Out-of-hospital births and the experiences of emergency ambulance clinicians and birthing parents: A scoping review of the literature
Authors: Hill Michella G. , Miles Alecka , Flanagan Belinda , Hansen Sara , Mills Brennen , Hopper Luke 
Published: November 2024

Objective

Emergency ambulance services attend a wide array of medical and trauma patients. Infrequently, this includes imminent or out-of-hospital births (OOHBs). There is a paucity of research pertaining to 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; two reviewers independently determined inclusion using the Joanna Briggs Institute framework and ‘participant, concept, context’ criteria.

Methods

CINAHL, Embase, Medline, Web of Science, and Wiley Online were searched from database inception until 20 February 2024. Articles discussing an unplanned OOHB, or a planned home birth with complications where an emergency ambulance was required were included.

Results

Sixty-three articles were included for review. The majority (n=36) involved retrospective research. Most articles were published since 2015 (n=38), with the highest contributing countries being USA (n=17) and Australia (n=13). Risks factors for OOHBs were varied with maternal age or being multigravida/multiparous often cited. Ninety-nine complications were described in the literature ranging from relatively minor ailments such as nausea and vomiting through to life-threatening situations such as maternal or neonatal cardiac arrest. The most 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, falling under the broad categories of ‘emergency ambulance clinicians desiring additional education and training’, ‘communication and collaboration difficulties’, ‘environmental issues’, ‘technology and aids’ and ‘other’ limitations.

Conclusion

OOHBs are rare events requiring expert assistance to optimise patient outcomes. There remains significant challenges to unplanned OOHBs; ongoing training and skill competency is required to improve patient safety and clinician confidence.

Article Summary

Strength and limitations.

This review provides a comprehensive overview of unplanned OOHBs attended by emergency ambulance clinicians in high-income countries; this also includes planned home births or freebirths where emergency ambulance assistance was required.

We utilised a rigorous methodology framework as per the JBI guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews.

This review did not consider risk of bias, rigour, or quality from included studies, however most research in this space is from retrospective or qualitative research methodologies.

Only peer-reviewed, full text publications in English were included. Educational material, conference papers, letters to the editor, or opinion articles were excluded.

Review registration

This scoping review is registered with the Open Science Framework (https://osf.io/bd62h), registration DOI 10.17605/OSF.IO/TA35Q.

Summary Box

What is already known on this topic

Unplanned out-of-hospital births occur rarely, yet have the capacity to be life-threatening events for both birth parent and neonate.

What this study adds

This study provides an extensive overview of emergency ambulance clinician involvement in unplanned out-of-hospital births, birth complications and interventions provided. Furthermore, it comprehensively explores the patient and clinician experience, which is frequently described as traumatic and anxiety-provoking, with evidence suggesting support services such as telehealth could aid both the patient and emergency ambulance clinician in these situations.

How this study might affect research, practice, or policy

Quality ongoing training, education, and exposure to birthing for emergency ambulance clinicians is strongly recommended. Ensuring emergency ambulance service guidelines have been appropriately adapted for unplanned out-of-hospital birth is also encouraged, as it appears some guidelines (such as resuscitative hysterotomy in maternal cardiac arrest) are unrealistic for the out-of-hospital environment.