Unplanned Out-of-Hospital Births: The Unseen Challenges of EMS
The unexpected and often unpredictable nature of unplanned out-of-hospital births poses significant challenges for emergency medical services (EMS) personnel.
- EMS personnel must be prepared to provide care for mothers and newborns during any clinical shift, despite the risks associated with out-of-hospital births.
- The lack of information about gestational age or potential complications can make it difficult for EMS personnel to provide optimal care.
- Teenage patients may be in denial of their pregnancies or fearful of discovery by their families, adding to the complexity of the situation.
While the specific challenges faced by EMS personnel may vary, the need for targeted training and support is clear.
| EMS personnel reported attending | Teenage patients | Unanticipated imminent births | Complex births |
| in the following situations: | Teenage patients who were in denial of their pregnancies | Abdominal or back pain in female patients, only to encounter an unanticipated imminent birth upon arrival | Medical emergencies and limited specialised neonatal equipment |
Despite the challenges, EMS personnel are often the first point of contact for women experiencing labour and birth outside of a hospital setting.
“The call was for non-traumatic back pain. The patient had a cryptic pregnancy and was not aware she was pregnant until I informed her that she was in labour. I was the senior clinician in attendance, we were 25 minutes to a maternity unit that didn’t have surgical facilities and a neonatal unit.”
These situations can be high-pressure and require EMS personnel to think on their feet and make quick decisions. EMS personnel reported using makeshift solutions to care for newborns, such as plastic clingfilm to keep them warm.
The distance to a specialised newborn care facility, as well as rules around who could be transported and when, meant mothers and babies sometimes needed separate transport. One North Island-based paramedic highlighted the distressing experience of a mother who was transported by road to a tertiary hospital while her baby was flown to another facility.
In some cases, EMS personnel attended births in remote and poorer areas, far away from hospital facilities and with no backup readily available. One South Island-based paramedic described a situation where the mother had a severe postpartum haemorrhage and the newborn required resuscitation, and the paramedic had to manage the mother and newborn by themselves during a 15-minute drive to the birth suite at hospital.
The stories shared by New Zealand ambulance personnel highlight the critical role they play in providing care during labour and birth, but also highlight a gap in care for women not accessing routine antenatal and birth services.
The need for targeted training and education is clear, and recent updates to Hato Hone St John guidelines, resources, and training aim to prepare EMS personnel for these unpredictable and high-risk scenarios.