So, you’re peacefully enjoying a coffee on an afternoon weekend shift (ps that never happens) when suddenly one of the triage nurses runs back with a frantic look on her face stating, “Someone’s about to deliver a baby in the lobby.” It’s amazing how quickly that single phrase can get everyone into action. Immediately I asked the secretary to page OBGYN (aka baby delivery experts), asked one nurse to turn on the baby warmer and I found the nearest box of gloves and a facemask (spoiler alert, deliveries are messy). I then proceeded to run to catch up with everyone else who is heading to the lobby.
When we arrived in the lobby this poor lady had a small group of onlookers wondering what all the commotion was in front of the Dunkin' Donuts. The poor patient was attempting to get out of a wheelchair and onto a stretcher that one of the nurses had rolled out. I took a quick look behind the privacy of a sheet held by one of the nurses and saw no evidence of a baby yet. The patient was clearly in distress so the plan was to whisk her into the emergency department. As we rounded the second corner behind the Dunkin' Donuts the patient just started yelling, “It’s coming, it’s coming!”. I took another look at this point and sure enough, the baby’s head was out. “Ok, everybody stop. It’s happening here.” We then proceeded to deliver the baby right in the hall behind Dunkin’ Donuts. The steps to do this include controlling the head coming out. That doesn’t mean pulling it, just placing some mild pressure so it comes out slow, not fast. If it comes out to fast, you can cause tares. Most babies who we have to deliver in the emergency department, tend to deliver themselves as often times it is not the first child. If it’s someone’s first child, you often have more time and they deliver where they are should, in the labor and delivery department.
If you are ever in a position to deliver a baby, let me provide you with some pointers. Ninety percent of the time, there is really not much to do. Women have been delivering children for 1000s of years before modern medicine, there is no advanced science required. In MOST cases (there is always a caveat), your only job is going to be to apply very mild pressure to the head as it's coming out and don’t drop the little sucker. Before the head is completely out, check to see if the umbilical cord is wrapped around the neck. If it is, using 2 fingers, gently slip it over the head. NEVER PULL THE HEAD OR UMBILICAL CORD! Don’t worry about which way the head is facing, facing down is the norm and it will likely turn to some degree coming out. You can have the mother push if the baby’s body is not coming out following the head.
You will then deliver one shoulder, followed by another shoulder. In MOST cases, this will be a very rapid process after the head is delivered (within 30 seconds). The most important part at this point, don’t drop it. It sounds straight forward, but new babies are liked greased chickens. Taking your pointer finger and thumb make a very tight grip around the baby’s lower leg, just above the ankle. Put your other hand in a c-like grip behind the baby’s neck. Then place the baby on the mother’s chest.
You will then have the placenta to deliver. Don’t pull on the umbilical cord (please see above). The placenta should deliver by itself naturally. You will need to rub on the belly just below the belly button after the placenta comes out to help the uterus to stop bleeding. Do not cut the umbilical cord until the placenta has been delivered and only if medical personnel are very far away (unlikely situation, but possible). You can then tie off a spot 3 inches from the baby’s belly button with a piece of string and then another piece about 2 inches farther down. You can then cut the cord, which is a painless process. Immediately put the baby back with mom and keep them warm. Congratulate yourself, you just delivered a baby!
In our case, the mother had the baby behind the Dunkin' Donuts and we were able to clamp off the umbilical cord and quickly transfer her back to the emergency department to deliver the placenta and let the labor & delivery team take over. I was hoping that they would call the baby sprinkles, but they settled on another name.
On a side note, just some quick housekeeping…so a lot of you seem to have liked, shared and provided feedback on our last post (over 6000 people at this point). We are going to try to make this a weekly event where we write a topic on emergency medicine geared towards the general public. So, if this is something that interests you please like the page and then follow us. We will try to keep it regular, informative and entertaining. Feel free to leave feedback or post topics you may have questions. Rub the babies back with a towel to stimulate it and help it breath.
All for now...