Jan. 20, 2012 -- A train and an elevator: Just two of the unlikely places babies were born this week.
Rabita Sarke of Harrison, N.J., surprised morning commuters on Monday when she gave birth to a boy on a PATH train. And Katie Thacker of Spanaway, Wash., delivered son Blake on Wednesday in a hospital's stuck service elevator.
While most moms-to-be make it to the delivery room with time to spare, experts say a quick labor can surprise even the most practiced of parents.
"The vast majority of women have plenty of warning before their baby is going to come," said Dr. Marjorie Greenfield, chief of obstetrics and gynecology at University Hospitals Case Medical Center in Cleveland. "But some people have very, very rapid labors."
Other unplanned labor locales include a Baltimore airport bathroom, a Denver library, a McDonalds in Vancouver, Wash., and an airplane en route to San Francisco.
Despite having a due date -- an estimate based on the time of conception -- babies tend to come out when they're ready, regardless of whether the parents feel the same. But several warning signs signal the start of labor, which for first-time moms lasts an average 16 hours.
"About 1 percent of women break their water before they go into labor," said Greenfield. "It's usually a big gush, but sometimes it's more of a constant trickle." Either way, "you can usually tell."
There are other, more ubiquitous signs that a baby is ready to go: Contractions that start out feeling like menstrual cramps and steadily grow more intense; a tightening feeling across the lower back; and the sensation that the baby is curling up inside. But there are false alarms, too.
"I think that's part of what keeps people from acting at first," said Greenfield. "People sometimes feel crampier and have more pelvic pressure" late in pregnancy. "And there's the bloody show -- mucus and blood coming out of the cervix. But they're not very predictive of labor."
Some women are caught off guard because they don't feel pain with contractions.
"Everyone's been telling them, 'Pain, pain, pain,' and they don't recognize what contractions feel like," said Greenfield of the women some would call lucky. "But that's pretty rare."
Some women fail to recognize the signs of labor because, as Greenfield puts it, they're in denial.
"I've certainly seen moms who don't accept they're pregnant," she said. "They kind of know but are really in a state of denial. That's one situation where we see deliveries outside the hospital."
Even for veteran moms who've been there, done that, labor can be sneaky.
"If their first baby came in two hours, the next baby may be the one they're going to deliver in the car on the way to the hospital," said Greenfield. "The second delivery, on average, is usually half the length of the first."
Although few women would choose a train or elevator over a hospital or midwife-assisted homebirth, Greenfield said quick labors are usually a sign that everything is going smoothly.
"This is the way nature intended," she said. "Labor wasn't intended to happen in hospitals hooked up to IVs."
And for those amateur obstetricians compelled to help out on the morning commute, Greenfield has two important pieces of advice: Don't pull on anything; and keep that baby warm.
"Never pull on anything if a baby is part-way born," she said. "Mom needs to do the work. People trying to help need to let things happen and just make sure the baby doesn't fall on the floor." And when the baby is out, "dry it off and put it skin-to-skin against mom." Don't cut the umbilical cord, Greenfield added. Just get mom and baby to the nearest hospital.
When Labor Is Unexpected
As a due date approaches, expectant moms are usually on the lookout for labor. But the signs of preterm or early labor are usually subtler, and both babies and moms may need extra care.
"Preterm or early labor is usually less intense, so it can be a little harder to recognize," said Greenfield. "Things like having any blood or mucus, a significant increase in pelvic pressure or mild contractions that don't stop with fluid and rest are all potentially signs of preterm labor. Definitely tell your doctor if you're worried."
Despite their conventional birthplaces, the Sarke and Thacker babies and moms are healthy.
"It's so dramatic and exciting," said Greenfield. "When it ends well, it's certainly a story to tell."