Sudden Arrivals: NZ Ambulance Crews Describe What It’s Like When Babies Are Born Out Of The Blue

It doesn’t happen very often, but every now and then expectant
mothers don’t quite make it to the delivery suite on
time – requiring specialised care from emergency
medical services (EMS).

This can happen when babies
come early, when the mother-to-be is in denial, or when they
simply don’t know they are pregnant. These out-of-hospital
births can increase the risks for both mother and
child.

While there haven’t been any New
Zealand-specific studies, data from Norway
and Ireland
show infant mortality rates are two to three times higher
for unplanned out-of-hospital births compared to those in
medical facilities.

In 2024, Hato Hone St John,
Aotearoa New Zealand’s largest ambulance service, responded
to 2,745 obstetric emergencies. This accounted for 0.9%
of all ambulance patients – similar to comparable
countries such as Australia and the United
States.

In our new research, we surveyed Hato Hone
St John ambulance personnel to better understand their
experiences attending unplanned out-of-hospital births.
Although such events are rare, personnel must be prepared
to provide care for mothers and newborns during any
clinical shift.

The 147 responses we received
highlighted the need for ongoing and targeted training for
staff as they balance supporting the safe arrival of a
newborn with patient and whānau-centered
care.

Navigating the unknown

EMS personnel
reported being dispatched for reports of abdominal or back
pain in female patients, only to encounter an unanticipated
imminent birth upon arrival.

In many of these cases,
patients were unaware of their pregnancies and had received
no prior antenatal care. This left EMS personnel to lead
labour and birth care without crucial information about
gestational age or potential complications. As one paramedic
explained:

The call was for non-traumatic
back pain. The patient had a cryptic
pregnancy and was not aware she was pregnant until I
informed her that she was in labour. I was the senior
clinician in attendance, we were 25 minutes to a maternity
unit that didn’t have surgical facilities and a [neonatal
unit].

In some situations, EMS personnel
attended teenage patients who were in denial of their
pregnancies or fearful it would be discovered by their
families.

Attending to the mother’s emotional needs,
respecting her dignity and navigating family dynamics
compounded existing challenges to providing care. Another
paramedic explained:

Attended an
18-year-old that did not know or was in denial that she was
pregnant. She had the baby on her own in the bathroom. The
parents came home during the birth, and she was too scared
to tell them and kept the baby quiet by nursing her. She
called an ambulance from the bathroom and told them she
didn’t want the parents to
know.

Practical
challenges

Complex births, medical emergencies and
limited specialised neonatal equipment required EMS to
improvise in such cases. While some focused on skin-to-skin
contact between mother and baby, others prepared makeshift
blankets using things such as plastic clingfilm to keep
their newborn patients warm. An intensive care paramedic
said:

I needed to “chew” through the
cord with the scissors provided, which was frustrating given
the patient was under CPR. Also, I wanted to keep the
patient warm as the house was cold and it was winter, so I
used the Gladwrap in the ambulance. The roll I had was a new
one and very difficult to start up as it shredded. I ended
up using the patient’s industrial size wrap with a plastic
blade attached.

The distance to a
specialised newborn care facility, as well as rules around
who could be transported and when, meant mothers and babies
sometimes needed separate transport. This distressed mothers
and added pressure to already stressful situations. One
North Island-based paramedic
explained:

The baby was flown to [a
tertiary hospital] – great for the baby but very
distressing for mum as she had to be transported by
road.

Detailed accounts emerged of EMS
providing labour and birth care in remote and poorer areas,
such as homes with no electricity or heating, far away from
hospital facilities and with no back up readily available.
Another South Island-based paramedic
said:

It was 2 degrees outside and the
front door was open. The house was cold, and the mother was
standing in the bathroom with the [newborn] lying on the
cold floor. I called for backup as the mother had a severe
postpartum haemorrhage, and the [newborn] required
resuscitation. I was not sent assistance and had to manage
the mother and [newborn] by myself during a 15-minute drive
to the birth suite at hospital.

The
stories shared by New Zealand ambulance personnel not only
described their critical role in providing care during
labour and birth, but also highlighted a gap in care for
women not accessing routine antenatal and birth
services.

Training and support needed

Studies
from Norway, Australia,
the US and
the United
Kingdom have previously highlighted the need for
dedicated EMS training and equipment to support
out-of-hospital births.

Change is happening in New
Zealand. Recent updates to Hato Hone St John guidelines,
resources and training, including education on cultural
considerations related to birth, aim to prepare EMS
personnel for these unpredictable and high-risk
scenarios.

Ongoing training and education will be
critical to support clinicians to confidently address birth
emergencies while continuing to deliver patient and
whānau-centered care.

Vinuli
Withanarachchie, PhD candidate, College of
Health, Te
Kunenga ki Pūrehuroa – Massey University;
Bridget
Dicker, Associate Professor of Paramedicine,
Auckland
University of Technology; Sarah
Maessen, Research Fellow, Department of
Paramedicine, Auckland
University of Technology, and Verity
Todd, Senior Lecturer, Paramedicine, Auckland
University of Technology

This article is
republished from The
Conversation under a Creative Commons license.
Read the original
article.

Disclosure
statement

Vinuli Withanarachchie works for Hato
Hone St John.

Bridget Dicker is an employee of
Hato Hone St John.

Sarah Maessen works for Hato
Hone St John.

Verity Todd receives funding from
the Heart Foundation NZ and Health Research Council NZ. She
is affiliated with Hato Hone St John.

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