The challenges of delivery in Pre-hospital Emergency Medical Services ambulances in Iran: a qualitative study

Abstract Background: Although encountering with unplanned births in the ambulance is uncommon, but the Emergency Medical Service (EMS) providers may face with it before arrival to hospital, that can accompany with problems and challenges for ambulance staff, pregnant women and neonates. This research was done to explain the experiences of EMS providers and pregnant women. Methods: A qualitative study was conducted, and 28 Emergency Medical Technicians (EMTs), midwives and pregnant women who had experience of prehospital births in ambulance were interviewed. Data were analyzed with thematic content analysis also MAXQDA/10 software was used for data analysis and code extraction. Results: The analysis of the interviews revealed two main categories. Factors that cause delivery in ambulance and its challenges. The factors include cultural problems, weak managers and inaccessibility to facilities and the challenges consist of fear and anxiety, native culture and lack of resources. Conclusions: Several approaches should be taken to reduce birth in ambulances and Pre-hospital Emergency Medical Services (PEMS), including long-term cultural activities with community participation, public education and awareness-raising activities, education and follow-up of pregnant women with simultaneous increase accessibility to health facilities. Also, EMTs should be educated and trained about delivery in ambulance. Services improvement by providing proper and equipped ambulance as well as support EMTs against litigation claims are other important activities.