Ambulance clinicians' preparedness for unplanned pre-hospital childbirth: a rapid evidence review.

Abstract

Introduction: Unplanned pre-hospital births present one of the most challenging and complex incidents for ambulance personnel to attend. This rapid review aimed to consider the barriers to providing effective maternity care in the emergency pre-hospital setting.

Methods: A rapid evidence review was performed using Medline and Cumulated Index to Nursing and Allied Health Literature Complete on studies dating between 2000 and 2024. A critical appraisal and thematic synthesis were also carried out. Qualitative studies written in English that considered staff and patient perspectives for pre-hospital maternity care were eligible for inclusion in this review.

Results: Six studies were identified, and three analytical themes were generated: intrinsic, extrinsic and non-technical factors impacting obstetric care. Most ambulance clinicians felt insufficiently prepared for unplanned pre-hospital childbirth. Undergraduate-level training and continuing professional development opportunities were considered poor and were acknowledged as areas requiring improvement. Academic and ambulance service organisations should work towards addressing clinicians' lack of exposure to and confidence with maternity incidents.

Conclusion: Without regulatory and organisational input, unplanned pre-hospital births will continue to challenge both newly qualified and seasoned ambulance clinicians. There is an inherent need for revised maternity training standards for pre-hospital personnel that aims to address the barriers identified within this review paper. To set forth a provision of multidisciplinary and collaborative education opportunities, pre-hospital clinicians need to be acknowledged as key care providers for pregnant women in the emergency setting.