Emergency medical services’ experiences with prehospital births in Aotearoa New Zealand

Abstract

Objective: Births in the prehospital setting are infrequent yet associated with increased odds of maternal and neonatal morbidity and mortality. There is limited understanding of the experiences of emergency medical services (EMS) staff in handling these potentially high-risk situations. We explored the perspectives of EMS personnel in Aotearoa New Zealand (NZ) when responding to out-of-hospital births. Methods: Hato Hone St John Ambulance is the largest EMS provider in NZ. Between October and November 2023, all EMS staff were invited to complete an online survey including open text questions about their experiences and challenges attending unplanned birth. Data was coded and organized into themes using Nvivo software and the general inductive approach to thematic analysis. Results: 147 responses were received and included in the survey. Analysis found participants encountered a range of challenges in providing intrapartum care in the prehospital setting. Two key themes were identified: 1. Navigating complexity and uncertainty in unplanned births, and 2. Practical challenges and unsuitable environments; with several subthemes demonstrating that EMS personnel in NZ respond to obstetric emergencies in diverse circumstances, diligently working to deliver optimal care for both mothers and neonates. Conclusion:This study describes novel challenges faced by EMS attending unplanned births in NZ and obstacles previously reported by EMS in other jurisdictions. These findings will be invaluable in guiding further research, curriculum, and resource development to better prepare EMS for the challenging and uncertain situations that characterize prehospital birth events.