I am about to doze off when my pager yelps its insistent static voice at me.
Ughh… this always happens, dispatch always have impeccable timing on night shifts.
Dispatch: “99 Fox, pre-alert.”
I scramble out of bed and pull on my boots.
Me: “What do you want to do tonight?”
Partner: “I’d prefer driving if you don’t mind.”
Me: “Sure, that’s all good with me.”
I wonder what intoxicated person we are going to pick up tonight.
I hop into the ambulance, and log onto the CAD (Computer Assisted Dispatch) device. The call didn’t show up.
Radio: 98 Kilo, respond code 3 to back up 99 Fox
Hmm that doesn’t sound good if dispatch thinks we need a second crew.
At this point I still have no idea what call we are going to.
Me: “99 Fox.”
Dispatch: “99 Fox. Did you get the call?”
Me: “99 Fox, that’s a negative.”
Bling. The call pops up onto our CAD. I read it – Code 3 for imminent delivery. The call is coded as pregnancy = > 20 weeks. I skim down the notes and read: Water broken, contractions.
Dispatch: “99 Fox, from the sounds (in the background) the baby is coming immediately.”
A wave of excitement and nervousness washes over me. My partner hops into the driver seat, still clueless as to our call.
Me: “We’re going to an imminent delivery.”
Just as well I had a refresher on childbirth and obstetrics two weeks prior from an ITT (Infant Transport Team) paramedic instructor. This is a call I’ve always wanted to do, yet am I ready for it? Is it going to go sideways? There is no time to think, off we went with lights and sirens. On the way down the road, we see Fire pull out just ahead of us. Then they did something unusual, they slowed down, and put on their flashers, urging us to go ahead of us.
Partner: “Are they telling us to pass them?”
Me: “Looks like it, seems like they don’t want to be the first on scene for this one.”
I look at the notes on the CAD it read: Crowning.
Me: “Ahhh… it looks like the she’s crowning (crowning means the baby’s head is showing). I’m going to call the doctor to give her a heads up.”
I can tell my partner is apprehensive about this call. I don’t blame her, all I can remember is the last delivery in this area. It didn’t go well at all, the baby was a breech delivery, and the results were not good. This memory is still fresh in everybody’s mind: paramedics, firefighters, and hospital staff. I am lucky to not have been on that call.
OB kit, stretcher, oxygen, jump kit… I was going over what I needed for this call in my head.
We find the correct address, my partner and I grab the equipment we needed, and ask Fire to help with the rest. As I enter the house, no one is there to greet us, then we hear a voice coming from upstairs. It is the dad. I remember distinctly walking up the long narrow flight of stairs thinking, these stairs don’t look good for extrication.
Dad has a massive grin on his face, next to him is a young boy, of maybe two years. We enter into a room and I find mother on all fours.
Me: “How many weeks in is she?”
Dad: “40 weeks.”
Oh thank goodness it’s a full term baby!
I didn’t have much time to rejoice in that fact, as mom lets out a panting scream. I gather a few more pertinent information from dad regarding the mother’s pregnancy, it seems that everything has been going well for her.
Dad: “The baby’s head is showing last we checked.”
The two year old is dancing around the room, energized by the excitement in the atmosphere. I am about to ask if dad wants to place his son in another room when dad plops himself down on the couch, directly facing mom’s vagina.
Dad: “Come here son! Let us watch mommy give birth!”
And so they sat, front row seats to the miracle of birth. Wow! What an open family.
Child: “Look! Mommy’s pooing!”
Mom: “Yes, mommy is pooing!”
Oh my… ok time to focus…
I take a look, sure enough, there is part of the infant’s head poking out. But wait a minute… something isn’t quite right. My heart sank. I see a cord, directly over the baby’s head, and the vaginal wall is cutting the circulation from the cord to the baby. I have to admit, I am in slight denial, I gently touch the baby’s head and the cord, it is tight, no way to move it up or down. I turn to my partner.
Me: “Call the hospital and update them that we have a prolapsed cord.”
Me: “A prolapsed cord, we have a prolapsed cord.”
I watch as my partner lost all the colour on her face. A prolapsed cord isn’t good, it means the main supply for oxygen and blood delivery to the infant is obstructed by the collapse of the umbilical cord.
Me: “Figure out how to best get her down those stairs, we need to get to the hospital.”
My mind is racing, the adrenaline rush didn’t help, there isn’t much of an option for me: One, I place slight pressure with three fingers to push the baby’s head slightly back, to allow the umbilical cord to delivery oxygen and blood to the infant, and the other was…nothing, which isn’t an option. Getting her down the stairs is going to be difficult as well, we can’t use the stair chair, not with the baby’s head popping out like that. I can remember the ITT Paramedic’s story ringing in my head, about how his fellow colleague had to hold an infant’s head with his fingers, all the way to the hospital, into surgery, and stay there until the surgeon has removed the baby from the womb.
Oh god! This better not happen to me! For the sake of mom and myself.
I explain the gravity of the situation to the parents when the second ambulance crew arrives to help out. Things are happening so quickly. Suddenly mom screams.
Mother: “It’s COMING!!!”
The infant’s head pops out, I can see its tiny blue face, and the cord has now slipped down around its neck. The infant is making gasping motions with its lip, like a fish surfacing to suck up food. Open, close, open, close.
I don’t know if I am relieved or not, the shoulder hasn’t come out yet, otherwise I can try slipping the cord over its shoulder. The cord is tight around the neck. Worst case scenario, I can talk to medical direction to see if I can cut the cord early and suction the baby to let it breath its first breath of fresh air.
Mother: “It’s coming! It’s COMING!!”
Her shouts broke my thoughts, I just suddenly see this mass of flesh shooting out, I reach out with my arms to catch the baby. A big gooey blob landed in my arms, along with a whole burst of fluids, drenching my jacket.
Oh my! Oh my… I wasn’t exactly thrilled at the state of my dripping arms, just thankful that I had a jacket on!
The baby is blue, and didn’t make any movements or any noise. On the bright side, the infant is no longer tangled with the umbilical cord. I rub the infant with a towel, and quickly suction it with a bulb suction. When I suction the mouth, the baby responds by spitting out fluids, and immediately starts wailing. The heaviness inside me lifted, this is what we were all waiting for!
Me: “It’s a girl, you got yourself a baby girl.”
Mom and dad are ecstatic, the paramedic from the second crew wraps the baby up and gives her to mom. I am holding my arms outstretched away from my legs as birthing fluids drip from me onto the carpet. I wipe myself down with a towel. The smell of the fluids won’t leave my nose, it isn’t an awful smell, it just isn’t a smell I want to be showered with.
There is meconium staining in the fluids, an indication that the baby was distressed during birth and had had a bowel movement. Mind you, I’d be distressed too if I wasn’t getting oxygen for a period of time. I am worried the baby may have inhaled some of the meconium by accident, but it is a good sign earlier that she spat the fluids out. I got the clips ready for the cutting of the cord, as my colleague help deliver the placenta. The infant look good, she has pinked right up and is clutching onto mommy’s chest.
We give the honour to daddy to cut the cord, and of course the two year old is right beside him throughout the whole process. I place the placenta into a red biohazard bag to bring with us, it is much heavier than I imagine it to be, perhaps half a pound to one pound in weight.
On the way to the hospital, the infant is already suckling. She is adorable, and a lovely pink colour.
One thing I learned that night is you can never have enough towels on a birthing call, and don’t trust those gowns in the OB kit, they are more like a butcher’s apron than a proper gown (proper gown has sleeves and sleeves are so important!).
Delivering the baby girl is exhilarating, sleep isn’t to come for hours. I just lay in bed after the call thinking about the opportunities given to you as a paramedic. The snap shots of life you get to witness and play a role in, the ability to participate in the most joyous moments of life as the birth of a new being, the hope that awash with relief as your loved one is brought back to life, and the pain of losing the one dearest to you. Emotional extremes of the extremes. There are not many jobs out there that allows you to be an intimate part of life, death, and rebirth.
Being a paramedic, it is an honour and will always be.
Update: October 2015
I ran into mom and her baby at a grocery store a year after her delivery. She recognized me and we had a wonderful chat. Baby girl has gotten big! Is healthy, bright eyed and happy. So great to see! Silly me, I forgot to take a picture with the two of them.