Emergency childbirth is the precipitous birth of an infant in an unexpected setting. In planned childbirth, mothers choose the location and obstetric team ahead of time. Options range from delivering at home, at a hospital, a medical facility or a birthing center. Sometimes, birth can occur on the way to these facilities, without a healthcare team. The rates of unplanned childbirth are low. If the birth is imminent, emergency measures may be needed. Emergency services can be contacted for help in some countries.
Emergency childbirth can follow the same steps as a planned childbirth. However, the birth can have increased risks for complications due to the prematurity of the baby or the less than ideal location.
Background In 2020, 1.34% of births took place outside of a hospital in California, USA, where 1 out of 8 births in the country happen. Most of the out-of-hospital births are planned, and thus, not considered an emergency childbirth. However, about 12% of attempted home deliveries need urgent transport to a hospital. Some of the reasons for transferring to a hospital include failure of labor to progress, parental exhaustion, need for more pain medication, or parental/fetal complications.
In the United States, 0.61% of all births happen in an unplanned setting. The percent is even lower in countries like Finland and France.
Each year more than 250,000 women around the world die from complications due to childbirth or pregnancy, with bleeding and hypertension as the leading causes. Many of these deaths are preventable by emergency care, which include antibiotics, drugs that stimulate contraction of the uterus, anti-seizure drugs, blood transfusion, and delivery of baby with assistance (vacuum or forceps delivery) or C-section. In addition, it is important to prevent hypothermia in the newborn because this is linked to poor outcomes.
Preparation Many pregnant women seek medical care throughout pregnancy and plan for the birth of a baby with a healthcare team. Access to high quality care lowers the risk-averse events in pregnancy. In an emergency childbirth situation, it is recommended to seek further education and make a plan.
Early preparation
Many childbirth education classes cover emergency birth procedures. Parents are trained to learn the signs of early labor or other indications that may require assistance. Signs of early labor include regular contractions (4 or more within one hour) accompanied with cervical changes, such as effacement or dilation. Caregivers can take a class on infant and child life support. Some recommend having a kit of emergency supplies in the home such as: clean towels, receiving blanket, sheets, clean scissors, clean clamps or ties, ID bands for mother and baby, pencil, soap, sterile gloves, sanitary pads, diapers, and instructions for infant-rescue breathing.
Late preparation
Additional help may be found by calling 911 (in the United States) or an applicable number to get emergency medical services or nearby medical staff.
A vehicle driven safely toward medical care may be considered an acceptable option during the first stage of labor (dilation and effacement). During the second stage of labor (pushing and birth), a vehicle is usually stopped unless imminently arriving at a medical facility. If a vehicle is taken, additional occupants can support the mother and baby should assist in delivery. The mother and baby are kept warm throughout.
If unable to reach a medical facility, a safe building with walls and a roof are sought that will provide protection from the environment. A warm and dry area with a bed is preferable.
Supplies are collected for both the mother and the baby. Possible supplies may include blankets, pillows, towels, warm clean water, warm water bottles, soap, clean towels, baby clothes, sheets, sterile gloves, sanitary pads, diapers, identification tags for mother and baby, and instructions for infant-rescue breathing. A bed may be prepared for the baby with a basket or box lined with a blanket or sheets. Items are needed to clamp or tie the umbilical cord in two places. Shoestrings or strips of a sheet folded into narrow bands may be used. These items can be sterilized by boiling (20 minutes) or soaking in alcohol (up to 3 hours). Scissors or a knife are needed to cut the umbilical cord and may be sterilized with the same procedure.
Evaluation A background obstetric history should be obtained: how many prior births has the patient had (if this is not her first birth, the patient's labor could be short), how many weeks along is she or what is her estimated date of delivery, any special concerns related to this pregnancy such as being told she has twins, being told she has a complication, or even if she has received regular prenatal care. Any other relevant medical history, allergies, drugs, recent signs of infections (fever) should be asked.
Signs and symptoms Any gush of fluid? This would indicate that the rupture of membranes has occurred releasing amniotic fluid and that labor will probably begin soon if the patient is near term. Any vaginal bleeding? Could indicate a bloody show, a small amount of bloody discharge prior to labor, or if large amounts of bleeding occurred it could indicate potentially life-threatening complications. How frequent are her contractions? One common recommendation is the patient may be in active labor if contractions are 5 minutes apart for one hour (if rupture of membranes has not occurred). Does she feel the urge to push with her contractions? This is an indication delivery will occur soon. Pregnancy and Prenatal History? Certain conditions can increase the risk of complications during labor, including preeclampsia, gestational diabetes, parental obesity, and more.
Physical exam
If time permits and if trained: one should obtain vital signs to include maternal heart rate, respiratory rate, blood pressure, temperature, and oxygen rate.
The patient should be draped with available blankets for privacy.
The patient's abdomen should be examined and felt for the presence of contractions, and the intensity, frequency, and length of contractions should be noted.
With the patient's permission and privacy, an exam of the pelvic area should be performed; in general, one would: Inspect to see if there is any presenting part of the baby. The baby's head will feel hard versus their buttocks will feel soft. If the baby's head is presenting out of the vagina (crowning), then delivery will be happening soon and preparation should begin to deliver the baby Trained physicians would conduct a manual cervical exam to determine the patient's cervical dilation. After the physical exam and if the patient is not crowning, the patient should be placed in the left lateral decubitus position (laying on her left side).
Delivery of term baby in normal position First stage of labor: dilation and effacement of the cervix
This stage of labor on average lasts from 2 to 18 hours, but can last even longer in normal pregnancies. This stage can be further broken up into the latent stage and active stage depending on how dilated the cervix is. The latent stage, when the cervix is dilated less than 3–5 cm along with regular contractions, can last as long as 20 hours without being considered prolonged. The active stage, when regular contractions are accompanied with dilation greater than 3–5 cm, can also be significantly long, with anything less than 11.7 hours being considered normal. Further care may be sought during this time. Evaluation (above) is repeated, assessing for change in stage of labor. The mother is encouraged to walk or sit in a comfortable position.
Second stage: cervix is dilated
This stage may last from 5 minutes to 3 hours. Position. The mother is positioned in the lithotomy position, lying on her back, with her feet above or at the same level as the hips. The perineum (the space between the vagina and anus) is positioned at the edge of a bed. Wash. The perineum is cleaned with antiseptic solution or soap and water. Any assistants will wash hands with soap and water and put on sterile or clean gloves. Pushing. Pushing is encouraged during contractions. Head. The head of the baby is delivered. Delivery of the head is controlled to prevent rapid expulsion. One hand is placed on the perineum while the other applies gentle pressure to the baby's head as it comes out. Soft pressure can be applied to the baby's chin through the perineum to help expel the head. Rapid expulsion is still prevented with soft head pressure to reduce vaginal lacerations. Cord check. The presence of an umbilical cord (nuchal cord) is checked to determine if it is around the baby's neck. If it is present, an index finger is used to attempt to pull it over the baby's head. If this cannot be done, the cord is clamped/tied in two places. Then the cord is carefully cut, avoiding injury to the baby or mother. Front shoulder. The front shoulder is delivered. This is the shoulder on the mother's front side, towards her belly. The assistant holds the baby's head with two hands and may need to apply slight downward pressure (towards the mother's anus) to help the front shoulder out. Firm pressure can injure the baby. If the shoulder gets stuck this is called shoulder dystocia. There are certain risk factors for shoulder dystocia, including gestational diabetes. See procedure for relief of shoulder dystocia (below). Back shoulder. The back shoulder is then delivered by providing slight upward pressure (away from the mother's anus). Catch baby. The baby usually comes out right away after both shoulders. The baby is caught carefully, considering that newborn babies can be slippery. The assistant holds the baby at the level of the vagina. Cut cord. The umbilical cord is clamped and cut. The cord is clamped in two places about 6 cm to 8 cm from the baby. The clamps or ties are tight in order to stop the blood flow. The cord is cut between the two clamps or ties. Sterilized scissors or a sterilized knife is used. Another assistant may help with this. Dry baby. The baby is dried, wrapped, and kept warm. Appropriate neonatal care is provided or the baby is placed to the mother's breast on her bare skin. An identification band may be placed on the baby.
Third stage of labor: the delivery of the placenta
The baby is attached to the placenta by the umbilical cord. After the cord is cut, the placenta is usually still inside the mother. The placenta usually comes out in 2–10 minutes, but it may take up to 60 minutes. This process is usually a spontaneous one, but may also require pushing from the mother. Before the placenta is delivered there is a gush of blood as the cord gets longer. The umbilical cord can be held taut, but must not be pulled with much force. The placenta is delivered and is inspected for completeness. The placenta should be stored in a bag for inspection by trained medical personnel. The mother will need to have a trained physician inspect for vaginal lacerations that will need suture repair.
Maternal complications Complications of emergency childbirth include the complications that occur during normal childbirth. Potential complications for the gestational parent include perineal tearing (tearing of the vagina or surrounding tissue) during delivery, excessive bleeding (postpartum hemorrhage), hypertension (high blood pressure), and seizures.
Vaginal bleeding and shock Bleeding during pregnancy is fairly common (experienced by up to 25% of pregnant women) and may not always indicate a problem. However, bleeding can be a sign of a serious complication, including miscarriage or another condition that threatens the health of the mother or fetus. It is important to get medical attention for any of the following:
Vaginal bleeding early or late in pregnancy Severe abdominal pain Trauma (such as a fall or car accident) while pregnant