hospital transfer

maybe some of you who've planned or considered homebirths in the USA can
give me a perspective on this, I've been reading through the
documentation from the midwives on informed consent, one of the things
is transfer to hospital and that in an emergency it would be 911 to the
ER. This worries me, the local hospital is quite big, maternity and the
ER are quite a way apart, the ER is on the ground floor quite away from
the main hospital tower, where maternity is on the top floor. I guess
it's a 10 minute push on a trolley!

When weighing up the pros and cons of out of hospital birth in the UK,
one of the things that is very clear is that if you transfer in an
emergency the midwife will be in contact with the delivery suite and an
ambulance would take you to wherever the drop off point is for that
section of the hospital (UK hospitals tend to have the main ambulance
drop off at A&E, but multiple ones around the site for getting patients
to other wards, if the admission isn't by the patient calling an
ambulance, but say a doctor deciding it's needed then calling a non
emergency or emergency, as the case may be, ambulance to transfer). So
the transfer time to the hospital can be estimated by the average time
to get an ambulance to you and get to the hospital, then a very short
pushing the trolley when you get there, the lifts are usually right by
the entrances and the units on higher floors are generally right there
when you get out the lift.

In the information they are quick to remind you that most transfers are
not an emergency, but that isn't really the point, the last thing you
want on the off chance an emergency should occur is to get to the
hospital and only at that point then waste 10+ minutes as you work your
way through the system, because if it really were an emergency that time
would be valuable. Same with transferring a baby, if resus beyond what
the midwives can offer is needed, in the UK babies would be transferred
directly to SCBU, again they call ahead and although there are special
neonatal ambulances they are usually for hospital to hospital transfer
so the baby would likely arrived in a normal ambulance, but if they are
expecting a sick baby, they get a team right there in the foyer. I am
aware of reports of babies dieing because ambulance teams failed to
follow instructions as to where to go and the time delay may have
contributed.

My logic behind out of hospital birth as roughly been, there is no
evidence that it's any more risky, and should an emergency happen there
isn't necessarily any difference in getting help particularly if, as we
did, you live near where an ambulance is stationed and they get to you
fast and to the hospital fast. Now, my crutch has been whipped away, I
still thinking it's overall safer, but the rare what if scenario
suddenly seems a lot scarier!

Cheers
Anne