Describing Prehospital Deliveries in the State of Michigan.

Abstract

IntroductionWe observed clinically that prehospital deliveries locally appeared to have a high rate of complications and appeared associated with midwife deliveries. There is scant literature that addresses prehospital deliveries across a state. We set out to describe utilization, complications, and short-term outcomes of EMS-attended prehospital deliveries in Michigan in 2015, and to describe the relationship between prehospital delivery and socioeconomic status (SES).MethodsWe identified candidate cases for prehospital deliveries through the Michigan EMS Information System (MI-EMSIS). To assess the relationship of SES with the frequency of EMS delivery, we utilized the mean income of the patient residences' zip codes.ResultsWe identified 223 EMS-attended deliveries from 1.6 million MI-EMSIS records. Most births were normal vaginal deliveries on the scene or en route to the hospital (92, 40.0%) or delivered prior to EMS arrival (58, 25.4%). Maternal or fetal complications were identified in 69 (32.0%) deliveries. We identified a few midwife-attended deliveries (31), but these had a high rate of complications (19, 61.3%). The frequency of prehospital delivery was inversely related to estimated patient income (Pearson=-0.85).ConclusionsEMS deliveries were rare and most were normal vaginal deliveries, but almost a third had complications. Midwife and EMS-attended deliveries were rare, but when they occurred, had high rates of complications. Although an imperfect measure of patient SES, frequency of delivery was inversely related to patient income, and agencies that provide care in these communities should have focused training.