Emergency delivery: What to do when the baby’s coming – right now

Every year, nearly 9,000 women in the U.S. go into labor and, unable to make it to the hospital, have an unplanned or unattended birth at home or in the car on the way to the hospital. Some of those women later make it to UT Southwestern.

My colleagues and I typically recommend that women head to the hospital to deliver when their water breaks or when contractions become regular, meaning four or five minutes apart for more than an hour. But sometimes, neither of these signs of labor occur.

That’s exactly what happened to Jenea Jones, a labor and delivery nurse who used to work at Parkland Hospital here in Dallas and had to deliver her own baby in her vehicle. Jenea shares her story below, along with some tips for what to do if you find yourself in a similar situation, either as a delivering mom or as a bystander.

Jenea’s story: I delivered my own baby on I-30

I was about a week past my due date with my fourth baby, and I was patiently waiting to go into labor. I went about my shift, working with laboring moms and training emergency responders in labor and delivery techniques. Toward the end of my shift, I noticed that my contractions were getting a little closer together – some more frequently than those of my patients!

With my previous baby, I didn’t make it home after my shift. I went into labor at work and was admitted to the hospital right away. This time, I really wanted to go home first, then head back to the hospital when labor began. My contractions weren’t regular or intense yet, so I clocked out at the end of my shift and headed home.

Related reading: Hungry during labor? Women may now get more than ice chips

Once I got home, I ate some cereal, watched a little TV, dozed off for a bit, then took a shower. The contractions got stronger and more intense, but they were irregular and my water hadn’t broken. I decided it was time to go to the hospital when the contractions started to get a little more painful. In the car, everything was very annoying to me: the radio, the sound of my husband at the time talking on the phone, just everything. I remember thinking that was weird because I’d been coping with my contractions pretty well to that point. Then the situation got hairy.

Most women will notice a definitive change in how pre-labor or false labor contractions feel compared to real labor contractions. The real thing typically feels more intense, more painful, and might move into the cervix, back, or another part of the body, and the change might occur too quickly to get to the hospital in time. As we drove down I-30, I began to feel rectal pressure, which usually is an indication that the baby’s head is entering the birth canal and it’s time to push. That’s when I knew we weren’t going to make it to the hospital.

We were about 20 minutes away from Parkland when I said, “We need to pull over right now – the baby’s coming.” I refused to panic, but I couldn’t help thinking how this is the kind of thing that happens on sitcoms, or to a friend of a friend, not to a labor and delivery nurse!

We pulled over along I-30 in the grass in front of a hotel and called 911. The next thing I knew, several men’s faces were peering through the windows of our vehicle. The emergency responders were there, ready to help me deliver. I started to push, and the baby – Carys – arrived soon thereafter, but she was in trouble. The umbilical cord was wrapped twice around her neck, membranes covered her face, and she was pale and limp.

I switched from “laboring woman” mode to “nurse” in an instant. Labor and delivery nurses are taught with neonatal resuscitation to warm up the baby with a warm towel. All I had was my undergarments, so i used them to rub her back and stimulate her skin. But Carys still wasn’t responding.

I asked one of the emergency responders for an Ambu bag, which is a device that produces positive-pressure ventilation by forcing air into the chest to get the lungs working. Thankfully they had the bag and a pediatric mask. As I worked to resuscitate Carys, one of the paramedics started to cut the umbilical cord, and I stopped him – that was her only steady source of oxygen.

After several minutes, Carys began to perk up. The emergency responders cut the cord and escorted us to a waiting ambulance for the 20-minute ride to Parkland. In the rush after delivery, all of my senses were totally heightened. I remember looking up at the EMT and saying, “It’s such a gorgeous day today, isn’t it?” He looked at me like I must have been in shock, but I think I was just flying high on endorphins.

Looking back on the delivery, I have to laugh at myself. I had planned to deliver Carys naturally, with no pain medication. I kept that to myself, though, because I didn’t want to let myself down if my birth plan changed at the hospital. As luck would have it, I got my wish – but in a very unexpected way!

What to do in an emergency delivery situation

If your baby is coming and you can’t make it to the hospital, call 911 as soon as you can. Then remove your pants and underwear. Lie down or sit propped up (standing or squatting could result in the baby falling and suffering serious injury). Try to stay calm, and practice deep breathing. When the urge to push becomes overwhelming, push for counts of five then pause and breathe. Do your best to gently guide the baby out as it emerges from your pelvis, and carefully unloop the umbilical cord if it’s wrapped around the baby’s body or neck.

Immediately after the baby comes, follow these steps:

• Dry off the baby and place the baby directly on your chest to keep it warm.
  
• If the baby doesn’t immediately start to cry, run your fingers along either side of its nose to ease away mucus, and stimulate the baby’s skin as Jenea did by rubbing firmly but gently on its back with a piece of clothing or a dry towel.
  
• If you have two strings of any kind handy (a shoelace, thread, or a ribbon, for example), tie one string around the umbilical cord four to five inches away from the baby’s belly. Tie the other further from the baby two to three inches past the first string. Then cut the cord with a scissors or knife between the two ties. This way, when you do skin-to-skin contact against your chest, the baby is protected from potential bleeding if the cord were to tear away from the belly button.
  
• Seek medical care as soon as possible after delivery. Home births, whether planned or unplanned, can be risky for mothers and babies during and after delivery.
  

The likelihood that you’ll go into emergency labor like this is low, especially with your first baby. But it never hurts to be prepared. If possible, put a neighbor or loved one on “baby watch” as a contact to call if you need a ride to the hospital or help in the event of an emergency. We also recommend that you take childbirth preparation classes to get comfortable and face emergency situations more confidently should they arise. You can call 214-633-6640 or Email to sign up for free.