Abstract
BackgroundHealthcare 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.MethodsThis study utilised a narrative inquiry methodology to explore the experiences of women who birth in paramedic care.ResultsThe 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.ConclusionsThis 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.
Highlights
Healthcare literature describes predisposing factors, clinical risk, maternal and neonatal clinical outcomes of unplanned out-of-hospital birth; there is little quality research available that explores the experiences of mothers who birth prior to arrival at hospital
Most births in Australia occur in hospitals, most recent statistics report that in 2016, 1237 births occurred prior to arrival at hospital; these account for 0.4% of all Australian births [1]
Studies concerning women who birth before arrival at hospital report that between 28.2–91.5% of these births occur with paramedic attendance [3,4,5]
Summary
Healthcare literature describes predisposing factors, clinical risk, maternal and neonatal clinical outcomes of unplanned out-of-hospital birth; there is little quality research available that explores the experiences of mothers who birth prior to arrival at hospital. Studies concerning women who birth before arrival at hospital report that between 28.2–91.5% of these births occur with paramedic attendance [3,4,5]. Recent reports indicate a significant rise in unplanned out-ofhospital birth, and as a consequence, a rise in paramedic response to such cases [6, 7]. Births that occur in unplanned environments present with different risk factors and the ability of healthcare providers to identify women at risk is difficult to mitigate [6, 8]. Unplanned out-of-hospital births are linked to higher than usual rates of perinatal morbidity and mortality, and studies indicate that the complications experienced are largely due to preventable causes [3, 4, 9, 11, 12]
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