Unplanned out-of-hospital births: Stories about the competence of paramedics and midwives
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Tampere University, Tampere, Finland
South-Eastern Finland University of Applied Sciences, Kouvola, Finland
University of Helsinki, Helsinki, Finland
Docent, retired
Publication date: 2023-10-24
Corresponding author
Jussi Hänninen   

Tampere University, Tampere, Finland
Eur J Midwifery 2023;7(Supplement 1):A18
This study was originally presented in a peer-reviewed research article published in the book ´Changing Work and Operating Environments in Education - 10 studies utilizing the method of empathy-based stories’1 and carried out in accordance with the guidelines of the Faculty of Education and Culture, Tampere University, Finland. The purpose of the study was to discover the perceptions of midwives and paramedics who have assisted with unplanned out-of-hospital births during their careers and to identify the key factors that foreshadow a successful delivery. The study was grounded in the educational sciences, focusing on the informants’ perceptions of the reasons behind the phenomenon, the required resources for childbirth, their views on professional competence and how it is developed in degree education, workplace learning, and vocational further education and training. There is currently limited research on Finnish paramedics' competence in obstetric care. The number of unplanned out-of-hospital births has tripled in Finland in recent years, and with the network of maternity hospitals becoming sparser, they may continue to increase further. Unplanned out-of-hospital delivery carries significant risks for both the person in labour and the newborn.

Material and Methods:
The research data (N = 34) was collected from midwives (n = 12) and paramedics (n = 22) from four hospital districts and rescue departments across Finland. Using the method of empathy-based stories, the informants were presented with a frame story where they were asked to empathize with an imaginary situation and write a story based upon it. The variable element in the frame stories was whether the unplanned out-of-hospital birth was successful or unsuccessful from the professional's perspective.

In some stories, the underlying cause of unplanned out-of-hospital births was the challenge of arranging childcare, which delayed the departure to the maternity hospital. In others, it was due to patient backlog and lack of resources after the centralisation of births to larger maternity units. In the remaining maternity units, they should take care not to easily turn away those who have travelled long distances to give birth. One of the key factors foreshadowing a successful unplanned out-of-hospital birth is the involvement of an experienced midwife. However, the midwives’ professional competence in assessing the need for treatment over the phone should be developed by midwifery education in the future. The paramedics' perception of their competence in obstetric care was twofold. Some informants felt they knew how to handle an uncomplicated unplanned out-of-hospital birth, while others felt it was a matter of survival or good luck. In the treatment of complicated childbirth, almost all paramedic informants felt that their competence was insufficient. However, paramedics recognized the limitations of their competence and wanted to develop further.

Patient safety can be improved through educational policy decisions and by developing the overall processes of unplanned out-of-hospital obstetric care. The results of this study encourage social debate in the context of the possibilities of social and health services or education and work organisations to develop the necessary professional competences and resources related to unplanned out-of-hospital childbirth and care. An operational concept based on dialogue is needed to develop maternity care providers' expertise and activity systems. This would ensure that a person who goes into unplanned labour outside a hospital can rely on the competence of the professional who will provide the necessary care for a successful birth.

Härkönen S, Lätti J, Rytivaara A, Wallin A. Changing work and operating environments in education: 10 studies utilizing the method of empathy-based stories. Tampere: Tampere University Press; 2022.
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