Listening to women’s voices: the experience of of unplanned out-of-hospital birth in paramedic care in Queensland, Australia

While some women end up with an unplanned out-of-hospital birth due to fast labor and a lack of time to access care, other women make decisions to delay planned hospital care due to previous birth experience or interactions with healthcare professionals. The authors of a recent paper in BMC Emergency Medicine have published a new paper in BMC Pregnancy and Childbirth exploring these decisions and in this blog post they discuss the perspectives of these women and of the paramedics who care for them and their own reactions to the narratives in the study.

Paramedics managing out-of-hospital birth

In Australia, approximately 1,974 births, representing 0.7% of total births, occur prior to arrival at hospital each year. This population, although a small proportion of paramedic caseload, is associated with considerable perinatal mortality and morbidity and possesses factors that may complicate paramedic clinical management. While many births that occur in paramedic care are uncomplicated, paramedics are expected to use evidence-based guidelines to identify, manage, and refer patients with high-risk conditions or emerging problems related to pregnancy, recognize and manage a severely compromised pregnant patient, and provide appropriate care during the intrapartum and postpartum period.

Our new article published in BMC Pregnancy and Childbirth, a companion to our recent article in BMC Emergency Medicine, explores women’s experience of unplanned out-of-hospital birth attended by paramedics in Queensland, Australia. Interviews with twenty-two women revealed that the participants had various reasons for their births occurring in an unplanned and unexpected way, but their reasons were not necessarily the normally assumed ‘precipitate’ or ‘multiparity’ birth.

Women negotiating the system

This research identified a relationship between perceived deficits in the current Australian Maternity Care system and the decisions women made when labor began. When paramedics became involved, some women described very positive interactions. However, it was clear that the need for paramedics was sometimes based on the need for medical backup ‘just in case something went wrong.’ These women did not doubt their ability to birth; they were knowledgeable about the birth process and expressed a desire to have components of their birth plan acknowledged. Yet, when these needs conflicted with a paramedic’s care decisions, the women described feeling disempowered. Some women did not understand why paramedics had to make, during what was meant to be a planned natural experience, a series of medical interventions to which they did not consent.

Woman-centered paramedic care

Participants who had positive birth experiences spoke of paramedics who were professional, had good communication skills, and were empathetic and reassuring. They were particularly impressed with paramedics who provided care holistically, acknowledging that the woman was an individual who had physical, emotional, social and spiritual needs. It was amusing during the interviews when women became excited describing an ‘amazing’ and ‘wonderful’ paramedic who put a load of washing on, provided her time for a shower, and thoughtfully left a towel with the baby’s scent on it for the family dog. These were the actions of a paramedic who was not only confident and comfortable with the physical birth process, but also practiced and appeared to appreciate a holistic approach to person-centered care specific to the out-of-hospital environment.

The authors’ perspective

The experience of conducting this study and interpreting women’s stories on a topic such as this ignited a personal and highly emotional reaction for the authors. The authors believe that although a baby is born into a family and society, the event of birth itself belongs to the woman – she births the baby. It is a time of joyful anticipation, a moment that should surpass her expectations, and a time when she should feel the most powerful and fearless. However, during these interviews the authors expressed disappointment, not for the various ‘professions’ involved in these narratives, but towards some of the individual paramedics, midwives, and doctors that women described in their narratives. The authors took comfort in the fact that when positive care experiences were portrayed, those experiences were exceptional in nature.

This research motivated the authors to reflect on their own perspective of patient care as a midwife and paramedic. The phrase ‘rest and reassurance’ is one of a few descriptors in the patient care report form that addresses providing psychological support during patient care episodes. It is interesting to reflect on what value paramedics place on this phrase; is it a throwaway line, just a box to be ticked routinely, or do paramedics actually demonstrate it from the patient’s perspective?

Researching the ‘person’ as well as the physical body

We acknowledge that the scope of skills expected of paramedics has increased over the last 20 years, as has the scope of paramedics’ roles and responsibilities. As such, there has been a preoccupation within paramedic education and research that has a purely biophysical approach. However, from this research and others referenced within it, when patients are asked what they value most from paramedic care, they reply ‘professionalism.’ This includes confidence in care, clinical competence, and a high level of clinical knowledge. They also want person-centered care which is respectful and responsive to the preferences, needs, and values of the individual patients themselves. We intend that this research will contribute to making necessary improvements in paramedic education and providing a basis for a paramedical model of care that is patient-centered, embodies respect and empathy for patients, and requires paramedics’ empathy and interpersonal communication skills.

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