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BackgroundAs the landscape of women presenting for maternity care changes, so do the challenges associated with providing quality, informed and compassionate care, particularly for women with complex needs.AimTo explore the lived experience of midwives in facilitating care for women with complex needs who choose to birth at home.MethodA qualitative design is employed, using an interpretative phenomenological analysis informed by hermeneutic principles. Purposive sampling is used to recruit midwives through social media and JiscMail. Data are collected via semi-structured interviews.FindingsTwo interpretative themes arose. A ‘radical midwife’ embraces the phrase ‘radical’ by positioning midwives between traditional beliefs and practices, physiological processes, midwife knowledge and skill set by applying current evidence and professional context. A ‘conflicted midwife’ arises out of this dichotomy and exposes the realities of striving for radicality while the negotiating ‘the system’.ConclusionsIt is no longer acceptable to assume that home birth for women with complex needs is exceptional. This must be the catalyst to move towards a constructive discourse with midwives, women and the wider team to address and expand the evidence base and pathways to support those who are already facilitating this care and those who will inevitably continue to provide care ‘outside of current guidelines’.

BackgroundOver the last decade, paramedics in the United Kingdom (UK) have increasingly taken up clinical employment away from ambulance services, with many moving into primary care settings. Reasons for this move are multifactorial and interwoven. However, in an effort to retain the paramedic workforce, rotational roles between ambulance services and primary care providers have been initiated.MethodsAn online survey was distributed via the College of Paramedics to paramedics in primary care in England, Northern Ireland, Scotland, and Wales. The survey utilised both qualitative and quantitative items to better understand the scope of role undertaken by paramedics in NHS primary care and explore the perceptions paramedics in primary care have on their contribution to primary care teams. This presentation will focus on the results relevant to paramedics who rotate between ambulance services and primary care settings only.ResultsThe survey was completed by 341 paramedics. Of these, 10% worked one day a week in a rotational role. The most common job title was Advanced Paramedic Practitioner (44%) or First contact Practitioner (25%), though other job titles were also reported. Of particular note is the correlation between hours worked and attending presentations such as catastrophic haemorrhage (rs=.109, p=.044), anaphylaxis (rs=.127, p=.019), angioedema (rs =.140, p=.009), seizures (rs =.147, p=.007), and overdose/poisoning (rs =.200, p=<.001), where respondents who worked in a rotational role attended these presentations to a greater extent.ConclusionThe survey highlighted the variety of work that paramedics in rotational roles undertook in primary care, however paramedics in these roles attended emergency presentations in primary care to a greater extent when compared to their full-time counterparts. Whilst the ability for paramedics to attend emergency presentations in primary care may be a benefit for primary care providers, this does little to develop their primary care clinical acumen.