Ready or not, here it comes

Planning aside, it may be a cab driver, a neighbor or your partner who ends up delivering your baby. Here'’s how to prepare.

Lisa Hickey never expected to give birth in a 1993 Toyota Camry on an on-ramp to Interstate 90, but that’s what happened. Early on a July morning in 2003, Hickey, 31, of Natick, Mass., went into labor with her second child. Her husband drove her and her 22-year-old sister, who planned to watch the delivery, to the hospital in Boston. When Hickey’s doctor found she was only 4 centimeters dilated, he estimated that the baby wouldn’t arrive for a long time and sent them home. The temperature was over 90 degrees that day, so Hickey took a shower to cool off. That’s when her contractions really kicked in. The three got in the car to rush back to the hospital, but their trip ended five minutes later. “As we were getting on the on-ramp, I said, ‘Pull over, the baby’s here,’” Hickey says. Her husband called 911 on his cellphone and her sister opened the door to the front seat and helped Hickey pull down her pants. “The head was right there,” Hickey says. “My sister caught the baby.” The two women unwrapped the umbilical cord from around the newborn’s neck, and help arrived shortly after. “I think the entire Natick fire department came,” says Hickey. “They were so gentle. They took care of the cord and suggested I start breastfeeding.” Hickey and baby Katharine were taken to the hospital, both OK. Your motto: be prepared

Chances are you won’t have to deliver your own baby, as more than 99 percent of all births occur in hospitals and birth centers. Unplanned deliveries occur most often when women have unexpectedly short labors, and most mothers experience shorter labors with each child. However, since there is no way to predict how long it will take for a baby to be born, all parents should prepare for the possibility that their baby may arrive unexpectedly. That’s the thinking behind the guide to emergency preparedness “Giving Birth in Place” (see below), created by the American College of Nurse-Midwives (ACNM). “Having a plan makes people feel more confident,” says certified nurse-midwife Marion McCartney, director of professional services at ACNM. As your due date approaches, you might want to print out the online ACNM guide and gather the recommended supplies, which include a baby-size bulb syringe to suction the newborn’s mouth and nose; a box of disposable gloves; a pair of clean, white shoelaces; sharp, sterilized scissors; a towel; large plastic trash bags; and a dozen large sanitary napkins. It’s also wise to take an infant CPR class, to post emergency numbers by each phone (and cellphones) and to keep cellphones charged and car gas tanks full. “If you feel your baby is starting to come out, there’s absolutely nothing you can do to stop it,” says Fiona Dunne, R.N., a teacher at the UCLA Daniel Freeman Paramedic Education Program in Los Angeles. “And when a woman has the urge to push, it’s uncontrollable.”

What to do when your baby won’t wait

If you’re at home and realize you can’t get to the hospital in time, call your local fire department or 911. If you’re alone, call a neighbor to come over immediately. And don’t forget to unlock the front door. “A common mistake is leaving the door locked,” McCartney says. “The woman is inside having the baby, and the rescue squad is outside pounding on the door.” Lie on a bed or carpeted floor, preferably with your bottom on a clean sheet or towel that you’ve placed over a shower curtain. If you’re alone, position yourself in such a way that the baby will emerge safely onto a flat surface. Once the baby comes out, dry her with a sheet or towel; the rubbing helps stimulate her first breaths. Then put her on your naked belly for warmth as you wait for the paramedics to arrive. There is no rush to cut the umbilical cord, but it’s important to keep the baby close so the cord won’t be pulled tight. When the cord stops throbbing (usually after 10 minutes or so) and if help hasn’t arrived, tightly double-knot a clean shoelace (sterilized in boiling water, if possible) around the cord 3 inches from the baby. Double-knot another shoelace 2 inches up the cord from the first knot (5 inches from the baby) and cut the tough, rubbery cord between the laces with sharp, sterilized scissors. The placenta should deliver itself within about 20 minutes. The good news about emergency births is that the newborns usually are fine because they haven’t been stressed by hours of contractions. “Fast labors tend to be very easy for the baby,” McCartney says. Hickey acknowledges the delivery wasn’t hard on her, either. As for her sister? Hickey laughs and says, “She swears she’ll never have a baby.”

[Unplanned arrivals] Some babies make their debuts in the strangest places. Here are a few, according to news reports: >> In the elevator of a high-rise in New Jersey >> During a wedding celebration at a restaurant in Minnesota >> Next to the cash registers at a Wal-Mart in Georgia >> Behind the teacher’s desk in a classroom in Texas >> In a Starbucks bathroom in Illinois >> In a Kwik Stop parking lot in California >> On board a tour bus in Florida