title: Paramedics׳ involvement in planned home birth: A one-year case study.
abstract: OBJECTIVE
  to report findings from a study performed prior to the introduction of publicly funded home birth programmes in Victoria, Australia, that investigated the incidence of planned home births attended by paramedics and explored the clinical support they provided as well as the implications for education and practice.
  
  
  METHODS
  retrospective data previously collected via an in-field electronic patient care record (VACIS(®)) was provided by a state-wide ambulance service. Cases were identified via a comprehensive filter, manually screened and analysed using SPSS version 19.
  
  
  RESULTS
  over a 12-month period paramedics attended 26 intended home births. Eight women were transported in labour, most for failure to progress. Three called the ambulance service and their pre-organised midwife simultaneously. Paramedics were required for a range of complications including post partum haemorrhage, perineal tears and neonatal resuscitation. Procedures performed for mothers included IV therapy and administering pain relief. For infants, paramedics performed intermittent positive pressure ventilation, endotracheal intubation and external cardiac compression. Of the 23 women transferred to hospital, 22 were transported to hospital within 32minutes.
  
  
  CONCLUSIONS
  findings highlight that paramedics can provide clinical support, as well as efficient transportation, during perinatal emergencies at planned home births. Cooperative collaboration between ambulance services, privately practising midwives and maternity services to develop guidelines for emergency clinical support and transportation service may minimise risk associated with planned home births. This could also lead to opportunities for interprofessional education between midwives and paramedics.
authors.affiliation: School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, VIC 3199, Australia. Electronic address: Gayle.McLelland@monash.edu.
authors.forename: Gayle
authors.initials: G
authors.lastname: McLelland
authors.affiliation: School of Nursing and Midwifery Monash University, Building 13C, Clayton Campus, Clayton 3800, Australia. Electronic address: lisa.mckenna@monash.edu.
authors.forename: Lisa
authors.initials: L
authors.lastname: McKenna
authors.affiliation: Royal District Nursing Service, St. Kilda, VIC 3108, Australia; Department of Primary Health Care, Monash University, Clayton, VIC 3168, Australia. Electronic address: amee.morgans@rdns.com.au.
authors.forename: Amee
authors.initials: A
authors.lastname: Morgans
authors.affiliation: Ambulance Victoria, Blackburn North, VIC 3130, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Clayton, VIC 3168, Australia. Electronic address: karen.smith@ambulance.vic.gov.au.
authors.forename: Karen
authors.initials: K
authors.lastname: Smith
mesh_terms: D000328:Adult; D000488:Allied Health Personnel / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000379:methods*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D061214:Patient Safety; D011247:Pregnancy; D012189:Retrospective Studies; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: Birth; Intended home birth; Paramedic; Perinatal emergencies ambulance; Planned home birth