Diseases & Conditions

Birth, Emergency - Childbirth, Emergency Delivery


Overview, Causes, & Risk Factors

An emergency delivery happens when unplanned events cause a woman to give birth at home or on the way to the hospital. Emergency deliveries should not be confused with intentional home deliveries.

Unexpected complications can develop when labor and delivery happen at home. These complications include:

  • sudden separation of the afterbirth, called placenta abruptio
  • fetal distress during labor
  • unexpected multiple pregnancy
  • unexpected maternal bleeding after delivery of the placenta
  • infant breathing problems after delivery
  • What is going on in the body?

    There are different stages of labor. When the water breaks it usually means the baby will be coming soon. Contractions often start after the water breaks, sometimes before. Contractions of the uterus can go on for hours. For first-time mothers, contractions usually last 10 to 24 hours. Later births are faster, usually 3 to 8 hours.

    Contractions cause the cervix to open, or dilate. Once the cervix is completely opened, the baby begins to move down into the birth canal, or vagina. Eventually, the baby is delivered by the mother's pushing. Babies are usually born head first, facing down. Sometimes the baby's feet or buttocks are the first through the birth canal. After the baby is delivered, the placenta separates from the uterus and is also pushed out.

    What are the causes and risks of the condition?

    Certain conditions make emergency deliveries more likely. Rapid delivery occurs more often in women who:

  • have given birth before
  • have had a rapid delivery before
  • have certain connective-tissue diseases, such as Marfan's syndrome or Ehrlos-Danlos syndrome
  • have a history of cervical incompetence, which is a cervix that does not stay closed when it should
  • go into labor prematurely, or before 36 weeks
  • have been injured or seriously ill, which may start premature labor
  • Other reasons for an unexpected delivery are that:

  • the mother lives far from a medical facility
  • bad weather prevents getting to the hospital

  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    Among the signs that a baby is close to delivery are:

  • regular contractions at least three minutes apart, lasting about a minute each
  • a sensation of rectal pressure, or an urge to have a bowel movement, caused by the baby's head in the birth canal
  • a strong urge to push
  • bulging of the birth canal opening, through which the baby's head may be visible
  • the mother warning that the baby is coming

  • Prevention & Expectations

    What can be done to prevent the condition?

    As the baby's delivery date approaches, all plans for getting to the hospital should be reviewed. Routes to the hospital should be planned, especially if the mother will be traveling away from home. Emergency numbers should be on hand.

    Most births will proceed without anyone's help. The wrong help can cause complications. If birth is at hand, do NOT do the following:

  • Do NOT prevent delivery by holding the mother's legs together or pushing the baby's head back into the birth canal. This can seriously injure the mother and the baby.
  • Do NOT allow the mother to sit on the toilet during delivery. The toilet could injure the baby.
  • Do NOT allow the baby to be pulled from the vagina.
  • Do NOT pull on the umbilical cord.
  • Do NOT use chemicals or antiseptics on the birth canal or the baby. The baby should be dried off and wrapped in a dry warm towel

  • Treatment & Monitoring

    What are the treatments for the condition?

    First aid can be helpful in an emergency birth.

  • Emergency childbirth supplies should be handy at all times in the car, home, and office of a pregnant woman. This is important if she has a history of speedy deliveries.
  • Emergency supplies should include a flashlight, pillow, clean sheets and towels, suction bulb, sterile rubber gloves, clean scissors, and two clean cord ties.
  • Hands should be washed with clean soap and water. Rubber gloves should be worn if possible.
  • The mother should be placed in a comfortable, flat position. The water breaking usually means that the baby will be coming soon. Clean sheets or towels should be placed under the mother's buttocks.
  • The mother's back and head should be supported with pillows or by another person.
  • The mother should bend her knees to her chest and spread them apart when she feels like pushing.
  • Gentle pressure should be applied at the lower edge of the vagina as the baby's head starts to show. This prevents the baby from coming too fast and ripping the vaginal tissues.
  • Once the baby's head is delivered, it is likely that the head will turn to one side. The baby's head should be supported and any amniotic fluid should be wiped away. Fluid should be very gently suctioned out of the nose and mouth.
  • If the umbilical cord is wrapped around the baby's neck, a finger should be hooked under the loop to gently and quickly slip it over the baby's head.
  • If the baby's shoulders are not too large, the rest of the baby's body usually delivers quickly after the head. A towel should be used to support the baby because newborns are very slippery. The baby can also be delivered directly onto a flat surface between the mother's legs.
  • If the baby seems stuck after the head is delivered, pressure should be put above the mother's pubic bone. She should push hard. This usually releases the shoulders to allow for delivery.
  • The baby may look blue and floppy at first. The baby's back or the bottom of the feet should be rubbed with the towel. This starts breathing. The baby should be held face down to allow fluids to drain out of the lungs. Fluids should be suctioned out of the nose and mouth.
  • Once the baby cries and is breathing well, the baby should be dried off, wrapped in a towel that does not block breathing, and placed on the mother's stomach or chest. Breastfeeding should be encouraged.
  • The umbilical cord must be tied off. A clean shoelace, or an umbilical clamp, if there is one in the emergency kit, should be tied no closer than four inches from the baby. The cord must not be cut.
  • The placenta usually delivers within 30 minutes after the baby is delivered. The mother will continue to have contractions during this time. She may bleed from the birth canal. Once the placenta is expelled, it should be put it in a clean container or plastic bag so that it can be taken to the hospital for analysis.
  • It is important to prevent hypothermia, or low body temperature, in either the mother or the baby. Both should be kept dry and warm.
  • What are the side effects of the treatments?

    Emergency delivery is difficult for all involved. That's because it involves so much physical and psychological stress. It is important to talk about any fears, guilty feelings, or negative reactions to the experience with a healthcare provider. Unplanned delivery has no harmful long-term psychological effects, as long as medical problems do not occur.

    What happens after treatment for the condition?

    Both mother and baby need immediate medical attention as soon as possible after delivery. This is to prevent possible complications. Emergency rescue (911) should be called.

    How is the condition monitored?

    A short stay in the hospital is usually wise. Mother and baby can be watched for signs of infection or bleeding.


    Attribution

    Author:Eva Martin, MD
    Date Written:
    Editor:Duff, Ellen, BA
    Edit Date:05/25/00
    Reviewer:Adam Brochert, MD
    Date Reviewed:09/11/01