Assessing Australian and New Zealand Prehospital Clinicians’ Training, Experience, and Confidence with Out-of-Hospital Childbirths

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Introduction: Unplanned out-of-hospital births (OOHBs) pose significant risks, particularly in rural areas where access to maternity services and response times may be limited. Given that OOHBs are uncommon, prehospital clinicians use these specialized skills infrequently, leading to skill and knowledge decay, impacting clinician preparedness and confidence in managing these presentations. This research investigates prehospital clinicians’ perceptions of training, experience, and confidence in managing OOHBs.Methods: Australian and New Zealand paramedics and volunteers were recruited via social media and asked to complete a cross-sectional mixed-methods questionnaire. Training and exposure were assessed via multiple-choice, matrix, or open-text responses. Confidence in recognizing and managing an OOHB situation (antenatal, second stage, third stage, and postpartum care) was assessed utilizing summed scores of Likert scale responses. Independent samples t-tests compared means between groups.Results: In total, 222 participants were included in the study, with 147 (66%) being female. Participant ages ranged from 18–72 years old. One hundred and sixty-eight participants (76%) had exposure to laboring or birthing patients prehospitally, and 123 (55%) participants had assisted with at least one OOHB. Complications reported (n=531) included stillbirth, neonatal death, postpartum hemorrhage, and maternal death. Obstetrics refresher training was undertaken by 141 participants in the previous 12 months.Participants who had previous experience managing an OOHB were significantly more confident recognizing and managing an OOHB compared to participants without previous management experience. Paramedics expressed more confidence recognizing and managing OOHB situations compared to volunteers. However, for participants with children, confidence was only greater for antenatal care (not second stage, third stage, and postnatal care) compared to participants without children.Conclusion: Participants with prior real-world exposure to OOHBs indicate a greater level of confidence in recognizing and managing OOHB situations. Targeted, practical training and ongoing in-service education are recommended to build capability and improve outcomes in these high-risk, low-frequency events.

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