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.