâ to a flashing-lights emergency without anything happening in between. One of the most important things we do is pay attention to those spaces in between.
Weâre watching mama. Weâre watching baby. Weâre watching how labor is progressing, how everyone is coping, how much energy mama has left, and whether what weâre doing is working.
And when something starts drifting away from normal, the answer isnât always an emergency intervention.
Sometimes mama needs to move. A baby who isnât descending well may need a little more room in the pelvis, so we might try hands and knees, side lying, a supported squat, the birth stool, or a position that makes everyone in the room wonder whether weâre doing birth or advanced yoga.
Sometimes mama needs food and fluids because labor is work, and bodies generally perform better when we donât expect them to run a marathon on three ice chips and determination.
Sometimes she needs to empty her bladder. Sometimes she needs warmth or water. Sometimes she needs counterpressure or hands-on support. Sometimes she needs everyone to stop talking, dim the lights, leave her alone with the people she trusts, and give her nervous system a chance to settle down. Sometimes she just desperately needs to sleep.
We may use positioning, movement, nourishment, hydration, rest, hands-on techniques, water, herbs, or other traditional supportive measures when theyâre appropriate for the situation and for the individual mama.
Those arenât random little midwife tricks, and they arenât ways of avoiding ârealâ care.
They are real care.
Understanding physiology means understanding that sometimes a body needs support rather than rescue. We start with the least disruptive thing that is appropriate for the situation, and then we reassess.
Did it work? Is mama doing better? Is baby doing better? Is labor moving in a healthier direction? If yes, wonderful. If not, we do something else.
And sometimes what is needed isnât gentle or physiologic at all. Sometimes itâs medication. Sometimes itâs an emergency procedure. Sometimes itâs EMS. Sometimes itâs the hospital.
Thatâs why loving normal birth is only half of our job.
We train for postpartum hemorrhage, shoulder dystocia, breech birth, babies who need help breathing, hypertensive emergencies, cord prolapse, concerning fetal heart rates, maternal emergencies, and the other rare things we hope we never encounter.
We carry medications and emergency equipment. We bring neonatal resuscitation equipment. We monitor mama and baby throughout labor because our goal is to recognize concerning changes early whenever we can.
And we typically attend births with one licensed midwife and two trained assistants and/or student midwives because if something does happen, suddenly having six trained hands instead of two feels pretty important.
But there is another piece of emergency preparedness that doesnât fit inside even our ridiculously overpacked birth bags.
Knowing when to leave.
There are things we can safely manage at home or at the birth center. There are things we can stabilize while arranging additional care. And there are things that require resources we simply donât have.
Weâre not going to pretend otherwise.
Being a good community midwife means knowing what we can do really well and being equally honest about what we cannot.
Sometimes the safest decision we make at a birth is calling EMS. But sometimes really good emergency care actually looks much less dramatic than that. Itâs noticing a concerning pattern early enough that we can say, âOkay, I think itâs time to head in,â gather everyone up, call ahead, bring our records, and make that transition while mama and baby are both stable.
A hospital transfer IS NOT a failed home birth. Sometimes itâs exactly what good midwifery looks like. The goal isnât to prove that we can keep everybody out of the hospital. The goal is the right care, in the right place, at the right time. ZAnd if the right place becomes the hospital, you donât suddenly stop being our family when we walk through those doors.
Whenever circumstances and hospital policies allow, we go with you. We communicate with the receiving team, bring your records, explain whatâs happened, and help make that transition as smooth as we can. Our clinical role changes in the hospital, but we can still be a familiar face standing beside you in a place you didnât expect to be.
And afterward, weâre still your midwives.
We come back. We check on you. We talk about what happened. We answer the questions that didnât occur to you until three days later in the shower. We help you process it, because a birth can be medically successful and still leave a mama with a whole lot of feelings about how it unfolded.
We love our people when everything goes beautifully according to plan, and we love them just as much when absolutely nothing does.
We take this part of our work so seriously that emergency obstetric education has become a pretty significant part of what we do outside of caring for our own families. We donât just take emergency courses ourselves. We teach these skills to student midwives and birth professionals, and we teach obstetric emergency skills to physicians, residents, nurses, EMS clinicians, and other rural healthcare providers too.
Because if one of our families ever needs that whole chain of care, we want everyone in it to be prepared. Community birth and hospital birth donât need to exist on opposite teams. When things get complicated, collaboration matters a whole lot more than who gets credit for being right.
Thereâs a phrase we use in our emergency training that pretty perfectly describes how we feel about birth:
Rooted in physiology. Prepared for the unexpected.
We donât want fear of everything that could possibly go wrong to interfere with every perfectly normal birth. And we donât want our love and respect for normal birth to blind us when something isnât normal anymore.
We can trust birth without being naive about it. We can respect physiology and carry emergency medications. We can believe in home birth and be incredibly grateful for hospitals when we need them. We can believe interventions shouldnât be used unnecessarily and also be thankful they exist when they become necessary.
None of those things are contradictions.
Theyâre part of caring for our people well.
Now we really want to hear from you, especially on this one. What scares you or makes you wonder about the safety of home or birth center birth?
Hemorrhage? A baby who isnât breathing? Shoulder dystocia? Emergency cesarean? How we monitor babies? What equipment or medications we carry? How far away the hospital is? What happens during a transfer? How we decide when itâs time to go?
Ask us. You donât have to word it carefully or worry that youâll offend us. These are exactly the kinds of questions families should be asking when theyâre deciding where and with whom to have their babies.
Weâd much rather have an honest conversation about the things people are genuinely worried about than pretend those questions arenât there.
And chances are, if youâre wondering about it, somebody else is too.
Your question might just be our next Ask the Midwives post.
