Epidemiology of unplanned out-of-hospital births attended by paramedics

Abstract

BackgroundOver the previous two decades the incidence and number of unplanned out of hospital births Victoria has increased. As the only out of hospital emergency care providers in Victoria, paramedics would provide care for women having birth emergencies in the community. However, there is a lack of research about the involvement of paramedics provide for these women and their newborns. This research reports the clinical profile of a 1-year sample caseload of births attended by a state-wide ambulance service in Australia.MethodsRetrospective data previously collected via Victorian Ambulance Clinical Information System (VACIS ®) an in-field electronic patient care record was provided by Ambulance Victoria. Cases were identified via a comprehensive filter, and analysed using SPSS version 19.ResultsOver a 12-month period paramedics attended 324 out-of-hospital births including 190 before paramedics’ arrival. Most (88.3%) were uncomplicated precipitous term births. However, paramedics documented various obstetric complications including postpartum haemorrhage, breech, cord prolapse, prematurity and neonatal death. Furthermore, nearly one fifth (16.7%) of the women had medical histories that had potential to complicate their clinical management, including taking illicit or prescription drugs. Mothers were more likely to be multiparas. Births were more likely to occur between 2200 and 0600 h. Paramedics performed a range of interventions for both mothers and babies.ConclusionsParamedics provided emergency care for prehospital out-of-hospital births. Although most were precipitous uneventful births at term, paramedics used complex obstetric assessment and clinical skills. These findings have implications for paramedic clinical practice and education around management of unplanned out of hospital births.

Unplanned out-of-hospital birth and risk factors of adverse perinatal outcome: findings from a prospective cohort

“…All the women were multiparous, without any context of maternal or fetal pathology. As described by us and McLelland et al [23], most of the births (79%) occurred between the hours of 20.00 and 08.00 [24]. Moreover, Flanagan et al reported in a retrospective analysis of 192 unplanned out-of-hospital births, that 21% of the newborns had an Apgar score scored ≤7 out of 10, whereas in our cohort, it represented only 14% of the newborns [25].…”

“…Similarly to our study, most of the births (88.3%) were uncomplicated births in multiparous women. Obstetric complications included postpartum hemorrhage (6.5%), breech (1.3%), cord prolapse (0.6%), and prematurity (11%) [23]. Scott and Esen reported 14 cases of unplanned out of hospital births, which occurred over a three-year period, with a reported incidence of 0.31% [24].…”

“…In a prospective case series of consecutive out-of-hospital deliveries in United States, Moscovitz et al reported 9 neonatal deaths among 91 out-of-hospital deliveries (9.9%), with 86% occurring in the presence of paramedics [20]. McLelland reported nine (2.7%) neonatal deaths, including three that were not viable being less than 24 weeks gestation [23]. In France, Renesme et al reported one neonatal death in a retrospective case–control study of 76 unplanned out-of-hospital births, and eleven admissions in NICU (14.5%) [3].…”

Emergency medical technicians' experiences with unplanned births outside institutions: A qualitative interview study

“…However, another Norwegian study found a 50% increased risk of eclampsia/HEELP in nulliparous women living more than 1 hr away from the hospital, underlining how reduced availability may delay or complicate the identification of obstetric emergencies (Engjom et al, ). One Australian study examining the details in 4,096 maternity‐related cases reports various obstetric complications in relation to out‐of‐hospital care, such as postpartum haemorrhage, breech position, cord prolapse, prematurity and neonatal death (McLelland et al, ). Even though adverse outcomes might be rare, these studies underline how unidentified obstetric complications could constitute a great risk to women affected.…”

“…In 2017, 344 infants were registered born unplanned outside institutions in Norway: this included 152 unplanned home births, 171 births en route to hospital, 16 births in unknown locations and five births in institutions without maternity care services (Medical Birth Registry of Norway, ). Unplanned births outside institutions include all accidental out‐of‐hospital births and are often dealt with by emergency medical technicians (EMTs) without assistance from midwives or physicians (Dietsch, Shackleton, Davies, Alston, & McLeod, ; McLelland, McKenna, Morgans, & Smith, ; McLelland, Morgans, & McKenna, ; Thornton & Dahlen, ). Reasons for the increasing number of out‐of‐hospital births have been attributed centralisation of care (Engjom, Morken, Høydahl, Norheim, & Klungsøyr, ) and midwives acting as gatekeepers of the labour ward (Eri, Blystad, Gjengedal, & Blaaka, ; Vik, Haukeland, & Dahl, ).…”