Lead: Prof Sara Kenyon, Dr Nimarta Dharni, Sophie Dann
Dates: 2024 – ongoing
Background:
In the UK, approximately 0.5% of births are unplanned pre-hospital births, or ‘births before arrival’ at hospital (BBA). BBAs are associated with unfavourable perinatal outcomes and increased mortality for women and babies. They can result in psychological distress for both women and birth partners, and frustration and loss of trust in maternity services. BBAs can also be highly stressful for ambulance clinicians, who have limited training on labour and birth and only rarely attend such events. However there is a lack of evidence of the impact of BBA on UK healthcare professionals and service users.
BBAs have been highlighted as a priority by local service providers, led by the deputy Chief Midwife in the Midlands Office, and supported by the Directors of Midwifery (DoMs) and Heads of Midwifery (HoMs) across the Midlands. There is concern amongst midwifery and ambulance services that the number of BBAs is increasing. While this may be linked to problems accessing maternity services due to capacity and pressure on services, the scale of the problem is unknown. For the purposes of this service evaluation, the research team will work closely with regional ambulance service providers and NHS maternity services, to evaluate rates of BBA according to ambulance services, and the experiences of those involved, including ambulance clinicians, midwives and parents.
Discussions with local ambulance services in the East and West Midlands have highlighted variation between the regions as to how BBAs are recorded. This has the potential for BBAs to be unrecorded – particularly because documentation focuses on the reason for the 999 call (eg. abdominal pain), rather than the outcome (eg. birth).
The challenge of assessing the scale of BBAs is further exacerbated by the lack of a clear definition. Anecdotal evidence suggests there is great variation across services and individuals in what would be documented as a BBA, which limits rigorous audit or analysis.
The maternity team at NHS England (NHSE) are undertaking a survey across the Midlands, of maternity services’ data on BBAs and how they define a BBA. This includes the numbers recorded at each Trust, the babies’ gestations, the Trust reporting and review of these cases. The findings of this survey will be shared with the research team to complement this project.
Policy and Practice Partners:
NHS England. West Midlands Ambulance Service. East Midlands Ambulance Service.
Aims and Objectives:
This study aims to obtain a clearer understanding of babies ‘born before arrival’ (BBA) in the Midlands. The quantitative element aims to identify the numbers of babies ‘born before arrival’ in the Midlands. The qualitative study aims to capture the views and experiences of ambulance clinicians, midwives and women.
Methods:
A mixed methods service evaluation, comprising quantitative and qualitative studies.
Quantitative Study:
- Collection of 12 months retrospective and 6 months prospective pseudo-anonymised data by the East and West Midlands Ambulance Services to record the number of ‘unscheduled births outside hospital, attended by either an ambulance clinician or no healthcare professional’.
- Collection of Trust data across the Midlands by NHS England regarding the definition, incidence, gestation, reporting and review of BBAs.
- Potential triangulation of this data to explore similarities and differences.
Qualitative Study:
- 10-12 interviews with ambulance clinicians who have experience of caring for a BBA.
- 10-12 interviews with midwives who have experience of caring for a BBA.
- 10-12 interviews with women or birthing people who have experienced a BBA, or birth partners present at a BBA, in the Midlands.
Analysis: Quantitative data will be analysed using descriptive and inferential statistics to explore incidence of BBAs, and comparison of data collected retrospectively and prospectively, and from the East and West Midlands. Qualitative data will be coded systematically and iteratively until the analysis framework adequately captures the data and saturation has been achieved, and analysed using thematic analysis (TA) to explore patterns inherent within the data. Findings from both aspects of the study will be triangulated to build an overall understanding of the incidence and impact of BBAs in the Midlands.
Main Results:
Study currently underway – May 2024 to April 2025.
Conclusions:
Study currently underway – May 2024 to April 2025.
Implications for Implementation:
To advise service providers of the current picture of BBA within the Midlands, and to potentially inform a larger project exploring BBA and its impact on parents and healthcare professionals.