Emergency childbirth, particularly twin deliveries, poses profound challenges in pre-hospital contexts, where health professionals must often act swiftly under conditions of uncertainty. In rural Pakistan, where access to healthcare facilities is limited, ambulance-based deliveries have become increasingly common. This qualitative study draws on semi structured interviews with emergency medical technicians, emergency vehicle operators, and a skilled birth attendant in Khairpur and Naushero Feroz districts of Sindh to explore the realities of managing such emergencies. The analysis revealed that variations in training, adherence to protocols, and inter-professional coordination shaped both the process and outcomes of care. Participants described the difficulties of working within constrained environments, confronting clinical complexities, and navigating cultural and gender dynamics, all while making critical decisions under pressure. Their accounts also reflected the emotional weight of these experiences, underscoring how professional background and preparedness influence responses in moments of crisis. The study points to the urgent need for structured obstetric training, strengthened infrastructure, wider integration of telemedicine, and improved collaboration among emergency personnel to safeguard maternal and neonatal health in resource-limited rural settings.

Umair Maqbool is a Research and Development professional currently serving as Assistant Manager (Research) at the Sindh Integrated Emergency and Health Services (SIEHS), Health Department, Government of Sindh. He has over five years of experience in public health research, with expertise in qualitative research methods and implementation-focused evaluations. He has previously worked at the Aga Khan University, Centre of Excellence in Women and Child Health, contributing to internationally donor-funded public health research projects supported by the Bill & Melinda Gates Foundation, SickKids Canada, and the Swiss Red Cross. His work focused on evidence generation, program evaluation, and policy-relevant research in maternal, child, and health systems domains. He has authored multiple peer-reviewed publications as first author, including review articles, opinion pieces, letters to the editor, commentaries, and short communications. He is also an active public speaker who presents health-related research findings to diverse audiences and contributes regularly to national English newspapers in Pakistan on health system challenges and policy reforms. He holds a Master’s degree from the Department of Social Work, University of Karachi, and is currently pursuing a Master of Science in Public Health (MSPH) at SZABIST, Karachi. His long-term goal is to translate research evidence into actionable health policy and practice to improve population health outcomes.