When the ambulance becomes the delivery room, with Elizabeth Travis

[00:00:00] So every morning I go in to Google and I just search EMS birth news, so place that in now and see what comes up. This is Liz Travis. Man. Liz is tracking news stories about babies being delivered, not by doctors in hospitals or even midwives, but by people from EMS, Emergency Medical Services.

[00:00:26] Paramedics who are helping mothers in labor deliver their babies in ambulances, in their cars, on the side of the road. Well, this is a birth story to remember for one Orange County mom who delivered her baby boy in the back of an ambulance on the 22 freeway. Not only did Greg Williams deliver her son Emmerich, he did it in the back of a moving ambulance on the 22 freeway. And these are the kinds of stories that Liz is tracking. I mean, it's a ton of stories.

[00:00:54] New at nine, we are hearing from two EMS workers who helped deliver a baby girl in the back of an ambulance. It's where Pittsburgh EMS says they've noticed an increase. EMS officials tell us they've gone from around eight pre-hospital births a year to 12. I might find, oh, six months ago this happened, this happened, maybe another three months after that. But in the recent news, we are seeing every couple of weeks there's one, two, three stories cropping up.

[00:01:22] And it has gone from isolated incidents to trend. And I can tell you right now, it's not all happening in one place. It's not even all happening in maternal care deserts. A maternal care desert is an area which has no hospital offering obstetric care. So expectant mothers have to travel longer distances to have their baby. You know, moms are having to drive 40, 50, 60 minutes out of the way.

[00:01:48] An advocacy group called the March of Dimes studies this issue. And their most recent research found that one in three counties in the United States can be classified as a maternity desert. I want you to just take a moment and let that sink in.

[00:02:04] There are states in the U.S. that have entire regions where there is no doctor, no nurse, no midwife, no health care staff who have obstetric training and who can help you when you're in labor if you need help. We are missing a very important resource in maternal care as it relates to being a caregiver.

[00:02:27] And that important resource, Liz says, is the people who come to expectant mothers when they dial 911 and who make the news when they deliver a baby. So I'm talking about medics, EMTs, firefighters and police officers. All people, I think, should be trained to a higher level of birth. This is the new focus in EMS. We are deep in cardiac arrest work.

[00:02:54] We are deep in trauma work and blood transfusions. And now, now it's time to get deep into maternal care. This is Overlooked and I'm Golda Arthur. In this episode, I'm talking to Liz Travis, who is a paramedic herself and who's been studying how to train emergency services in maternal care because of the firm belief that maternity deserts aren't going to go away. We have critical care medics.

[00:03:23] Why not have maternal care medics? As an advocate and researcher, Liz has also developed a framework for how paramedics can be more integrated into maternal health. She says paramedics are overlooked as a resource and they need more training in delivery. Baby decides they're coming out face first into the world. A cord over a baby's head? What are you going to do with that? It's that fear in the back of your head and you're just not as comfortable and competent with it. And that can lead to stress for you, stress for mom, stress for baby.

[00:03:53] That just doesn't need to be there. I used to be the medic that was like, better not get a birth today. I don't want to do that. None of that. And now I am a flip 360 all the way around kind of gal where I'm like, give it to me. Call me if you have one. If you need me there, I'll wake up and get there. Whatever you need me to do. What changed for Liz?

[00:04:21] She gave birth at home. They call 911 and into my neighborhood comes an ambulance, a fire truck, a couple responders. Everybody and their mother came out to my house. That story and my conversation with Liz Travis is coming up in just a minute. Are you curious about what it's like working in healthcare today? Do you believe in the power of storytelling?

[00:04:48] I'm Dr. Emily Silverman, the host of The Nocturnist Podcast, where healthcare workers share personal stories of joy, sorrow, and self-discovery. Each episode, whether a compelling performance from one of our live shows, an intimate series of audio diaries from one of our documentaries, or an engaging conversation with guests such as book authors or filmmakers, aims to connect, provoke, and inspire.

[00:05:14] Learn more at thenocturnist.com or subscribe to The Nocturnist wherever you get your podcasts. Hey, Liz. Welcome to Overlooked. And thank you for joining me. Hey, good to be here. Thanks for having me. I'm really excited to talk about all of these things because I think this is very much like the definition of an overlooked topic and story. And in fact, not even just one topic.

[00:05:40] There's so much here when we start to talk about what we're about to dive into. Let me just start by asking you a little bit about yourself. Give listeners a view into who you are and what you do right now. I was a career paramedic for some time, a lieutenant paramedic down by Christiansburg, Virginia, which is right outside of Virginia Tech. And then I moved up to this area in Virginia, close to D.C. And while I was doing all that, I was getting my doctorate.

[00:06:10] So my doctorate focused in maternal care and how that relates to EMS. And since then, I've kind of been putting a large part of my energy into bolstering paramedics in what they're doing in the maternal care space as we're seeing more and more need for that. What made you want to become a paramedic? I love and hate that question. I think you have a general personality type that does go into those things. The helper. I think Mr. Rogers said it best. You know, he said, look for the helpers.

[00:06:40] I always had that mentality of going towards people who needed care and understanding. And a large part of it was just, it's such an underserved area where I was. I saw the need and I was always interested in medicine, but not necessarily always interested in going into the hospitals once I learned a little bit more about that structure. So I became a medic and I kind of never looked back. I'm still a certified medic and I still run on the trucks.

[00:07:06] I used to be the medic that was like, we better not get a birth today. I don't want to do that. None of that. And now I am a flip 360 all the way around kind of gal. I'm like, give it to me. Call me if you have one. If you need me there, I'll wake up and get there. Whatever you need me to do. Why were you the paramedic that did not want to have to deal with birth? What was the reluctance, the hesitation there?

[00:07:36] Tell me about that. It was because of the way I was trained. I had an amazing instructors all through my EMT, my advanced, my paramedics. Paramedic. Fantastic instructors. They trained me to what they were supposed to train me for. We have not flipped the switch to train for true competence and comfort in birth. And what I mean by that is a lot of the times we get a one four-hour class. Here's what it might be. Normally, we're taught just one way of giving birth, which is,

[00:08:04] lie a mom on her back, see if she's crowning, and here are some complications you might see. And that's roughly all you're given. You do a couple of births with a prompt trainer where they just kind of push the baby out. But there's no in-depth training. We're literally talking one class. They tell you to read the textbook. They give you that class. You're good to go. And then if you're a medic, you will go to the hospital. And if you're lucky these days, you might see a natural birth. Most of us are seeing C-sections, which isn't contextualized.

[00:08:33] And that's all I saw. So I was not comfortable as somebody who had never seen a birth at that point until I had my own. And then I started to see it more and more. And I was like, oh, well, this isn't that scary. But it can be that not scary for everybody if we train them appropriately. Okay, so let's start to understand sort of the nature of the problem in that sense. And I want to start at the ground level.

[00:08:57] For those listeners who've never heard the term maternity desert, and I sort of almost wonder if it's a very American term. Tell people what a maternity desert is. So maternity desert, in America anyway, is a county that lacks or has no maternal care resources. And we're talking about no certified nurse midwives, no OBGYNs or labor and delivery units, no birth centers, all of that.

[00:09:23] There is kind of an intermediate and then a complete maternal care desert. So it's low access to care and then complete maternity care desert. And we're seeing more and more and more of those deserts pop up. I think at this point, I want to say it's Texas. That's about 50% of those counties are maternal care deserts. It's just, you know, moms are having to drive 40, 50, 60 minutes out of the way. It's hard because all of these things are closing down. We don't have enough midwives.

[00:09:52] The hospitals aren't supporting these things anymore. And yeah, you can walk into an emergency room and have your baby. Is that really where we want to go with this? We have the highest morbidity and mortality rate of any high income country when it comes to maternal care. So we are not really getting better either. Yeah, but you're keeping track of the news coverage, aren't you?

[00:10:13] Like I think you are very regularly and publicly on LinkedIn, for example, noting what seem like one-off stories and what are presented as one-off stories, you know, at local stations when they cover the story. And you're keeping track, so you're in a position now to say, hang on, this is a trend and here is what it means. So talk a little about that.

[00:10:41] Talk a little about what you're seeing and what it means. Right. So in my space, I keep a really weather eye on birth stories and community response. So I'm talking about medics, EMTs, firefighters and police officers. All people I think should be trained to a higher level of birth. And it used to be over probably even just in the last year, I would look every couple of weeks because you wouldn't really find anything new. I might find, oh, six months ago this happened.

[00:11:11] This happened maybe another three months after that. But in the recent news, we are seeing every week, every couple of weeks, there's one, two, three stories cropping up. And it has gone from isolated incidents to a trend. And we're hearing medics say, well, I've never done a birth before, but now I've done three in the last year. And we've reached that pinnacle of now, if you're not training for it, you're behind because it is going to happen at some point.

[00:11:41] And as we get into a bigger desert situation, we're going to see more and more and more of it. And we're just not going to be, I won't say as prepared because a lot of medics are really good about digging in and trying to educate themselves on things. But in their minds, they're thinking not a common occurrence, right? As soon as it starts to pop up, it's that fear in the back of your head and you're just not as comfortable and competent with it. And that can lead to stress for you, stress for mom, stress for baby. That just doesn't need to be there. What's driving that escalation?

[00:12:10] What do you see is going on? Read the tea leaves for me a little bit. There are so many factors. I don't think you could point to one driver, but you can point in my mind to a couple of really specific ones. First off, when you have areas where L&D units are closing, maybe rural areas or whatever, that drives women to go into the cities. Well, these city hospitals, they have the unit, but does the unit have the capacity?

[00:12:37] So now we're seeing them send moms home if they're not in a very active labor situation or scheduled for a C-section, which is a whole other can of worms in the United States, right? So you have moms coming into these hospitals. And two of the stories in the last couple of months have been, I was in labor and I went to the hospital. And they told me to go home. And 30 minutes later, I had my baby. Who are they going to call?

[00:13:04] EMS has really integrated itself into the care structure of the United States. So they call us. And who shows up? Us. Oftentimes police officers who just have faster lights and sirens, little vehicles than we do. So they get there a lot. There was a story where a police officer assisted a woman in a birth. The idea of whole patient-centered care is not exactly new, but we kind of drove away from it once standardized hospitals and practices and insurance and all that big situation came in.

[00:13:33] And now we're trying to drive back to it, but it's hard to get out of that. But if there's ever a space, ever a space to do individualized care, it's with women. And not just the woman that you saw pregnant with her first. Now she has her second. So it's going to be the same. As we know, if you've had a child, and especially if you've had more than one, every single one of them could be different. Every single one. So I think those are combining factors.

[00:14:03] And when you raise this issue, what you're saying here is, hey guys, let's pay attention to this because this is not as rare as we think. This is increasing in incidence and we should start to pay more attention to it. Do you get any pushback? Do you get anybody saying, holy horses there, lady, we're okay? EMS is very interesting and I'll say something that probably everybody who's a medic who might be listening or in that space has heard like 5,000 times. If you've seen one system, you've seen one system.

[00:14:33] So I will preface this with there are a lot of systems that are doing a lot of great things in maternal care. However, a majority are just sticking with what they train to. But in terms of pushback, it's normally those agencies that go, well, we don't see this a lot or we don't have a ton of moms in our community. We have an elderly community. It doesn't make sense for us to do a ton of training on this, right? And the response to that is always, wouldn't you want to train on it more if you're going to see it less?

[00:15:02] A lot more providers are doing higher level neonatal resuscitation skills. A lot more providers are going in and doing high performance CPR skills. And it's a big focus. And the logic is you don't see it enough. So when you see it, we want everything to be super proficient and super, super, super easy for you. We want you to know it. You know what everybody's going to do. And the communication is nice. And everybody's quiet.

[00:15:29] And when somebody comes into a birth scenario, it really needs to be the same. Even more so, I think, in my mind, because your patient is awake. It's not a huge pushback that I get. But normally, that's the argument. We're just not seeing it. We never see births. So really, why would we focus on that? I would love to see medics trained more as midwives and or for us to have our own certification. We have critical care medics. Why not have maternal care medics?

[00:15:57] You know, I'm listening to you talk, Liz. What I'm wondering is the system right now is really failing, right? If we have an increasing desertification, like if there are more and more maternity deserts, because the health care system and the economics of hospitals is failing, and rural communities, not even rural communities, really, if you're talking about Pennsylvania and Philadelphia, these are not, Philadelphia is not rural.

[00:16:25] If this is increasingly happening, then really the pressure is put on paramedics. The pressure is put on patients. The pressure is put on these individual groups within this system. And I come to it, I guess, from the point of view of patients, right? To pick up the slack and to make sure that they know what to do in any given situation.

[00:16:52] And these are high stakes situations that we're talking about. That seems a little unfair that because the system has failed, individuals sometimes have to go a further distance to protect themselves, whether it's a paramedic that understands, am I really fully equipped to do this? Or a patient who's having to give birth on the side of the road, in the car, in an ambulance. Does that seem a little unfair to you? It's all unfair. You know, as a mom, it's totally unfair.

[00:17:22] Yeah, it is unfair. And it's not malicious in any regard, right? I don't think there's a malicious intent behind everything, but it's unfair. And there's a very interesting thought in my mind. It's more that medics are kind of looked over and that they wouldn't be able to do it almost. Like, why haven't we been trained to this?

[00:17:46] You know, there are, I think I want to say 16K midwives in the United States. And for years, we've been saying bolster the midwives, bolster the midwives. We can't out recruit crisis. There are 150 to 200K active practicing paramedics every year in the United States. Even just a third of them trained kind of to a midwife style, even maybe a baby midwife, mini midwife level,

[00:18:14] are going to make a huge impact not just on the fairness of them treating patients. We don't want to walk into a situation and feel unprepared and be scared because everybody has to do it. If you're in medicine, you've learned how to put that face on and look confident. But you want to feel confident. You want to actually be confident when you walk in, especially into that scenario. We don't want a mom to have to drive 500 million miles to get to the hospital, especially not in labor.

[00:18:43] That's not comfortable, right? We don't want them to have to give birth on the side of the road with cars going by. That sets up a whole other domino effect when we look and we see the mental health of moms. We're seeing that mental illness is actually one of the leading causes of maternal mortality a year out from having a child. And it's depressing, but we have to look at what is causing that trauma. What are we doing?

[00:19:13] And I can tell you from my research that a lot of women would be if they knew we were trained to it. And a lot of medics would love to have that training. Yes, absolutely. So it is unfair. In my mind, we are overlooked as a very reasonable, not whole solution, but at least a help. Yeah. So medics are overlooked in this respect. Yeah. I think EMTs, medics, AEMTs, there's a lot they can all do in a natural birth situation.

[00:19:42] And there needs to be a lot better education on what can you do. And tell me about what has drawn you to the topic that you're immersed in right now. What was it that pulled you in there? So it was actually my pregnancy with my first. I went to a midwife. And I walked in and I realized I could do this, right?

[00:20:07] As a medic, most of those things with proper training, I could do a majority of, especially a lot of the birth work things, if I felt comfortable and trained. But it was the birth of my son was that catalyst. It just coincided perfectly. I was trying to figure out what research to do for my doctorate. And I just started to dive into maternal care and into that world and learned all about maternal care deserts and where we were there in America.

[00:20:33] And I thought to myself, we are missing a very important resource in maternal care as it relates to being a caregiver. We talk a lot about we need to bolster OBGYNs and all the labor and delivery units are closing. And we're missing a piece where we could train up paramedics to do a large part of this. Obviously, not all of it, but a large part of it is just learning and getting comfortable with natural births.

[00:21:04] I had a unmedicated natural birth with a midwife. I was standing up. My husband caught my child. Good luck getting a hospital to let you do that. And it was a beautiful, wonderful experience. It's weird because for the whole time, I mean, a lot of people are probably in it thinking, wow, I'm having a baby. I was in it thinking, huh, this isn't scary like I thought it would be when I was a medic. This isn't crazy like I thought it would be.

[00:21:33] I did have a pretty easy birth. In that moment, having my own, it went from something that terrified the bejeebers out of me to something where I was like, oh, how many moms and babies could we help if we just got rid of the fear by truly empowering ourselves with that knowledge and that appropriate training? And then earlier this year, Liz had her second baby and she gave birth at home with a midwife by her side.

[00:22:04] My child was not doing horribly. I mean, I'm also a medic, so I can keep pretty calm in these situations. But she wasn't pinking up like she needed to think of it. It had been about three hours. We had done some blow by oxygen. She's still kind of ashy and bluish. She still had a lot of gunk she was trying to get out of her lungs because she was born quick. We're sitting there and we're talking about it.

[00:22:30] I'm talking about it when my midwife, my midwife goes, uh, I think. And I said, I know you're going to say it because I'm thinking the same thing. She goes, I think we need her to go to the hospital just in case she can't get that gunk out of her lungs. She said, you're really going to love this one. I think we need to call the ambulance. I said, oh, I said, I, okay. And I knew it. Babies compensate really well until they don't.

[00:22:54] And I thought to myself, yeah, I'd like to have, again, for me, I'd like to have that truck with me so I could do things. The medics were all wonderful. It would have been fine. But in my mind, I was like, if somebody else thinks they were touching my baby in an emergency, I just don't think that's going to be the case. So they call 911. And in my neighborhood comes an ambulance, a fire truck, a couple responders.

[00:23:24] And I'm looking out the window thinking, they dumped the station. In their minds, they heard, you know, three-hour-old newborn. They probably heard difficulty breathing, which kind of the case, kind of not, you know. Everybody and their mother came out to my house. I actually was like, okay, before they, because I could hear them all coming. And I said, before they get here, I'm going to go in the bathroom. I'm going to change because I'm going to the hospital.

[00:23:53] I'm going to get dressed, you know. We'll feel like a human being who hasn't just had a baby or try. And I walk out. And my room is full of providers. And they are all stressed. And I know what that looks like because I came from that world. I'm not sure if somebody else would have been able to pick up on that. But I put my hand on one of the guys' shoulders coming from behind him from out of the bathroom. And I say, it's okay.

[00:24:23] She's all right. She's not going to go downhill at this moment. It's going to be okay. He didn't know who I was. They didn't know I was the mom. They were asking my friend who's a doula, Oh, are you mom? Mom? She's like, no. That's mom. And they just didn't hear it. So that was another thing that, like, keyed me into the fact that they were all so amped. They couldn't even hear her say no. And it's so important to hear moms in that situation.

[00:24:55] If they are telling you something, especially when it comes to themselves, maybe they're bleeding and you haven't caught it yet for whatever reason, and they're starting to say, I don't feel well. You're so focused on the baby. You need to also focus on the mom. It just solidified in my mind that we're not doing enough for our medics to really help them feel comfortable in those situations.

[00:25:22] If you go in with the mindset that, oh, my gosh, this person is having a child outside of a hospital wall, it's an emergency because most women have C-sections, you've done yourself and that mom an incredible disservice. Well, Liz, this has been just a really eye-opening interview to hear your perspective as an insider to these things and the kind of change that you're urging. So I'm going to keep an eye on you.

[00:25:50] And I hope that as things change, voices like yours are kind of listened to a little bit more in the system and we start to reframe and rethink these things. Thank you so much for joining me on the show. It's been really eye-opening. Yeah, it's been a pleasure. Overlooked is here for information and empowerment, but not medical advice. Every person's body is unique. So if you have questions, it is best to speak to your doctor or healthcare provider.

[00:26:21] We're building a community around women's health so that no one is overlooked. If you'd like to be part of it, hit the follow button on this podcast wherever you're listening to this. Or you can show us some love by writing us a review and sharing this episode with someone. Overlooked is written and created by me, Golda Arthur. Jessica Martinez-DeJos is the show's producer. You can stay up to date with the show by signing up for the newsletter and following us on Instagram and LinkedIn.

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