Out-of-hospital births and the experiences of emergency ambulance clinicians and birthing parents: a scoping review of the literature.
BMJ Open · 2025-05-02 · Scoping review
Abstract
OBJECTIVE: Emergency ambulance services attend a wide array of medical and trauma patients. Infrequently, this includes imminent or out-of-hospital births (OOHBs). This scoping review explores emergency ambulance clinician involvement with OOHBs, and patient and clinician experiences with birthing in the out-of-hospital setting. DESIGN: Scoping review using the Joanna Briggs Institute framework and 'participant, concept, context' criteria. DATA SOURCES: CINAHL, Embase, Medline, Web of Science and Wiley Online were searched until 20 February 2024. ELIGIBILITY CRITERIA FOR SELECTING ARTICLES: Articles discussing an unplanned OOHB, or a planned home birth with complications where an emergency ambulance was required, were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently determined inclusion using Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews guidelines. A data extraction tool summarised findings for descriptive synthesis. RESULTS: 63 articles were included. 36 articles involved retrospective research. 38 articles were published since 2015, with USA (n=17) and Australia (n=13) the highest contributors. Risk factors for OOHBs were varied, with maternal age or being multigravida/multiparous often cited. 99 complications were described, ranging from relatively minor ailments (ie, nausea and vomiting) to life-threatening situations such as maternal or neonatal cardiac arrest. Common management/interventions reported were assisting with birth, maternal intravenous cannulation and medication administration.Birth parents, partners and clinicians all describe OOHBs as anxiety-provoking but joyous when a healthy neonate is born. The OOHB experience is enhanced for patients when clinicians communicate well, while those who appeared inexperienced increased patient anxiety.OOHBs experience many challenges to optimal care, categorised as 'emergency ambulance clinicians desiring additional education and training', 'communication and collaboration difficulties', 'environmental issues', 'technology and aids' and 'other' limitations. CONCLUSIONS: OOHBs are rare events requiring expert assistance to optimise patient outcomes. There remain significant challenges to unplanned OOHBs; ongoing training and skill competency is required to improve patient safety and clinician confidence. Further research investigating patient outcomes and experiences is recommended.
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Tags
Clinician perspective · Communication & handover · Neonates · Patient experience · Pregnant patients
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