1
|
Strózik M, Wiciak H, Szarpak L, Wroblewski P, Smereka J. EMS Interventions during Planned Out-of-Hospital Births with a Midwife: A Retrospective Analysis over Four Years in the Polish Population. J Clin Med 2023; 12:7719. [PMID: 38137788 PMCID: PMC10743867 DOI: 10.3390/jcm12247719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023] Open
Abstract
Planned out-of-hospital births, facilitated by highly skilled and experienced midwives, offer expectant parents a distinct opportunity to partake in a personalized, intimate, and empowering birth experience. Many parents opt for the care provided by midwives who specialize in supporting home births. This retrospective study is based on 41,335 EMS emergency calls to women in advanced pregnancy, of which 209 concerned home birth situations documenting obstetrical emergencies over four years (January 2018 to December 2022), of which 60 involved the assistance of a midwife. Data were obtained from the Polish Central System for Emergency Medical Services Missions Monitoring, encompassing all EMS interventions in pregnant women. The most frequent reason for emergency calls for obstetrical emergencies with the assistance of a midwife was a failure to separate the placenta or incomplete afterbirth (18 cases; 30%), followed by perinatal haemorrhage (12 cases; 20%) and deterioration of the newborn's condition (8 cases; 13%). Paramedic-staffed EMS teams conducted most interventions (43 cases; 72%), with only 17 (28%) involving the presence of a physician. Paramedics with extensive medical training and the ability to provide emergency care are in a unique position that allows them to play a pivotal role in supporting planned out-of-hospital births. The analysed data from 2018-2022 show that EMS deliveries in Poland are infrequent and typically uncomplicated. Continuing education, training, and adequate funding are required to ensure the EMS is ready to provide the best care. EMS medical records forms should be adapted to the specific aspects of care for pregnant patients and newborns.
Collapse
Affiliation(s)
- Mateusz Strózik
- Department of Emergency Medical Service, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.S.); (P.W.)
- 2nd Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Hanna Wiciak
- 1st Department and Clinic of Gynaecology and Obstetrics, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Department of Clinical Research and Development, LUXMED Group, 02-676 Warsaw, Poland
| | - Pawel Wroblewski
- Department of Emergency Medical Service, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.S.); (P.W.)
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, 50-367 Wroclaw, Poland; (M.S.); (P.W.)
| |
Collapse
|
2
|
Jakobsen MH, Udjus E, Røseth I, Dahl B. Midwives' experiences with accompaniment service work in Norway: A qualitative study. Eur J Midwifery 2023; 7:5. [PMID: 36844193 PMCID: PMC9951232 DOI: 10.18332/ejm/160074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 01/28/2023] [Accepted: 02/02/2023] [Indexed: 02/28/2023] Open
Abstract
INTRODUCTION The centralization of health services appears to be prevalent both in and outside Europe. As the distance to the nearest birth institution increases, so does the risk of unplanned births outside of an institution. A primary factor to prevent this is having a skilled birth attendant present. This study examines midwives' experiences of working in the accompaniment services in Norway. METHODS This was a qualitative interview study of 12 midwives working in the accompaniment services in Norway. Semi-structured interviews were conducted in January 2020. Systematic text condensation was used to analyze the data. RESULTS The analysis identified four main themes. The midwives felt that accompaniment service work was a heavy responsibility, but it was professionally fulfilling. They felt that being on call was a lifestyle, and they were motivated by their relationships with the pregnant women. Presenting themselves as confident midwives helped the women to feel reassured. The midwives considered the cooperation within the health service to be key to good transport midwifery. CONCLUSIONS The midwives who worked in the accompaniment services felt that their responsibility for caring for women in labor was challenging, but meaningful. Their professional knowledge was important for identifying the risk of complications and handling difficult situations. Despite carrying a heavy workload, they continued to work in the accompaniment services to ensure that women who had to travel long distances to birth institutions received appropriate help.
Collapse
Affiliation(s)
- Marita H. Jakobsen
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
| | - Elise Udjus
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
| | - Idun Røseth
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway,Department of Child and Adolescent Mental Health, Telemark Hospital Trust, Skien, Norway
| | - Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway, Borre, Norway
| |
Collapse
|
3
|
Cash RE, Swor RA, Samuels-Kalow M, Eisenbrey D, Kaimal AJ, Camargo CA. Frequency and severity of prehospital obstetric events encountered by emergency medical services in the United States. BMC Pregnancy Childbirth 2021; 21:655. [PMID: 34560847 PMCID: PMC8464145 DOI: 10.1186/s12884-021-04129-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/15/2021] [Indexed: 03/21/2023] Open
Abstract
Background Prehospital obstetric events encountered by emergency medical services (EMS) can be high-risk patient presentations for which suboptimal care can cause substantial morbidity and mortality. The frequency of prehospital obstetric events is unclear because existing descriptions have reported obstetric and gynecological conditions together, without delineating specific patient presentations. Our objective was to identify the types, frequency, and acuity of prehospital obstetric events treated by EMS personnel in the US. Methods We conducted a cross-sectional analysis of EMS patient care records in the 2018 National EMS Information System dataset (n=22,532,890). We focused on EMS activations (i.e., calls for service) for an emergency scene response for patients aged 12-50 years with evidence of an obstetric event. Type of obstetric event was determined by examining patient symptoms, the treating EMS provider’s impression (i.e., field diagnosis), and procedures performed. High patient acuity was ascertained by EMS documentation of patient status and application of the modified early obstetric warning system (MEOWS) criteria, with concordance assessed using Cohen’s kappa. Descriptive statistics were calculated to describe the primary symptoms, impressions, and frequency of each type of obstetric event among these activations. Results A total of 107,771 (0.6%) of EMS emergency activations were identified as involving an obstetric event. The most common presentation was early or threatened labor (15%). Abdominal complaints, including pain and other digestive/abdomen signs and symptoms, was the most common primary symptom (29%) and primary impression (18%). We identified 3,489 (3%) out-of-hospital deliveries, of which 1,504 were preterm. Overall, EMS providers documented 34% of patients as being high acuity, similar to the MEOWS criteria (35%); however, there were high rates of missing data for EMS documented acuity (19%), poor concordance between the two measures (Cohen’s kappa=0.12), and acuity differences for specific conditions (e.g., high acuity of non-cephalic presentations, 77% in EMS documentation versus 53% identified by MEOWS). Conclusion Prehospital obstetric events were infrequently encountered by EMS personnel, and about one-third were high acuity. Additional work to understand the epidemiology and clinical care of these patients by EMS would help to optimize prehospital care and outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04129-1.
Collapse
Affiliation(s)
- Rebecca E Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Robert A Swor
- Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Royal Oak, MI, USA
| | - Margaret Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Eisenbrey
- Department of Emergency Medicine, McLaren Flint Hospital, Flint, MI, USA
| | - Anjali J Kaimal
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Genowska A, Strukcinskiene B, Villerusa A, Konstantynowicz J. Converging or diverging trajectories of mortality under one year of age in the Baltic States: a comparison with the European Union. ACTA ACUST UNITED AC 2021; 79:76. [PMID: 33985577 PMCID: PMC8117592 DOI: 10.1186/s13690-021-00598-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Information about trends in perinatal and child health inequalities is scarce, especially in the Eastern Europe. We analyzed how mortality under 1 year of age has been changing in the Baltic States and the European Union (EU) over 25 years, and what associations occurred between changes in macroeconomic factors and mortality. METHODS Data on fetal, neonatal, infant mortality, and macroeconomic factors were extracted from WHO database. Joinpoint regression analysis was performed to analyze time trajectories of mortality over 1990-2014. We also investigated how the changes in health expenditures and Gross Domestic Product (GDP) contributed to the changes in mortality. RESULTS The reduction of fetal, neonatal and infant mortality in the Baltic countries led to convergence with the EU. In Estonia this process was the fastest, and then the rates tended to diverge. The strongest effect in reduction of neonatal mortality was related to the annual increase in health expenditure and GDP which had occurred in the same year, and a decrease in fetal mortality associated with an increase in health expenditure and GDP in the 4th and 5th year, respectively, following the initial change. CONCLUSIONS These findings outlined convergences and divergences in mortality under 1 year of age in the Baltic States compared with the patterns of the EU. Our data highlighted a need to define health policy directions aimed at the implementation of effective intervention modalities addressing reduction of risks in prenatal and early life.
Collapse
Affiliation(s)
- Agnieszka Genowska
- Department of Public Health, Medical University of Bialystok, Bialystok, Poland
| | | | - Anita Villerusa
- Department of Public Health and Epidemiology, Institute of Public Health, Rīga Stradinš University, Rīga, Latvia
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, University Children's Hospital, Bialystok, Poland.
| |
Collapse
|
5
|
Ovaskainen K, Ojala R, Tihtonen K, Gissler M, Luukkaala T, Tammela O. Unplanned out-of-hospital deliveries in Finland: A national register study on incidence, characteristics and maternal and infant outcomes. Acta Obstet Gynecol Scand 2020; 99:1691-1699. [PMID: 32609879 DOI: 10.1111/aogs.13947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Unplanned out-of-hospital deliveries (UOHDs) have earlier been related to higher perinatal mortality and morbidity, but recent research has not paid much attention to them. Our aim was to evaluate the incidence, characteristics, risk factors, and maternal and perinatal mortality and morbidity in UOHDs in Finland. MATERIAL AND METHODS We conducted a national register study on births, causes of death and congenital anomalies for all live and stillbirths during 1996-2013. The study group included 1420 infants delivered by mothers with UOHDs. The 1 051 139 infants born in hospitals during the study period were the reference group. Data on maternal and delivery characteristics, obstetric procedures, infants' characteristics, neonatal care unit admissions, diagnoses, congenital anomalies and causes of death were collected. RESULTS The annual rate of UOHDs increased in 1996-2013 from 46 to 260 per 100 000 deliveries, whereas the number of delivery units decreased from 44 to 29. UOHD infants had five times higher perinatal mortality rates than those delivered in hospitals. The perinatal mortality rate did not change by time in the UOHDs, whereas it diminished among in-hospital deliveries. Maternal morbidity in UOHDs was low. The predictors for UOHDs were delivery after the year 2001, delivery in sparsely populated areas, alcohol, drug abuse and/or smoking during pregnancy, being single, fewer prenatal visits, having delivered earlier and birthweight <2500 g. UOHD was one of the predictors of perinatal morbidity and mortality. Among the UOHD cases, the predictors of perinatal morbidity or mortality included low birthweight and preterm delivery. Time period seemed not to predict morbidity or mortality. CONCLUSIONS The UOHD rate increased, probably due to multifactorial causes, including living in area with low population density and short duration of labor. UOHD was a significant predictor of perinatal morbidity or mortality, but the numbers were very small. Neonatal morbidity and mortality in UOHDs did not seem to be related to the area or time period of birth.
Collapse
Affiliation(s)
- Katja Ovaskainen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,School of Medicine Doctoral Program, University of Tampere, Tampere, Finland
| | - Riitta Ojala
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Kati Tihtonen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland.,Karolinska Institutet, Stockholm, Sweden
| | - Tiina Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Outi Tammela
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| |
Collapse
|
6
|
GUTVIRTZ G, WAINSTOCK T, LANDAU D, SHEINER E. Unplanned Out-of-Hospital Birth-Short and Long-Term Consequences for the Offspring. J Clin Med 2020; 9:jcm9020339. [PMID: 31991747 PMCID: PMC7073687 DOI: 10.3390/jcm9020339] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/18/2020] [Accepted: 01/21/2020] [Indexed: 01/08/2023] Open
Abstract
The unpredictable nature of childbirth infrequently results in unplanned out-of-hospital birth, in a pre-hospital setting. We evaluated the perinatal and long-term outcome of children accidentally born out-of-hospital. This was a population-based analysis of singleton deliveries occurring at a single tertiary hospital. The maternal characteristics and pregnancy outcome of unplanned out-of-hospital births were compared with in-hospital attended deliveries. Long-term cumulative incidence of hospitalizations (up to 18 years) involving respiratory, neurological, endocrine or infectious morbidity were evaluated using Kaplan-Meier survival curves and Cox regression models were used to control for confounders. In total, 243,682 deliveries were included, and 1.5% (n = 3580) were unplanned out-of-hospital births. Most occurred in multiparous women, and about a quarter of these women had inadequate prenatal care. Perinatal mortality rate was significantly higher for out-of-hospital births as compared with in-hospital births (OR = 2.9; 95% CI 2.2-3.8, p < 0.001). Kaplan-Meier survival curves demonstrated a significantly lower cumulative incidence of hospitalizations of children born out-of-hospital and the Cox models showed that hospitalization rates involving any of the above morbidities were significantly lower in children born out-of-hospital. While perinatal mortality was higher in unplanned out-of-hospital births, offspring born out-of-hospital showed a lower incidence of hospitalizations involving a variety of morbidities, possibly owing to under-utilization of healthcare services in this population.
Collapse
Affiliation(s)
- Gil GUTVIRTZ
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel;
- Correspondence:
| | - Tamar WAINSTOCK
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva POB 653, Israel;
| | - Daniella LANDAU
- Department of Neonatology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel;
| | - Eyal SHEINER
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva POB 151, Israel;
| |
Collapse
|
7
|
Vagle H, Haukeland GT, Dahl B, Aasheim V, Vik ES. Emergency medical technicians' experiences with unplanned births outside institutions: A qualitative interview study. Nurs Open 2019; 6:1542-1550. [PMID: 31660182 PMCID: PMC6805291 DOI: 10.1002/nop2.354] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 01/23/2023] Open
Abstract
AIM To explore emergency medical technicians' experiences with unplanned births outside institutions. DESIGN A qualitative interview study. METHODS Individual semi-structured interviews with 12 emergency medical technicians in Norway. Systematic text condensation was used to analyse the data material. RESULTS Analysis showed that there is a mismatch between society's expectations about emergency medical technicians and the reality they encounter in out-of-hospital maternity care, that emergency medical technicians experience a general lack of training in caring for labouring women and that poor communication with other health professions challenges patient safety. The participants expressed how they do their best in caring for both mother and child, in spite of a lack of education, training and competence in assisting labouring women.
Collapse
Affiliation(s)
- Hanne Vagle
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Gunn Terese Haukeland
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Bente Dahl
- Centre for Women's, Family and Child Health, Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayKongsbergNorway
| | - Vigdis Aasheim
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Eline Skirnisdottir Vik
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
| |
Collapse
|
8
|
Mileder LP, Gressl J, Urlesberger B, Raith W. Paramedics' Newborn Life Support Knowledge and Skills Before and After a Targeted Simulation-Based Educational Intervention. Front Pediatr 2019; 7:132. [PMID: 31024872 PMCID: PMC6467958 DOI: 10.3389/fped.2019.00132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/20/2019] [Indexed: 01/08/2023] Open
Abstract
Objective: Resuscitation of neonates after birth in the out-of-hospital setting is challenging. Thus, we aimed to assess paramedics' newborn life support knowledge and skills before and after targeted simulation-based training. Methods: Voluntary paramedics were recruited from a single Red Cross division. During a 1-day simulation-based educational intervention, essential aspects of neonatal resuscitation were taught and practiced. Before and after simulation-based training, we assessed (1) knowledge of current European Resuscitation Council (ERC) guidelines using a 20-item-questionnaire and (2) the quality of simulated bag-valve-mask ventilation by measuring face mask leakage, using a respiratory function monitor (Standardized Measurement of Airway Resuscitation Training [SMART], GM Instruments Ltd., United Kingdom). Results: Forty-one paramedics participated in the initial survey and 12 took part in the simulation-based educational intervention. There was a significant increase in the number of correctly answered questions: median 62.1% (IQR 37.5-77.4%) vs. 91.7% (IQR 83.3-100%; p = 0.001). A total of 1,332 inflations were analyzed. The incidence of substantial mask leakage >75% decreased significantly after training (15.8 vs. 6.1%; p < 0.001), while median mask leakage was similar (17.0% [IQR 0.0-55.0%] vs. 18.0% [IQR 6.0-34.0%]; p = 0.414). Conclusions: Among paramedics, theoretical knowledge of current ERC guidelines was moderate in this study. Participation in a targeted simulation-based educational intervention was associated with a significant increase in theoretical knowledge. The initially high incidence of substantial mask leakage >75% was decreased after simulation-based training using respiratory function monitoring.
Collapse
Affiliation(s)
- Lukas P Mileder
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Jennifer Gressl
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Wolfgang Raith
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| |
Collapse
|
9
|
Gunnarsson B, Fasting S, Skogvoll E, Smárason AK, Salvesen KÅ. Why babies die in unplanned out-of-institution births: an enquiry into perinatal deaths in Norway 1999-2013. Acta Obstet Gynecol Scand 2017; 96:326-333. [PMID: 27886371 PMCID: PMC5347971 DOI: 10.1111/aogs.13067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/19/2016] [Indexed: 12/01/2022]
Abstract
Introduction The aims were to describe causes of death associated with unplanned out‐of‐institution births, and to study whether they could be prevented. Material and methods Retrospective population‐based observational study based on data from the Medical Birth Registry of Norway and medical records. Between 1 January 1999 and 31 December 2013, 69 perinatal deaths among 6027 unplanned out‐of‐institution births, whether unplanned at home, during transportation, or unspecified, were selected for enquiry. Hospital records were investigated and cases classified according to Causes of Death and Associated Conditions. Results 63 cases were reviewed. There were 25 (40%) antepartum deaths, 10 (16%) intrapartum deaths, and 24 neonatal (38%) deaths. Four cases were in the unknown death category (6%). Both gestational age and birthweight followed a bimodal distribution with modes at 24 and 38 weeks and 750 and 3400 g, respectively. The most common main cause of death was infection (n = 14, 22%), neonatal (n = 14, 22%, nine due to extreme prematurity) and placental (n = 12, 19%, seven placental abruptions). There were 86 associated conditions, most commonly perinatal (n = 32), placental (n = 15) and maternal (n = 14). Further classification revealed that the largest subgroup was associated perinatal conditions/sub‐optimal care, involving 25 cases (40%), most commonly due to sub‐optimal maternal use of available care (n = 14, 22%). Conclusions Infections, neonatal, and placental causes accounted for almost two‐thirds of perinatal mortality associated with unplanned out‐of‐institution births in Norway. Sub‐optimal maternal use of available care was found in more than one‐fifth of cases.
Collapse
Affiliation(s)
- Björn Gunnarsson
- Department of Research, Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigurd Fasting
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Anesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Eirik Skogvoll
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Anesthesia and Intensive Care Medicine, St. Olav's University Hospital, Trondheim, Norway
| | - Alexander K Smárason
- Institute of Health Science Research, University of Akureyri, Akureyri, Iceland.,Department of Obstetrics and Gynecology, Akureyri Hospital, Akureyri, Iceland
| | - Kjell Å Salvesen
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Obstetrics and Gynecology, St. Olav's University Hospital, Trondheim, Norway
| |
Collapse
|