"I think I'm going to throw up," said Noelle, an electronic dummy "giving birth" in the back of a Salem Fire Department ambulance Friday.

"Me too," said Tim Sice, as he and fellow firefighters Steve Woitkun and Joe Scanlon surround Noelle, checking her medical stats and the position of her "baby.''

The men were participating in the Fire Department's labor and delivery training with Parkland Medical Center in Derry. Over the last four weeks, firefighters have been doing drills to learn how to handle premature, breech and other difficult births.

As the the heroin crisis worsens across New Hampshire, medical professionals and first responders are preparing for a potential increase in challenging births associated with drug use.

Women addicted to drugs tend to wait longer to call for help and their babies are born faster and smaller than most babies, Parkland nurse Deb Bell-Polson said.

"We're seeing all across the state, all hospitals are seeing babies with addiction and withdrawal issues. The numbers are going up across the state," she said.

Emergency medical technicians and paramedics generally receive limited training on labor and delivery, often only from PowerPoint presentations and videos.

When he began his EMT training many years ago, Salem firefighter Jeff Jensen said members of the department spent around three hours total on obstetrics.

"It was very hands off, pretty much observational," he said.

This month's training with the Salem Fire Department is the first time the hospital has conducted a simulation with an outside agency.

Brian Allard, emergency medical director for the Salem Fire Department, said he contacted Parkland after one of his staff members requested the training. The department experiences only a couple of pre-hospital births each year and hasn't seen an increase in drug use-related pregnancy and childbirth calls, he said.

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