Emergency Birth in the Community is brought to you by the same family that produces the UK national ambulance service guidelines: Joint Royal Colleges Ambulance Liaison Committee (JRCALC) and Association of Ambulance Chief Executives (AACE). This is no coincidence. This book has been specifically adopted from the official JRCALC guidelines and expands on many topics including maternal resuscitation, umbilical cord prolapse, shoulder dystocia and post-partum haemorrhage. The editors claim it is the essential resource for ambulance clinicians, midwives, GPs and all health professionals who come into contact with emergency birth—and I agree.
The book's target audience consists of staff in a community setting who may respond to an emergency birth. The editor cleverly groups these professions together by using the term ‘responder’. This is a term that paramedics can easily identify with and they appear to be very much at the forefront of the editor's mind when she put together this book as several references are made to equipment, drugs or training relating to UK NHS ambulance trusts.
What makes this book even more relatable to paramedics is that alongside the midwife editor, Amanda Mansfield, the book was reviewed and contributed to by dual-qualified paramedic and midwife, Aimee Yarrington.
The book is divided into:
Within the overview section, chapters are dedicated to everything from maternity care and bleeding in pregnancy to umbilical cord prolapse, shoulder dystocia, breech birth, post-partum haemorrhage and even maternal/newborn resuscitation. The emergency cards are ideal for placing in a uniform pocket for use when needed. One of my esteemed colleagues commented that they would certainly not be getting out a flashcard when attending a time-critical emergency, but I would argue that I would rather get out an evidence-based flashcard to ensure I provide the best patient care possible than solely rely on my limited experience of attending obstetric emergencies—of course, it would equally be appropriate to consult these flashcards en route to these emergencies.
The sample template similarly provides a standardised method to record information to ensure that handover to the receiving unit or attending midwife contains all of the relevant information. Personally, I think it would almost be worth buying this book just to have the flashcards and standardised template to hand when needed.
The overarching theme across all of the chapters is communication. Specifically, the editor points out what terms should be included in a pre-alert call to the receiving hospital for a variety of different scenarios, e.g. maternal cardiac arrest, foot/arm presentation, cord prolapse. More generally, the editor encourages good communication between the responder and the woman by, for example, making eye contact, and between all responders in order to enhance teamwork. Without expressly mentioning it, the editor consistently uses the term ‘women’ thereby inferring that patients in these scenarios should be referred to as women, rather than patients, which is a change in terminology that might take paramedics some time to get used to.
Throughout reading the book, there were many eye-opening moments for me where I came away thinking I had learned something new and that was directly relevant to my practice as a paramedic. One of those was that for women bleeding in early pregnancy, if shock ensues, this may be ‘out of proportion to the amount of blood loss [because] there is added vagal nerve stimulation from tissue trapped in the cervix’. Informative was also the distinction between primary (<24 hours) and secondary (24 hours–3 months) post-partum haemorrhage, which was followed by an excellent chapter outlining the causes of post-partum haemorrhage and different management steps such as uterine massage, drug administration, emptying the bladder and providing analgesia.
However, there were also aspects that I would hope the editor would address in any subsequent editions of this book. My main suggestion would be to include chapters on maternal mental health, safeguarding, as well as one on women's experiences surrounding emergency birth (Flanagan et al, 2019). I believe that including these chapters would ensure that responders provide more holistic care to women and, in many cases, would merely reflect the patient care that is already provided by many paramedics and emergency medical technicians when attending obstetric emergencies.
Chapter 2 details the assessment of the pregnant woman, and discusses the ABCDEF approach to the primary survey. While it was interesting to see that ‘F’ was added to the acronym to ensure that the fundus/fetus was included in the assessment, I do believe that this approach has now been overhauled by the cABCDEF approach to ensure that catastrophic haemorrhage is addressed first rather than within ‘C’ as reflected in this chapter. There is also an occasion where a sentence is repeated (p.8 ‘increased blood volume results in a pregnant woman being able to tolerate greater blood loss showing signs of hypovolaemia’), which is a highly important message to get across but I do believe the repetition is an oversight by the editor in this case. In addition, tables are not always placed sensitively; for example, on p. 9, the table cuts the sentence in half so the reader has to turn to p. 13 to finish reading the sentence before turning their attention back to the table on p. 9. Lastly, within the ectopic pregnancy chapter, it would have been nice to see more anatomy and physiology, as well as some pathophysiology, rather than the difficult-to-follow list of symptoms and risk factors that is included.
However, these are just minor issues and suggestions for future editions. Overall, I think this book is worth reading and would even go as far as saying it is a must-have to support paramedics in delivering safe maternity care in the community. I agree with Edward Morris who, in the foreword of this book, concludes that it ‘has a place not only on your bookshelf but also in your back pocket’. Personally, I would embrace the publishing of similar expansions of JRCALC for other aspects of prehospital care such as elderly care, paediatrics or trauma. Even the comprehensive reference edition of JRCALC leaves plenty of room for questions but additional publications like this book would allow JRCALC to provide paramedics with enhanced knowledge, thereby improving patient care in the prehospital setting.