This is part of a series of stories about people working on solutions to New Hampshire's maternity care challenges. Catch up on more of our coverage here.
In recent years, New Hampshire has seen a rise in so-called "unplanned location births." That means dozens have given birth unexpectedly at home, in a car or en route to a hospital, according to state data.
That’s also meant that emergency responders are playing a growing role in labor and delivery, by guiding new parents through giving birth outside of a hospital setting.
Maria Varanka, an EMS training coordinator at the New Hampshire Department of Safety, is leading an effort to make sure those healthcare workers are prepared to help families through that process. As she recently told NHPR All Things Considered Host Julia Furukawa, that training is already paying off in preparing emergency responders for real-world birth emergencies.
Transcript
How was the need for labor and delivery EMS training in the state identified?
Some OB[-GYN]s in New Hampshire were looking around—this was before my time with the Bureau of EMS—they were like, “Oh, there's a lot of labor and delivery closures statewide.” We're kind of seeing patients having less access to [labor and delivery] units, having less access to seeing their OB-GYN for a variety of reasons.
So we're kind of seeing a more acute population. The distance was just too much. Maybe they're having a baby on the side of the road. So they're interacting with the EMS system at a higher rate than what was previously seen.
What does this new effort look like to train first responders more on labor and delivery?
So it's a variety of different teaching methodologies to kind of get their engagement and get their comfort level up, and their baseline knowledge [to] increase a little bit. So maybe it's normal labor and delivery. Where do you place your hands? Where's [the] baby go once [the] baby's out? What does active management of the third stage of labor really look and feel like especially in a field situation?
And then we run it in simulation. We have a patient actress. She physically pushes a simulated baby out, physically “bleeds” [and] physically pushes out an umbilical cord and placenta. And then whatever happens in the simulation, the EMS providers have to manage in a very controlled setting.
So I've been hearing you use “EMS” to describe the people doing these trainings. Could you tell us a little bit more? Who is coming to these trainings – firefighters, dispatchers? Who's there?
We are primarily targeting services that run an ambulance or run a rescue, have EMS providers on their roster [and] who have lost labor and delivery. In New Hampshire, most — not every — fire departments have dual-certified members. So they're firefighters and they're some level of EMS providers. That's kind of the primary target. I would love for the whole state to engage with this, but we got to start somewhere.
What are you hearing from first responders about this program?
I'm hearing that they're stressed before it. I'm hearing that they're anxious about needing to manage this. Or maybe they did have some sort of obstetric emergency that maybe didn't go as smoothly as they would have liked it to. They're recognizing this gap and that they want this education.
Can you tell me about a success story in which this program really helped? Maybe both a patient and a first responder?
So it's funny. It seems that every time I show up and do a training, someone [encounters] a childbirth like a couple weeks later.
Actually, one of my instructors — she's been in the field forever and a day, but this was not a population she was super comfortable with — she did the train-the-trainer with me at the end of October. I think two weeks later, they ended up having almost a field delivery. They delivered as they were getting into the hospital. It was on the EMS stretcher. But she's like, “Maria, I felt great. I knew what was going on. I knew my role. I wasn't stressed at all.” She said she had had two field deliveries prior to that in her 30-something year career. And she's like, “This was the one that I felt calmest about. This is the one that I was like, oh, we got this.”
It's just nice to hear people afterwards kind of come up to me. I've had a few other providers come back to me and they're like, “Oh my gosh, we just had a field delivery. And it wasn't that bad.” And I was like, “That's awesome! I'm so glad it's great!”
We want to hear from you: What do you wish you knew before you had a baby here? What made a difference for your family when you, or your partner, were pregnant? Where were you surprised to find support — or, where did you feel like you needed more help? Let us know at voices@nhpr.org, and your stories could help shape more of our journalism on this topic.
