Out-of-hospital unexpected delivery

Women's experiences of unplanned pre-hospital births: A pilot study

INTRODUCTION

Prehospital births are fairly rare in Sweden but occasionally occur in the ambulance care system. The ambulance nurse's experience of prehospital births has previously been studied, but there is a lack of research that depicts the woman's perspective of a prehospital birth.

AIM

To describe women's experiences of unplanned prehospital births.

METHOD

A qualitative questionnaire consisting of six open-ended questions that encouraged participants to describe their prehospital-birth experience. Eight women answered the survey and nine birth stories were included. A qualitative content analysis with an inductive approach was used as an analysis method.

RESULTS

The analysis of the texts resulted in four main categories. The main categories were an unpredictable event, the woman's suffering, her perceived gratitude and the importance of the ambulance nurse now and in the future. The main category of women's suffering resulted in two subcategories: physical stresses and psychological and emotional suffering.

CONCLUSION

The women are not prepared to give birth to a child outside the hospital, and the course of events happen quickly. A prehospital birth is described as a tumultuous event for women. The ambulance nurse has a central role in the care outside the hospital. The advice women suggest to ambulance nurses are remaining calm and safe no matter what the situation looks like, listening to the mother and meeting the woman's wishes. Proposals for further research are to investigate the importance of further education in childbirth care for ambulance nurses and how that affects the care of women and their family.

Out-of-maternity deliveries in France: A nationwide population-based study

Introduction

In France, many maternity hospitals have been closed as a result of hospital restructuring in an effort to reduce costs through economies of scale. These closures have naturally increased the distance between home and the closest maternity ward for women throughout the country. However, studies have shown a positive correlation between this increase in distance and the incidence of unplanned out-of-maternity deliveries (OMD). This study was conducted to estimate the frequency of OMD in France, to identify the main risk factors and to assess their impact on maternal mortality and neonatal morbidity and mortality.

Materials and methods

We conducted a population-based observational retrospective study using data from 2012 to 2014 obtained from the French hospital discharge database. We included 2,256,797 deliveries and 1,999,453 singleton newborns in mainland France, among which, 6,733 (3.0‰) were OMD. The adverse outcomes were maternal mortality in hospital or during transport, stillbirth, neonatal mortality, neonatal hospitalizations, and newborn hypothermia and polycythemia. The socio-residential environment was also included in the regression analysis. Maternal and newborn adverse outcomes associated with OMD were analyzed with Generalized Estimating Equations regressions.

Results

The distance to the nearest maternity unit was the main factor for OMD. OMD were associated with maternal death (aRR 6.5 [1.6–26.3]) and all of the neonatal adverse outcomes: stillbirth (3.3 [2.8–3.8]), neonatal death (1.9 [1.2–3.1]), neonatal hospitalization (1.2 [1.1–1.3]), newborn hypothermia (5.9 [5.2–6.6]) and newborn polycythemia (4.8 [3.5–6.4]).

Discussion

In France, OMD increased over the study period. OMD were associated with all the adverse outcomes studied for mothers and newborns. Caregivers, including emergency teams, need to be better prepared for the management these at-risk cases. Furthermore, the increase in adverse outcomes, and the additional generated costs, should be considered carefully by the relevant authorities before any decisions are made to close or merge existing maternity units.