Tag: Talks

When Tess Camp was pregnant with her second child, she knew she would need to get to the hospital fast when the baby came. Her first labor had been short for a first-time mother (seven hours), and second babies tend to be in more of a hurry. Even so, she was not prepared for what happened: One day, at 40 weeks, she started feeling what she thought was just pregnancy back pain. Then her water broke, and 12 minutes later, she was holding a baby in her arms.

Needless to say, she didn’t make it into the hospital in time. But the first contraction after Camp’s water broke at home had been so intense—“immediate horrific pain; I could barely talk”—that she and her husband rushed into the car. He drove through town like a madman, running red lights. They were turning into the ER when she saw the baby’s head between her legs. Her husband tore out of the car, yelling for help. A security guard ran over to a terrified Camp in the passenger’s seat, and in that moment, her son slipped out and into the security guard’s hands. His umbilical cord was wrapped around his neck. An ER nurse finally appeared to take the baby—still blue and limp—and resuscitated him right on the curb.

What Camp experienced is called “precipitous labor,” when a baby is born after fewer than three hours of regular contractions. It is uncommon but not entirely rare, occurring in about 3 percent of deliveries, usually in second, third, or later labors. Having had a previous fast birth, like Camp did, increases the chances of a precipitous labor. But otherwise, doctors can’t predict for sure  who will have one, especially among first-time moms with no previous birth experience. Like many topics in pregnancy and childbirth, precipitous labor remains understudied.

Counterintuitively, perhaps, an extremely fast labor is not always a better one. It can even be a terrible one. “It felt like being hit by a truck and dragged along behind,” says Stephanie Spitzer-Hanks, a doula and childbirth-class instructor who had precipitous labors with her two children. “People would tell me I was lucky, and I don’t feel like that. I tell my students, ‘I don’t really wish for you to have this kind of labor.’” In normal labor, each contraction gradually opens the cervix and prods the baby out. In a precipitous labor, the cervix still has to open just as wide, and the baby still has to move just as far—but in much less time. It’s like running the length of a marathon at the punishing pace of a sprint.

Babies born through precipitous labor tend to do just fine, but the process can be traumatic for the mother’s body. In the normal course of labor, says Tamika Auguste, an ob-gyn at MedStar Washington Hospital Center, the back-and-forth movement of the baby’s head during contractions stretches the perineum, a layer of tissue especially likely to tear in childbirth. In one study, precipitous labor multiplied the odds of a severe third-degree perineal tear by 25 and the odds of postpartum hemorrhaging by almost 35. (Precipitous labor is also responsible for one of the most horrifying case reports I have ever come across, whose title contains the phrase “severed external anal sphincter.”)

Even for ER doctors, “a precipitous delivery is right up there with some of the most stressful events that we managed,” says Joelle Borhart, an emergency-medicine doctor also at MedStar Washington Hospital Center. Precipitous labor can happen so fast that even if the mother makes it to the hospital, there is sometimes no time to transfer her from the ER to the labor-and-delivery unit. ER staff are trained in childbirth, but it’s not what they do on a daily basis. Borhart says the emergency department at her large hospital in Washington, D.C., gets about one case a month. Brian Sharp, an emergency-medicine physician at UW Health—a large academic hospital in Madison, Wisconsin—told me his hospital averages a little over once a year; the smaller community site where he also works just had their first case of precipitous labor in years. The rarity of these events means that hospitals aren’t always the most prepared. When Camp arrived with her baby almost born at the entrance of the ER, the hospital sent out the wrong code, mistakenly suggesting that there had been an abduction. No one from labor and delivery came to meet her, because they were counting babies to make sure none had gone missing. The hospital later reviewed her case, Camp told me, to figure how to improve the response in future situations.

All of this means that precipitous labor can be psychologically distressing too. When Bryn Huntpalmer, who runs the podcast The Birth Hour and a childbirth course, talks with postpartum mothers, “​​more times than not, the person who shares their precipitous labor has that shell-shocked view of it.” Some of the mothers I interviewed talked about feeling out of control and deeply disconnected from their bodies. “I couldn’t get words out. I couldn’t open my eyes. I couldn’t control what my arms were doing,” says Shannon Burke, who had a precipitous labor with her second child. “I couldn’t do anything.” For many people, the experience of childbirth is an experience of ceding control, of letting our most animal instincts take over. But in normal labor, this is at least a gradual process; you can joke and laugh and walk in the early phases, and only hours in, when you’ve mentally prepared yourself, do the screaming and vomiting take over. Burke remembers her 24-hour first labor fondly, in fact; she had spent the early phase at home with her mother and sister, readying the house for the baby. With her precipitous labor, she had no time for any of that. She plunged straight into full-blown pain.

“There’s no buildup to prepare your mind and body,” Huntpalmer, the podcaster who herself went through precipitous labor, told me. “Everything was so compressed.” But in talking about her experience—and talking since on The Birth Hour with hundreds of women about their experiences—she ultimately came to see her precipitous labor as affirming, too: Her body knew what to do. “It was so hands-off from my midwife. I was able to just kind of do it all myself,” she says. Emily Geller, who delivered her second baby during a precipitous labor in a car, told me the same. She had what she felt was an unnecessary C-section with her first child, so she wanted a natural vaginal birth this time—and she did have one, just faster than she planned. It was empowering, she said, to know that she could do it after all.

When Camp got pregnant with her third child, though, she did not want to give birth in the car again. Her husband was terrified too—he kept saying he was going to rent a trailer so they could spend the final weeks of her pregnancy sleeping in the hospital parking lot. “It’s $150 a week to rent a trailer,” she remembers him telling her. They didn’t do that, but she did schedule an induction at 39 weeks. Her daughter was born after two pushes.