Melissa Cheyney, Courtney Everson, Paul Burcher

The purpose of this study was to explore the contested space of home-to-hospital transfers that occur during labor or in the immediate postpartum period, as a means of identifying the mechanisms that maintain philosophical and practice divides between homebirth midwives and hospital-based clinicians in the United States. Using data collected from open-ended, semistructured interviews, participant observation, and reciprocal ethnography, we identified six key themes-three from each provider type. Collectively, providers' narratives illuminate the central stressors that characterize home-to-hospital transfers, and from these, we identify three larger sociopolitical mechanisms that we argue are functioning to maintain fractured articulations at the time of transfer. These mechanisms impede efficient and mutually respectful interactions and can result in costly delays. However, they also contain the seeds of possible solutions, and thus are important starting points for developing an integrated maternity system premised on mutual accommodation and seamless articulations across all delivery locations.