If there’s one type of job most ambulance people, especially male ambulance people, are apprehensive about it’s maternity jobs. For me they’re the scariest type of job. Part of our job is to deal with obstetric emergencies (emergencies in pregnancy), delivering babies and life support/resuscitation, and general newborn baby care. I’m always reassured by the thought that Homo sapiens have successfully been giving birth to their off springs for about 200,000 years. It’s only in the last 100 years or so that birth has moved into the domain of the medical profession. Still scares me though.
Most of our maternity cases are in early stages of labour. Birth is not imminent. These types of jobs get called ‘maternitaxi’. This isn’t really an appropriate case for an emergency ambulance, if we politely question why the ambulance was called, normally we are told that the potential mum has rung the Maternity Unit (MU) and “they told me to ring 999”. When we arrive and hand the patient over, normally the midwife scolds them and says that they said to get a taxi not and ambulance!
Maternity cases differ from other emergencies in many ways; one major difference is the destination. When we deal with most non-maternity jobs the destination will usually be the emergency department (ED) of the local hospital. Certain conditions are taken to specialist units but generally for a given emergency in a given region the destination is determined by location and condition. Maternity cases however the potential parents choose in advance which hospital MU they want to go to. Obviously this has to be within reason – if a mum-to-be is hundreds of miles from home and labour starts an ambulance can’t travel hundreds of miles we have to settle for one of the local units. The other main difference is that we can’t just turn up at a MU unannounced. If the mum or dad hasn’t rung the MU then we have to get our dispatcher to ring and we can’t set off until the MU agrees to accept. It can and sometimes does happen that a particular MU is full, in which case we are told to go elsewhere. This is stressful for the prospective parents because they will have had lots of visits to the MU they chose during the pregnancy and to be told at the big moment that they have to go to an unfamiliar unit must be scary. It’s scary for us too because it normally means longer before we can hand over to the midwife!
When we arrive and birth is imminent we don’t transport, we deliver the baby at home. One of the first tasks is to request a community midwife to come to the address. If he or she arrives before the baby then that is fantastic, midwifes are the experts in assisting birth. If not it’s down to us. The area where I work is covered by several MU’s. One is a specialist MU where it is recommended all high risk pregnancies in the area book into. Ironically, that one MU does not send midwifes into the community so the higher risk home births are left to us. Another benefit of a midwife attending is that if all has gone normally and mum and baby are well we don’t need to transport anywhere and the new family can stay at home. If we deliver with no midwife present then mum and baby have to go to the MU. We then have 2 patients: mum and baby (possibly 3 if dad has fainted during the birth!).
The biggest risk to a new born is the cold. A baby comes into the world naked and very wet. They have very little body fat at that stage so lose heat quickly. A priority once we know the baby is alive and breathing is to dry baby off and get them in skin-to-skin contact with mum to warm up, then wrap both up and make sure the room is warm. A hat is an excellent idea for baby. My regular mate Tony is a big fan of baby hats and it has become a bit of a catch phrase for him once baby is dried off: “get a hat on that baby!”
I have assisted with many births over the years, some stick in my mind:
One dad tried to drive his wife to the MU but had just left it a bit too late (or baby was impatient) and mum started to deliver in the car. Luckily we were driving past and he was able to flag us down. I opened the passenger door of the car to find mum with one foot on the dash board and baby’s head just visible. I assisted the birth in the car foot well then quickly got mum and baby into the ambulance. I asked if mum and dad had a name for their new daughter and dad joked that he would call her Corsa after the car. I asked if he was glad he didn’t drive a Skoda…It seemed funny at the time.
Another time we were on the way to an imminent birth and we were told that the baby was breech. The normal position for a baby about to be born is head down in the uterus so the baby comes out head first. Breech means the baby is bottom first. This is a complication because the head may get stuck after the body has been born. This is a very scary situation. As we arrived the response car was already there. To our great relief Stella, on the car was assisting the delivery and thankfully baby came out with no complications. Stella said that when she got there baby’s foot was visible and that was all. She had a very anxious wait for the next contraction when mum managed to push the rest of the baby to the world. Since no midwifes had been available to attend we had to transport mum, dad and baby to the MU.
One final birth which sticks in my mind is a 17 year old girl who lives with her parents. She was 36 weeks pregnant and hadn’t yet figured out how to break it to her parents – she had spent the last few months wearing baggy clothes. One Sunday morning she thought she needed the loo and baby decided to make his appearance. Mum and baby were fine the new grandparents were shell-shocked, they had no idea when they went to bed the night before that they would be grandparents in the morning.