Temperature management of babies born in the pre-hospital setting
Paramedics' experiences and an analysis of local patient care records
- Dr Laura Goodwin (UWE Bristol), Chief Investigator
- Professor Jonathan Benger (UWE Bristol)
- Dr Sarah Voss (UWE Bristol)
- Professor Sarah Purdy (University of Bristol)
- Dr Sarah Black (South Western Ambulance Service NHS Foundation Trust)
- Adam Bedson (South Western Ambulance Service NHS Foundation Trust)
- Nick Miller (UWE Bristol)
- Mrs Hazel Taylor (Research Design Service)
- Dr Graham McClelland (North East Ambulance Service NHS Foundation Trust)
- Dr Toity Deave (UWE Bristol)
- Emily Beach (UWE Bristol)
Around 0.5% of all UK births are unplanned Births Before Arrival at hospital (BBA); where the birth occurs in the outside of the hospital setting without the attendance of a qualified midwife or obstetrician. Paramedics are often in attendance at such births, or arrive shortly after the baby is born.
Birth before arrival is associated with poor outcomes, and increased risk of death for babies. Hypothermia (low body temperature) is shown to be one of the biggest factors for these poor outcomes for babies born before arrival; for every 1°C decrease in hospital admission temperature below 36.5°C, the risk of death increases by 28%.
Of all the factors which increase the risk of death for babies born before arrival, hypothermia is the only one that can be influenced after birth. Paramedics are often best placed to help change this; for example by providing hats, using a plastic bag wrap and/or encouraging skin-to-skin contact with the mother. The UK ambulance service guidelines give information to paramedics about the risk of hypothermia for babies born before arrival, and recommend that paramedics measure babies’ temperatures. However, recent research by the North East Ambulance Service suggests that paramedics do not often measure or record temperatures for babies born before arrival.
There is a very little research looking at paramedics’ experiences of BBAs in the UK, and there is nothing which has specifically asked paramedics about temperature measurement and management. Because of this, we do not know why paramedics are not monitoring temperature during BBAs. We also don’t know what methods paramedics use to try and keep babies warm.
This study is funded by the UWE Bristol Vice-Chancellor Early Career Researcher Development Award, in collaboration with the South Western Ambulance Service NHS Foundation Trust. We will use ambulance service data from the South West of England to look at what percentage of babies born before arrival had temperature measurements recorded in their care records, over a three-year period. We will also speak with paramedics to find out their experiences of BBAs, focusing on measuring temperature and how they keep babies warm. It will be useful to find out which methods paramedics think are best at keeping babies warm, and what they think might encourage paramedics to check and record babies’ temperatures.