I’m in New Jersey, driving towards Manhattan as fast as I can without breaking too many laws. Next to me in the passenger seat is a 34-year-old woman with no significant past medical history, 39 weeks’ pregnant, status post two prior uncomplicated deliveries. She looks to be in mild-to-moderate discomfort. Vital signs unknown, gravid abdomen appropriate with third trimester pregnancy.
She happens to be my wife. I happen to be a board-certified emergency medicine physician. She screams out, “It’s coming!”
What would you do? You have no tools, no gloves, no support. Go! Sounds ridiculous, but this is the situation I found myself in on Dec. 5, 2021.
I have a pre-shift ritual that has stuck with me since my early residency days in which I randomly walk myself through cases that we see in the emergency department. Gunshot wound to the chest, chest tube, blood, stabilize, and assess the damage. I’ve got those types of cases on lock. But driving my wife through the Lincoln Tunnel with decent odds of having to deliver my own baby in the front seat of my car underneath the Hudson River or in Midtown Manhattan? Never have I given myself a scenario anything like that.
How did this saga begin? At home, around 12:30 p.m., my wife began to have what she called “legit contractions” rolling in every 15 to 20 minutes. She is full term and ready to pop so we grab our things, ship our two toddlers to a friend’s house, and hit the road.
After an hour of bumper-to-bumper traffic crawling through the tunnel, those contractions quickly become the “this is happening” contractions. There are so many thoughts running through my head: Do I call 911? Have an ambulance meet me at the tunnel exit? We continue to inch forward. I see the panic building in my wife’s eyes with every contraction, so I do my best to stay cool and act as a calming presence.
Finally, daylight. We exit the tunnel, and, luckily, a cop car is just ahead. I drive over, hop out of my car, and approach the cop — with my hands up, of course, can never be too safe these days.
“I am an ER doc and my wife is in imminent labor. Any chance you could hightail it over to Cornell with lights and sirens for us?” I ask.
The cop says yes, hops in his car, and turns on his sirens. Walking back to my car I can see some shred of relief on my wife’s face. I turn back to the cop: “If I stop following you, please pull up next to me and turn the lights on because that means I am delivering the baby in the car.”
At this point, I am nearly certain I am going to have to deliver, but I ask my wife if she wants me to have an ambulance come, as that would definitely get her to the hospital faster. But she too already knows that we are unlikely to make it, and screams, “Put your f***ing foot on the gas and ride that cop!”
Following the cop, I find myself walking through the delivery “oral boards-style” and making sure I’m ready to deliver. I decide the best position would likely be on her knees, leaning over the front seat, as I can’t imagine having her try to keep her own legs up in the normal lithotomy delivery position in the front seat of a car with no assistance and no pain meds. Next up, it is time to assess the baby’s positioning, feel for the head, and assess the neck for nuchal cord as soon as possible. Slight rotation, cradle the head, remove the cord if needed, deliver the shoulders, deliver the body, assess for breathing and circulation, assess for a good cry, blue or pink in periphery or core, stimulation with a gag and back slaps, get the baby as warm as we can, and await help/tools to cut and clamp the cord. I really hope I don’t have to do this.
Sixteen blocks away from the hospital, and making great time with our new cop friends, I allow myself a brief sigh of relief — we might actually make it. No sooner do I let this thought creep into my head than my wife yelps, “This is happening!”
I tell her to take her pants off, and I reach over to the passenger side — sure enough the head is in the canal. Holy s**t! I hit the brakes, pull to the side of the road, and run around to the passenger side. I can’t believe this is happening.
Opening the door, I can see pain and terror in my wife’s eyes like I have never seen before. I tell her to turn around and climb onto her knees on the front seat. I recline the seat a bit so she is leaning forward and I tell her to push. One push and the head is out! I reach around to cradle the head and the umbilical cord is wrapped around the neck. Really?! Is this what I need right now?! A smooth delivery is the least I could ask for.
I unwrap the cord, rotate the baby, and ask my wife to give another push. The shoulders come out and I gently slide the rest of the body out. She’s blue, no cry. (It’s a girl — sweet! But there’s no time to dwell on such details because her Apgar score might be a negative number. Is that a thing?) Several expletives roll off my tongue as I place my fingers in the back of the baby’s throat — no gag, nothing. A few more thrusts in a moment that feels like an eternity, and then, finally, a gag and some spit up. Still no cry. I turn my baby over and perform some back thrusts, flip her back over, some more gags, a little more spit up. My heart is pounding, but I keep acting.
Finally, she cries. And now I’m crying. I finally have the confidence to nervously muster the words to tell my wife we just had another baby girl. More tears. I glance at my wife to make sure she is okay. Skin color is good. I ask for her wrist. Her pulse is strong and steady, no evidence of hemorrhage. She’s good.
It’s 28° outside and I had not exactly prepared to deliver a baby in my car. Certainly not in this weather. As I am down on one knee, holding the baby, I glance around the floor of my car looking for anything I can use to wrap up my newborn daughter. No luck. I tuck the baby inside my shirt as we wait for an ambulance to arrive.
At this point I realize several things have happened while I was delivering the baby. A nice woman had taken off her jacket and held it across the front windshield of my car to give my wife some privacy. An internal medicine physician had opened my passenger-side back door and was keeping my wife calm and up-to-date with what was happening behind her. Another woman, who was with her two children, had stopped, given us some blankets, and congratulated us through tears. Somehow the paparazzi had shown up as if I were a Kardashian; I heard the paramedic threatening to punch some guy if he came any closer while my wife was not covered up.
To this, I say thank you to New York and all of the good people who reside in this city that I love. As for my wife, I have so much respect for her resolve and positive energy throughout this whole experience. She remained calm, listened to everything I said, and gave me her trust in a truly terrifying moment.
After helping my wife into the back of the ambulance and handing her our baby girl for the first time, I sat back down in my car and allowed a massive wave of emotion and adrenaline to roll over me. I shed a few more tears. This really just happened. None of this had been on the emergency medicine oral boards. But, hey, maybe the lessons had been tucked in. Think on your feet. Do the next indicated thing. You’re never alone.
Joe Pinero, MD, is an emergency physician working in New York and New Jersey.