At 4 a.m. on her due date, Sarah Chapin woke up to irregular contractions. They were nothing intense enough to cause Chapin to panic. This was her third pregnancy, and she knew the drill. When the contractions became regular and five minutes apart, she woke up her husband. Around 6 a.m., they left their home in the Boston area and began the 40-minute drive to the hospital.
That’s when things started to get intense. “I started feeling like I might vomit,” Chapin says. “I almost suggested we go to a different, closer hospital but figured we'd just keep going.”
Half an hour later, she could feel her baby’s head in the birth canal. There was nowhere to pull over, and instinct took over. “I flipped to hands and knees and on the front seat, giving all the commuters and traffic cameras quite a show.”
She caught the baby herself and then held him against her body, rubbing his back as her husband drove the final blocks to the hospital. He ran inside to let them know they had delivered a baby in the car, and a swarm of nurses and doctors rushed out.
“They took the baby to examine him and brought me up to L&D to deliver the placenta, all before 7 a.m. It was a whirlwind. His birth certificate says, ‘Place of Birth: En route to Beth Israel Deaconess Medical Center.’”
Chapin’s super-fast labor and delivery experience has a name: precipitous birth. Doctors define it as “quite forceful, with close-together contractions that produce full-on labor and delivery in three hours from the start of contractions,” says Dr. Rachel Blake, M.D., a board-certified OB-GYN in Boston. Compare that to the average 12 to 24 hours of labor for first-time parents and eight to 10 for subsequent births.
Precipitous birth is responsible for some of the most sensational, widely passed-around birth stories, like those of Seth Meyers’ wife, Alexi Ashe, who famously gave birth to their second baby in the lobby of their apartment building in 2018. “I called 911, and over the course of a minute conversation, I basically said, ‘We’re about to have a baby; we’re having a baby; we had a baby,’” Meyers recalled on Late Night. “I went from someone calling in about an emergency to sharing good news with a stranger.”
The phenomenon is fairly common: In one study of more than 11,000 hospital births, 14% involved precipitous labor, though the reported rate is 0.1% - 3% in the United States. Estimates are complicated by challenges of pinpointing the start of labor, says Dr. Nicole Alexandria Smith, M.D., M.P.H., a maternal-fetal medicine specialist at Brigham and Women’s Hospital in Boston. Some people feel every contraction, while others may not feel all contractions, she explains, and some may confuse labor contractions for the “false labor” of Braxton Hicks contractions or may otherwise miss the start of labor.
Kalli Shelton had been having so many Braxton Hicks contractions that, by the time she was 41 weeks, she no longer waited for them to develop into labor. When they started up again one night after dinner, she hopped in the bath. A few minutes later, the contractions felt different, and she texted her husband from the bathroom, “I think these might be real.” Minutes later, she was on her hands and knees, asking him to call the midwife. Shelton could barely make it to the car, and when she arrived at the ER in Madison, Wisconsin, she was wheeled into a delivery room 9 centimeters dilated. “There was no time to unpack my perfectly planned bags or discuss comforting techniques. It was go time.” The midwife made it just in time, and Shelton’s daughter was born almost exactly three hours after she sent that text from the bathtub.
“I went in the bathroom because I felt like I had to pee, and I left on a gurney with a baby.”
Birth is wildly unpredictable, and every pregnancy and birthing experience is different. Still, research says precipitous birth tends to be more common in “multiparous” women, meaning those who have already birthed babies. In a small study of 99 precipitous labors, only nine of the 99 people were giving birth for the first time. Blake says that in subsequent deliveries, “the uterus has essentially done birth before, so it knows how to contract more efficiently; the birth canal is often more compliant.”
People who have had one precipitous birth are at risk of having another, according to Blake. Other risk factors for precipitous birth include a lower gestational age and a smaller birth weight since the uterus may more easily be able to birth a smaller baby quickly, she says. Younger mothers are at a higher risk factor for a precipitous birth, she says, and there’s some literature suggesting that hypertensive disorders such as gestational hypertension or preeclampsia increase the likelihood of precipitous labor. Precipitous births may also run in families, at least anecdotally. “I have a lot of people tell me that their mother or their sister had a certain type of labor, and often there’s an expectation that theirs is going to be similar,” says Smith. Sometimes, it is similar. (Shelton says that her mother had very quick labors with her and her brother.) But just because a mother or grandmother had a certain type of birth doesn’t mean that you will, too.
For people who labored for 48 hours before having a C-section, precipitous birth might seem enviable. But doctors and people who experienced it say it can be complicated. Quick deliveries carry risks of postpartum bleeding, retained placenta, and vaginal tearing. “It’s not a gentle stretching of the tissues; it’s more forceful, which can cause lacerations,” says Blake. There can also be a slightly increased likelihood that a baby may need intervention for breathing. “During the labor process, the baby gets squeezed down the birth canal, and this helps the baby to release fluid from their lungs,” she explains. When babies come down the birth canal quickly, they can sometimes need extra assistance breathing because they didn’t get that gentle, gradual squeeze, she says. (This can also sometimes be the case for babies born by a C-section.) These risks become higher when you add the potential for delivering somewhere unexpected, far from medical care.
The fears are especially acute for those with pregnancy complications. When Jill Evilsizer realized her contractions were too strong and she wasn’t going to make it to the hospital, she asked her husband to pull into the parking lot of a steakhouse near their home in Ohio. It was three weeks before her due date, and she knew her son had trisomy 21 (commonly known as Down syndrome), which comes with an increased rate of stillbirth. They had called 911, but their son arrived before the ambulance did, delivered by her husband who stood at the open passenger side door.
Evilsizer was worried that the baby seemed cold and wasn’t moving enough. She only heard him cry once, while her husband was chasing down the paramedics, who had mistakenly entered the restaurant. After a short NICU stay, her son was just fine, though his dramatic birth was the start of a medically complex first year of life that included surgery, a feeding tube, and many specialists. “We got a really cool story to tell,” Evilsizer says. But when she looks back on his birth, she thinks about the drive from the restaurant to the hospital, and how terrifying it must have been for her husband, who was following the ambulance in their car. “He drove for 20 minutes to the hospital and had no idea even if our baby was alive,” she says.
Precipitous births are often too fast for interventions like epidurals and cesareans, which eliminates the risks that any intervention carries but also takes away the potential benefits. Ellen Warfield was planning a medicated hospital birth in New York City in 2013. Instead, she says, “I went in the bathroom because I felt like I had to pee, and I left on a gurney with a baby.”
She estimates she was in the bathroom for less than an hour, though it was a harrowing one. She had her doula call 911, and when the fire department paramedics showed up in her apartment, Warfield begged them for pain-relieving drugs that they did not have. “I was screaming ‘I’m going to die; I’m going to die.’” Then, she says, a final, higher-ranking firefighter came into the bathroom. “He just seemed like he was ordering a sandwich at the deli, saying, ‘Hey you’re going to have the baby right now.’ I said, ‘No, I'm not.’ He said, ‘Yes, you are, you need to push.’”
With one firefighter holding each hand and each leg, Warfield pushed three times and the baby was born. “One of them said, ‘It's a boy!’ and I said, ‘I know!’” The firefighters had told her she was going to feel great after the baby came out, and they were right. “There were a couple seconds of just pure humanity,” she says. After her son cried, tension and panic gave way to shared elation. She remembers one firefighter’s legs shaking from the adrenaline comedown on the drive to the hospital. Still, Warfield says the experience validated her initial desires for her birth. She imagines going back in time to 1750 and explaining hospital versus home birth to a very pregnant woman. “Clearly, that woman in the 18th century would be shocked that anyone would choose to sit at home and hope for the best.”
“When the nurse parted my legs, the anesthesiologist turned on her heels and left the room, while the nurse yelled, ‘We have a baby!’”
Jalenna Francois, a mom of three in Gilbert, Arizona, was also unprepared for the “uncontrollable pain” of her unmedicated, precipitous birth. “I didn’t know it at the time, but my baby got stuck, and my midwife had to reach inside to pull her shoulder out.” She felt shocked and dazed when they put her daughter, who was 9 pounds, 10 ounces and bruised from her quick arrival, on her chest. Although Francois had minimal tearing, she says, “getting numbed and stitches were so uncomfortable compared to my first baby, where I didn’t feel the stitches with an epidural.”
For her part, Chapin felt “strong and in control” delivering her son in her car. “I was surprisingly calm, probably somewhat from having had two births prior,” she says. But experts note that, sometimes, precipitous birth comes with emotional trauma. For some, it can be terrifying to go into active labor unexpectedly without medical supervision, particularly if you have planned pain interventions. Shelton is thankful that her fast delivery went smoothly, but she feels she was ill-served by the prevailing wisdom that you shouldn’t rush to the hospital when contractions start. “I wish that what people shared, instead, was to recognize the pace of change in your body and respond accordingly,” she says.
Jen Babakhan, a mom of two in California who had a precipitous birth in the hospital in 2014, came away disappointed that nurses mistook the signs of her fast labor for a low pain tolerance. An anesthesiologist was trying to place an epidural when Babakhan started “writhing in pain, pushing involuntarily, and begging for help.” Her husband asked the nurse to recheck her dilation, and she could suddenly feel her son’s head crowning. “When the nurse parted my legs, the anesthesiologist turned on her heels and left the room, while the nurse yelled, ‘We have a baby!’ She instructed my husband to hold a leg, and she held the other and told me to push one more time, as my son was born in the amniotic sac — my water had never broken — which the nurse ruptured as he lay on the table still encased. I was in shock, and I think the nurse was even more shocked at the speed at which he arrived.”
Signs of precipitous labor to watch for, according to Blake, are contractions that come on very quickly and a strong sensation of pressure within a half hour or so of starting contractions. The pressure and heaviness were how Brigid Mitz knew she couldn’t make it from the bathroom of her home in Chicago to the car. “It became clear that something wasn’t right,” she says, and she told her husband to call 911. The operator told her not to push and to lay on her side.
“Not pushing felt impossible from the intense pressure, and I laid on my side and started crying from the pain,” she says. “They said help was coming, and then the call was over.” Somehow, she says her pants had come off, and her husband saw the baby’s head coming out. “He helped me lay on my back and basically pulled the baby’s head and shoulders out. A perfectly pink, healthy-looking baby suddenly started crying, and my husband yelled, ‘It’s a boy!’ It was crazy.” It was about 30 minutes from the time her water broke to when her baby was born.
When paramedics arrived, they cut the cord with a switchblade, she says, and she traveled to the hospital in an ambulance while nursing her baby. Upon arrival, she was given pitocin and a pain-relief drug to help deliver the placenta. “I was running on adrenaline for a few days, and then once it set in, I was pretty traumatized,” says Mitz. “It was hard not to think of the ‘what ifs.’ We were so lucky that he was a perfect, healthy baby, and there were no complications.”
The wide range of experiences that fall under the umbrella of precipitous birth is one reason that Smith says she doesn’t like to rely on definitions alone. “If a woman tells me that she’s had a precipitous birth before, I like to know what that means to her. Is it that she very quickly had an onset of very painful contractions, and then the baby came three hours later? Is it that she showed up at the hospital thinking she was having menstrual-type cramps but was 8 centimeters dilated? This tends to be helpful in the conversation about managing the next baby’s labor.” She encourages pregnant people to have a birth plan and stay open to the variety of developments that cause those plans to get thrown out. “In general, for parenting, it’s probably best to be prepared for the unexpected,” she says.
The morning after her baby was born, Mitz woke up at the hospital only to realize she was missing a couple of things. “We had no car, no car seat, and basically only a few essentials I had thrown into a hospital bag in preparation the weeks prior. With my first baby, I overpacked so much, and you realize quickly the hospital has everything you need... aside from pants and shoes, of course.”