Due Date

This epistle is dedicated to a dear friend. She is a great ER nurse who recently "caught" a baby.



Docs, nurses, cops, and EMT's don't deliver babies. Women deliver babies. Everyone else involved just helps. The hospital where I "live" has a busy OB service. More than 3,000 babies a year enter this troubled world from within our doors. Highly trained labor and delivery nurses and special care nursery staff along with obstetricians, anesthesiologists and pediatricians all work hard to ensure a safe and healthy outcome for mother and child.



Occasionally the delivery occurs in the ER. ER docs and nurses are trained, have the appropriate equipment and are ably backed up by the L&D and nursery pros. Deliveries in the community are the responsibility of police, firemen, and EMS personnel. The mother and child arrive in the ER and stop only if not stable enough for transport upstairs.



A recent episode highlights an unusual OB and neonatal case. The call was for a precipitous delivery in an apartment. The mother was OK but the baby was reported to be blue. The night ER staff was ready with a warming stand, and all the equipment for entubation and resuscitation of the newborn. The baby arrived crying lustily. His face was blue but the rest of his body was pink. He had good muscle tone and good respiratory efforts. His oxygen saturation was 100%. The blue face was caused by bruising from his too rapid descend through the birth canal. His mother's use of cocaine was probably a factor in his hasty entrance.



The twilight zone of deliveries resides in the cars that drive up to the ER entrance with a usually male driver yelling that his wife/girlfriend is having the baby in the car. In my 30+ years of ER experience, I have done 2 "auto" deliveries.



The first was in a small car. It was February and the ambient temperature of 20 degrees (F). The delivery was easy. The cold was the problem. Being a much younger "world's oldest ER doc", I placed the baby on the mother's stomach, wrapped both in a blanket and lifted them up in my arms and rushed into the ER. All went well for mother and baby.



My second drive-up delivery was very different. My "old" friend (the nurse to whom this blog is dedicated) ran out to the minivan in response to the husband's cries for help. A rather large woman of about 110 Kg was lying on the passenger's seat that was in the reclined position. The mother's feet were up on the dash and between her legs the nurse saw two tiny feet dangling from the vagina. The nurse's calls for help were clearly heard in the ER core as she yelled my name. I grabbed some gloves and went through the ER waiting room to the minivan. An obstetrician (who no longer works at our hospital) arrived almost at the same time.



A breech delivery is when any part of the lower half of the baby leads the way down the birth canal. This unfortunate mother was scheduled to have an elective Cesarean section at 8:00 AM that day for an ultrasound proven breech presentation. I was faced with a double footling breech delivery. Most emergency medicine residencies give little training in the management of abnormal deliveries. Ultrasound has decreased the unexpected brow, breech, or shoulder presentations. The OB doc who met me at the minivan offered only the advice that I should get the mother upstairs and then turned and reentered the hospital.



There was no way to safely lift and transport this woman from the van to the ER. My mind and hands recalled a single leg and full breech delivery that I had done while on my obstetrical rotation, during my EM residency back in the seventies. I probed and brought out the upper arm and then the lower arm and finally the baby's head. I clamped and cut the umbilical cord and rushed the baby into the ER. The mother followed soon there after. The baby had a broken clavicle but was otherwise perfectly healthy.



My nurse-friend and I were shaken by this close call. My partners all commented that they had never seen any type of breech delivery and were relieved that I (not they) had been working that night. The nurse shared with me that she had nightmares about this case. The what ifs were hard to digest. I slept well that morning, after my shift ended and I arrived home. Being OCD, I brushed up on all less than normal deliveries with a very old textbook from my medical school collection.



There is nothing more satisfying to anyone who works in health care than being part of a delivery. The birth of another human being is awe inspiring. It was a privilege to have had the opportunity to assist these 2 women. My dear friend currently works in the ER of a tertiary care hospital that handles most complicated OB cases in our region. Her occasional per diem shift in my ER and our friendship keep us connected. The case of the double footling breech is our special bond.