Sala de partos

Carly and Jemie (second year residents) were given the opportunity to observe four a few hours in the maternity unit at the National  Hospital in Huehuetenango next to Casa Materna.

We were greeted by Isaac, an OB resident, and given a short tour while waiting for deliveries. The floor is divided into three rooms: labor, delivery, and recovery for postpartum women. Additionally, there are operating rooms and a separate recovery room for Cesarean deliveries. Typically they have upward of 20+ vaginal and 10+ Cesarean deliveries in one day.

The labor room is a large open room with seven beds, full of many nurses and nursing students milling about. We learned about the admission and labor flow sheet that is used to document H&P data and to track progress of labor. The resident explained that many women present in labor without having had any prenatal care, so most of the routine labs are done on admission. Continuous fetal monitoring was not feasible as supplies were limited. We observed one resident using his stethoscope to check fetal heart tones. Women who are laboring towards vaginal deliveries do not get epidurals because there is not adequate anesthesia support, so only women going for c-section will get anesthesia. We watched several women progress to complete dilation before being wheeled into the delivery area.

In the delivery room, there were three stirrup beds. Women are placed in the stirrups and told to push.  We saw one woman who had a female family member with her, but no spouses were present. It appears to be expected that things progress very quickly at this point, and providers use fundal pressure maneuvers to push baby (including two men pushing with all their strength) down and primiparas frequently receive episiotomies. The three women we saw delivered within 3-15 minutes after arriving in the delivery area. After delivery, women are told to perform breast massage to stimulate oxytocin release, and intramuscular oxytocin is available as needed.

After delivery, women are transitioned quickly to the recovery room where they are observed for an additional 2 hours prior to returning to the maternity floor.

There is a heavy emphasis on medical education, as the students take a lead role in labor management, delivery, and episiotomy repairs with resident supervision; we did not see any faculty doctors. Medical school is six years long in Guatemala, and the students we observed were in their sixth year, so could be considered equivalent to first or second year residents in the US.