Jessica Arno, NRP, CPM, knows her way around ambulances, home births and training combat medics in the military during the aftermath of 9/11.

Thanks to her credentials as a paramedic and certified professional midwife, no two days ever look the same. Arno also is one of our EMS instructors. Since childhood, Arno has always dreamed of delivering babies — and that’s exactly what she does as a certified professional midwife. In a recently published EMSWorld article — “EMS and Midwives: Navigating the Out-of-Hospital Transfer” — Arno gives detailed suggestions about what to expect when paramedics are required to assist during or after an at-home emergency childbirth.

Some families prefer home births over hospital births. If you have not yet been dispatched to a emergency home birth complication, don’t feel left out, Arno added. An emergency birth at home is likely to happen sooner than you think.

Whether an emergency or non-emergency transport is needed during childbirth, without hesitation, midwives need to know when to call 911 and get paramedics involved.

A few possible scenarios to expect could range from a birth stalling, a mom hemorrhaging after delivery or a mom who simply needs stitches at the hospital postpartum, Arno said.

Once the paramedics arrive, the last thing you want to deal with is a turf war where egos and tempers flare. When that happens, communication breaks down between midwives and paramedics. You both need to work together for the sake of mom and baby.

“I do not want it to be like I’m the boss,” Arno said. “I want it to be co-management between the midwife and EMS. We want to focus on providing co-care whenever we’re transporting an out-of-hospital birth.”

Communication is key during emergency childbirth

emergency birth

Jessica Arno, NRP, CPM

Communication between the EMS professional and midwife is key to the health of mother and child.

You can follow this on-the-scene checklist provided by Arno to make the emergency childbirth process smoother for all involved:

  1. Start with good communication. Both you and the midwife should provide your names, titles, levels of experience and credentials. Arno summarizes various midwife credentials in her EMSWorld article.
  2. Next, the midwife should give you the patient’s name, age, number of pregnancies and number of hours she’s been in active labor, plus any medications that were administered.
  3. With complications like a stalled labor, Arno tells the paramedic if she’s concerned about hydration levels, fever and when the water broke. She also lets EMS know whether an emergent or non-emergent transfer to the hospital is necessary.
  4. Arno said she lets paramedics know about the patient’s pain level, so they can offer medication and keep her comfortable. “I might say, she’s not tolerating labor very well right now and she’s in a lot of pain, she might be interested in pain medication at this time,” Arno said. It’s not uncommon for paramedics to assume that moms who elect to give birth at home do not want pain medication, Arno said. But that’s not always the case. If the midwife does not provide the patient’s perceived pain level, it’s a good idea for you to ask for one.
  5. Arno usually rides with the expectant mother to the hospital. It’s a good idea to establish the ride arrangements with the midwife ahead of time. Many midwives prefer to accompany moms to the hospital.

How to manage the fear factor during an emergency childbirth

Midwives and paramedics usually get along, but not always, Arno said.

“When I’ve had to call EMS — nine times out of 10 paramedics are very cooperative, super helpful and amazing,” she said. “However, I’ve had a handful of times when things go wrong.”

When attitude issues crop up between the midwife and paramedic, during or after a home birth, Arno said the root cause usually boils down to fear and poor communication.

“EMS professionals feel fear [during emergency childbirth],” she said. “I can say this because I am both, EMS and midwife.”

Fear is a normal reaction when EMS is dispatched on a pediatric call. Below is Arno’s take on why paramedics face fear.

  1. “We don’t see pediatrics very often. When we do, it’s usually horrific, it’s abuse or a face down child in the pool, usually something bad.”
  2. “We value pediatrics as humans, so it crushes our hearts when we see them sick or injured.”
  3. “The fear of someone having a baby outside the hospital — it’s that feeling of ‘what the hell am I about to walk into’ when the call comes in from the CAD system.”

Fear is not something we have much control over, said Arno. But there are ways to work with it. She suggests tapping into a part of the ego that allows you to get really confident about going into fearful situations. Some people refer to this as channeling their emotions.

Arno said our ego can be a useful tool. She uses hers to find inner strength while she gives herself a pep talk.

“You can tap into ego in a positive or negative way,” she said. “To combat the fear, I have to jump into some ego and say, ‘I’m going to crush this.”

It takes gumption and grit to be an EMS professional, Arno said. That’s because you work in dire conditions with limited resources. Having the right attitude makes all the difference when trying to manage fear.

Learn more in our course about pediatric emergencies and OB trauma management.