The Exhaustion of Hospital Midwifery

Haven’t updated in awhile. I blame the craziness of my job.  Seriously.  And I feel like very few people actually understand how bad it can get, unless you too are a hospital midwife on your feet 12 hours a day, triaging, admitting, delivering and then doing it all over again, and again, and again.

This past Monday was the craziest day I have ever worked in my 3+ years at my job, hands down, which is saying a lot because we’re actually a pretty busy hospital, and given that several nearby hospitals have closed recently and this past summer we got the contract for staffing the MIC clinics in our neighborhood, our volume has been going up lately.  The problem isn’t really the volume, though.  The problem is space, or lack thereof.  On Monday, for example, we actually did not physically have enough space to do our job correctly.  By the end of the day, triage was overflowing, there were at least 4 people waiting to get onto beds/ monitors and be seen, and we had no more rooms inside to put anyone.  The recovery room was full of women who were either triage patients or patients waiting to be admitted.  There were several women awaiting inductions–all for good reasons, such as diabetes or oligohydramnios or postdates–who couldn’t even start their inductions because again, we had no free rooms to put them into.  Thankfully there were a few empty beds on the Antepartum unit, so we admitted them and sent them to Antepartum to spend the night, with the hope that in the morning we could move them back over to Labor& Delivery to begin their induction.  If we had 6 triage beds, for example, instead of only 4, we could have done more about the backlog of patients waiting to be seen.  If we had 10 LDRPs (labor-delivery-recovery-postpartum rooms, i..e rooms equipped for births) instead of only 6 rooms, we would have had space to put some of the inductions.  If we had a few more quiet rooms (smaller isolation rooms which aren’t fully equipped for birth, but are good rooms for antepartum patients who need continuing monitoring, or patients on magnesium, or being kept for observation) instead of only 2, we also might have fared better.  But, what are you going to do when your unit is just physically too small to meet the demands of all of the incoming patients?

And don’t get me going about staffing.  2 midwives per shift.  That’s it.  2 midwives to take care of….8 laboring women, 8-10 women to be triaged, 4-5 women to be admitted…my head was aching and my brain was spinning by the end of the shift.  I literally didn’t know where to start or what to do first, there were so many equally imperative tasks awaiting my attention.  We also could have used a few more nurses too (there are generally 10 nurses per shift, but a few had called in sick).  The advantage to being a nurse instead of a midwife, though, is that as a nurse you are only assigned to 2-3 patients, and that’s it.  As the midwife, I’m responsible for the entire floor.  We could really use 3 midwives per shift, honestly.  Easily.

The icing on the cake came when EMS wheeled in a multiparous woman huffing and sweating in active labor, who was very clearly going to be delivering shortly.  And still, we didn’t have a triage bed or a LDRP to put her in.  She labored in the hallway with a small screen around her for about 2 hours while we hustled a recently delivered woman out of her LDRP and transferred her over to Postpartum.  When I checked the woman in the hallway shortly before the end of the shift, she was 9 centimeters dilated and about to begin pushing.  We didn’t have time to fully clean the newly vacated LDRP.  Instead, Housekeeping cleaned the bed only, we threw on a clean set of sheets, and got the woman into the bed, while the rest of the room remained dirty.  Not ideal, by any stretch of the imagination.  This was around 7:50. Our shift was finished at 8:00 pm.  I went to the board to give the poor, inundated nightshift midwives report.  I told them room ## was about to deliver, she hadn’t even been admitted yet, but one of them should get in there ASAP (which she did; we gave the rest of the report to the other midwife, who looked like she was about to cry).  I wish I could have stayed longer and helped out, but honestly, after 12 hours of such intensity, I felt like I was about to drop.  Thank god for shift changes and fresh midwives!

I had Tuesday off.  I slept until noon.  I was working again on Wednesday.  And let me tell you, one single day off is not nearly enough time to recover from the kind of exhaustion that a shift as crazy as Monday can create.  It’s not just physical exhaustion (although there is plenty of that); it’s mental exhaustion, too.  It’s trying to balance the information and histories and stories of all of these women in your head at the same time, keeping track of so many patients, and then figuring out who needs attention first; it’s taking histories and writing up admissions and putting in orders for nurses, and getting requests from nurses for such-and-such patient down the hall while you’re trying to admit such-and-such patient in triage and find the doctor so you can present such-and-such patient to her because you think she needs yadda yadda, and you forgot to put the orders in for that other patient who needed an expedited HIV test, and then there’s a sudden deceleration in room ## so you have to drop everything you’re doing, run into the room, check the patient, turn her on her side, put in and IUPC or ISE as needed, call the attending, present the patient to him (dredging the  information up through a cloud of other patients…was this the one who was being induced for oligo, or the one who had come in ruptured for 2 days who’d been on pitocin all afternoon?), and then as the decel recovers, grabbing her chart, writing a quick note about what you just did, then heading back to triage again to try to pick up the admission where you’d left off, except that a different nurse is now tugging on your sleeve telling you that the patient in ## feels like pushing, and can you please come check her? That’s the kind of exhaustion I’m talking about.

And I wish I could say Wednesday was loads better.  It was a little bit better.  Slightly less frenetic, slightly less overwhelming, but only slightly. At least we weren’t overflowing, with too many patients and not enough beds to put them on.  But even so, I had three deliveries, and the other midwife had three deliveries too.  6 deliveries in 12 hours is not exactly a slow day.  The very first delivery of the day was a woman who came into triage fully dilated and ready to push.  Again, not a single LDRP to put her in, so we brought her to the operating room and we did the delivery in there.  That was at 8:50 am.  The next delivery I did was around 1 pm.  The last delivery was right before I left, at 7:30 pm.  Welcome, Antonio, Jayden and Natalia! And at least we got to eat lunch on Wednesday, and sit every now and then.  Big improvement over Monday.  But seriously.  And then clinic on Thurs and Friday…which is certainly easier than Labor & Delivery, but still not exactly a piece of cake.

It was a killer week.  Truly.  And don’t think I’m complaining, since I do really, honestly, unabashedly love my job….but only trying to explain how amazingly, gut-wrenchingly exhausting it is.  I have 4 days off now.  I feel like I will be sleeping for most of it.