Inequalities in birth before arrival at hospital in South West England: a multimethods study of neonatal hypothermia and emergency medical services call-handler advice

Laura Goodwin; Kim Kirby; Graham McClelland; Emily Beach; Adam Bedson; Jonathan Richard Benger; Toity Deave; Ria Osborne; Helen McAdam; Roisin McKeon-Carter; Nick Miller; Hazel Taylor; Sarah Voss

doi:10.1136/bmjopen-2023-081106

Inequalities in birth before arrival at hospital in South West England: a multimethods study of neonatal hypothermia and emergency medical services call-handler advice

BMJ Open. 2024 Apr 28;14(4):e081106. doi: 10.1136/bmjopen-2023-081106.

Authors

Laura Goodwin¹, Kim Kirby^{2

3}, Graham McClelland⁴, Emily Beach¹, Adam Bedson⁵, Jonathan Richard Benger¹, Toity Deave⁶, Ria Osborne⁷, Helen McAdam⁸, Roisin McKeon-Carter⁹, Nick Miller¹, Hazel Taylor¹⁰, Sarah Voss¹

Affiliations

¹ School of Health and Social Wellbeing, University of the West of England, Bristol, UK.
² School of Health and Social Wellbeing, University of the West of England, Bristol, UK kim.kirby@uwe.ac.uk.
³ Research, Audit and Quality Improvement Department, South Western Ambulance Service NHS Foundation Trust, Exeter, UK.
⁴ Northumbria University, Newcastle upon Tyne, UK.
⁵ South Western Ambulance Service NHS Foundation Trust, Exeter, UK.
⁶ Centre for Child and Adolescent Health, University of the West of England, Bristol, UK.
⁷ Research, Audit & Improvement, South Western Ambulance Service NHS Foundation Trust, Exeter, UK.
⁸ Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK.
⁹ University Hospitals Plymouth NHS Trust, Plymouth, UK.
¹⁰ Research Design Service, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.

Abstract

Objectives: To examine inequalities in birth before arrival (BBA) at hospitals in South West England, understand which groups are most likely to experience BBA and how this relates to hypothermia and outcomes (phase A). To investigate opportunities to improve temperature management advice given by emergency medical services (EMS) call-handlers during emergency calls regarding BBA in the UK (phase B).

Design: A two-phase multimethod study. Phase A analysed anonymised data from hospital neonatal records between January 2018 and January 2021. Phase B analysed anonymised EMS call transcripts, followed by focus groups with National Health Service (NHS) staff and patients.

Setting: Six Hospital Trusts in South West England and two EMS providers (ambulance services) in South West and North East England.

Participants: 18 multidisciplinary NHS staff and 22 members of the public who had experienced BBA in the UK.

Results: 35% (64/184) of babies conveyed to hospital were hypothermic on arrival. When compared with national data on all births in the South West, we found higher percentages of women with documented safeguarding concerns at booking, previous live births and 'late bookers' (booking their pregnancy >13 weeks gestation). These women may, therefore, be more likely to experience BBA. Preterm babies, babies to first-time mothers and babies born to mothers with disability or safeguarding concerns at booking were more likely to be hypothermic following BBA. Five main themes emerged from qualitative data on call-handler advice: (1) importance placed on neonatal temperature; (2) advice on where the baby should be placed following birth; (3) advice on how to keep the baby warm; (4) timing of temperature management advice and (5) clarity and priority of instructions.

Conclusions: Findings identified factors associated with BBA and neonatal hypothermia following BBA. Improvements to EMS call-handler advice could reduce the number of babies arriving at hospital hypothermic.

Keywords: accident & emergency medicine; health equity; maternal medicine; neonatology; paediatric A&E and ambulatory care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Emergency Medical Services* / statistics & numerical data
England
Female
Focus Groups
Humans
Hypothermia* / therapy
Infant, Newborn
Male
Pregnancy