'Be calm': How to deliver a baby coming quickly any time, anyplace
Dispatchers and midwives trained to coach bystanders through deliveries over the phone
When Lakin Afolabi's wife, Ibukun, went into early labour at home and told him she couldn't make it to the hospital, he joked: "I can catch, I play football."
But minutes later, when a midwife began to explain over the phone how to deliver the baby, he said: "Are you serious?"
"I'm just a regular guy," says the 33-year-old lawyer who successfully delivered the couple's first child, Dari, now 3½, one Saturday afternoon in the couple's London, Ont., home.
"I could see the head, and after two pushes, he was out."
After a rub on the back, the baby began breathing. The midwives arrived a few minutes later.
"It felt like a really long time but it was only a few seconds," says Ibukun, also 33.
'It's coming'
While many home births are planned, some are not. It's not uncommon for 911 dispatchers to receive emergency calls and hear "it's coming" on the other end of the phone. In those instances, they can coach others through the steps of delivery before paramedics or other medical professionals are available to take over.
Occasionally, paramedics arrive to find a baby has just been born, delivered by bystanders with little to no training.
Known as "born before arrival," emergency childbirth is rare.
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While statistics on frequency of such births are not tracked nationally in Canada, only one in 200 babies born in the U.K. arrives suddenly, almost always to women who have previously had short labours.
In Ontario last year, the Ministry of Health says there were 3,039 calls to 911 in connection with an imminent childbirth or labour.
When babies do come quickly, "most of the time, they just fall out," says midwife Melissa Coubrough, who practises in London, Ont.
Coubrough and her colleague Emily Eby, a midwife in Collingwood, Ont., account for such a possibly in the birth plan of women who are known to have "precipitous deliveries," they say.
"At 37 weeks, we have a chat. If the baby is coming quickly, here's what you need to know," says Eby.
Step 1: Call for help
The first step is to phone for help. "Call 911 and then call your midwife," says Eby. Both 911 dispatchers and midwives are trained to coach a bystander through a delivery over the phone.
Medical communications officer Shannon Kosick, who works for Emergency Health Services in Nova Scotia, agrees.
"Let us come to you," she says.
After 17 years working on ambulances as an advanced care paramedic, Kosick has been a 911 dispatcher for the last six years after a back injury meant she couldn't "work the streets."
Delivering a baby over the phone "is a completely different experience," says Kosick, who delivered four babies in her 17 years working on ambulances and has been involved in several deliveries through her headset.
"You have to go by what people tell you and what you hear in the room," she says.
"Panic is contagious, but so is calm," she says, adding that dispatchers are trained to use "repetitive persistence" with phrases like "I need you to be calm in order to assist you."
Step 2: Get comfortable
Eby and Coubrough advise removing the woman's lower clothing and having her lie flat.
"That way, if the baby comes out, it doesn't have anywhere to fall," says Eby.
Dispatchers will direct the person on the phone to collect plenty of dry towels or blankets to keep the baby warm once it is born.
Step 3: Try to wait or time to push?
After consulting your midwife or obstetrician to confirm that labour has begun, panting can slow the progression of the baby while midwives or paramedics respond.
"If you have an uncontrollable urge to push, stop and have a look to see if the baby is crowning," says Eby.
Crowning is the medical term for the head exiting the vagina.
"It feels like a ring of fire and you'll feel like you need to have a bowel movement," she adds.
If the baby is crowning, Eby advises to stay put — the baby could be moments from being born.
At that point, dispatchers will instruct the caller to "place the palm of your hand against her vagina and apply firm but gentle pressure to keep the baby's head from delivering too fast and tearing her," according to the script dispatchers follow.
Step 4: Catch
As the baby is born, support its head and shoulders. The baby will be slippery and should be handled with a firm grip. Don't pull on the baby, but rather let the mom's pushes bring the baby out naturally, says the script.
"Let the mom do all the work," says Kosick.
Step 5: Warm and dry
Once the baby is born, use towels or clean clothing to dry and stimulate it. It should be crying — if not, you may need to provide mouth-to-mouth breaths or CPR. Dispatchers can coach you through that, too, says Kosick.
Place the baby skin to skin on the mom's chest and cover it with a blanket.
"Breastfeeding is good for both mom and baby," says Coubrough.
The professionals say that tying or cutting the umbilical cord can wait, and that the delivery of the placenta — often called the afterbirth — will happen naturally without any need for pulling or tugging on the cord.
The cord can be cut later by paramedics or midwives. If they'll be a while, dispatchers will explain how to tie off the cord before cutting it.
"It may seem like a long time, but help will be there in a flash," says Eby.
"Just be present for the moment," says Coubrough. "Childbirth is a beautiful thing."
'A very good day'
Kosick remembers the last delivery she assisted over the phone.
"Afterwards, people were crying. The women were crying, the men were crying, everyone was crying. Bringing a new human into the world is really great.
"People who call 911 are usually having a bad day. But that was a very good day," she says.
Kosick recalls the last phrase written in her script before the paramedics arrive and take over:
"Is it a boy or a girl? Then I disconnect," she says.
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