It doesn't just happen in the movies: Sometimes babies really are born in taxis or on trains -- even in the hospital parking lot. Rapid labor is most common in women who have given birth quickly in the past, have given birth several times before, or have previously gone into labor prematurely. But you never know when you may be called upon to assist in an emergency birth.
The first rule of thumb? Stay calm and call 911. Childbirth is a natural event, even when it happens unexpectedly at home or on the way to the hospital or birth center. So if you are in labor, or are accompanying someone who is about to give birth, don't try to stop the process or delay delivery. Fast labor is often uncomplicated, and both mother and baby usually do well.
How can I tell if the baby is about to be born?
There's no way to tell how long the "pushing" stage of childbirth will last, but here are some signs that the baby is definitely on the way:
- Regular contractions occur less than two minutes apart (timed from the beginning of one contraction to the beginning of the next).
- The woman feels an overwhelming urge to push or move her bowels.
- The mother says: "I can feel the baby coming now!"
- You can see the top of the baby's head.
What should I do before the delivery?
Don't try to move the mother if the birth seems imminent. For example, if the woman feels an overwhelming urge to push, there is probably not enough time to reach the hospital or birth center. It's better to be in the safety and comfort of your home or a building, rather than having to pull over on the freeway, panicked and unprepared.
First, call the woman's doctor or midwife for emergency instructions. If you can't reach him or her, call 911 so a health care provider can coach you through the birth while help is on the way. (If you're home alone and its possible to do so, unlock your front door after calling 911 so emergency help can get in.)
Set up a birth area on a bed or on the floor. Cover the area with a plastic sheet (a shower curtain can do the trick), clean sheets, towels, washcloths, and pillows. Keep the area as clean as possible. If you have nothing else nearby, use clean newspapers. Above all, stay calm. Reassure the mother and encourage her to take slow, deep breaths. Cover the mother with a blanket or towel if she's cold, and help her out of her clothes if that will make her more comfortable. Encourage her to walk or try positions that may make the birth easier, such as lying on her side or kneeling on all fours.
Next, wash your hands well with soap and hot water. Some experts advise using an alcohol-based sanitizer (if available) or scrubbing hands up to the elbow for about four minutes. Don't forget to clean under fingernails, and remove your wristwatch and any other hand jewelry. Wear sterile rubber gloves if they are available. Sterilize any equipment you use by dipping it into boiling water.
What should I do during the delivery?
Once the baby's head "crowns," meaning the widest part appears at the vaginal opening, it won't be much longer before he or she is born. As the baby's head is emerging, apply very gentle pressure to help the head come out slowly and in a controlled manner. This may help prevent damage both to the baby and to the mother's perineum, the area between the vagina and anus.
Once the head emerges, make sure the umbilical cord isn't wrapped around the baby's neck. If it is, gently ease it over the baby's head. Also check to see whether the amniotic sac is still intact around the baby. (It will look like the baby is covered with cellophane.) If so, carefully break it using anything clean and sharp, then wipe baby's face with a clean towel.
Gently support the baby's head as it exits the vagina. NEVER pull on the baby to deliver the rest of the body. The baby's shoulders should slide out on the next contraction or so, and the rest of the body will slip out very quickly after that.
A word of warning: The baby will be very slippery when he or she comes out, so be ready to hold the baby firmly but gently with a clean towel or other material.
What should I do after the delivery?
When the birth is complete, hold the baby with the head slightly lower than the body, so any fluids or mucus will drain from the mouth and nose. The main thing is to keep the new arrival warm, so immediately wrap the baby in a clean blanket or towel and place him or her on the mother's belly.
If the baby is gagging on mucus, use a clean cloth to gently wipe it away from the nose or mouth. If you have a suction bulb available, you may use it to remove secretions from the mouth and nasal passages. If the baby doesn't start breathing within 30 seconds, stroke the soles of the feet and then rub the back. If the baby is still not breathing, begin infant rescue breathing -- two to five very gentle puffs of air, with the rescuer's mouth covering the infant's nose and mouth until the baby takes a breath.
Encourage the mother to nurse the baby right away. The baby's sucking helps release a hormone that makes the uterus contract and expel the placenta. And of course, nursing is a wonderful way for mother and baby to bond.
If the placenta comes out before emergency help arrives, or before you reach the hospital, handle it as carefully and as little as possible. Wrap it in a newspaper or garbage bag and save it for a doctor to examine later. Massage the mother's belly firmly to help the uterus contract and stop further bleeding once the placenta is out.
If emergency help does not arrive before the placenta delivers, there are some measures you can take to make the mother more comfortable. Her vagina and bottom will be sore, and she may have bleeding from a tear. In this case, ice packs can relieve soreness, and applying direct pressure with a sterile gauze dressing or washcloth can stop any bleeding from a tear. Give her a sanitary pad or clean cloth to control vaginal bleeding.
Should I cut the umbilical cord?
No. Under normal circumstances, there's no need to cut the cord. It's best to wait for trained personnel to arrive, or you can transport mother and baby to the nearest hospital with the placenta and cord still attached.
What things should I be careful about during and after the delivery?
- Try not to interfere with the birth. Your job is simply to support the woman and "catch" the emerging baby.
- Keep your hands outside of the birth canal.
- Don't pull on the baby's head or body or the umbilical cord.
- Never cut the umbilical cord unless specifically advised and coached by a health care professional.
- Don't use harsh chemical products around mother or baby. Sterilized water and a mild soap work best.
How do you prepare for an emergency childbirth?
If you have had rapid labor before or suspect your child may come in a hurry, you may want to take the class on infant and child life support, offered by the American Red Cross. Also, make sure you have a contingency plan for getting to the hospital and for care of other children, if needed, and talk to your doctor or midwife about it.
Keep a kit of emergency supplies -- including clean towels, sheets, and cloths, clean scissors, clean cord ties, sterile rubber gloves, a baby-size suction bulb, sanitary pads, diapers, emergency contact numbers, and infant-rescue breathing instructions -- in the house, at work, and in the car.
As the due date approaches, all pregnant women (and their labor coaches) should take a childbirth education class, which will cover emergency birth procedures.
Keep the car in good working order, filled with gas, and equipped with a working flashlight and extra batteries. There's a good chance that you won't need them, but being prepared can help you stay calm and better able to handle the situation.
Make sure you have emergency numbers available near the telephone, including the numbers of your doctor or midwife and a friend or neighbor who can help out in a pinch.
American College of Nurse-Midwives
U.S. Food and Drug Administration, Food Safety and Inspection Service. Protect Your Baby and Yourself from Listeriosis http://www.fsis.usda.gov/Fact_Sheets/Protect_Your_Baby/index.asp
Spinal Cord Injury Information Network. Pregnancy and Women with SCI. http://www.spinalcord.uab.edu/show.asp?durki=21489
World Health Organization. Birth asphyxia. http://www.who.int/reproductive-health/publications/MSM_98_1/MSM_98_1_chapter2.en.html Nemours Foundation. Bonding With Your Baby. http://kidshealth.org/parent/pregnancy_newborn/home/bonding.html
Dr. Spock. Preparation for Rapid Labor. August 2004. http://www.drspock.com/article/0,1510,6255,00.html?r=related
American Red Cross. Anatomy of a First Aid Kit. http://www.redcross.org/services/hss/lifeline/fakit.html
Nemours Foundation. When It's Just You In an Emergency. http://kidshealth.org/kid/watch/er/emergency.html
Medline Plus. Childbirth: Emergency delivery. National Institutes of Health. http://www.nlm.nih.gov/medlineplus/ency/imagepages/17002.htm
American Medical Association. First Aid Guide