Unplanned home births

[nickle730]

You know what, I just typed a really long response. And then I deleted it all. Sometimes there is no point. HotI, I am a bloody good paramedic and I , like the vast majority of my colleagues, would only ever act in the best interests of my patient. If I don't have the area of expertise to determine that it is safe to leave you at home, I defer to specialist care by taking you to hospital. Arse covering? Yep, I'll own it. But more important to me than my arse is the health and welfare of you and your baby. Dead babies are not a card to be played, and as someone who has held more than my fair share of dead babies, I find it offensive to hear them referred to as a playing 'card'.

You do have the right to make choices about your medical care, and that includes refusing transport to hospital. But why did you call us in the first place if you don't want our care and treatment? Why call us if you don't want to go to hospital? If there is no emergency, we shouldn't be there. Your right to autonomy sometimes directly conflicts with my Duty of Care. Psych patients and alcohol or drug affected individuals are the most common patients where this occurs. I'm not comparing a pg woman to a psych pt or a drunk, but I don't think we've ever been called to a delivery where mum has refused transport, so I can only relate to the cases where people who I think should go to hospital refuse. It is my responsibility to do everything in my power to get you to the medical care that in my opinion you require. It is my professional opinion that a woman who has had an UNPLANNED and unsupported home birth should be assessed by a health professional with specialist knowledge - that would be a midwife or an ob. I recognise my own professional short comings and the fact is paramedics lack obstetric experience. For the drunks and the psychs, we ultimately call the police if we assess that the patient does not have the capacity to refuse and they are a risk to themselves or others. The police compel the pt to come to hospital, either physically or under the Mental Health Act. I can't imagine calling the police for a woman who has just delivered a baby. I would discuss with the patient the reasons I would like her to come to hospital, I would listen to her reasons for refusing and ultimately I would log the refusal with our central management, complete an incident report and fill in a patient care record meticulously detailing the efforts I had made to convince the patient to be assessed in hospital, I would then have the patient sign that patient care record. Yet, we are told time and again by our employer that none of this will offer us any protection should something happen to mother or baby. We are qualified professionals who should recognise if a patient is at risk - clearly we failed in that duty if the patient we leave at home dies. The Coroners Court is not a threat or a card, it is the place I or my colleagues end up if we screw up or fail in our duty of care to our patient and someone dies.

My response is long again! Not what I intended. Thank you to those of you who defended my previous post, your support is very much appreciated.

I actually returned to this thread because I woke up this morning and felt concerned that I may have discouraged people from calling an ambulance to assist with an unplanned delivery. You should call. We do have training, limited as it is, we have the capacity to contact a specialist hospital for guidance if the delivery is difficult. And whilst our obstetric experience is limited, our resuscitation skills are second to none IF they are required. Because, you know, we'd like to avoid those 'dead babies'.