BACKGROUND:
Transfers from home and birth center settings to hospitals are a critical yet complex part of maternity care systems. While quantitative studies focus on specific clinical outcomes, qualitative research highlights the lived experiences of birthing people and providers, an area less frequently synthesized. Understanding both dimensions is essential to improving transfer processes, enhancing person-centered care, and supporting interprofessional collaboration.

OBJECTIVES:
This integrative review synthesizes quantitative, qualitative, and mixed-methods research on community-to-hospital birth transfers. The goal is to identify patterns in maternal outcomes and lived experiences of birthing people and providers to inform improvements in safety, communication, and system integration across birth settings.

METHODS:
Following Toronto and Remington’s six-step integrative review framework, we analyzed peer-reviewed literature published between 2014 and 2025 from multiple high-resource countries. Fifty-four studies were included: 35 quantitative, 12 qualitative, and 7 mixed-methods. Quantitative and mixed methods studies were assessed for transfer indications, timing, rates, and maternal outcomes. Qualitative and mixed-methods studies underwent thematic analysis using Braun and Clarke’s approach. Themes included emotional and systemic impact, preparation and decision-making, relational dynamics, and post-transfer processing.

RESULTS:
Most transfers were non-emergent, often prompted by slow labor progression or requests for pain management. Transfer rates were higher among nulliparous and those with elevated risk factors. Qualitative findings revealed wide-ranging experiences shaped by preparation, midwife continuity, hospital interactions, and communication. Experiences ranged from collaborative and supportive to distressing and marginalizing.

CONCLUSIONS:
Findings underscore the dual importance of clinical safety and emotional experience. Clearer protocols, stronger interprofessional collaboration, and structured debriefing may improve outcomes. Future research should evaluate interventions that integrate clinical, relational, and systemic dimensions of care to support respectful, person-centered maternity systems globally.

KEY MESSAGE:
Community-to-hospital transfers involve more than clinical outcomes—they are shaped by relationships, communication, and systems. Integrating evidence across methodologies reveals opportunities to improve respectful, person-centered care during transfers. Complications - decision making