Every year there are approximately 4 million babies born in the U.S. and most will arrive in a hospital or a Birth Center. However, there are moments when this may not be the case. In the past 4 years the number of home births has increased by 20% and these births will hopefully be attended by a midwife or someone skilled in childbirth. But then, there are those unexpected births that no one was prepared for; the ones that occur at the most inopportune time and place, even on an airplane in flight. These are the ones that the mother never “saw” coming, although she might have experienced warning signs but didn’t take heed.

Most unexpected deliveries occur because of prematurity. What are the signs that a pregnant woman should not ignore?

• Low back pain that lasts for greater than an hour. This is typically how premature labor begins.
• Abdominal pressure that lasts for greater than an hour
• Bleeding
• Leaking fluid from the vagina
• A sudden urge to have a bowel movement

Any of these signs requires an immediate trip to the labor and delivery suite as soon as possible.
If you are bleeding (especially passing clots), get off your feet and attempt to lie down on your left side while someone prepares to take you to the hospital. If the blood is bright red, this is a medical emergency because the placenta might be separating and the baby might be depleted of oxygen.

If your membranes rupture (water “breaks”) and there is a rope-like structure hanging from your vagina, it could be the baby’s umbilical cord. Call 911 immediately and do not allow the cord to be squeezed or manipulated. Lie down, preferably with your feet lifted on pillows with the cord undisturbed. This is ca cord prolapsed which means the baby’s in a breech position (feet first) and is an obstetrical emergency.

If you have a strong urge to have a bowel movement at home that is associated with contractions or abdominal pain, be aware that this could represent an impending delivery. Sit on a bed or floor with your knees separated to see if someone can visualize the head of the baby. If so, call 911 for guidance and further instructions. If the baby should be born unexpectedly, gently rub its back to stimulate crying and keep it warm in a blanket until the emergency technicians arrive.

Although you assume that your delivery will be “normal,” it never hurts to be prepared for the unexpected. Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.