Research drives frontline services to improve outcomes for babies born outside hospital
A collaboration of South West perinatal stakeholders, supported by Health Innovation South West, uses research and training to focus on improving the optimal temperature management for babies born outside of hospital; driving changes in paramedic and 999 call handler practice in the South West and beyond.
Each year, approximately 3,700 babies in the UK are born unplanned outside of the hospital setting without the attendance of a qualified midwife or obstetrician, known as Births Before Arrival at hospital (BBA). These babies face worse health outcomes than hospital-born babies. A key concern for babies born outside of the hospital environment is hypothermia.
In 2022/23, Health Innovation South West supported research, led by Dr Laura Goodwin at University of West of England, investigating neonatal temperature management in the UK.
Dr Goodwin’s research revealed that only 2.7% of uncomplicated births in the out of hospital setting in the South West had their temperatures recorded during the study period. When temperatures were taken, 72% were hypothermic in the pre-hospital setting A second study, which analysed data from six of the region’s hospitals, showed 35% of babies born unplanned in the prehospital setting were hypothermic on arrival at hospital, and 25% of these were classed as ‘moderately’ or ‘severely’ hypothermic, with warming needed urgently to prevent poor outcomes.
The research findings led to the formulation of a series of recommendations to improve outcomes for babies born outside of hospital. Dr Goodwin’swork across two academic studies has resulted in changes to neonatal temperature management advice given by emergency call handlers in the UK and internationally.
In 2023, these findings also prompted a collaborative effort between Dr Goodwin and Katie McNee, Lead Quality Improvement Clinician at South Western Ambulance Service Trust (SWASFT), supported by Health Innovation South West. Together, they developed and implemented comprehensive recommendations to change paramedic practice to improve measurement and management of neonatal temperature across the South West.
Additionally, following Perinatal Bias and Newborn Assessment (PBNA) training supported by Health Innovation South West, to addresses perinatal care and clinical assessment inequity, focusing on implicit bias and stereotyping for black, Asian and minority ethnic families, SWASFT initiated direct improvements for the care of these babies by frontline staff.
As a result of Dr Goodwin’s research:
- Recommendations have been implemented by NHS Pathways and AMPDS (Advanced Medical Priority Dispatch System), transforming triage systems in the UK and over 50 other countries.
- SWASFT has revised its digital patient care record system (ePCR system) to introduce a new record page for newborns, highlighting to paramedics the need to measure and manage neonatal temperature. The new record page enables better documentation of multiple newborn observations including temperature, blood glucose, respiratory rate and oxygen saturation.
- SWASFT has also introduced delayed cord-clamping, skin-to-skin, breastfeeding, applying hats, and TransWarmer infant warming mattresses to all frontline vehicles, as well as restocking their under-arm thermometers. University of West of England now include temperature measurement as an assessment point for paramedic science students in their year 3 maternity simulations.
- Dr Goodwin’s research has featured in the British Medical Journal and Emergency Medicine Journal, as well as BBC Points West, extending the reach of this important research further.
Website Links
- Temperature measurement of babies born in the pre-hospital setting: analysis of ambulance service data and qualitative interviews with paramedics
- Prehospital birth: inequalities and neonatal hypothermia in the South West of England
- Inequalities in birth before arrival at hospital in South West England: a multimethod study of neonatal hypothermia and emergency medical services call-handler advice
- Health services respond with changes after research reveals chance to improve temperature checks in prehospital births | UWE Bristol
- Temperature management of babies born in the pre-hospital setting - Emergency care | UWE Bristol
- Results of study on prehospital births driving improvements to urgent neonatal care - Health Innovation South West
- Supporting culturally competent perinatal care - Annual Review (healthinnovationsouthwest.com)
- Supporting positive outcomes for births before arrival at hospital - Annual Review (healthinnovationsouthwest.com)
- BBC Points West
- BBC Spotlight covering Devon and Cornwall
Temperature management is one of the biggest risk factors for babies born in an out-of-hospital setting but it’s also one of the easiest issues to address.
Dr Laura Goodwin
