When baby's coming and you can't reach the hospital

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Let’s face it: Babies aren’t great at sticking to their parents’ schedules. Sometimes they enter the world before mom can make it to the hospital.

Sometimes they arrive when mom can’t get to help at all, like the Miami baby born at home in the midst of Hurricane Irma.

It doesn’t happen that often – unplanned out-of-hospital births account for about .25 percent of U.S. births. But what would you do if this happened to you or to someone you’re with?

Barring any serious complications, the steps are relatively simple:

1. Call your obstetrician and/or 911

Your obstetrician or an emergency dispatcher can help you determine if labor has advanced enough that you shouldn’t attempt a trip to the hospital. (Usually, if there are contractions but the water hasn’t broken, you have plenty of time.)

If you can’t safely attempt that trip, the medical professionals on the phone can talk you through delivery and complications that may arise. The dispatcher can send paramedics your way.

Moms who are alone should also call a relative or neighbor to act as a helper if it will take long for the paramedics to get there.

2. Remember: Your number-one priority is conserving blood loss

Hemorrhage is the number-one cause of maternal mortality worldwide. We rarely see that in the United States, but in third-world countries, steps often aren’t taken to conserve blood loss during birth.

3. Stay calm

I know it can be difficult not to freak out in this situation. Even in the hospital, it’s hard for new parents to stay calm. But remember: While it’s best for baby to be delivered with healthcare providers nearby, this isn’t the end of the world.

4. Start pushing only when you have to

To prevent tearing of the cervix or skin, don’t push until it feels like the baby is already almost out.

In the hospital, you would have someone checking the dilation of your cervix to tell when it’s safest to begin pushing. If you can't determine that dilation, it's best to wait as long as possible before pushing. Tearing your cervix could cause serious hemorrhaging.

5. Keep baby dry, warm and breathing

Once the baby is out, dry her off with a clean towel, wrap her with a dry blanket for warmth, and put her on mom’s belly or chest. If the baby doesn't start crying soon after emerging, firmly rub her back up and down to get her to cry.

Keep her mouth and nose clear of mucus or fluid so that she can breathe. A bulb syringe will help clear the mouth and nose, but if you don’t have that on hand, you can stroke the sides of her nose to help push out fluid.

6. Begin nursing, if possible

Nursing the baby will help produce the hormone oxytocin, which helps the placenta deliver and the uterus contract, conserving blood loss.

If the baby isn’t interested in nursing or the umbilical cord is too tight for her to reach the breast, having her nuzzle or even just stimulating the nipples by hand can help.

7. Deliver the placenta

The placenta will eventually come out on its own, but massaging the belly externally can help ease it out and help the uterus contract.

Signs that the placenta is on its way: lengthening of the umbilical cord, hardening of the abdomen, and a gush of blood. The vagina will feel similar to when the baby was about to come out, but to a smaller degree.

8. Cut the umbilical cord

It’s best to wait for paramedics to cut the cord using sterile clamps. If that’s not an option, wait to cut the cord until after it stops pulsating.

Clamp the cord or tie it off in two places with something as sterile as possible. (A shoelace will work in a pinch.)

To prevent infection, place the clamps or ties so that about six to eight inches of the cord will remain attached to the baby. That extra length will give a doctor or nurse some space to trim it with sterile tools at the hospital.

Once it’s firmly clamped or tied off, cut the cord between the two ties with scissors. Boiling the scissors beforehand can help sterilize them.

9. Get to a hospital

Even if mother and baby both seem fine, it’s important to get to the hospital as soon as possible to be safe. Sterility will be an issue, and the baby probably will need antibiotics.

This will also help you get started on the necessary legal paperwork for a newborn in the United States.

The good news is that women have been delivering babies for a pretty long time. And while the obstetricians at The Ohio State University Wexner Medical Center don’t advocate solo home births, it is possible for pregnant women to deliver healthy babies on their own. 

 

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