Midwives' experience of managing emergencies during labour and birth in a community setting: a mixed-methods systematic review

Background

For women at low risk of complications during labour and birth, in the United Kingdom, planned birth in a ‘community’ setting (at home or a freestanding midwifery unit) is generally safe, and intrapartum emergencies are uncommon. Limited exposure may affect midwives’ experience of managing an emergency.

Aim

Identify and synthesise available evidence about midwives’ experiences of managing intrapartum emergencies during labour in a community setting.

Methods

A mixed-methods systematic review was undertaken, with searches conducted in April 2021 and February 2024. Studies were eligible for inclusion if they described midwives’ experience of managing intrapartum emergencies in high-income countries and if the setting(s) explicitly included community settings. Analytical themes were identified through integration of qualitative descriptive themes and a narrative summary of quantitative findings.

Findings

Ten papers were included, reporting seven studies carried out in the United Kingdom, United States of America, Australia and the Netherlands. Four inter-related themes were identified: unexpected and unpredictable nature of events; confidence and preparedness in skills and the birthing process; immediate and enduring emotional impact; and mediating effects of relationships and support.

Discussion and conclusions

Limited research exists about midwives’ experience of emergencies in community settings and much of the evidence included in this review was from studies about traumatic births, where emergencies were a subset of those studied. Further research about midwives’ experience would be valuable to inform optimal training and support.