By Michael Morse
They are the best of calls, they are the worst of calls…
Just about every firefighter I know would rather enter a fully involved, occupied fertilizer factory without a charged line than deliver a baby. Until, that is, they deliver one. Field deliveries are a bit unnerving, but they can be one of the most gratifying moments in a firefighter’s career. Sure, your patient load doubles, and it can be a bit messy, but I have found little more satisfying that pressing the mic button with my sweaty fingers, asking dispatch for a time check, and then announcing over the air, “It’s a girl; time of birth 2330 hours.” Even the people listening get a moment of pride and satisfaction and feel a part of something bigger than the job.
Making that announcement is more involved than just saying the words; training and experience certainly help. Having a member of the crew who was present during delivery of a child of his own or who has actually done a field delivery is a luxury and will definitely ease the tension. Understanding our role as health care providers and being proficient is essential.
Chaos is never welcome at any emergency scene, and considering the birth of a child anywhere but in a controlled environment is foolish. Calming the scene and creating a serene atmosphere once you realize that delivery is imminent can be accomplished while attending to the task at hand. The expectant mother and others in attendance need to know that things are as under control as they can be, and it is up to us to be the bringers of calm. By being confident and capable, we do just that.
Some Things to Consider
Step 1: Assess whether transportation to an appropriate medical facility is possible.
- How far from that facility are you?
- Is this a first child? Labor with first children is usually slower.
- How frequent are contractions? If under five minutes, and sustained for more than a minute each, consider delivery in place. Over five minutes apart: strongly consider transport.
- Has the water (amniotic sac) broken? If yes, delivery may be imminent. If no, strongly consider transport.
- Does the expectant mother feel the need to move her bowels? If yes, there is a good chance the baby’s head is in the birth canal and pressing on the mother’s rectum, creating the sensation of a bowel movement. If no, you may still have time to transport.
Step 2: Examine the mother.
- By being professional and knowledgeable, you will have eased most of the concerns of the mother and others in attendance. Speaking of others, now is a good time to clear them out, except for anybody who insists on staying, and the father. Your confidence has earned their trust. It is a little uncomfortable exposing the mother, but obviously necessary. Communication is key. Explain why the examination is necessary.
- Remove clothing that may obstruct exam and delivery.
- Place sheet, blanket, or whatever is handy beneath the mother’s buttocks and lower back.
- Have the mother bend her knees and spread her thighs so you can observe crowning (the appearance of the baby’s head in birth canal).
Step 3: Delivery.
- Glove up, if you have not already done so.
- Get whatever equipment you have readily available (a well-stocked and updated maternity bag is essential on every EMS Fire department vehicle).
- When the head is visible, support it with one hand. Have a bulb syringe in the other hand.
- Insert the compressed syringe 1 – 1.5 inches into baby’s mouth and slowly release.
- Be aware of the umbilical cord. If it is around the baby’s neck, use two fingers to slip the cord over the shoulder. Alternatively, clamp, cut and unwrap the cord with a sterile scalpel and clamps.
- Don’t pull; allow the baby to come to you.
- Have a sterile (if possible) towel or blanket to wrap the newborn in, pick the infant up to allow mucus to drain from nose and mouth, and assist gently with your bulb syringe. Check for breathing. If yours has resumed, check the newborn. If the infant is not breathing, stimulate by gently rubbing its back or slapping the soles of the feet. If still no response, ventilate with an appropriate device or mouth to mouth, remembering to use tiny puffs. If the infant fails to breathe and the heart rate is below 60, begin CPR with ventilations until transport arrives or the infant begins to breathe on its own.
Do not worry about the cord or placenta. Nature works wonders. The umbilical should become limp and stop pulsating as the baby no longer needs the blood supply. Keep the baby warm, continue suctioning as needed, and prepare to transport two patients!
Under normal circumstances–which thankfully the majority of live births are–the whole process is as natural as breathing. Mothers have been doing it, often unassisted, since the beginning of time. Complications do occur and it is wise to do as much reading as possible on emergency childbirth prior to encountering a complicated delivery. Always keep in mind: we are firefighters, paramedics, and EMTs. We do our job to the best of our ability and training. Sometimes situations confront us that are beyond our capabilities and equipment. All we can do is our best to stabilize and transport.
Michael Morse is a former captain with the Providence (RI) Fire Department (PFD), an author, and a popular columnist. He served on PFD’s Engine Co. 2., Engine Co. 9, and Ladder Co. 4 for 10 years prior to becoming an EMT-C on Rescue Co 1 and Captain of Rescue Co. 5.