Call an ambulance

The NHS gives one clear instruction, and it is the first thing to do: "Call 999 and ask for an ambulance if you think your baby is coming now and you have a strong urge to push."

Outside the UK, use your local emergency number — 999 in Ireland, 911 in the US and Canada, 000 in Australia, 111 in New Zealand.

Then stay on the line. Emergency call handlers are trained to talk people through a birth, and the single most useful thing you can do is keep the phone connected and on speaker. Call your maternity unit too if you can, but do not delay the 999 call to find the number.

NICE categorises transfers in labour as either a "life-threatening emergency (ambulance service category 1)" or "urgent, for example for pain relief (ambulance service category 2)". Telling the call handler that you have an urge to push, how many weeks pregnant you are, and whether there is any bleeding is what lets them make that call correctly.

While you wait

In the order that matters:

Unlock the front door, or get someone to. Paramedics arriving at a locked door is the avoidable problem.
Get low. A floor is safer than a bed or a sofa, because there is nowhere to fall from. Kneeling, on all fours or on your side are all reasonable.
Get towels. Several, plus a blanket. You will need them dry and warm more than you will need them sterile.
Turn the heating up. Newborns lose heat extremely quickly, and a cold room is the practical risk in an unplanned birth.
Do not get in the bath or the pool. Water birth is a planned and supervised event, not an improvised one.
Do not drive yourself anywhere once you have the urge to push.

If you are on your own, unlock the door, get to the floor near the phone, and keep talking to the call handler.

If the baby arrives before help does

Babies who come this fast usually come without assistance. Nobody needs to catch, pull or manoeuvre anything.

Once your baby is born, NICE's recommendations for immediate newborn care apply exactly as they would in a hospital room, and they are short enough to remember:

Skin-to-skin, immediately. NICE: "Encourage women to have skin-to-skin contact with their babies as soon as possible after the birth. If the woman is not well enough, encourage her birth companion to have skin-to-skin contact instead."
Dry and cover. NICE: "In order to keep the baby warm, dry and cover them with a warm, dry blanket or towel while maintaining skin-to-skin contact with the woman." Dry them briskly with one towel, discard it, and cover with a dry one. A hat if you have one.
Keep the airway clear. NICE asks staff to "prioritise optimal baby airway positioning, ensuring the head is supported so the airway does not become obstructed during skin-to-skin contact". Baby's face turned to the side and visible, head supported, nothing over the nose and mouth.

Tell the call handler whether the baby is crying or breathing. That is the piece of information they most need.

Leave the cord alone

There is nothing to do about the umbilical cord before help arrives. Do not cut it, do not tie it and do not pull on it.

Both routine approaches involve waiting. The NHS describes active management, where the midwife waits to clamp the cord "between 1 and 5 minutes after birth", and physiological management, where "the cord is not cut until it has stopped pulsing... this usually takes around 2 to 4 minutes". Neither is urgent, and both are done by the person with the equipment.

The placenta may follow on its own. If it does, keep it with you and with the baby — it stays attached — and let the paramedics deal with it.

If you are under 37 weeks

Tell the call handler immediately. The NHS's advice for premature labour is to contact your midwife or maternity unit straight away, and the HSE's instruction is the same: call your midwife or go to the hospital "if you are less than 37 weeks pregnant and think you might be going into labour". A baby born early may need help with breathing and warmth from the moment of birth. Everything above still applies, and warmth matters even more.

Being transferred in an ambulance

NICE has requirements for transfers in labour, and they are worth knowing because they are frequently forgotten in the moment. Before transfer, you should be "dressed, wrapped in a blanket or otherwise covered in a way that she feels is comfortable and appropriate", and made as comfortable as possible before and during the journey.

It also states that ambulance staff "are aware that some positions may make the woman uncomfortable or afraid and could affect her labour, so she should be encouraged to choose how to move and what position to adopt if possible, in accordance with ambulance service protocols", and that "communication and companionship are maintained".

You do not have to lie flat on your back because it is the default position on a stretcher. Say if it is unbearable.

Afterwards

Expect to be checked properly, either at home or at the unit. NICE lists precipitate labour among the risk factors for postpartum haemorrhage that should be taken into account, so heavier-than-expected bleeding is something the team will be watching for. The placenta needs delivering and checking, any tear needs looking at, and your baby needs the newborn checks.

Whether you are taken in afterwards depends on how you both are, and on where you are. The NHS's guidance on where to give birth describes home birth as a planned and supported option with a midwife present — an unplanned birth without one is a different situation, and being assessed afterwards is the norm.

How you may feel about it

Fast, unplanned births are frequently described afterwards as frightening rather than empowering, even when everything went well. That reaction is common and worth taking seriously. Ask for a debrief with a midwife once things have settled — going through what happened and why is a reasonable request, and it helps.

When to call someone

Your local emergency number — 999 in the UK and Ireland, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — if you have a strong urge to push and think your baby is coming (NHS).
999 again, without hesitation, if the baby is not crying or breathing, is floppy or looks blue, or if you are bleeding heavily.
Your maternity unit as well, once the ambulance is called, so the team knows you are coming.
Your midwife afterwards for a debrief, and for anything about the birth that is troubling you in the days that follow.

The short version

Ring 999 and stay on the line. Unlock the door, get low, and get towels and warmth ready. When the baby arrives, put them skin-to-skin, dry them and cover them with a warm dry towel, keep the face clear, and leave the cord completely alone. Everything else is the paramedics' job.

Unplanned Birth at Home or in an Ambulance