“999 was contacted by a patient who was unaware that she was pregnant and was presented with a foot coming out of her vagina. The call was handled well by the team and classed as an emergency – “birth imminent”.

Two double-staffed ambulances arrived in under 8 minutes, and when they went inside the home the patient was on the bed, with a foot protruding from the vagina that was blue in colour. The patient was pushing but nothing further was becoming visible.

A quick discussion was had between the crews and the critical care desk was contacted for support. The critical care team advised the on-scene crews to move the patient into an all-fours position (on her hands and knees) to encourage the baby’s movement in her pelvis, and preparations were made to the leave and meet the critical care team on route.

The teams acted quickly and left with the patient within 15 minutes of arriving at scene. The ambulance crew met with the critical care team at the agreed rendezvous point as planned within 30 minutes of the initial call to 999. At this point, there had been no progress with the birth – there was still one foot visible. The patient was encouraged to push throughout the time with crew and was given gas and air for pain relief.

The maternity unit was contacted, and a community midwife was arranged and sent to meet the teams at the rendezvous point. The critical care team freed the baby’s other foot which then allowed some descent of baby.

They then recognised that the breech baby was not progressing, so they rotated the baby by its hips then under advice of the midwifery team, did this a second time which aided in descent. Secondary manoeuvres were undertaken to facilitate delivery of the baby. 18 minutes after arriving on scene and 48 minutes after the call to 999, the baby was born. The baby was floppy, blue and not breathing.

Care of the mother was handed to the paramedic crew, and the critical care team alongside the EMT crew commenced newborn life support. The baby responded well to resuscitation and ongoing support was provided until the baby was breathing on its own.

After the baby began breathing on their own, and following arrival of the midwife, the crews all left for the hospital where midwifery staff were awaiting their arrival. 
The baby was taken to neonatal intensive care due to how long the birth had taken and because nobody knew how long the mother had been pregnant for. The baby was then transferred out for “cooling” in line with national guidance to minimise any brain injuries sustained from the difficult birth. 

Both mother and baby are now doing well, and this was an amazing example of quick thinking and exemplary teamwork across multi-professional teams.”