Prehospital Births in the Region of Southern Denmark—A Cohort From 2016 to 2024

BACKGROUND: Unplanned births outside hospitals involve higher risks of complications for mothers and newborns and require special obstetric or pediatric skills. However, ambulance calls for childbirth are rare, making it difficult for ambulance staff to maintain their skills. In Europe, unplanned out-of-hospital deliveries constitute 0.10% to 0.61% of all births. The exact number of prehospital births in the Region of Southern Denmark remains unknown. The study aimed to determine the extent of unplanned prehospital births attended by the ambulance service outside hospitals in the Region of Southern Denmark from January 2016 through June 2024. We further aimed to identify where the unplanned pre-hospital births took place and to report any birth-related complications in the mothers or newborns encountered by ambulance staff. METHODS: The study was a cross-sectional study utilizing the pre-hospital electronic Patient Medical Record system over 8 years in a mixed urban-rural area with a population of 1.2 million people. All prehospital medical records for ambulance missions dispatched for childbirths were manually examined. The study period spanned from January 2016 through June 2024. RESULTS: Out of 1,137,222 ambulance dispatches, 3543 cases (0.31%) involved a dispatch code related to childbirth. Many labor incidents were considered uneventful by the prehospital personnel. Of all ambulance runs related to childbirth, we identified 310 births in the Region of Southern Denmark in which ambulance staff assisted with complicated out-of-hospital deliveries. An additional 10 labor cases were regarded as sufficiently complex that obstetric manoeuvres aimed at delaying the delivery of the baby were performed prehospitally, while the mother was rushed to hospital for delivery. CONCLUSION: Births outside the hospital while the mother is in the care of the EMS were rare, occurring in 0.03% of all ambulance missions. Most of the births took place without complications for both mother and neonate. In four cases, however, the neonate was in cardiac arrest and required resuscitation. Given the limited exposure to prehospital births, we suggest incorporating training in handling these rare events into routine training for prehospital caregivers. EDITORIAL COMMENT: This cohort study presents obstetrical cases that have been managed first in the prehospital setting by ambulance personnel. Obstetrical outcomes related to this are presented, and there are considerations for what can be desirable as preparation and competencies for ambulance responses for these types of cases.