Labor Delivery in a Rural Hospital

I did a stint at a small country hospital that had only 5 beds for post partum moms and one labor room.   The usual count of babies per month was around 24 to 26 - give or take.   It was a sweet little hospital, all on one floor, and as the the Night Shift RN - I was the only L&D RN on from 10 pm to 7 am.  

 

My patient load would often be a couple of post partum moms (maximum of 5) and perhaps one mom in labor....and if it was quiet, I would get an "easy" patient that wasn't critical or in need of a lot of attention to fill up the extra room....because when things got hopping in L&D - there was going to be very little attention shown to anyone else.

Occasionally there would be another mom in labor and there was an extra room just in case, that was set up for deliveries if need be....in a pinch.  It had everything needed for a delivery - but due to the population numbers....it was rare that you would have two deliveries at once, although it has happened.

The small town I worked in had a good number of moms that were what the nurses in the hospital I worked in in California called "Berkeley types"(....and hey, if you are from Berkeley - no disrespect meant, that is just the way they referred to the sandals/long hair/au naturel types down there).  They seemed to deliver their babies with no problem and little effort.  It was amazing.

There were several GPs that did anesthesiology that would come in to put epidurals in.  Now, some RNs  might not be familiar with GPs having the training to do epidurals and give anesthesia might give pause at that bit of info, but the truth is, this is a commonplace thing in rural Canada where the access to anesthesiologists is limited.   It has been shown that it is quite safe to have an epidural put in place by one of these GPs and in fact studies have shown there is no difference in complications and no life threatening incidents occurred when compared to a university affiliated hospital. (these GPs do not do complicated cases - only ASA class 1 or 2)

We did not have obstetricians at this small town hospital.  I looked at that as a positive thing.  Coming from a hospital in California that only had OBS specialty docs and Midwives, I was suspicious at first.   But, I was soon to find that the GPs in Canada are quite competent and usually -  if they knew you were an experienced nurse - they would treat the nurse as a peer rather than someone beneath them.

The GPs I worked with were very capable and did lovely deliveries with less intervention than in the larger hospitals I had worked in - and in fact - were comparable to the midwives I worked with in California.  Mind you, most of the moms were low risk types.  Anyone complicated would go to the next town over.

It was interesting to work at night. Alone. There was a float RN available at home that you would call in if you needed help - if a second laboring mom walked in, or if delivery was imminent.   Of course, not really knowing when a mom was going to deliver had it's challenges.   After the multitude of deliveries I had done up until that point which was in the thousands....one has a little bit better idea as to the timing.  It is just something you *know* after a while....based on a combination of the behavior of the mom in labor, mom's delivery history and intuition..... and somewhat on the dilatation, believe it or not. 

It was nice to have the woman in charge of her labor as opposed to the MD or the nurse.  She was allowed to mobilize at her leisure and only have intermittent monitoring with a Doppler.   I saw very few care plans because there was really no need for any.  Everyone just knew that whatever the woman wanted, or requested, we did our best to fulfill.  There were never any objections to anything that I knew of.    The birthing beds were rarely, if ever, broken down.  I never saw a scalp electrode or a pair of forceps the entire time.   Sometimes babies would go home without the "newborn bath".

I find it interesting that when you google "laboring moms"
they are all pictured in a supine position......

I can remember one winter night one of the GPs phoning up to let me know that she was going on a cross-country ski Christmas excursion put on by the town.   She told me she "might" be out of range with her cell at certain times, so if one of her patients went into labor and she doesn't answer right away - don't worry, she would pick up the message at some point.  As luck would have it, one of her patients did come in and, sure enough, I wasn't able to get a hold of her for a good 2 hours.  I almost had to deliver the baby myself, which wouldn't have been a panic at all, really.

When a laboring mom came in, the practice was to wait until approximately 1 hour before she delivered (!) then have one of the other nurses from another ward would call the "2nd pair of hands" to assist with the birth and I  would pick up the phone in the delivery room to notify the GP to come in. 

Most of the time they would get there in time.   Like I said, you develop a 6th sense after a while, and at that point I was at 4 to 5 thousand births and counting.    If they or the backup nurse didn't get there on time, the RNs from the Med/Surg side of the hospital would come and "help out".  Mostly all they did was stand at the door with eyes wide open - they all hated L&D.  Most of them wanted nothing to do with the deliveries - and when they asked if all was OK....and they would give me an expression of relief at my "no thanks" - and run off.

By the time I had worked at the country hospital, I had been fully conditioned to the way most hospitals delivered babies in BC.   It was easy to orientate to the new place -   the same "Partogram" or delivery record is used for monitoring labor and immediate post partum throughout the province.  It didn't matter what hospital you worked at  - the charting was all the same.   Basically, it was just getting used to the MD's routines and where stuff was kept.   Being alone on nights had it's advantages in that I could develop my own routines without interference.

The nursery was another ball of wax entirely.    There was a room beside the nursing station that the moms could wheel their baby into if they wished.  There was no nurse - just a baby monitor that would have the other listening end at the nurses station.  My problem with that system is that sometimes there would be no nurses at the station if it was busy on the Med/Surg side.

 I always encouraged moms to keep their babies with them at all times, and if I did have a baby between feeds if a mom was desperately in need of a rest and wouldn't take "no" for an answer,  I would take the baby with me on my break - I couldn't ever bring myself to leave a babe unattended in the "nursery". 


All in all, a great experience.  I would work there or at any other small hospital again in a minute.   Anyone contemplating working in a very small hospital such as this....I would advise that you be very secure in your OB skills.

The one other piece of advice? Listen to the mom.

She knows her body better than you do.  If she tells you something - listen!  I don't understand those stories I hear that some moms have told me: "the nurse didn't believe me when I told her I felt like I was going to deliver....."

The one thing I can predict about L&D ?

                             - it's unpredictable.



(all photos googled and borrowed from "wikihow" and employment sites)