Overcrowding in L&D

klone, MSN, RN · Apr 29, 2015

I work in a large city that has nearly a dozen hospitals with L&D. When it's super busy, we go on divert, and have to send people to other hospitals.

When I worked in a smaller community where our hospital was the only L&D unit for 80 miles, we just dealt with it. We would make postpartum rooms into LDR rooms, and postpartum moms would have to go to med/surg. Usually it was the other way around, though - we had 5 LDR rooms, plus triage, and only 12 postpartum beds - more often we were turning an LDR room into a postpartum room.

**LibraSunCNM, BSN, MSN, CNM** · Apr 29, 2015

I read this article and was conflicted. I feel terrible that the reporter had such a bad birth experience from start to finish. That being said, I feel like a lot of New York women choose to deliver at hospitals like Roosevelt, or other large teaching facilities, because the name is considered prestigious. I think people "research" the labor and delivery process up to a point, but are still generally unprepared for what the reality of birth at a large hospital entails.

A couple of months ago a blog post from some reporter was circulating Facebook, about how horrible his wife's labor experience at NYU was because they were packed to the gills with patients and his wife had to wait for a labor room and an epidural. The staff kept telling him emergencies were going on, and they were doing the best they could, but when he TWEETED that he was with his wife at NYU and no one would give her an epidural (he seemed convinced it was on purpose??), they somehow "magically" found an anesthesiologist and a labor room for them.

Certainly I can understand how she felt neglected in that situation, and overhearing staff talking about mundane things while seemingly ignoring all the patients in the waiting room must have been terrible. But I don't know what the answer is to an overcrowded L&D unit in a busy NYC hospital. Sometimes patients do just have to wait. Perhaps they should look more thoroughly and ask more questions during pregnancy into what their experience will be like at such a large facility. But I guess you don't know what you don't know, especially if you're healthy and this is your first real hospital experience.

Elvish, BSN, DNP, RN, NP · Apr 29, 2015

How I WISH we could divert patients. We have had days where postpartum is full (47 beds), L&D is full (12 beds), triage (8 beds) is full and people were laboring/delivering back there, and we are laboring patients in ORs (we have 3 dedicated and were using two, leaving the 3rd one for 'just in case'). We have had to open up one of the regular short-stay units that almost always stays closed but that's wired for EFM. It sucks, really, and we pray the whole time that no one we're keeping in the obs unit has an emergency. If there is a postpartum bed crunch and peds has available beds, we will sometimes shunt 4-5 couplets and a nurse over to peds to free up more mother/baby beds. Thankfully, we don't run into this much but when we do it's a nightmare and we pray the patients never figure out how crazy it really is.

bagladyrn, RN · Apr 30, 2015

I've been in the situation where we had 8 women laboring in a 4 bed ldr in a critical access hospital. We had women on stretchers behind folding screens in the hallway! The one doc on duty and I would evaluate and try to figure who was likely to deliver next, moving women in and out of rooms for delivery. As fast as we moved one out, er would roll a new patient in.

We ended the night with 7 women in labor - not the same ones we started with!

NurseNora, BSN, RN · May 5, 2015

We've canceled elective inductions and scheduled repeat sections, sometimes even turned off the Pit and discharged inductions that have been started but not kicked into labor yet. I've also had women on stretchers in the hall with folding screens. Once I had two women laboring in recliners in the residents lounge. I turned a family waiting room into a 4 stretcher Post Partum ward. That's one of the things I love about OB, you never know what you'll find when you come into work.

NicuGal, MSN, RN · May 6, 2015

Ours rarely diverts, even when NICU is completely full.

bagladyrn, RN · May 8, 2015

One time I came into work to see the day shift nurses moving the unit director's desk out of her office and moving a bed in there to accommodate overflow labor patients!

eden · May 11, 2015

If it is insane we manage the best we can and do those who require our most immediate attention first. That is we discharge early and do priority PHN visits if baby/mom meet the criteria and if we are back logged on labouring beds we have shut off Pitocin for our inductions in favour of those who are actively labouring. We also divert to other city hospitals.

With my last baby I was in early labour for several days and they were going to keep me and do an ARM augment but then 3 emergency deliveries came in so they sent me home ( and I agreed) as I was 5 minutes from the hospital. I came in on my own the next day and had my delivery been imminent at the time I was originally there, they would have dealt but they definitely would have been very thinly spread.

DoGoodThenGo · May 16, 2015

A little perspective.....

New York City has experienced a boom in population as "white flight" has mostly ended and the reverse has occurred; families are choosing to move to/remain in New York City (especially Manhattan) instead of moving to the suburbs. Fine that is all very well and good.

The flip side is that many of these new "transplants" and or those already living here are middle (which would be upper middle to wealthy elsewhere) and or very well off. By and large even when they move to places like Brooklyn (which is experiencing a population explosion), they still return to Manhattan for their healthcare and that includes hospitalization. That or they go to Long Island for same.

NYC has lost about ten to fifteen hospitals to closures in the past decade or so, several of them in Manhattan. The dirty secret is that there are only a handful of NYC/Manhattan hospital systems people deem "acceptable"; New York Presbyterian Cornell, New York University, Mount Sinai, Beth Israel and Saint Luke's Roosevelt (the last two were once part of Continuum Healthcare network but were purchased and merged into Mount Sinai).

Saint Vincent's Hospital in Greenwich Village (now closed) had an excellent maternity service. Beekman Downtown (now NYP "South" campus) discontinued their maternity service years ago and so far don't think NYP has any plans to bring it back.

You walk around Manhattan these days and all you see are babies and young children. So you have all these moms to be basically almost all going to the same (few) hospitals with L&D service in Manhattan. Have seen heavily pregnant and obviously in labor women getting off the IRT subway at 77th Street (with husband and overnight bag) heading for Lenox Hill hospital.

Think the recent baby boom has caught many NYC hospitals off guard. For years the declining birth rate meant many places reduced or eliminated maternity service. That and the related high costs of malpractice insurance (parents and or an individual can sue for claimed injuries suffered at birth until 21 IIRC in NYS) meant places wanted to limit exposure.