Unveiling paramedic confidence: exploring paramedics' perceived confidence in out-of-hospital births and obstetric emergencies – a scoping review

Early Abstract:

Background: The centralisation of birthing care, driven by the closure of 225 of Australia’s rural birthing centres over the past 20 years, has resulted in a 47% increase in births before arrivals at hospitals. This shift positions paramedics as critical primary health providers for out-of-hospital births (OOHBs) and obstetric emergencies. Despite the infrequency of such emergencies for paramedics, they demand proficient clinical management due to their severity and potential complications. Confidence is vital for paramedics in managing OOHBs and high-risk obstetric emergencies effectively. However, there is limited research on paramedics' confidence levels and the factors influencing them, particularly in Australia following the introduction of paramedic registration and mandatory obstetric training in 2018. This scoping review seeks to explore paramedics' confidence in managing OOHBs and prehospital obstetric emergencies, identify influencing factors, and examine the implications of confidence on both patient and paramedic welfare.
Methods: Following Joanna Briggs Institute (JBI) methodology, a comprehensive literature search across 3 databases yielded 125 results. Screening of titles and abstracts by two authors, followed by full-text screening of 18 remaining articles, was conducted. Conflicts were resolved by the primary author, and 3 additional relevant articles were retrieved manually. Fourteen studies met the inclusion criteria and were analysed to inform the review.
Results: The findings consistently highlighted feelings of low confidence, insecurity, vulnerability, and heightened stress among paramedics when confronted with OOHBs and prehospital obstetric emergencies. These were largely attributed to infrequent and inadequate education and training, leading to skills decay and difficulties in distinguishing normal from complicated obstetric events. Rurality due to various logistical, geographical and resourcing factors was found to exacerbate paramedic insecurity attending and managing OOHBs and obstetric emergencies. The decline in confidence not only affects clinical proficiency but also poses risks to patient safety and contributes to paramedic stress and poor mental health outcomes. 
Conclusion: Proportional confidence emerges as a crucial factor in medical education, facilitating enhanced clinical competence and better mental health outcomes for patients, clinicians, and teams. This is of increased importance in rural areas where logistical barriers to ensuring appropriate care are prevalent. Further research is needed to ascertain the optimal frequency and type of training/education required to bolster paramedic confidence in managing OOHBs and obstetric emergencies effectively.