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David Gelinas, Jason Travis and Louis Sassone boasted decades of experience as paramedics, but on this summer morning, they would encounter among the rarest of contingencies.
They would be delivering a newborn in their ambulance.
The rescuers from the combined fire district of Centerville, Osterville and Marstons Mills (COMM) were summoned by 911 to the home of Eugenia Manganelli, where it was immediately evident that nature would not wait.
“When we first entered the Manganellis’ home, she was walking around, and I thought to myself that we had more time to attend her,” recounted Sassone. “We went to get our transport cot to begin preparing her for the ride to Cape Cod Hospital.”
But, almost immediately, the scenario dramatically changed.
“The husband, Thiago, was excited and nervous. He looked at me and asked, ‘Are we going to have the baby here?’”
‘Yes, sir,” I responded.
“He looked back at us and said outright, ‘Let’s do it,’ and gave me a high five.”
Sassone went back into the house and Gelinas, Travis and Ryan Scott, a paramedic intern, began preparing for the delivery. The paramedics began asking Manganelli questions about her prenatal care and what number child this would be (it was her third).
As she was answering, they saw the baby’s head starting to crown.
They decided to move her immediately to the ambulance – an emergency room on wheels – where the environment would be more sterile and they had ready access to all necessary equipment and medications, including birthing kit.
Within two minutes of travel time, the baby’s head emerged.
A Team Effort
Scott, who was experiencing his first delivery even before he became a certified paramedic, attended to Manganelli while Gelinas assumed the obstetrician’s role.
“I continuously coached her throughout,” he called. “As the baby’s head emerged, I started suctioning her mouth to remove any mucous.”
At the same time, Scott administered oxygen to the mother, while Gelinas continually encouraged her to push, while intensely watching to be sure the umbilical cord was not around the baby’s neck.
As the newborn arrived, she was immediately checked for the presence of meconium, a dark green, thick substance that is mostly water plus amniotic fluid, intestinal cells, mucous, bile and lanuga (a fine hair that covers the fetus).
With all signs appearing normal and the baby now crying, Gelinas placed her on Manganelli’s chest, while calculating the first APGAR score, which measures the newborn’s heart rate, respiratory effort, muscle tone, response to stimulation and skin coloration.
“The APGAR was normal, as well as a second assessment five minutes later,” he recounted.
As they rushed to Cape Cod Hospital, the team alerted the Emergency Department and obstetrics staff to be ready for their arrival.
Training With Laurie Parker
The COMM Fire Department responds to 3,200 emergency medical calls a year, according to Fire Chief Michael Winn. Before another such incident recently, “we probably had a combined 20,000 calls since the last time we participated in a birth. That’s how rare this is,” he said.
It’s also why they praised the education they all periodically receive at the Cape & Islands Emergency Medical Services training center in Hyannis.
“While we were proceeding on instinct and common sense, we all were vividly recalling our training and even visualizing Laurie Parker, an obstetrics nurse at Cape Cod Hospital, in front of the classroom,” said Travis.
At a recent Cape and Islands EMS training refresher session attended by more than 40 paramedics and EMTs across the Cape, Parker reviewed all the protocols that are triggered, if and when they need to deliver a baby. She also shared case studies that, while occurring in the hospital, could happen at home or in the ambulance.
“Pregnant women are presenting with more medical complications and high-risk diagnoses than ever before,” said Parker. “What if the mother is in labor in only her 27th week? What about a mother who has been negligent with her prenatal care or has substance-abuse issues? What about a delivery that includes placenta-related complications or a ruptured uterus?”
“What are the signs of shock in pregnancy?” she asks the class. “How can you tell if the mother is suffering from internal bleeding? What do you do for placenta previa?”
While these circumstances occur somewhat regularly in obstetrics, the same firefighters who will respond to a two-alarm blaze or water rescue must also be ready to address these child birthing challenges.
Parker, over the years, has had to significantly enhance training regarding mothers with addiction issues including what she terms “a pretty high population on methadone.” She reminds paramedics that IV access with high-risk IV users is often difficult – and to plan accordingly.
Over a recent month, her unit awaited 20 women due within four weeks who were suffering such high-risk conditions as diabetes, renal failure and chronic hypertension, as well as multiple gestation patients (twins). She reminds her students that these high-risk patients could be taking beta blockers and insulin.
“This is what we are up against,” she alerts the paramedics and EMTs. The message is clear. Every one of her students could encounter the same things.
Parker uses a life-size replica of a woman’s pelvis and lower extremities for training. She invites groups of the paramedics and EMTs around her to simulate different birthing contingencies, frequently requiring rapid-fire answers to her questions.
“What side do you place the pregnant patient? (It’s the left). How are you monitoring the baby’s airway? Is the uterus sitting on the baby’s vena cava?”
Parker also illustrates in detail how to resuscitate a baby who arrives blue and is not breathing.
Then, there is the need to immediately monitor heartbeats.
“If less than 100 heartbeats a minute, start with ventilation,” she tells the class. “If less than 60, initiate chest compressions.”
That’s not chest compressions on a 70-year old male suffering a heart attack. It’s compressions on an infant who might even be premature.
“Ninety percent of all babies arrive in fine shape,” she explains. “But 10 percent will need resuscitation. One in 100 will need advanced resuscitation.”
During a two-week refresher term, paramedics and EMTs will attend upwards of 30 or more classes. None may engage their attention more than Parker’s.
“I constantly envisioned Laurie in front of the room as we were delivering the baby,” recounted Gelinas.
And then, there she was.
As the team arrived with Manganelli and her daughter, who was right there to meet them?
Today, the Manganellis report their daughter Clara is totally healthy. Dad was so pleased he actually posted a video of the entire delivery in the back of the ambulance.
By Glenn Ritt