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Emergencies happen anywhere, anytime, and sometimes medical professionals find themselves in situations where they are the only ones who can help. Is There a Doctor in the House? is a Medscape series telling these stories.

“Dad, they just called for a doctor.”

It was a routine flight home to Hawaii from Salt Lake City with my two daughters. About midway through, I was half asleep, half watching a movie, when one of my daughters poked me. 

I flagged a flight attendant. “Could you use some help?”

“I have a woman giving birth,” she said.

I hurried over there, but the situation wasn’t quite as described. The woman had already delivered her baby in the bathroom.

The baby was clearly premature, no more than 29 weeks. He was so small he could fit in my hands. And he was not looking good, blue and grunting.

Miraculously, I wasn’t the only medical professional there. We had three neonatal intensive care unit nurses and a physician assistant on this flight.

The first thing we had to do was tie off the umbilical cord. A football player from The University of Utah, Salt Lake, Utah, gave us his shoelaces to use.

We couldn’t resuscitate the baby until we were able to physically separate him from mom. We needed to cut the cord. On land it’s easy to find scissors, but TSA spends a lot of money keeping sharp objects off planes. We had nothing.

We searched for anything that was sharp enough to cut. Finally, one of the flight attendants found a small first aid kit that had a pair of aluminum scissors, and we used them to sort of saw through the cord.

While we assessed the baby, I was also communicating with the pilot. I asked if we could turn around and fly to San Francisco. He said, “No, we’re beyond the point of safe return.” That meant we had nearly 4 hours of flight time left with a critically sick baby.

With a premature baby, the things you worry about are body temperature, blood sugar, and oxygenation. An airplane is about the worst place to be for all of those — cold, high altitude, low pressure. Also, nothing is sterile.

So we began to build our own incubator. We had the flight attendants warm up water bottles, and we packed the baby in those.

Next, we needed to give the baby oxygen. The plane did have an oxygen tank, but the only oxygen masks were those yellow ones for emergencies. It would fit over his head like a bucket, preventing us from watching for signs of distress.

Fortunately, we found a small pediatric resuscitation mask. We cut the oxygen equipment and duct taped it together to make an even smaller oxygen mask, so we could provide oxygen manually.

We didn’t have suction, and we were thinking we might have to use a straw. But luckily, the baby didn’t seem to need it.

There was no pulse oximeter, but we had a thermometer. We also had a blood glucometer, but we decided against using it in this nonsterile environment. I used my Apple Watch as a heart monitor, and that worked really well.

While we were doing all of this, two of the nurses stayed with the baby’s mom. They were very experienced. After they helped her deliver the placenta, they had her lie down in the emergency exit row. Our biggest concern was that she would bleed. But as the baby was so small, the delivery was relatively uneventful.

Baby had started to pink up and gain some color, so we were able to tuck him in on his mom’s chest, what we call the kangaroo position. That helps a baby warm up, especially a preemie. The nurses were also very creative and used plastic bags as insulation, so he wouldn’t lose moisture and heat through his skin.

Baby was breathing easier and he finally went to sleep on mom’s chest. But he still hadn’t cried. That worried me. It’s one of the first things you want to happen. In my experience delivering babies, usually mom’s screaming, baby’s screaming, dad’s screaming. But this was an almost completely silent delivery.

Once we got the baby settled in, I talked to the mom.

“How long have you been pregnant?” I asked.

“I didn’t know I was pregnant,” she said.

That was a surprise.

A cryptic pregnancy is when someone is unaware they are pregnant. This happens in about 1 in 400 births. Fortunately, once labor started the mom was aware enough to catch the baby as it was coming out. She was definitely in shock.

While the whole event was stressful, there were a few lighthearted moments. Because we were in the emergency exit row, every time one of us would change seats or move over to work with the baby, the flight attendants would come over and say, “Look, I’m really sorry, but federal law requires me to ask you this question: Would you be willing and able to assist in the event of an emergency?”

I was like, Isn’t one emergency enough for this flight? 

At one point, I looked up, and every single person had their phone out, filming what was going on. Many were relatives. It turned out that the mom’s mom, dad, brothers, sisters, and cousins were onboard, all going on a family trip to Hawaii. Everyone — except the father of the baby.

I said to her, “As soon as we land, you’re going to have to call him. Once we hit the ground, those videos are going to be everywhere, and he cannot find out he’s a father on social media.”

I was also thinking, We’re a thousand miles from the nearest hospital. There’s a possibility this kid might not make it. I was very concerned that this woman might have to go through the shock of both having and losing a baby in public.

Finally, the plane landed. The pilot announced that we had a healthy baby boy born on the flight. Everybody was clapping and cheering. It was kind of a fun moment.

Except, I was still worried. This baby hadn’t cried yet, but he was breathing better.

The pilot asked everyone to stay in their seats while about 10 firefighters and police officers came on board. We helped pick the mom up to put her in a wheelchair. And at that moment, the baby woke up and started to cry for the first time.

My heart just stopped. We made it. He was going to be okay.

And I knew right where he was going, Kapi’olani Medical Center for Women and Children in Honolulu. I know all the neonatologists there. He was going to be in great hands.

Now, I was thoroughly exhausted.

Because I live in Hawaii, I was able to spend quite a bit of time with the family while the baby was recovering. He spent 10 weeks in the NICU, but he’s a tough little guy.

His mom is a brave lady. She adjusted to the fact that her life was going to be dramatically different from that moment forward. The dad flew in, and they handled becoming parents and being world famous overnight pretty well.

Later, I got a call from the airline asking what I thought about the supplies on the flight and how to improve them. I offered some suggestions like adding a pulse oximeter and a better stethoscope. Basic items that could be invaluable in an emergency. They probably can’t carry a complete baby delivery kit. But there’s instant oxygen now, stop-the-bleed kits, and other small, self-contained items that can increase chances of survival.

What amazed me was just how supportive and engaged everybody on the plane was. This happened in the middle of COVID. None of the passengers complained. People moved out of their emergency row seats so we could work there. They offered whatever they had to help out.

Several people gave us diapers. They were bigger than the baby, but we still appreciated it.

The nurses were absolutely incredible. We had so many people trying to help this kid get home safely. We felt like we had angels with us up there because things could easily have gone the other way.

This family went home with a souvenir that most people don’t get on their Hawaii trip. And he arrived at 500 miles an hour, 40,000 feet up. Quite an entrance.

Dale Glenn, MD, is a family medicine physician with Hawaii Pacific Health.

Are you a medical professional with a dramatic story outside the clinic? Medscape would love to consider your story for Is There a Doctor in the House? Please email your contact information and a short summary to access@webmd.net.