Do you have an OB in the hospital 24/7?

[adpiRN]

I used to work L&D at a large teaching hospital in NYC. We had residents and at least one OB attending physically in the hospital 24/7.

If an OB was on call at home for their group and a labor patient came in they usually came in right away.

But honestly it was so busy that "on call" usually meant "at the hospital"

If an OB had a patient getting an epidural or they wanted to induce with cervidil or pit they had to physically be in the hospital or ask another attending to cover their patient.

I recently started working PRN at a smaller hospital in the South and it is SO different.

They hardly ever have residents and OBs are hardly ever in the hospital, especially on nights.

There is no protocol that there has to be an OB in house when patients are getting epidurals or being induced. It's crazy to me!! And feels so unsafe.

Nurses manage the whole labor. Can even put in an order for pit based on a verbal order from an OB. Doctors check in via phone on their patients progress and usually arrive when multips are fully or after primips have been pushing for awhile.

What really blows my mind is if they had a REAL emergency on night shift (abruption, prolapsed cord or FHR in the 60's and not recovering....) there would be no one to do a stat c-section. The closest OB could be 15-20 away. That is too much time!!

I've decided to leave this job for a variety of reasons (this being one of them) so I'm not looking for advice on how to adjust.

I'm just curious if this is how L&D is in most of the country.

It feels to me like a disaster waiting to happen and I want OUT ASAP.

[ReneeRN0521]

I work at a hospital that does have 24/7 laborist coverage, but this is fairly new (within the last 2 years). We did about 4300 deliveries last year which was the most in the state. The laborist is not a substitute for the patient's OB. We still communicate with their OB for updates, orders, etc and they are not usually in house. We do have anesthesia and our OR staff in house 24/7. We have never had to have a doc in house for epidural placement and usually the patient's OB or the one on call for them doesn't show up until complete and/or pushing. The laborist is there for STAT sections, precipitous deliveries, unassigned patients, and transports that we have accepted from outlying hospital. They also occasionally cover for other OBs when they have a VBAC patient so they don't have to stay at the hospital the whole time they are in active labor.

[beachmom]

No, we don't have a 24/7 OB. Luckily all our OB's live 5-10 minutes away, and they can park right next to LDRP. The clinics are across the street - 2 minutes away. Our peds live farther away, 10-20 minutes. All of us are expected to be skilled with NRP. The next nearest LDRP is 2 hours away, so we do our best. Some of are CRNAs (anesthesia) live 15 minutes away, and that's scary. We have a "stat C/S box" in case the Dr. needs to get a baby out with a local. We all hope and pray we don't have to use it. It was used once in the past, and it was quite traumatic for the pt and the nurses.

We have about 600 births/year. Not enough to pay for a 24/7 Dr. or CRNA. Although there is a 24 hour hospitalist if we have a medical problem. Doctors don't have to be in house for epidurals or inductions. Never heard of that. They have to see the pt. at teh start of an induction, and they all answer their phones quickly. Doctors and anesthesia both have to be in house or at the office (2 min away) if we do a VBAC. We have sleep rooms if they need it.

[NurseNora, BSN, RN]

I spent 30 years working in big city, high risk, teaching hospitals where the nurse had to fight her way thru the med students, interns, residents, and attending a to get to her patient. When I moved to a rural hospital with no OB in house, I was really scared. It took a while, but I developed new reflexes. The nurse has to be on her toes and pick up problems early. She has to develop a good relationship with the providers, a real sense of mutual trust. It's a different world. I'm glad I've experienced both.

[stephncal544]

We do not have an OB in house, We do not have Anesthesia in house. And starting soon we will not have Neonatalogists in house. We have 1-6 deliveries per day. The docs do not show up for triages unless very serious, nor for pitocin or epidurals....Soon I will not be in the house. :)

[Kimberlee1225]

I currently work in a hospital in NH on the L&D floor. We use midwives here mostly. Often there is not an OB on the floor. They are able to access our EFM from home and they all are required to be within 30 mins away (most are much closer than that). They frequently monitor the strips at home, but they are rarely on the unit itself let alone in the hospital after clinic hours. Having been trained in bigger hospitals in MA this scared me to no end initially (we also do not have neonatologist and the pedi's play by the same rules as the OBs). As I've grown as a nurse however, I find it at times empowering. I feel as though I've learned so much more from the midwives and from having to be more independent. We don't have a NICU either. Obviously we do not take high risk pts but as we all know that's well and good to say but doesn't always happen. My assessment skills are stronger than they would have ever been staying in a bigger teaching hospital. I understanding that it can be scary though. As it is, we recently had a placental abruption that resulted in an emergency c/section at 28 weeks. Scariest day of my life, but in the end DART drove a breathing, crying very much viable 28 week newborn after we resuscitated her and stabilized her for over 2 hours. I guess this is just a long-winded answer to your question. There is at least one other hospital that operates like this, and yes it can be very scary at times. If you have a good team of nurses and providers and communication remains good it can be empowering. I too have about 3 years of experience in the field and feel as though I am much stronger having worked in a smaller hospital like this. Teaching hospitals are awesome and you will see things you don't typically see so if you are more comfortable with that then I think it would be a better choice for you. If you can work through the initial nerves and be confident in your skills and your team than a smaller place can be a good thing too. It has more to do with the individual dynamics of the unit, I think.

[SoldierNurse22, BSN, RN]

I work in a pretty big facility (~2500 births per year) and it was only around when I was hired that we had an OB in-house 24/7 for the first time. Prior to that, trauma surgeons in the ER were on standby for anything emergent that walked through triage or went super south super fast on the unit. We did (and do) have in-house anesthesia.