Emerg Med J doi:10.1136/emermed-2012-202309
  • Review

Involvement of emergency medical services at unplanned births before arrival to hospital: a structured review

  1. Lisa G McKenna3
  1. 1School of Nursing and Midwifery, Monash University, Frankston, Victoria, Australia
  2. 2Department of Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia
  3. 3School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Gayle Elizabeth McLelland, School of Nursing and Midwifery, Monash University, PO BOx 527, Frankston, Victoria 3199, Australia; Gayle.McLelland{at}
  • Received 21 December 2012
  • Accepted 18 January 2013
  • Published Online First 16 February 2013


Objective While infrequent, unplanned births before arrival (BBAs) are clinically significant events at which, conceivably, paramedics will be the first health professionals in attendance. This review aims to demonstrate that paramedics not only attend and transfer birthing women, but also use critical clinical and decision-making skills. It further proposes strategies that will support paramedics manage out-of-hospital obstetric emergencies.

Design The bibliographic databases EMBASE, MEDLINE, CINAHL and Maternity and Infant Care were searched from 1991 to 2012 for relevant English language publications using key words and Medical Subject Heading (MeSH) terms. Data were extracted with respect to study design, incidence of BBAs, attendance of paramedics, complications and recommendations.

Results Fourteen studies were selected for inclusion arising from the US, UK and Europe. While all studies acknowledged paramedics attend BBAs, seven reported the incidence of BBAs attended by paramedics, and two discuss issues specifically encountered by paramedics. Paramedics attended between 28.2% and 91.5% of all BBAs. While the articles reviewed noted that most of the births encountered by paramedics were uncomplicated, they all reported maternal or neonatal complications. Eight articles reported the most common maternal complication was excessive bleeding after birth, and nine reported the most frequent neonatal complication was hypothermia regardless of gestation.

Conclusions Paramedics need to be adequately educated and equipped to manage BBAs at both undergraduate and graduate levels. Protocols should be developed between health and ambulance services to minimise risks associated with BBAs. A dearth of information surrounds the incidence of BBAs attended and the management performed by paramedics highlighting the need for further research.

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