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Old 01-12-2012, 10:07 PM   #1
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If you gave birth in a small hosptital....

Out of curiosity, I have some questions about the birth experience at a small hospital. I'd define small as a combination of number of beds and a smaller city/town population. You can search the size of your hospital here: http://www.ahd.com/freesearch.php

My understanding is that many small hospitals do not have 24-hour anesthesia on-site, one big factor in why some hospitals will not do VBACs. But that makes me wonder: in a small hospital, do you often have to wait for an epidural? How does the potential of a wait go over among child-bearing women in your community? Maybe women or staff ask for epidurals sooner in anticipation of a wait, or maybe fewer women in small hospitals get epidurals??

In a small hospital, is there always an ob or pediatrician on-site in a hospital that delivers babies? I am pretty sure that my somewhat small hospital (176 beds) did not have 24 hour on-site ob.

What about emergencies? Have you heard or experienced times when a small hospital had an important delay in care in a labor emergency, newborn needing NICU emergency, or even an ordinary ER visit? I have never heard anyone in my town express concern at that; the sense is that the hospital can either handle it or will refer you on.

I used to work with rural hospitals and was always told that rural doctors learn, by necessity, to do a lot on their own. I've also heard many doctors say that learning when to refer is a crucial skill, so I'll grant rural doctor above-average intuition and resourceful-ness. But still, wondering about whether much of what seems normal to me is quite different the smaller your hospital.

As point of comparison, I'd consider my hospital and town to be small-ish, but not that small. My town has a 4 county population of 110,000. The health care is considered excellent: a big, well-regarded academic medical center and the very good 176 bed community hospital. In my rural health job, I visited hospitals with 25 beds or less, so I know small can be really small.

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Old 01-12-2012, 10:22 PM   #2
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The OB I had (before switching at 41+wks!) delivered at a small hospital. He was the only OB performing vbacs there, so he had to stay through the entire labor.

IF a csection had to be performed at night and no other OB was around, he had to quote..."wing it by himself."

Um. Yikes. Lol.
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Old 01-12-2012, 10:36 PM   #3
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Re: If you gave birth in a small hosptital....

I delivered in a small hospital. It was in a town with a population of about 5,000 though we live in the next city over that has a population of around 30,000. There's not only no ped 24/7 but no pediatrics at all in the entire hospital. A local dr just came in to see the babies in the AM and left. If the baby needed to go to the NICU then they would have to be rushed to a hospital 90 minutes away. There were 2 OBs when I was there but now there's only 1. It was a very awesome hospital that is working on becoming baby friendly and is relatively supportive of natural childbirth. I believe that the one OB there does do VBACs now and I am hoping to VBAC there in the future.
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Old 01-12-2012, 11:32 PM   #4
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Re: If you gave birth in a small hosptital....

Can laboring moms get an epidural waiting a wait at that hospital? Do women in your area talk/complain/plan around a wait for an epidural?

I am so curious about this because I've never heard women in the US talk as though they'd want an epidural but not be able to get one fast. But it seems that in a hospital without an on-site anesthesiologist, laboring women would have to wait.
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Old 01-12-2012, 11:37 PM   #5
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Re: If you gave birth in a small hosptital....

I'm not sure if the hospital I delivered at is considered small or not but I had to wait. I delivered on memorial weekend so I had to wait for the oncall dr to get there. I think it was only about 20 minutes.
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Old 01-12-2012, 11:48 PM   #6
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Quote:
Originally Posted by aggfan
Out of curiosity, I have some questions about the birth experience at a small hospital. I'd define small as a combination of number of beds and a smaller city/town population. You can search the size of your hospital here: http://www.ahd.com/freesearch.php

My understanding is that many small hospitals do not have 24-hour anesthesia on-site, one big factor in why some hospitals will not do VBACs. But that makes me wonder: in a small hospital, do you often have to wait for an epidural? How does the potential of a wait go over among child-bearing women in your community? Maybe women or staff ask for epidurals sooner in anticipation of a wait, or maybe fewer women in small hospitals get epidurals??

In a small hospital, is there always an ob or pediatrician on-site in a hospital that delivers babies? I am pretty sure that my somewhat small hospital (176 beds) did not have 24 hour on-site ob.

What about emergencies? Have you heard or experienced times when a small hospital had an important delay in care in a labor emergency, newborn needing NICU emergency, or even an ordinary ER visit? I have never heard anyone in my town express concern at that; the sense is that the hospital can either handle it or will refer you on.

I used to work with rural hospitals and was always told that rural doctors learn, by necessity, to do a lot on their own. I've also heard many doctors say that learning when to refer is a crucial skill, so I'll grant rural doctor above-average intuition and resourceful-ness. But still, wondering about whether much of what seems normal to me is quite different the smaller your hospital.

As point of comparison, I'd consider my hospital and town to be small-ish, but not that small. My town has a 4 county population of 110,000. The health care is considered excellent: a big, well-regarded academic medical center and the very good 176 bed community hospital. In my rural health job, I visited hospitals with 25 beds or less, so I know small can be really small.
I work in a small(ish) hospital...

Our epidural rate is sky high. Almost all first time moms get them. We do not have 24 hr on site anesthesia. But if we call the dr at home he is usually there in 20ish minutes anyway. This gives us time to prepare the room/meds etc.

Our OBs and peds are not on site 24/7. They come when called. I have delivered 1 or 2 (or more ) babies myself because when it's a mom with a precipitous delivery there is no choice!

The closest NICU is 4.5 hrs away from us. If needed we fly babies out. We are trained and have the ability to care for sick babies for a short time until the transport team arrives. In a situation where we know baby is early/sick and we have the time we will send mom still pregnant to deliver in a hospital with a NICU.
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Old 01-13-2012, 12:10 AM   #7
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The hospital here is 110 beds. There are 4 LD rooms, 4 RP rooms. The town pop. is 10,800, county is 32,400.

I had to wait probably 1.5-2 hours for my epidural for my second birth, because the anesthesiologist had to be called. With my first, it wasn't very long because an OB did it. He's been a doctor since the sixties, he knew what he was doing and he did it fast and pretty good at it.

If there's a need for a NICU, they do the same thing they do for trauma or emergencies - life flight you to Memphis or Nashville (2 or 3 hour drive normally). There is no pediatrician in hospital. There are actually only 2 in town. Many children see a family doctor, because there are several. After the baby is born, he/she is seen by the doctor you've chosen depending on how they do things. Our ped will come to the hospital whenever. At the family practice we used to use, whatever doctor was on call would come, and yours would the next day. I don't even know if there is a pediatric department. There are 3 OBs, their practice is conveniently across the street.

All that said, the hospital we are using for this next birth is one town over, roughly the same population. 65 beds!
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Old 01-13-2012, 12:37 AM   #8
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Re: If you gave birth in a small hosptital....

So, am I understanding that sometimes the ob's do the epidurals? I have never heard of that.
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Old 01-13-2012, 06:44 AM   #9
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Re: If you gave birth in a small hosptital....

I delivered DS1 in a small hospital. There were only 8-10 "birthing suites".
I had to wait a couple hours or more for epidural because they had to call the anesthesiologist in (which makes no sense to me because I got my epidural around 5pm? Why wasn't he already working?
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Old 01-13-2012, 07:59 AM   #10
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Re: If you gave birth in a small hosptital....

I gave birth in a small hospital. There are only 3 birthing rooms.

It was my experience that the anesthesiologist is NOT there during the evening. He's on call...and was not happy to be called in at 3am on a Monday morning. lol From the time I requested the epi until he got there was a couple of hours at least!

Furthermore, the OB's are ALL on call at all times. They are not at the hospital unless they are called in or have previously scheduled to see a patient. I've heard of many cases where the nurses have delivered the baby because the doc didn't get there on time!

Nonetheless I feel the care I recieved was immaculate. The nurses and OB were amazing. I never felt neglected of the care I needed.
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