What do you do if a woman unexpectedly has a baby and you have to help?

Like many things in life, giving birth doesn’t always go to plan.

In the months leading up to the birth, women often develop quite a detailed picture of what the experience will look like. They consider which hospital they’ll go to, which pain relief they’ll use, and who will be in the room. Some women like to have more control over the situation than others. Our very own Mia Freedman blow dried her hair before giving birth, only to abandon all concern for her hair about a third of the way in.

But as anyone who has given birth would know, babies are wildly inconsiderate when it comes to your plans.

They’ll come when (and where) they feel like it. In the last few years, we’ve heard about a woman giving birth on the street outside a clothes shop in the UK, another woman having a baby during her wedding in India, and another giving birth to a little girl in a tree in Mozambique.

While we learn CPR and first aid in the case of emergencies, few of us have any idea what we should do in the case of a surprise birth.

So The Motherish spoke to Marcia Morris, a midwife educator at the Royal Brisbane and Women’s Hospital, to get some answers.

In her 25 years as a midwife, she's seen some less-than-conventional birthing scenarios.

She calls them 'surprise births'. We call them 'our worst nightmare'.

There was the time a woman gave birth in a car, on the way to the hospital. There was the time a baby had to be delivered in a wheelchair, in the hospital foyer.

So Marcia has plenty of experience, and practical advice, when it comes to getting a woman through a child birth situation she wasn't expecting.

To start with, she says it's essential that if you find yourself in a scenario where birth appears imminent, you must call Triple Zero - 000. As a midwife, Marcia doesn't encourage women to deliver births in an uncontrolled environment, and even once the baby is born, it's crucial for the mother to receive medical attention as soon as possible.

Even if emergency services don't arrive in time to deliver the baby, they will be able to talk you through the birth. But while you're on the phone to Triple Zero, there are a few things you can do to facilitate the birthing experience.

Marcia starts with the basics for me, because it's quite obvious that I am clueless when it comes to the stages of childbirth.

"If it’s imminent it’s a completely different scenario to if someone’s just started to contract, because one of them is quite a controlled situation, and one of them would be more of an emergency situation. So, if you were with someone who was going into labour, then our advice would be to consult the hospital or the facility they were booked in to have the baby. They would give a description of what was happening to them, how long it’s been happening for, and then take the advice of the midwife or the doctor on the telephone. Either they would be asked to stay at home with some strategies to manage the pain, or they would be asked to attend the hospital, depending on the history that’s given."

So leading up to the birth, what should a support person do?

"You’d be wanting to look at simple pain relief such as paracetamol, we well as mobilisation, and perhaps using a bath or shower to get a woman through those easy contractions. But when the situation changes and you’re in that transition, getting ready to deliver the baby, you need to be looking at things like finding a suitable place to have a baby. You need to find somewhere that’s private but also quite roomy. You don’t want to be in a very small space where the ambulance crew can’t get in. You also want somewhere that’s got a little bit of light, so you can see what’s going on. You definitely want somewhere that’s relatively private because it’s quite traumatising for women who give birth in public places. It can be really distressing for them."

Okay. They need somewhere to deliver the baby - got it. But where would the best place be?

"If they're at home, maybe the bedroom or on the floor somewhere. You want somewhere that’s low down because you don’t want the baby to come really quickly and fall onto the floor. A bed, a sofa, or even the floor. You also need to look at gathering some towels or something to be able to keep the area clean. As a support person, as a friend, it would be about putting that pregnant lady in a really comfortable, safe place and getting towels available for her and the baby."

That's interesting. I asked Marcia about giving birth in the bath, because it seems to be the go-to place for childbirth in movies and on TV.

"If we’re talking about a normal, healthy pregnant woman with a normal, healthy pregnancy, we would want mum to be birthing on the ground, in the air. So being in the bath unsupported probably isn’t a good idea – we wouldn’t advocate for that. Some women may be comfortable in the shower but it’s not a great environment to have a baby in an emergency, because the baby may fall on the ground. It’s probably better to take water out of the equation, and to have the woman in a private, secure, comfortable place."

But then, why does childbirth on TV always seem to happen in the bath?

"The bath is a really great place to labour, and a great place to give birth for some women, but that would be in a controlled environment. That would be in a hospital environment or with a professional in place. It wouldn’t be something we would advocate to do on your own at home."

Okay, so that's a no to the bath.

I wanted to know what a support person can do in a psychological sense, to emotionally support a woman who is in the process of giving birth. What is one to say to someone who is currently experiencing one of the most painful experiences of their entire lives?

"It's really important to be very, very calm. Having someone on the other end of the line, be it the ambulance crew or a midwife being able to talk you through the process will be a big help, but it’s really about being calm around the situation, and telling the mum that she’s doing really, really well and everything will be okay. Because it will be quite a frightening situation."

BE CALM.

So what if I've (somehow) remained calm (which is highly unlikely), and the baby has actually arrived. What then?

"The important things to remember are that when a baby is born, you need to get a warm towel and gently dry the baby. That tactile stimulation helps the baby to take its first breath.

It’s really important that the baby is dry and warm, and one of the best ways to achieve that is through contact with mum. So put the baby down on mum’s chest. One of the important things to remember is that baby is still attached to the umbilical cord, so you need to be really mindful when you put the baby onto the chest that the cord isn’t stretched or pulled. Obviously the placenta is still attached and that is something we would want to manage in a hospital environment, so leaving the placenta and umbilical cord attached is absolutely vital. We would say do not attempt to touch anything around the cord or the placenta. Leave it alone – it will be fine."

Don't pull on the cord. Don't touch the placenta. DON'T TOUCH ANYTHING.

WHAT NOW?!

"We definitely would advocate that any woman who has had a baby would be transferred to hospital. The placenta can be a potentially complicated stage.

If the baby is looking well and responsive, you could offer a breastfeed as well, that would be a good time, if the baby looked like it was interested in feeding."

That is something I definitely would not have thought about. What other things would the average person not consider in this type of emergency situation?

"Blood loss. People may not be aware that women may bleed after the baby is born. And that’s one of the reasons we would say don’t touch the cord, don’t attempt to pull the cord, don’t attempt to deliver the placenta, because it comes with its own complications. Blood loss is something people may not be aware of, and it would be really helpful if the support person could collect the blood loss, be it on towels, or something like that. Then the ambulance crew can make an assessment of blood loss because that’s really important if doctors and midwives know what kind of blood loss has occurred."

MUST. GATHER. BLOOD. LOSS.

This makes sense. Anything I can do to help the paramedics. Because in a situation as confronting as a surprise birth, they will be absolute angels in my eyes.

So the real question is: does it happen often? Is giving birth unexpectedly in a public place something that pregnant women need to worry about?

"It's not particularly common. In a facility like ours, with a baby born every one or two hours, surprise births happen maybe once or twice a month. We don’t want to encourage women to deliver at home and we certainly don’t want to encourage them to stay at home too long, because we do know for most women, the hospital is the most appropriate place for them to deliver.

And at the end of the day, the woman doesn't have a choice in an emergency situation.

When a woman’s having a baby it’s a really painful experience. They’re overwrought with pain and discomfort and pressure, so they’ve got a job to do, and they know they’ve got a job to do. So I think they’re probably more focused on what's happening to the body and how they’re feeling rather than being aware of their environment. I mean it is a worrying and frightening experience having a baby, and obviously, not being in the environment you expected you would be in would give you added concern, but I think being in advanced labour would override that. It’s probably more the support person who would be feeling the anxiety. And the responsibility."

So basically, if a woman gives birth in my presence, it's really me who you should feel sympathy for.

Ultimately, Marcia concludes with, "babies will come whenever babies are ready to come, and we just have to anticipate and manage that birth as best we can."

Watch The Motherish team reveal their first thoughts upon seeing their baby.

Marcia Morris works at the Royal Brisbane and Women’s Hospital. If you have any concerns about your pregnancy or birth, both the Royal Brisbane and Women's Hospital and The Motherish encourage you to speak to your doctor or midwife.