Thursday, March 24, 2016

A Day in the Life on Labor and Delivery - 23 March 2016

(I am volunteering for 4 weeks with Project HOPE at the University Hospital in Prishtina, Kosovo. All opinions stated are my own and do not represent the positions, strategies, or opinions of Project HOPE.)

Obstetrics and Gynecology Clinic
Despite going to bed at 6:30 last night, I still woke up to my alarm at 6:30 feeling tired. I attribute that to the jet lag. I met with the head of the nursing department at 8AM this morning and also met with one of the Gynecology staff. I was brought up to the “normal” labor and delivery unit which is on the same floor where my apartment is. This hospital is quite busy as one would expect given that the average age of the population is in the 20s and >70% of Kosovaars are less than 27. They average 40-50 deliveries per day in the “slow” winter time and more than 80 per day in the “busy” summer time for a total of more than 10,000 births per year. There are 6 resident physicians who work here during the day (7AM - 2PM). They do three 24-hour call shifts (I think per week although this wasn’t clear) and at night, there are three residents present and three specialists. Once finishing high school, medical school lasts for 6 years after which they spend 1-2 years as general practitioners before they can specialize. Ob/Gyn is a 4 year training. There is not a specific training program per se but instead 4 years of training. They spend about 3 months in a department at a time. 

The view of my department
The first delivery of the day was a bit of a throwback to my very first day of residency. The woman was lovely. Women have to be at least 5cm dilated and have their water broken before they can be brought to the labor ward. Once there, they stay in a “labor” room with two patients per room and no curtains to separate them. Sometimes they have cervical exams in this labor room and sometimes they are moved to a separate checking room which has a half-bed and stirrups. Once a patient reaches fully dilated and is ready to push, she is brought to a labor room. These rooms are individual. No family is allowed in any part of the labor department. The labor bed is prepared for delivery by already being broken down with stirrups up. A bucket sits below the half bed to catch fluid and the placenta after delivery. The woman pushes, most often an episiotomy is cut, and she delivers her baby. This woman pushed like a champ and her baby came quickly and was placed on her abdomen until the pediatric nurses arrived. The pediatric nurses will dry the baby and weigh it and then wrap it in a series of blankets. In the meantime, the episiotomy is repaired. Epidurals are only available at the private hospitals for laboring women and are not available at this university hospital for normal labors. They do provide lidocaine prior to the repair. I held the woman’s hand as she pushed and watched her face light up with joy after her baby girl was placed on her abdomen. As the episiotomy was being repaired, I started to feel quite light-headed and really wishing I had figured out how to eat breakfast prior to starting my day. I let go of the woman’s hand, grabbed my coat, and walked to the end of the hallway where there was an open window and sat down. Shortly thereafter, several nurses and residents approached me and asked if I was okay. I was, just embarrassed. I sat for a while in one of the nurse’s rooms and received a very kindly lecture on how I just need to tell someone if I don’t feel well as they are more than happy to help me. 

I met several residents and went to their resident call room where we paused for a breakfast. One of the residents ordered breakfast for me from a local place which was delivered. We had our coffee, I had a chicken sandwich, and we had a leisurely breakfast. Then back to work.

The “specialist” (attending) does the checking of the patients at various points throughout the day. Nurse midwives do the deliveries and the residents do the repairs. They do not have enough fetal monitors for all the patients so most women have intermittent monitoring during the labor process. Some will have monitoring if they are complicated or demonstrate non-reassuring fetal status. The records are all kept on paper and like in the US, the residents are primarily responsible for the documentation. They also keep a large book with all of the deliveries from the hospital. They have between 4-6 scheduled c-sections per day and approximately 4-6 unscheduled c-sections. The c-section rate for the country is about 30%. One laboring woman was taken urgently for a c-section for a fetal bradycardia. There were no bells, no obstetrics team, just nurses and residents working very quickly to get the patient in a wheelchair to be wheeled down to the operating theater on the floor below. 

Many people are in and out of the room during the labor process and each has their set role. After delivery of the placenta, someone comes to mop the floor and replace the placenta bucket. The repair is completed, the foot of the bed is added, and the woman has two hours with her baby in this room before being moved elsewhere.

My Breakfast, Lunch, and Dinner with WiFi
I ventured out and found the cafe owned by a friendly man who spend several years in Britain. The food is delicious and cheap (2 Euros for a lovely greek salad, 0.50 Euros for a Turkish coffee, and 0.50 Euros for sparkling water) and the WiFi is excellent. The best part is that it is open from 0600-2200 every day except Saturday which means I have a place to grab breakfast in the morning!


My apartment in the hospital is the closest door on the left. The door to antepartum is on the right.
My room on the inside.

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