birth case scenarios

How to Deliver a Baby (If You Absolutely Have To)

Photo: ArtisticCaptures/Getty Images

Last weekend, a woman who was eight and a half months pregnant gave birth on a New York City–bound Amtrak train in Aberdeen, Maryland. When she unexpectedly went into labor on the train, she found a “Good Samaritan” to help her until they could stop for EMT help. By then, there was no time to get to the hospital, so she had her baby on the train.

If I were that Good Samaritan, I would have been stumped. I’m a woman, and a mother, but I have no idea what to do for a woman in labor. I know CPR, including what to do if someone is drowning; I know the Heimlich maneuver; I learned how to do a tourniquet in high school; I was tested on how to make a flotation device out of my own pants. And though I’ve never used any of these skills, I value them in theory. But never once in all my travels have I been instructed, in any rudimentary sense, what to do for a woman in any stage of labor. (I gave birth to my daughter via C-section, and the likelihood of me needing a Caesarean was guessed at early enough in the pregnancy that I never did that part of the reading).

I suspect that we’re all still a little bit uncomfortable with the process of bringing life into the world, and most of us only ever learn about it when absolutely necessary. So I did everyone a favor: I investigated exactly what to do if you’re stuck on a bus with a woman who needs to have a baby right now. And I’m going to share what I’ve learned.

Step 1: Call 911 and resist the urge to panic.

The first thing to do is get some EMTs on the scene. Unless medical help is hours away, they’ll probably arrive before the baby is born. In the meantime, Rita Wagner, a certified nurse midwife with Lower Manhattan Obstetrics and Gynecology at Weill Cornell, says, “You just have to stay calm.” Sure, this is a stressful situation for you, but think about how it feels for the mother-to-be! The best thing you can do for her, Wagner says, is “be present” and “with the woman,” which, it turns out, is literally what the word midwife means.

You’ve heard this over and over: People have been having babies for thousands of years; our bodies know what to do! That is supposed to be reassuring, and most of what Wagner says is reassuring. In the year 1900, almost all U.S. babies were born outside of a hospital. By 1944, that number was 44 percent, and by 1969, 99 percent of babies were born INSIDE hospitals. Presumably, most of our common knowledge of how to birth a baby slipped our minds, but we can get it back! Even though you’re not a doctor, you will get through this. Just stay very, very calm.

A woman in advanced stages of labor — her water has broken, her contractions are very close together — often senses what to do. Wagner says there is something “instinctual” in all of this. Hopefully, in your surprise baby-delivery scenario, that will be true, leaving you with the job of keeping her comfortable and relaxed.

Step 2: Support her through early labor and gather provisions.

Labor advances largely at its own pace — for some women it moves quickly, for others, it does not. You, the helper, aren’t likely to be able to slow things down. So, if the baby really is coming, it will be very obvious. There are three stages of labor, but the first stage is unhelpfully divided further into two phases: stage one, “early labor,” which is when the pregnant woman is like, “Oh, wow, I think something is going on down there.” This is when contractions — which start pretty mild and are comparable to menstrual cramps — begin.

In the second part of the first stage, “active labor,” the contractions get more intense: They are stronger, longer, and more frequent. The second stage of labor is the part you see in movies. It ends with active “pushing” (which shouldn’t go on too long) and the baby being born. We’ll get to the third phase, but for now, let’s pretend your laboring stranger is moving into second stage, i.e, the baby is being born, imminently, even if you don’t know exactly when.

The reason that babies are sometimes born, say, en route to the hospital rather than in the hospital is because stage one is extremely variable in length. If it’s the woman’s first baby, this phase can last anywhere from six to 12 hours. Many women prefer to do a bit of this stage at home, and are even encouraged to do so by their doctors and doulas (birthing coaches). In this stage, timing contractions (timing the beginning of one to the beginning of the next gives you the frequency, while timing individual contractions from start to finish gives you the duration) is important, but so is resting and keeping hydrated. That said, stage one of labor often slides into stage two fairly rapidly, catching the mom off guard.

When active labor starts, the contractions are much more frequent and often very painful. It can last a really long time, too — sometimes eight or nine hours, but it can be as short as an hour. This is how people get caught in cars and subways: Labor is totally unpredictable. In the U.S., at this point, many hospitalized women opt for pain medication — often an epidural — at this point. In our scenario, that isn’t an option, so although it’s been said a bunch of times, your main job is to help the laboring woman breathe and manage her situation. Validation will get you a long way here: Don’t argue or disagree with her, or even try to overcalm her at this point. You know from film depictions that some women scream obscenities and lash out in anger at whoever is around. Everyone’s labor is different, but your job as the Good Samaritan is to keep your cool. This is really your last chance to get any provisions — clean towels, blankets, washcloths, and buckets of water — before things get incredibly busy.

Step 3: She’s going to push and you (yes, you) are going to catch the baby.

At some point, a laboring woman will move to the end of the transitional phase of labor. This is the hardest part, and it’s when they begin to feel the unmistakable and uncontrollable urge to really PUSH. At this point, if the woman is wearing pants, it’s definitely time to remove them. Wagner says any position that the woman feels comfortable pushing in is okay, that she should “do what feels right” — but most women opt for some sort of sitting or squatting position. “The urge to push is unmistakable,” Wagner says. Women “usually bear down uncontrollably. It is rare for someone to not know when to push when unanesthetized.” In fact, she says, some women feel this way before it’s really time, which can result in them tiring themselves out. A professional usually knows how to manage and help a woman know when to push and when not to. In a surprise scenario, just let nature guide the woman in labor. This feeling — the unmistakable urge to push — arises as the baby descends into the birth canal.

Someone — let’s say it’s you — needs to support the baby as it comes out of the mother’s vagina. If you have a full view of the proceedings, you will know the baby is coming right this exact minute when you see the top of its head. This is called crowning. At this point, if she’s not already, you should instruct the mother to push — to bear down with each contraction. Ideally, the pushes will be less short — less than ten seconds each, with a little break in between. This is the most intense part of birth, but it doesn’t usually last very long.

You should support the baby’s head as it comes out of the vagina, but you should not pull on anything, including the umbilical cord. Once the baby’s head is out, it usually rotates a bit to one side. With the next push, one shoulder will emerge, then the other. Once the shoulders are out, keep supporting the baby and lift it very slightly toward the mother’s stomach. The rest of the body will come out easily. The baby will be slippery! Be careful!

Step 4: Keep the baby warm.

As long as the baby is breathing — it should be obvious, most babies cry at least a little upon contact with their new atmosphere — it should be placed directly onto its mother’s chest immediately. Wagner says, “There is no need for routine clearing of mouth and nose at birth unless mucus or fluids are preventing baby from breathing.” The easiest thing, she says, is simply to wipe the baby’s face with a cloth. The most important thing you can do is “dry the baby and keep it warm.” This is why skin-to-skin contact is ideal. Wrapping the baby in a towel or blanket or a coat overtop of its mother will help — “babies lose A LOT of heat when wet, especially from their heads,” Wagner says, so keeping them covered is a must.

The baby, at this point, will still be attached to its mother via an umbilical cord. There’s no need to detach it, Wagner says. So in any reasonable situation — where medical help is en route, the cord can be left undisturbed.

Step 5: Do not mess with the placenta.

The third and final stage of delivery is when the placenta comes out, and it’s also the most dangerous part if you’re not a medical professional, because it can lead to hemorrhaging. You’ve already done so much: Do you really need to know about this? Well, it won’t hurt. After the baby has been born, if medical help is actually not on the way — we’re talking about a Walking Dead scenario here now, which is pretty unlikely but — why not have at least an inking of what happens next?

In the hospital, drugs are often administered to help this next part, but not always. The point is that after birthing a baby, the uterus needs to contract in order to separate the placenta from the inside of the body. The most common sign that the placenta is coming — it can happen within ten minutes after birth or take up to an hour — is a “gush of blood,” says the midwife. She also cautions more than once that placental delivery is serious business, and an “untrained professional” should not facilitate this process. But, in an end-of-the-world scenario, after the gush of blood, the woman will again have the urge to push, which is helpful to the process. The placenta will come out as she pushes. Firmly massaging the stomach after this — which will probably hurt her a little — will help to slow down the bleeding.

Congratulations! You birthed a baby!

Or maybe you just sat with the mom and helped her stay calm while help arrived! Either way, take a minute to celebrate, you Good Samaritan, you.

A word about complications: There are so many hundreds of “What if” scenarios that to even present a tiny fraction of them would make any attempt to explain the process of birth completely useless. Most babies are born without complication; many are born in unexpected circumstance and turn out fine. But there are some complications that occur all the time — like when the baby is feet first (breech) or when the umbilical cord is wrapped around its neck — and aren’t much of a threat in the presence of a professional but would be a real problem on Amtrak. So the advice above is for “standard” births, at least as “standard” as a birth on a moving vehicle/during a zombie apocalypse could possibly be.

The reality is you will probably never ever need to deliver a baby. But that doesn’t mean you shouldn’t at least try to be prepared.

How to Deliver a Baby