By Mike Peach, EMS1 Contributor
It was a cold December night, just before Christmas, when the radio tones went off for an OB call. It was Bill’s turn to drive, which meant the patient would be mine. I had previously delivered 10 babies so I wasn’t too worried about it, my biggest concern became the weather; it was already -10 degrees Fahrenheit and falling, a very bad thing for a newborn.
En route, we had our two radio frequencies on and we were also monitoring the police radio channel. I was waiting for the usual panicked call from a high-pitched voice nervously asking for our location or if we were coming with lights and siren.
I am constantly amazed by how a tiny newborn can turn a burly cop into a panicked little puddle. Dispatch always assures them we are indeed coming as fast as our diesel engine will take us.
Then I heard that panicked, high-pitched voice I was hoping not to hear. The police had arrived well before us as they were intended to.
“5804, tell ambulance the baby is stuck by its head,” the cop said
We didn’t know it at the time, but our duty supervisor, Ron Robinson, was also en route. He was driving the supervisor’s vehicle, a fully stocked Suburban, which goes much faster than our type III ambulance. After hearing the officer’s call, I looked at Bill and asked, “Do you know how to handle that?”
And in his typical get-to-the-point, one-word answer, he said, “nope!”
So I grabbed the cell phone to consult with a doctor at the hospital emergency department.
Delivery instructions
“We’re en route to an OB call and the police are telling us that the baby is stuck by its head. I’m not exactly sure what that means, but I’m calling you for advice.”
I had a history of tomfoolery, so I wasn’t surprised at the doc’s initial response and brief pause. “Peach, I don’t have time for this crap. It’s really busy in here and … “
We were interrupted by the siren coming back on. Late at night, we wouldn’t use it if there were no cars in sight. After 30 years of its noise, we used it selectively.
“You’re not kidding, are you?” she asked.
“No.” I said. “We need to know what to do.”
“It all depends on how it’s stuck. If you have a body presentation with an arm and the head still inside, I’ll tell you what you need to do. Put a finger on the rib cage of the stuck arm side and slide your finger up until you feel the clavicle.”
“OK, then what,” I asked?
“Push firmly on the clavicle until it breaks.”
“What?!”
“Oh don’t worry, they do it all the time,” the doctor said. “It’s the only way to get the shoulder and head out.”
“Well they might do it all the time, but I don’t!”
“Don’t worry, you’ll do fine.”
“Anything else?” I asked, not wanting to know any more, my previous confidence fading.
“Yes. If the baby’s limbs are all out, you have to get the head around the corner to deliver it. All you have to do is get a finger in its mouth and tuck its chin to its chest and that should do it.”
“OK, anything else?”
“I can’t think of anything, call me back if that doesn’t work.”
I hung up the phone just as we were arriving. There were two police squad cars in front of the house and the supervisor’s vehicle, lights all still flashing.
We grabbed our bag, an OB kit and the cot and headed for the house. I opened the door and called out.
Tiny body, incomplete delivery
“Hello, North Ambulance.”
I went up the stairs and found Ron, our supervisor, on his knees, holding a tiny baby’s body, not much bigger than his hand. Fingers from his other hand were inside mom’s vagina trying to create a canal so the umbilical cord could maintain blood flow. It looked like it was working because the baby’s body was a nice healthy pink color. But Ron was grimacing in pain.
The mother’s vagina was in some kind of tight muscle spasm around the baby’s neck. Ron’s fingers were in pain trying to create space for the baby and the umbilical cord.
Just then, a cop was handing us a phone. Ron had asked for one to do what I had already done, call the ER for advice. I told him I already did that and grinned.
As I took in more of the scene, mom was naked, on her hands and knees on the floor just inside the bathroom door, her legs in the hallway where we were. Apparently, she was just about to take a shower. To further complicate things, the baby was now also face down with its face firmly wedged against mom’s pubic bone, the same space Ron’s fingers were trying to occupy.
“OK, here’s what the doc said we have to do. You have to get a finger in the baby’s mouth and tuck its chin to its chest. Then it should make the corner.” Ron grimaced in pain as he tried to maneuver his fingers into position.
“OK, I think I got it,” he said.
But the spasm mom was in was unrelenting. It became obvious that I was going to have to get in there to help. I had an idea. I gloved up and put some lubricating gel we used for airways on my fingers. I told mom my name and what the plan was. I told her we needed to overcome this muscle spasm and I apologetically told her it would probably hurt.
Now, we’re all on our hands and knees on the floor in the doorway. This meant I had to get on top of Ron to access mom. So I did, slimy gloves and all while trying not to hurt Ron. I put the backs of my hands together while I wriggled my first and second fingers up alongside the baby’s head. It was incredibly tight. I figured by putting my hands together back to back would give me the most leverage to manually dilate her enough to get the baby’s head out.
I pushed as hard as I could. Nothing happened.
“OK mom, on the count of three I want you to push this baby out, OK?”
“OK,” she said.
“Ready? One, two, three!” I pulled my hands apart as hard as I could. With Ron’s finger in the baby’s mouth, her push freed the infant into Ron’s hand. I clamped and cut the umbilical cord and Ron handed me the baby. It was a boy!
While all this was going on, my partner had prepared everything we needed for transport.
Off we went into the frigid night.
I covered the baby with blankets and a knit cap as Bill and I dashed for the truck. He grabbed my belt to steady me as we ran.
En route to the hospital
Once inside the warm ambulance, I checked on the baby. He was tiny, one pound, nine ounces and just 23 weeks old – perfectly formed, but I had never seen a baby that small. His color was great, still nice and pink. He had a weak rapid pulse, but not much for breathing. I started gently breathing for him. But it wasn’t mouth-to-mouth or mouth-to-face, it was more like mouth-to-head.
Bill called ahead to the hospital and told them we were coming in with lights and sirens with a preemie and we needed a neonate team with an incubator and a warmer at the door. They acknowledged.
The trip seemed to take forever despite the late evening lack of traffic and Bill’s skilled driving. As we entered the hospital, there was nothing prepared and no one to meet us. We continued inside to the stabilization room, where the most critical patients are taken. Not only was our neonate team complete with warmer not there, the lights weren’t even turned on.
Good color throughout care
Turns out the staff were confused as to why mother and baby were being transported separately and weren’t expecting us, despite us calling in ahead of time. They thought we were the truck bringing in mom, which was still en route.
Bill turned on the stabilization room lights and went for help.
I was dressed to be outside, and between that and the adrenaline pumping through my veins, I was sweating like a pig. One of the physicians grabbed a towel and carefully dried my face, a moment I will never forget. At the same time I was giving him my report, what we saw, what we did. I told him the baby’s color was good throughout the event.”
He said, softly, “I see that. Continue what you’re doing.”
Then he spun around to the just now arriving nurses and yelled “Get that neonate team and a warmer down here now!”
As I handed the baby to the nurse, my clinical side kicked in. I asked the doctor, “Is this baby even viable? Do you think he’ll even survive?”
He replied with “I have no idea.”
My destiny
As with most calls, once we dropped off our patient in the ER, we never heard or saw anything more about him. Weeks went by, until one day when Ron was the on-duty supervisor and he called me into the office.
“Here, I want you to see this.”
He handed me a printout of a Caring Bridge website, where families can go to share their medical stories with friends and family. It was one for the baby boy we had delivered.
“You done good. People were really amazed with the job you did on this one,” he said.
He told me about a phone call he had with the baby’s neonatologist at Minneapolis Children’s hospital. Ron said the neonatologist told everyone how completely amazed he was. Children born under those circumstances, in the hospital, had a less than one-percent survival rate and often had profound developmental and physical complications. The neonatologist felt he needed to call us because, in his words, “for those medics to successfully deliver this child, under those extreme conditions was nothing short of a miracle.”
I was blown away.
A miracle?
There was something quite profound about it all, this wasn’t you’re average call. People working that night would pass by me and say things like, “nice job, glad it wasn’t me!” Managers and directors also chimed in with the seldom heard, “nice job on that baby.”
As time went on, the call and its after effects didn’t go away. It’s hard to explain, but it’s like this call was my destiny. This call was why I became a paramedic and I had a feeling I was done, mission accomplished. From that point on, it was like everything was on a downhill slide, nothing mattered any more. We’re all too familiar with fleeting glory, yeah that was great, now get on to the next one.
But there was no next one for me.
Before you know it a year had rolled by. Another paramedic and friend, Al, attended the same church as the baby’s family. They asked if he and I could stop by their home, they had some questions for me. I jumped at the chance.
The day came, I met Al and we went to their home. It was the baby’s first birthday and I learned his name. His mother was holding him. She told me he had not been held by anyone outside the family, just before holding him out to me and saying, “Here, it’s only right that the man who saved his life should be the first one to hold him.”
And with that I was holding him again, but a much larger and healthier version. He was beautiful.
“I have a question,” she asked. “How do you guys decide who to work on and who not to work on? What made you decide to try to save my baby?”
I was shocked.
But as if we weren’t overwhelmed already and with a lump in my throat, I told her, “it’s not up to us. If there is any sign of life, we will pursue it, try to make it better. I believe if it’s not their time to go, everything works. If their time has come, nothing we do will change that.”
I have always believed beyond our technology and skills a higher power has the final say. I just hope St. Peter isn’t too angry about me interfering when my time comes.
This baby, now a teenager, is doing very well. Aside from some weakness in his legs, he doesn’t suffer from any of the usual maladies of those born like him – no mental impairments, no hydrocephalus, just a kid in a wheelchair whom his parents love very much.
But to this day he remains my final destiny.
About the author
Mike Peach lives in Maple Grove, Minn., and describes himself as a dinosaur paramedic, serving since one of Minnesota’s original pioneer paramedic classes in 1978. Currently working for Allina EMS as a paramedic external educator, he also teaches a wide variety of EMS-related classes at Hennepin Technical College in Brooklyn Park, Minn. He can be followed on Facebook.