Paramedics' Experiences in Managing Obstetric Emergencies: A Qualitative Study Based on Reason's Swiss Cheese Model

This study explores paramedics' experiences in managing childbirth-related emergencies and examines challenges through Reason's Swiss Cheese Model, which frames obstetric errors as the result of multiple system-level vulnerabilities.

A qualitative phenomenological design was employed to gain an in-depth understanding of paramedics' knowledge, experiences, and perceived barriers in obstetric emergencies. Purposive sampling recruited 18 paramedics who had encountered obstetric cases in prehospital settings. Semi-structured, in-depth interviews were conducted between March and July 2025, focusing on clinical experiences, decision-making, and system-related influences. Interviews were audio-recorded, transcribed verbatim, and analyzed using a thematic approach to capture explicit and latent meanings.

Three main themes emerged: experiences and interventions, challenges in emergency management, and patient transport issues. Participants identified multiple "latent conditions," such as insufficient obstetric training, limited simulation practice, equipment shortages, and unclear protocols, increasing error risk. Cultural differences affected communication and privacy, while transportation barriers and safety concerns posed additional risks for mothers and newborns.

System-level weaknesses, rather than individual shortcomings, significantly hinder paramedics' effectiveness in obstetric emergencies. Strengthening safety layers through simulation-based training, standardized equipment, and reliable supply access is critical to improving the quality and safety of prehospital obstetric care.