Born out of the blue


EVERY year in the Republic about 150 babies are what is known as BBA medical terminology for "born before arrival". Babies are regularly born in bathrooms, bedrooms, cars and even in one documented case a pizza take away. In some cases, their mothers are simply overwhelmed by the speed of labour since the quickest births take only 30 minutes from the first labour pain to the emergence of the newborn.

Dr Michael Turner of the Coombe Hospital Dublin, who has done a study 106 such BBAs, recalls twin boys who were born on the hop between their mother's home in Kildare and the Coombe, so that the first twin had Kildare written on his birth certificate and the second had Dublin.

While some might think that having a baby outside hospital unintentionally requires a certain ignorance if not a feckless attitude to birth nothing could be further from the truth. Only one in seven women who give birth outside hospital are first time mothers.

It's just that like so many other things in life, a BBA is simply something "which most women think will never happen to them. Dr Turner's study found that many of the BBA mothers delayed going to hospital until the last possible moment out of fear.

Some wanted to avoid what they saw as the unnecessary intervention of hospital staff by arriving in hospital at the last moment, while others were fearful of the birth itself and somehow attempting to avoid the inevitable.

It can be very difficult to judge the speed of a labour, however. When a labour will begin and how long it will take remains one of life's mysteries even for obstetricians. Dr Turner himself has had cases in which he has examined an expectant mother in his rooms and said, "see you next week", only to see her walk out to the car park and go into labour.

An expectant mother can get an idea of how fast she will deliver a second or subsequent baby by the speed of her first birth. Second, third and fourth babies tend to be born in half the time as first children but they can be even faster. To avoid a birth on the side of the road, expectant mothers should always go to hospital the moment their waters break, Dr Turner advises.

While most BBAs are simply cases of dramatic timing, there are a few in which the mother's circumstances have led directly to a traumatic and lonely birth in inappropriate surroundings.

The distressing finding of Dr Turner's study, published in The Irish Medical Journal recently, was that 14 of the 106 BBA cases were "unbooked" in other words, these were mothers whose babies were seemingly born out of the blue with no one least of all hospital staff knowing that they were pregnant. This means that these mothers and babies had no ante natal care whatsoever.

Ten of the 14 were first time mothers and 13 were unmarried. Seven were under 27 years of age. "It is disturbing that in the 1990s young, single, expectant mothers fail to register for ante natal care," Dr Turner writes in The Irish Medical Journal.

There are no statistics on how many babies are born in such grim circumstances annually, although Dr Turner estimates that the national figure is at least 20. He believes that such women should not fear seeking help from maternity hospitals. Whatever about the past, today midwives and obstetricians do not judge the mothers who come to them for help.

While most BBAs cause no harm to, mother or baby, infants born before arrival do have a six times higher mortality rate than infants born in hospital, largely because such infants tend to be premature by as much as three and are therefore in urgent need of neonatal intensive care if they are to survive.

Among the other risks for who are BBA, are hypohertnia and Newborns can get cold very or they may be injured if, upon eme into the world, they hit the floor or in the toilet, says Dr Turner.

Fortunately, all was well after Trimble's lightning strike arrival in mother's bedroom in Swords, Colin eight weeks ago. His 32 year mother, Avril Trimble, who has older children, gave birth to him on Saturday, March 23rd, with the help of 4 year old Chris Finnerty, a fireman based at Kilbarrack with 20 years' experience of delivering babies in a hurry.

Avril's "very mild" labour pain began at 10.40 a.m. as she was around helping her eldest child, Darren (9), get his football kit together in time for practice. She remembers telling her husband, Christy (30), who coaches? under nine football, to bring the mobile phone to practice with him lust in case". At 10.45 a.m., she was telling" him, "you'd better stay home this morning" and her daughter, Jennifer (8), was bringing her tea and toast in bed. At 10.50 a.m., her labour was so far advanced that Christy was on the phone to the ambulance.

Avril called her next door neighbour, Elizabeth Monroe, to take the three eldest Trimble children to her house, but of course the excitement grew so much that soon all of the children Trimbles and Monroes together were tumbling around the house while their mothers tried to figure out what to do. Avril remembers "total pandemonium" in a house that was "like Phoenix Park", as Elizabeth stood by the bed with a sponge, a bath towel and two lit cigarettes asking her "Which do you want?"

"Give me the cigarette," said Avril.

When Chris Finnerty arrived at 11.10 a.m., Avril was sitting at the end of the bed smoking and trying to cope with the pain, which had intensified in a peculiar way which Avril recalled as being the same as a previous breech birth she had, experienced. Understandably, she began to panic.

As Chris moved Avril onto the bed to examine her, Avril asked "Do you know what to do?"

"This will be my 15th so if I don't know by now I never will," Avril recalls Chris saying, which immediately set her and her husband Christy at ease.

Avril's waters broke as she was moving up onto the bed. A quick examination enabled Chris to reassure Avril that the baby was not breech, but that it would be born within six minutes not long enough to reach the Rotunda which was an 11 minute minimum ambulance ride away.

The next thing Avril knew she was looking into Chris's eyes as he helped her to breathe rhythmically, and said reassuringly "Don't panic... keep looking, into my eyes.

"Chris was very, very calming," Avril says now. "I don't think I've ever been so calm in my other births." As Avril, sat up in bed with her back braced against the headboard and concentrated on her breathing, Christy told jokes and Chris kept saying "It will all be over in a minute."

AND IT was. At 11.20 am. a mere 40 minutes after Avril felt her first mild twinge of labour beginning six pound Jamie Trimble was born into a house full of family and friends who then began dancing, around and hugging each other. Jamie's older brothers and sisters, Darren, Jennifer and Steve (7) were more in awe of the ambulance parked outside than of the miracle upstairs in the bedroom. Their greatest memory of the occasion is the celebration which continued through the day and into the night and the fact that they ate cold chicken curry from the Chinese take away for breakfast the next morning.

Avril missed all that, of course, because within a few minutes of Jamie's birth she was whisked away to the Rotunda to have the umbilical cord cut and the baby checked. Jamie had got cold and Chris had wrapped him in tinfoil, keeping him tightly bundled in his arms until arriving in the neonatal unit at the Rotunda. All was well, though, and Avril was back home on Monday morning. By Tuesday she was back to her usual routine. If she ever has another baby, Avril says she will have it at home, although this time she will make it a planned home birth.

"I have never felt so well after a birth," she says.

Not only was Jamie's arrival the best birth experience she ever had, it was also the least painful. Avril believes that this was because no one was telling her what to do or which way to move. Chris just let her sit on the bed in whatever position felt comfortable. She also naturally felt more relaxed at home than she would in hospital.

"Chris was as good as any midwife," she says, "If I had arranged a home birth it would not have gone as well."

Dr Turner also praises the expertise of ambulance staff. "Ambulance and fire people are terrific in these circumstances and we have them coming into the hospital all the time for training. They are very serious and enthusiastic about looking after the mothers in these circumstances," he says.

Jamie's birth was also a positive emotional experience for Chris Finnerty, who has held dead and dying children in his arms as well as helping bring them into the world. For fire and ambulance personnel, life and death jostle with each other from hour to hour and a call to a fatal traffic accident or cot death may be immediately followed by a call from a distressed woman in labour.

DELIVERING babies in bedrooms, sitting rooms and ambulances parked on the side of the road, Chris has lost count of the number of births at which he has assisted, although he estimates the number at about a dozen all of them boys. Again and again he has found himself awe struck by the agonising pain experienced by women during childbirth. "If men could have babies", he says, "there's no way we would ever go through with it. When he delivered his first baby as a 22 year old novice fireman, the first thing he learned was that "childbirth is not like they tell you in books.

"We're given a set procedure, and one of the first steps is to ask the lady are you in pain? And there she is in so much pain that she is calling you every name in the book."

The only pain relief which firemen can offer is a limited amount of entonox or "laughing gas", which they keep at all times to relieve the agony of road accident victims trapped in smashed cars.

Chris is always amazed at how only a few moments after giving birth the mother is sitting up and smiling and holding her baby close and saying that she would go through it all again in the morning.

"The mind must erase the experience immediately," he says. "I've often thought that if I could play some of those women a videotape of what they were going through they would never want to have another baby again."

Just as new mothers never get medals for bravery fireman don't, get medals for heroism either. Chris Finnerty reckons that in a job that gives you more than your fair share of dicing with death, helping a mother give birth to a healthy infant is probably the best reward any fireman will ever receive.