Hospital Maternidad

Week number 2 of my clinical experience and I am working at Hospital Maternidad, one of the main birthing hospitals in Quito. They have approximately 30 births a day and they also have an emergency room for pregnant women with emergencies.

Here is a picture of the hospital

Here is the emergency entrance.

My preceptor's name is Dr. Marquez. On the first day I put on my green scrub outfit and joined the other students, residents and attendings for morning rounds. The birthing area of the hospital has 5 main large rooms and 4 smaller rooms that are used for the actual births. One large room is for all of the laboring women with complications (pre eclampsia, gestational diabetes etc.), one is for all the laboring women without complications. There are two rooms filled with women who have already given birth and then there is one room for women who have had miscarriages. There were many differences on the maternity ward compared to the United States but I think the two biggest differences were 1) All of the women are together in one room with absolutely no privacy and 2) Non of the fathers or any other family members were allowed on the floor because there simply is not enough room. Some of the birthing moms are as young as 15 and 16 and to think of being that young and all alone giving birth, it must be very scary for those girls.

Rounds are a lot like rounds at home. We move from patient to patient and one resident presents the patient, the attending checks to see how dilated they are and then the whole group of medical personnel move on the the adjacent bed. My comprehension during rounds is maybe 10%. Huge plummet in comprehension from the week before. But when I talk directly with one of the residents or students it is easier to understand.

When the patients are fully dilated and they have pushed a few times in the communal room, the residents run the gurney into one of the birthing rooms yelling "parto!" (Delivery!). At this point one OB/GYN resident and one Pediatric resident get ready to receive the baby, the mother transfers herself from one gurney to the birthing table with stirrups (exactly like in the US) and within a few pushes (or maybe more) the baby is born!

Here is one of the birthing rooms ready for a patient.

The baby is then taken to the nursery to be checked and cleaned. The pediatrician brings the baby in one more time to see the mom and then I don't think the moms see the babies until they are discharged which is a minimum of 48 hours after giving birth.

On the first day, the floor was very empty (I wouldn't know this until I saw what it normally looks like) and I actually left an hour early because there was nothing for anyone to do. On Tuesday, it was extremely busy with all of the beds touching one another and many postpartum women spilling out into the hallways.

Here is a picture of the hall. You can't see it in the picture but behind all the students sitting on the left there are a few beds lined up in the halls containing postpartum women.

On Tuesday I counted 12 women in beds and 4 women on chairs waiting for beds. It was crazy and I went to work recording vitals and hooking up fetal heart monitors and measuring the number of contractions in 10 minutes and how long they last. I watched numerous births on Tuesday too. In the labor area there was one 17 year old who was having a baby with anencephaly which is when the skull does not form over the brain. Even though abortion is normally illegal in Ecuador, having a baby with anencephaly is one indication for a legal abortion. The resident told me that the family had petitioned for the patient to not have an abortion and to go through with the labor and birth even though the baby will never survive for more than a few hours.

On Wednesday I teamed up with a first year resident named Diana and she helped me deliver a baby! I was so happy. The patient was 20 and it was her first baby and she was not happy with the fact that she was in labor. Oh, I forgot to mention, huge difference number 3 is that no one gets an epidural. Diana was seated and made a whopping episiotomy (difference #4, episiotomies are common for first time mom's at this hospital even though a pediatric resident told me they are not indicated just like in the U.S) I hovered kind of to the side of Diana and caught the baby and delivered it to the mom's belly where the pediatrician took over. Then Diana repaired the episiotomy. And there were 5 Ecuadorean medical students watching this whole scene. haha. The baby would be named Eduardo and he was pretty tiny. Only 2330 grams which is a little over 5 pounds. Diana said that the next day I could do more during a delivery!

And then, on both Thursday and Friday mornings there were no deliveries at all! I was so bummed. What are the odds? But there were other things going on and I continued to make myself useful. Friday there was an emergency postpartum hemorrhage repair which was pretty hectic and there was no OR tech so things were getting very messy and I tried to help as much as I could in my limited Spanish.

Here is a picture of me with Diana and 2 other residents.

I really loved being at hospital maternidad and did not want to leave. The first day I was a little shocked by the communal birthing and the fact that the residents and students don't have a place of their own to hang out and end up hanging out in the communal birthing area which would probably be really annoying when you are in so much labor pain and there are some young doctors laughing about their weekends. But, I quickly became used to the scene and realized that this is just the way it is in Ecuador and especially at the free hospital where people without insurance go. At Kaiser, the residents had their little area where they hung out and were able to monitor all of their patients constantly with fetal heart monitors. Hopsital Maternidad only has 2 to 3 fetal heart monitors so you need to physically be with your patients and the best way to do that is have everyone in the same room. And maybe an Ecuadorian woman or doctor would go to the United States and think it was really weird to be isolated in a room with your husband during labor. Who knows what they would think about that.