Clinical profile of childbearing women attended by Victorian paramedics

2017-02-26T23:56:57Z (GMT) by McLelland, Gayle Elizabeth
Background: Restructuring of maternity services in Victoria, Australia, over the previous three decades has resulted in changes that potentially impact upon the ambulance service. As periodically reported by the media, ambulance services attend and transport women who have birth emergencies in the community. However, there is paucity of research investigating the clinical support paramedics provide during birth emergencies in the community including planned homebirths and unexpected births. Furthermore, there is a lack of knowledge about the maternity-related clinical profile of paramedics including the cases attended, managed and transported involving women during pregnancy, labour, and after pregnancy as well as births in the community. Methods: Using an evidence based practice framework, this epidemiological study examined one calendar year of retrospective clinical data, collected on-scene by paramedics via in-field patient care records were provided by Ambulance Victoria. Initially patient case reports were extracted electronically from Ambulance Victoria’s clinical warehouse via a comprehensive filter and then manually sorted. As paramedics’ documentation lacked consistency extensive recoding was required. Descriptive statistics were analysed using Statistics Package for Social Sciences (SPSS vs 20) for the dataset. Ethics approval was granted by Monash University Human Research Ethics Committee. Consent for the study was given by Ambulance Victoria research committee. Results: Although paramedic documentation was often incomplete and inconsistent, there were 4096 case reports found involving women with maternity-related health issues and 196 newborn infants. Cases were classified into three main categories ‘birthing’ (n=1917), ‘antenatal’ n=2102 and ‘after pregnancy’ n=273. These categories were further subcategorised into ‘birth records’ (n=534) including mother (n=338) and baby (n=196); labour (n=1383); pregnancy related antenatal conditions (n=1141); non-pregnancy related antenatal conditions (n=961); postpartum (n=166) and pregnancy loss ≤ 20 weeks gestation (n=107). Although a minor proportion of their workload, paramedics used their clinical judgement to manage numerous obstetric and medical complications during their management. Most women required minimal intervention but when required paramedics performed a range of procedures including intravenous cannulation, administration of a range of medications and neonatal resuscitation. Overall, the women appeared to improve in the care of paramedics, highlighting the role ambulance services have in pre-hospital emergency maternity care. When arriving at women in labour, paramedics appeared to use clinical judgement to discern between women in first stage of labour and women in second stage. Primary postpartum haemorrhage was less common when paramedics were present. As paramedics were called to provide assistance at very few homebirth emergencies, they were the primary health provider to the majority of the women they attended and transported. Conclusion: This unique study explored paramedics’ management and transportation of women during pregnancy, labour, birth and after pregnancy. As the primary health professional for most pre-hospital cases involving women during pregnancy, labour, birth and after birth, paramedics used extensive clinical judgment. Whilst paramedic documentation was often incomplete, they provided emergency care and transportation to childbearing women with a range of health conditions. Comprehensive education about maternity-related emergencies should be fundamental in both undergraduate and continual professional development programs. Protocols should be developed between maternity and ambulance services to allow paramedics to consult for assistance and transport to the appropriate maternity health services. Recommendations are made for future paramedic practice, education, policy and research.