If you happen have a siren that will get the traffic to move for you, AND you have a trained EMT available in case the baby doesn't wait until you arrive at the hospital, sure, drive yourself through rush hour traffic.

For what it's worth, driving in the breakdown lane is expressly permitted on a number of Mass. highways during specified hours, although not on that particular highway.

Accordingly, driving in the breakdown lane is not all that great a deviation from ordinary driving practice in the area, which is confirmed by the fact that the other police officers permitted the husband to do it.

The fact that the baby happened to be born five hours later is not particuarly relevant: unlike doomsday devices in James Bond films, most women in active labor do not have a large LED countdown timer attached to their midsection. The couple was reasonable in wanting to get to the hospital as soon as possible.

That said, the suggestion that the couple should instead have called an ambulance at that point (or at any point) does not make sense. The nearest exit was about 2 1/2 miles from the hospital.

The blog entry had to come from a man. Childbirth is quite literally, a life and death situation where an enormous number of things can go wrong for both mother and child - which is why we tend to like to have it happen at hospitals.

This post had to come from a woman. Driving is quite literally, a life and death situation where an enormous number of things can go wrong for both drivers and passengers - which is why we tend to like to have it happen on the road and not the breakdown lane.

His life was not endangered. The people saw him like they saw the other troopers previously and hoped he'd be able to help them. Instead, this cop needed to meet his quota.

"If it's a true emergency, call 911 and meet the ambulance at the next exit!"

In an emergency, I'm not going to stand around and wait for a bureaucrat driving a truck with sirens to hope to find me in gridlocked traffic.

In an emergency, I'm not going to stand around and wait for a bureaucrat driving a truck with sirens to hope to find me in gridlocked traffic.

Ambulance drivers are "bureaucrats"?

That is an awfully churlish take, professor Bernstein. Cops operating on the assumption that everyone is a criminal (e.g., forcing her to show her naked belly) are jerks.

A simple "No" to their request would've been jerky, but actually writing a ticket and forcing them to wait while she underwent contractions makes me wish he'd be fired. We should be policed by those with judgment not chippiness.

"Safety" is the empty excuse used by paternalistic legislators, school marms, jerky police and churlish Professors to excuse meanness.

If cops can legally set aside general standards of conduct because of exigent circumstances, why can't citizens? Create a rebuttable presumption against, and allow the citizen to defeat it with proof.

Have any of you ever been in a car with a woman in labor? I have. "Gee, honey, we'll just have to obey the traffic regulations, so hang on" is not something you want to say to a woman in that state of pain and anxiety.

guy in the veal calf office,

While I wouldn't say it the way you did (I have too many cop friends), I would say you are right on the money! In fact, if that lady was even asked to bare her belly, a sexual harassment complaint could be filed in many places.

That is what caught my attention. That was utterly inappropriate and all of my cop friends would agree with me on that one.

This cop was an idiot.....

Portland,

my experience with ambulances taught me the opposite: if this is an emergency AND you have somebody else who can drive, hop in the car and full speed ahead. Ambulance is in no rush to help your patient. They're not interested in saving lives. So long as they follow regulations, they will not be punished for making it too late.

FWIW, babies that come so quickly that you don't have time to get to the hospital are almost always fine. It's the babies that have trouble coming out that are prone to complications, for mother or baby.

It seems to me that it wasn't obvious that the couple had five hours until the baby would be born until the time the baby was actually born. Sure, looking back, they had five hours. Before that, it could come at any minute. Worse, a complication could occur at any time before that.

The obvious lesson here is that they should have had an HOV lane instead of a breakdown lane - then we could be arguing about whether they qualify for HOV-3 or only HOV-2, which would be just as productive, but funnier.

Otherwise - babies don't follow schedules, and do you really want to see ambulances routinely called for *all* labor? Like ambulance drivers don't have anything better to do?

Ambulance is in no rush to help your patient. They're not interested in saving lives. So long as they follow regulations, they will not be punished for making it too late.

Exactly. Ambulance drivers are bureaucrats.

DavidBernstein:

I think that there are two things which are missing here.... The first is that the response time for an ambulance may not be great. The second is that 3 min between contractions tends to occur fairly close to childbirth.

I don't have to make such a decision because I live and work 2 blocks from the hospital. Even in a real emergency, I could probably *walk* there faster than I could get an ambulance to come and pick me up. The simple fact is that under optimal conditions, you can get someone to a hospital faster in your own car than the ambulance will take to get to you. (I recognize that rush hour is a little different, but the fact is that what will the ambulance do? Probably drive in the break-down lane!)

Honestly though.... Who really cares about the ticket? It was a pretty minor one. Even if the cop was a jerk but within the scope fo the law, why isn't it reasonable to just accept the ticket as a part of the cost of getting to the hospital under these conditions and then get the fine reduced in traffic court (though if you make a reasonable amount of money, going to traffic court is a net financial loss compared to just paying the ticket).

Ambulance drivers are bureaucrats.

Sigh. I could explain to you the many levels on which your statement is absurd, but I'm just going to leave it alone, and hope that natural selection takes care of the problem.

The simple fact is that under optimal conditions, you can get someone to a hospital faster in your own car than the ambulance will take to get to you.

Of course, but the relevant question is what gets you to treatment faster. Traveling in your own vehicle, not only do you run the risk that the patient's condition will worsen, but you lose out on access to a streamlined process that begins with the first responders and greatly facilitates the speed of the response:

1. Paramedics can collect critical information (vitals, 12-lead ECG, blood glucose) on scene or on the road.

2. We select the right hospital. You may be smart enough to go to the nearest hospital, rather than the one where your doctor works -- although you'd be surprised how many people make that mistake -- but do you know which of your local hospitals have cath labs (for heart attacks) or a stroke teams (essential for optimal care in the 3-6 hour window for thrombolytics)? Do you know the criteria for transporting a patient to a level one trauma center? If the patient meets them, and you didn't, the receiving hospital is going to shove them into an ambulance and send them there anyway.

3. We give the ED a hear report (1-2 minute radio call) so they know what to expect and can prepare. If you wander in a bloody mess, or clutching your chest, expect to lose 2-3 minutes while the ED scares up staff and gets a room ready.

4. We have stretchers. Really sick people often cannot, or should not, walk. Some can't even sit. Have you thought about getting said patient out of your car when you get to the ED? That could easily eat up the five minutes you saved by driving the patient yourself.

5. If you're a sick person in the back of an ambulance, you go straight to a room. If you come in a private vehicle, unless you're dying, you're going to have to tell your story to the triage nurse, get a set of vitals taken, and run the risk that there are two or three people in said waiting room that are more worrisome to said triage nurse than you -- in which case, the five minutes you saved can end up being four hours in the waiting room. People die in those waiting rooms; I've seen it with my own eyes.


Now, obviously you don't need all these mechanisms for a split lip, or even for a broken arm. If you can get to the hospital safely by yourself, please do; I'm not paid on commission, and I like my sleep. But if your emergency is serious enough that you don't want to wait 5-10 minutes for the ambulance -- wait for the ambulance. If things are really as bad as that, chances are you may need it.

Have any of you ever been in a car with a woman in labor? I have. "Gee, honey, we'll just have to obey the traffic regulations, so hang on" is not something you want to say to a woman in that state of pain and anxiety.

Grow some balls and use your brain. That is why a woman in labor needs someone who can actually think on hand to help make decisions and not just scream incoherently. One of my sons was almost born in the car. We lived an hour from the hospital. My wife was in labor and yelling at me to run every red light on the way. If I decided to follow the advice of a woman screaming in pain and not using reason would it have been better? Should I have risked the lives of her, our two children, the unborn child, myself, and everyone else on the road just because some hormonal crazy woman was screaming at me to do so? Nope, sorry.

The child was born without complications at the hospital.

And even if I had to deliver it myself in the back of our van that would have been better than risking the lives of innocent people. I completely concur with the rule that a woman being in labor is no excuse for unsafe driving.

I'd accept the ticket as the cost of breaking the law. If the cop gave me an escort there and then ticketed my car, that would be a fine trade. Sign me up.

Sure. The appropriate response really is "Officer, I am trying to get my wife in labor to the hospital. I know I am violating traffic regulations to do it. Please give me a ticket as quickly as possible so I can get on my way."

It's not like a baby is on a timer. Can you really anticipate the baby will not be born sooner (or better off in a hospital)?

True, but the amount of time between contractions gives you a pretty good idea of how close the woman is to acutally giving birth.

Phooey. One of the delightful events of my med school OB rotation was the attending who saw a patient in the ER and sent her home with false labor. She never made it. She had the kid out on the loading dock.

If an experienced OB can't always tell, how's a patient to tell?

My father was stationed in Denver and my parents were living near downtown when I was due to arrive. When my mother went into labor, my father rushed her to the car and sped off towards Fitzsimmons Hospital (the military facility outside Denver). As he was speeding down a main road, a motorcyle cop pulled him over. When the officer asked what the big hurry was, my father explained the medical emergency. The officer peered into the back seat and, surprise, no one there!

As he pulled out his pad to write my dumbfounded father a ticket, he heard a loud, explitive-laden tirade from the back seat. Stunned, the officer and my father realized that my mother had somehow pried open the back of the bench seat and had rolled into the trunk. As she continued to give my father a piece of her mind in both English and Italian, the officer flipped on his siren and escorted them the rest of the way to the hospital.

Everyone told us wait until the contractions are five minutes apart and regular. I took that literally. They were never regular, but when her water broke we decided to go to the hospital. I drove and my wife moaned unable to speak to the doctor when she called on my cell phone. The doctor said, "I'm glad you are on your way in, be careful." I'm sure she could sense the panic in my voice. We arrived and my son was out within a half-hour. No one else in the family even knew we were at the hospital.

Leave it to Bernstein to play the contrarian and bag on the pregnant woman and her husband. A couple of points should be made:

1) Generally, the popular belief is that when the contractions are five minutes apart the expectant mother should get herself to the hospital because birth is imminent. It really doesn't matter that in the end she gave birth five hours later, as she could have easily given birth within an hour or two. This criticism alone causes me to suspect that Bernstein has never had children, or that if he did, he was paying no attention to the process.

2) I seriously doubt the husband was "endangering the cop's life." Given that he stopped more than one time to ask other trooper's for permission to drive in the lane, I question the notion that he sped up behind this other trooper at an unsafe speed or otherwise wasn't paying attention and or failing to drive safely.

So despite my careful reading, I still come to the conclusion that the trooper was in fact kind of a jerk.

Also, is there a niche for "being in labor is no excuse for unsafe driving" blogging that Bernstein is trying to fill, that this issue must be addressed more than once?

The question becomes: Does having a friend drive you to the hospital get you care sooner? That is the question I am asking.

This doesn't mean you should always go this route. If being mobile is a risk, or if you are in an area which has trained first aid people, you are certainly better off waiting for the ambulance. I am just saying that it is not universally correct, and the clock doesn't start ticking when the ambulance arrives.

Oh, I agree. No one rule works for all situations. To make an informed decision, it would be helpful to know a) the response time (call to arrival) in your area (typically, this will be the response time of your local fire department, or it will be specified in an ambulance company's contract with the county (within eight minutes 90% of the time, for example), and b) are first responders BLS or ALS units. ALS units are for most purposes like an ED that comes to you. BLS units can be lifesaving, but are more limited in the medications and interventions they are trained to use.

Common sense is the order of the day.

For baby number 2, we headed to the hospital, 45 minutes away, when the contractions were 3 minutes apart, regular and strong. We called the midwife on the way to meet us there. Baby arrived about 3 hours after we got to the hospital. We might have waited a bit longer, but the contractions had become stronger and closer very quickly, so I was concerned that the baby wouldn't wait.

I tend to disagree with Professor Bernstein. Sometimes, society needs clear rules that enable people to order their lives and know how to behave even if it means that sometimes the rule might not result in the best decision in a particular case.

Exempting women in labor from certain traffic regulations as a general matter lets people clearly know where they stand. Saying that it is sometimes OK and sometimes not OK creates uncertainty because people won't be sure what to do in any given situation.

Certainty about what is permitted helps people avoid accidents while doing what needs to be done in situations where action is required. The presence of uncertainty, and its resulting doubt and hesitation, can cause accidents.

DavidBernstein:

You should probably be aware that women go through the stages of labor at vastly different rates. If I waited until my wife had contractions 3 minutes apart, I suspect we would have no more than an hour, probably substantially less. There is NO WAY I would consider driving with her in labor to a hospital 45 minutes away. However, I am glad you can safely do that.

In the end, I don't think recklessness can be excused by this sort of thing, but quite frankly there is a difference between reckless driving and minor driving infractions. Personally I have absolutely no problem engaging in minor driving infractions when the need exists. But there are and should be limits.

Unsafe driving can mean a lot of things under different circumstances and to different people. It could mean going 6 miles an hour over the posted speed limit on the freeway to some people. It could mean driving 20 miles an hour on the shoulder to someone else. Or it could mean a total disregard for the law to someone else. We can all agree one should drive safely even during an emergency. I am not sure this means driving normally though.

No, I wouldn't run red lights, but I would drive 5-10 miles over the speed limit in a case like that when on the open road.

whit,

despite the fact that supposedly hitler got inspiration for some of his troops uniforms from the Mass State Police!

Was that during the junior year he spent at B.U., or when he was the third base coach for the Red Sox?

I think one of the key things to understand is that it is helpful to know the stages of labor and their signs before that day comes. Of course, as I mentioned, women go through the stages at vastly different rates. In both of my children's cases, early labor was SLOW (30 hrs on the first via an induction, 12 hrs on the second, and this is before contractions are regular and 5 min apart usually), followed by less than an hour of active labor, transition, and birth combined.

However this also leads to one important caution-- particularly for a first birth, you have absolutely NO IDEA how long you have. Even for a second one, you can be surprised.

We were advised not to travel more than 20 minutes from home during the last month of my wife's second pregnancy.

Speaking of Paul Harvey...

He told a story a while back about a woman who delivered her baby in the elevator on the way up to Labor and Delivery. As an orderly helped her into a wheelchair, the woman was crying about being so embarrassed at the event. The orderly, trying to put her at ease, commented that "A couple of years ago, a lady gave birth out on the front lawn."
The woman released another wail and said "Yes, that was me, too!"

The couple was definitely irresponsible in setting their hearts on Mt. Auburn even though it was over 30 miles away from their home in Dracut. Driving in the breakdown lane where it is prohibited is also not very safe. However, the couple had already come across two other Troopers that said that they should only use the breakdown lane if the main lanes are jammed, to be very cautious and to use their hazards. If they were doing this then the cop's life wasn't in danger any more than a crossing guard's is on a daily basis; if they weren't then I'm sure he'll make a statement very soon saying that they nearly hit him. Barring a near vehicular homicide, however, the cop acted inappropriately. He held them there while he wrote another ticket for no reason at all since he was only going to mail them their ticket anyway. THEN he made the woman open her jacket and PROVE her pregnancy as if they had a routine with a basketball and faked contractions. Sure, he asked if they wanted an ambulance but ambulances are EXPENSIVE! Why would you say "Sure, I'd love to pay 500-1000 bucks" to get to a hospital that's so close to where they were, particularly when you've already been given the go-ahead twice? In my opinion, if the cop wanted to be True Blue about it he could've 1) Given them a brief tongue-lashing, told them they'd be getting a ticket in the mail and sent them on their way for the time being or 2) given them an escort to the hospital to make sure they got there safely and given them the ticket or 2a.) just escorted them to the hospital with a warning. However, I don't know police protocol regarding escorting civilians so the last option may not have been possible.

Just a quick reply to Senate Wren:

my experience with ambulances taught me the opposite: if this is an emergency AND you have somebody else who can drive, hop in the car and full speed ahead. Ambulance is in no rush to help your patient. They're not interested in saving lives. So long as they follow regulations, they will not be punished for making it too late.

Note that this may depend where you are. However, a few quick points:

1) There tend to be response time contracts. This doesn't mean that every response is quick but most ones are reasonable in most parts of the country.

2) AFAICS, response times are calculated from dispatch. Obviously this means response times, from the point you pick up the phone, may be marginally longer (though probably not significant since they seem to assume whole numbers of minutes).

3) A lot of it depends on where you are. I will give you two cases where I think driving to the hospital is entirely inappropriate: I worked a contract for Intel Corp for a year, and worked another few years at Microsoft. In both those cases, they had special emergency response teams of people with real first aid training there to provide help while waiting for EMT's.

I think at that point, any urgent care situation where one is worried about first aid issues would suggest that driving would not be a good idea. Secondly, if you are driving and in danger of a heart attack, etc. that is a bad combination.

As always, there are right times to call for an ambulance (dizzy and having abdominal pain, for example), and times it is inappropriate. As Portland pointed out, a lot of it is common sense.

A lot of this debate is over tone more than substance, and exactly where you draw the line and call the ambulance rather than driving as feel you can safely in order to get to the hospital (driving safely and following the letter of the traffic laws are not always 100% synonymous). It is not generally over how useful ambulances are when you need them.