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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, although in both situations, the unexpected complications that can happen with any labor and delivery occur in a setting where they are harder to manage and may have dire consequences.

These complications include, but are not limited to:

• sudden separation of the afterbirth from the uterus, 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?

The name "labor" is given to the process during which the contractions of the uterus have the effect of dilating and effacing the cervix so that the baby can be born. Just because contractions are occurring does not mean that labor has started. However, when contractions become more regular and forceful, it is likely that labor has begun, and the woman should quickly get to a place where she can be examined to see if she is in labor, and if necessary, safely deliver the baby.

Usually after labor has begun but sometimes before, the amniotic fluid sac around the baby ruptures, that is, "the water breaks". This is another sign that the woman needs to get quickly to a place where she can deliver safely.

For first-time mothers, labor usually lasts 10 to 24 hours. Later births are faster, usually 3 to 8 hours. However, these time frames are highly variable, and it is not unusual for a birth to come much sooner. Therefore, despite the best intentions of a woman and those taking care of her, the delivery of a baby sometimes happens in an emergency setting.

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

At this point, the mother may warn those around her that she thinks the baby is coming right way. Such statements should not be ignored.

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 any of several conditions causing the cervix not to stay closed when it should
• go into labor prematurely, or before 36 weeks
• have been injured or seriously ill, which may start premature labor

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

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.

The most important thing to remember is to remain calm and keep in mind that when in doubt, doing nothing is better than guessing at any sort of action when one is not sure. Many thousands of babies have been successfully birthed with no medical attention at all. Most births will proceed without anyone's help if they must. Helping in the wrong way can cause complications.

• 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

What are the treatments for the condition?

If it is clear that the baby will come before the woman can reach the hospital, it is generally better to set up for the birth at home rather than to risk having to deliver in a vehicle on the way. However, if birth starts to occur while on the road, the driver should pull off the road, put on the flashing warning lights, and help with the birth, protecting the woman' privacy as best one can.

Some principles to follow in case of an emergency birth include:

• 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. 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 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 professional. 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 in order 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 there for signs of infection or bleeding.