Referral and Safety

85% of the time your birth will be uncomplicated and natural but should a your low risk pregnancy or birth move into the high risk category it is essential that there is a solid plan B.   Safety needs to be the top priority when talking about you and your baby’s wellbeing so it should not be compromised.

You need to ask the hard questions:   what is the plan, how do you ensure safety, what are the steps taken, what qualifications, what equipment, what is the transfer procedure, costs etc etc.

Bearing in mind that midwives are low risk specialist for natural birth.   Once a pregnancy or birth becomes what is considered high risk a midwife should know when to refer and have a good relationship with a team to refer to ensure a smooth transition as stress free as possible in those very stressful moments when it becomes apparent that your birth plan is not going quite the way you envisaged.

Plan B could then entail

  • an Obstetrician who can perform surgery/intervention and
  • a facility to perform the procedures necessary


  • a Paediatrician to take care of your baby if there are any problems
  • a facility to admit your baby to take care of it’s high risk needs (with a NICU)


  • a mode of transport to transfer you to this facility without unnecessary delay

Some examples of why Plan B or referral/intervention may be implemented:

  • A 2nd opinion
  • Epidural for pain relief (if in a homebirth or free standing birthing centre where risks are kept to the absolute minimal – synthetic pain relief does have some side effect that can cause complications so best to be in a hospital for this close to emergency care.
  • Induction of labour (no induction of labour is done at home or birth house as this is not considered low risk)
  • Instrument assisted birth
  • C/Section
  • Removal of placenta due to it becoming retained
  • Repair of a bad tear
  • D+C due to retained placental products/excessive bleeding


How does it work then:

You will need to see the back up obstetrician or have a sonar with a radiographer at least 2- 3 times during your pregnancy.  (usually around 12 weeks and 20 weeks and once around a month before your due date).   Some midwives do offer sonars but they are not diagnostic as we do not receive the specialized training to diagnose and detect major problems.

Our midwife practice has links with a variety of very competent and highly recommended back up obstetricians we use and depending on which venue you birth at we will refer you accordingly and send a referral letter with to ensure continuity of care.

During the pregnancy if we pick up any complications such as high blood pressure, gestational diabetes, bladder infections to mention a few we simply make contact with our back up and hand you over for further care.  Once you are deemed low risk again you come back to us for further care.

If you are not on medical aid and don’t have the funds for a private hospital should admission be necessary we usually refer to Steve Biko Academic Hospital which is very close to our practice.  You need to register with your nearest state clinic for antenatal care and the necessary blood tests as soon as possible in your pregnancy.  The clinic will issue you with a clinic card and registration number which is your admission ticket to the public hospital system.  Without this card it is often quite complication when admission is necessary.

Given our strict antenatal screening profile focussing on low risk candidates and our high rate of normal births the chance of needing transfer and back up is quite limited but we can never say it’s impossible.  We are very serious about safety and don’t take any chances when it comes to our responsibilities.  When necessary, transfer should happen timeously without delay and referral to the correct channels is imperative.

How then do we manage transfer:

If you are at the Midwife Unit at Femina Netcare Hospital or at Wilgers Life Hospital we would simply move you into the main hospital labour ward or theatre if it became necessary.  This would entail a transfer by wheel chair or bed.

If you are at the birth house or your own home we would transfer you via the fastest route and depending on urgency either by your own vehicle or an ambulance.  We have a contract with an ambulance service.  This would be for your own expense but we have negotiated a good fee for transfer.

Your midwife will accompany you to the hospital and remain with you as long as she is allowed to ensuring you still have the best possible experience.

It takes approximately 10-15 minutes to get from the birth house in Rietondale to both Femina Hospital and Steve Biko Academic hospital. (actual driving time 4 minutes).  


Should your Baby need Medical Attention:

From time to time a baby is born who needs urgent medical attention.  Should this be the case your baby will be stabilized and as soon as medically possible and be transferred to the Neonatal Intensive Care Unit (NICU).  Usually at this point in time we take the father along with baby for the transfer whilst the other midwife remains with mom in the birth unit quickly as possible assisting her to mobilise so she can be taken to her baby.  (If you are at home we transfer mom and baby together)

An admission to NICU may just be a short observation stay or may results in quite a number of days stay for baby.  Your baby will be treated by a paediatrician who specializes in high risk newborns and a very specialized and competent Neonatal trained sister.

When you first see your baby he/she may well be connected to various tubes, wires and machines and attended to by many medical professionals.    Should you find yourself in this situation please be assured that you and your baby are in excellent hands.  You will be fully informed and supported during this stressful time.

A stay in NICU is very expensive and should you not be on a medical aid you will have to put down a substantial deposit for this.  It is highly recommended that you take out a hospital plan (if you don’t have a medical aid) that will cover baby from the moment of birth.  Should you not have sufficient funds we would transfer the baby to a state hospital for further care.

Transfer of baby from the birth house or home to Steve Biko Academic Hospital NICU is a little more complex and admission is dependent on space being available at the NICU.  If not they refer us to the next nearest facility that can accommodate your baby.   We do everything humanly possible to ensure a speedy and safe transfer should it be necessary.

Some reasons why your baby may need NICU care:

  • Infection
  • Battling to transition from intra uterine respiration to extra uterine respiration (breath on it’s own)


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Images used in article by Andelle Schenach Photography and Sam Schröder Photography