Control Call
It was 06:43 on a drizzly Thursday morning when Control crackled into life:
“Red call – OB emergency. 27-year-old female, 38 weeks pregnant, abdominal pain, possible imminent delivery. Address: Flat 3, Beechwood Estate.”
You look at your partner, Jess – a sharp and cool-headed EMT. “You up for this?” she grins, pulling on gloves.
Estimated time on scene: 6 minutes.
Scene Arrival
The estate is a warren of narrow staircases and poorly lit corridors. A frantic neighbour meets you outside.
“She’s in the bedroom! Waters broke about an hour ago, now she’s screaming!”
Inside, the patient – Sarah – is lying on a mattress with towels underneath. She’s diaphoretic, flushed, and visibly distressed. Her partner is pacing.
Scene safety: Safe, no hazards.
PPE: On.
Patient consent: Gained, confirmed.
Initial Assessment (ABCDE)
- Airway: Patent
- Breathing: RR 22, no distress, SpO₂ 98% on air
- Circulation: Pulse 104, BP 120/76, skin warm
- Disability: Alert, GCS 15, responds to voice
- Exposure: Abdomen distended. No bleeding. Clear liquor
Sarah suddenly groans, “I need to push!”
Decision Point: To Stay or Go?
According to JRCALC (Maternity Emergencies), delivery decision-making hinges on:
- Previous obstetric history
- Presentation and stage of labour
- Proximity to hospital
Findings:
Gravida 2, Para 1 – previous rapid labour.
Contractions every 2 minutes, lasting 60+ seconds.
Crowning visible.
Decision: Stay and deliver. Time to prepare.
Imminent Delivery
Jess gets the maternity pack. You assist Sarah into position, place sterile pads, and monitor for crowning.
Delivery Stage 2 – Head born
You support the head, check for nuchal cord (none). With the next contraction, the baby is born.
Neonatal Care
You keep the baby level with the perineum, dry and stimulate, and assess using the APGAR score:
- Appearance: Pink
- Pulse: Over 100
- Grimace: Active cry
- Activity: Good flexion
- Respiration: Strong cry
APGAR: 9
You clamp and cut the cord after 1 minute (delayed cord clamping) and pass the baby to Sarah.
Third Stage: Placenta and Postpartum Care
Signs of placental separation observed – gush of blood, lengthening of the cord. Placenta delivers intact with gentle traction.
- Inspect placenta
- Estimated blood loss: 250ml
- Uterus firm, BP stable
- Jess administers 600mcg IM oxytocin (JRCALC-compliant)
Transport and Handover
Sarah and baby are cleaned, dressed, and transported. At hospital:
Pre-alert: “Full-term spontaneous vaginal delivery at home. Mum stable. Baby APGAR 9 and 10. No PPH. Oxytocin given.”
Handover: Delivered using ATMIST.
Debrief on the Ramp
You and Jess debrief. Calm. Focused. Another life brought safely into the world.
Knowledge Check: Questions for Reflection
Use JRCALC maternity section to guide your responses.
1. What are the indications that suggest imminent delivery and necessitate staying on scene?
Visible crowning, regular contractions < 2 minutes apart, rapid obstetric history, multigravida, inability to transport safely.
2. How does APGAR scoring influence your initial newborn assessment?
Provides an objective, repeatable way to assess the baby’s transition to extrauterine life. Scores < 7 may prompt ventilation or escalation.
3. What are the signs of placental separation, and how should the placenta be managed prehospitally?
Gush of blood, cord lengthening, and fundal change. Manage with controlled cord traction only when signs are present.
4. When and why is oxytocin administered in the prehospital setting?
After delivery of placenta, if no PPH, to encourage uterine contraction and prevent bleeding. Per JRCALC: 600mcg IM.
5. What red flags would indicate a need for urgent transfer post-delivery?
Heavy bleeding, retained placenta, poor neonatal tone or APGAR, maternal hypotension or collapse.
Sample/Examples of how you could document for CPD
What?
I completed a scenario-based learning module titled “A Shift to Remember: Maternity Emergency on the Estate.” It involved a full-term maternity emergency where an imminent birth occurred in a non-clinical setting. The scenario guided me through scene assessment, the decision to stay or go, supporting a normal delivery, managing the third stage of labour, using oxytocin per JRCALC, and conducting structured handover using ATMIST. The activity included reflection questions that prompted a deeper understanding of best practice and JRCALC alignment.
So What?
This scenario sharpened my readiness for rapid-onset, high-stakes obstetric cases—something I’ve encountered only a few times in practice. It reinforced the importance of early decision-making based on parity, presentation, and proximity, which is something I might have second-guessed under pressure. I revisited the correct steps for APGAR scoring, delayed cord clamping, recognising placental separation, and safe use of oxytocin, all of which I might need to recall instinctively in the field. It also highlighted how structured handover ensures continuity of care, especially in rare but high-risk calls.
Now What?
I’m going to refresh my knowledge of obstetric emergencies in JRCALC and make sure the maternity pack on our vehicle is checked more routinely. I’ll also share the key takeaways from this case with my crewmate during downtime and suggest a short discussion session on maternity incidents at the next training day. I plan to complete at least one more scenario on breech birth or shoulder dystocia within the next month and add it to my CPD portfolio.
Estimate Time: to read, digest and read any links that are referred to: 30 minutes
Source: A Shift to Remember: Maternity Emergency on the Estate (EMSUK Learning Scenario, Apr 2025)
A Shift to Remember: Maternity Emergency on the Estate
Advanced interactive maternity scenario for EMSUK Learning. WordPress-safe, full-width scenario layout, with complication branches for shoulder dystocia, neonate not breathing, and postpartum haemorrhage.
Live trackers
Reference ranges and key maternity points
Control Call
Decision log
CPD reflection builder
Complete these yourself or use the auto-generated version based on your decisions and branch path.
