Emergency delivery: What to do when baby comes before you can reach the hospital

A pregnant woman sitting in the car with hands on her belly

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

It doesn’t happen that often; unplanned out-of-hospital births account for about 1.5% of U.S. births. But what would you do if this happened to you or 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.

Birthing parents 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. Stay calm

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 health care providers nearby, this isn’t the end of the world.

3. 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.

4. 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 the birthing parent’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. You can wipe her face with a clean dry towel and stroke the sides of her nose to help push out fluid.

5. 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.

6. 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. This can also help to limit blood loss at the time of delivery.

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.

7. Don’t 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 piece of floss 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.

8. Get to a hospital

It’s important to get to the hospital as soon as possible. Hemorrhages can occur after delivery. If at any point you are feeling lightheaded or dizzy it is important to get to a hospital as soon as possible as this may be a sign that you have lost a dangerous amount of blood during delivery.

Sterility can be an issue with unattended deliveries, and the baby may need an evaluation and 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 babies have been being born 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 to deliver healthy babies on their own.

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