Women’s experience of unplanned out-of-hospital birth in paramedic care

Abstract

Background Healthcare literature describes predisposing factors, clinical risk, maternal and neonatal clinical outcomes of unplanned out-of-hospital birth; however, there is little quality research available that explores the experiences of mothers who birth prior to arrival at hospital. Methods This study utilised a narrative inquiry methodology to explore the experiences of women who birth in paramedic care. Results The inquiry was underscored by 22 narrative interviews of women who birthed in paramedic care in Queensland, Australia between 2011 and 2016. This data identified factors that contributed to the planned hospital birth occurring in the out-of-hospital setting. Women in this study began their story by discussing previous birth experience and their knowledge, expectations and personal beliefs concerning the birth process. Specific to the actual birth event, women reported feeling empowered, confident and exhilarated. However, some participants also identified concerns with paramedic practice; lack of privacy, poor interpersonal skills, and a lack of consent for certain procedures. Conclusions This study identified several factors and a subset of factors that contributed to their experiences of the planned hospital birth occurring in the out-of-hospital setting. Women described opportunities for improvement in the care provided by paramedics, specifically some deficiencies in technical and interpersonal skills.

Experiências de partos não planejados fora do ambiente hospitalar

“…No momento do parto, efetuados em sua maioria por equipes de socorro pré-hospitalar, as mulheres relatam vivências tanto negativas, quanto satisfatórias. As negativas, não se relacionavam com a falta de habilidade e competência obstétrica por parte dos paramédicos, mas com o atendimento pouco afetuoso e humano que receberam durante o evento obstétrico, ao tratamento pouco empático, ao excesso de protocolos e técnicas e a ausência de comunicação entre profissionais e pacientes, tornando o suporte obstétrico um ato mecânico, como fica evidente na fala de uma das mães que participou da pesquisa sobre a ausência de comunicação entre equipe e parturiente, sentindo que os paramédicos estavam ali apenas para fazer o seu trabalho, esquecendo que aquele momento pode ser o de maior angústia na vida de uma mulher 11,12 .…”

“…São Leopoldo, 2022. Ademais, queixas em relação à realização de procedimentos sem informar ou transmitir confiança ao paciente foram observadas, como segue exemplos de relatos via telefone no qual as mulheres queixam-se de situações em que os técnicos de enfermagem não esperam o alívio das contrações momentâneas para iniciarem a busca por acesso venoso, ignorando que aquela é uma ocasião que promove uma dor intensa, sendo necessário que em algumas ocasiões, a própria paciente tenha que solicitar calma e paciência para o profissional 11 .…”

Risk of infection in neonates born in accidental out-of-hospital deliveries

“…Neonates born in an unplanned setting have high rates of respiratory distress, hypoglycemia, and hypothermia, contributing to a considerably greater chance of requiring admission to special care nurseries or intensive care units (ICUs) than do neonates from similar in-hospital births [ 1 – 3 , 7 , 8 ]. In comparison with in-hospital deliveries, OHDs are associated with a higher rate of maternal complications, including extensive lacerations of the birth canal, uterine rupture, and post-partum hemorrhage [ 9 – 12 ]. Khupakonke et al also demonstrated LBW to be a predicting factor of OHD [ 11 ].…”

Listening to women’s voices: the experience of giving birth with paramedic care in Queensland, Australia

“…The aim of this study is to explore the women's experience of unplanned out-of-hospital birth in Queensland, Australia. This study is part of a larger study that explores the experience of unplanned out-of-hospital birth in paramedic care [1], therefore each woman birthed with paramedic attendance.…”