Women who plan to have a baby at Howard County General Hospital should not be surprised if they undergo labor in a hallway.
Deliveries at the county's main hospital jumped from 120 a month in early 1987 to as many as 170 by late last year, hospital officials said, and the crunch has forced nurses and doctors to use every available space, including hallways, for women expecting to deliver.
The head labor and delivery nurse at the hospital, Susan Kallini, acknowledged that the hallways are sometimes used, but said the hospital is still "satisfying the needs of the patients." She added that hospital officials estimate that births could soon hit 200 a month.
One labor delivery nurse, who asked not to be identified, said that as often as twice a week the department is so crowded that beds are moved into hallways.
Dr. Paul Valove, chairman of the hospital's obstetrics department, agreed that the six labor rooms are sometimes full and extra space is needed. "When it happens it is unfortunate," he said, but added that it is not practical to build or staff a facility to meet the demands of the busiest times that would then sit empty at other times.
He said that although women are sometimes placed in the halls, they usually are not in labor or in need of fetal monitors and special equipment. He added that the hall area often used is partitioned with a curtain and is used at peak times for women who have just finished delivering and women who have come for evaluation.
"I think it is a very good facility for a community hospital," he said, adding that the staff is the strong point. He said the doctors are all recently university trained in the latest techniques and the nursing staff has been increased in the past six months to meet the increase in births.
Officials said the situation in the maternity area is an example of how the hospital has been swamped by rapid developement in the county and the resulting population surge. According to Jean Fries, vice president for nursing administration, the hospital is operating at 100 to 108 percent rate of occupancy and is in the midst of a two-phase expansion project scheduled to be completed by December.
The first phase, which will cost $21.6 million, includes an addition and renovation that will improve the emergency room, the critical care unit, a surgical suite and the radiology, physical therapy and cardiopulmonary departments, and will replace 36 beds.
The hospital, which began as an overnight facility for the Columbia medical plan in 1973, has been so overwhelmed with the increasing demands for services that officials were forced to apply for state approval for the second phase of construction before the first was done
Gill Chamblin, the hospital's director of public relations, said that ther second phase will include 20 new beds for the hospital and a new administrative floor. The cost is estimated at $3.5 million.
However, neither of the projects includes expansion to the maternity area. Hospital President Donald J. Jacobs said the hospital plans to upgrade the maternity-related departments, but officials have not set a timetable for those improvements.
Jacobs and Kallini said the maternity crowding is difficult to plan for because delivering babies is such an unpredictable service.
Private physicians also have raised concerns about the level of services offered for newborns at the hospital. According to doctors and hospital staff, the hospital maintains a level 1 nursery, which is the term for a standard nursery for full-term, healthy babies. The nursery is staffed by private pediatricians, most of whom live and work five minutes from the hospital, officials.
But some pediatricians are concerned that the hospital does not have the facilities or staff to handle serious emergencies with newborns. Dr. Carole Parnes, a private pediatrician, said she would like to see the hospital bring a neonatologist, a specialist in newborns to the staff.
She said it is possible "that people choose ob-gyns elsewhere if they suspect high risk deliveries." Babies delivered at Howard County General with problems are transported to nearby hospitals, usually in Baltimore, with the necessary equipment and staff, officials said.
Head nurse Kallini said she does not believe the hospital a neonatal intensive care nursery, but said "They need to go to a higher level of care nursery."
Vaslove said that he also would like to see the hospital's facilities upgraded for newborns. He said the one shortcoming of the maternity-delivery departments is the absence of a nursery for premature babies born between 32 and 36 weeks. Forty weeks is considered a full-term pregnancy.
Valove said that babies under 35 weeks old born at Howard General are stabilized and transferred to St. Agnes Hospital in Baltimore. If the Howard hospital had a Level 2 nursery, it could handle these babies, he said.
Babies born between 28 and 32 weeks require much more specialized nursing and surgical care, he said, and it is better that they be taken to Baltimore hospitals. Women who are considered to have high-risk pregnancies are generally sent by their doctors to hospitals in Baltimore for the same reason.
As for a neontologist on staff hesaid, "It will not happen in my lifetime. It is too much of a financial burden."
Jacobs stressed that hospital officials hope to continue to improve the labor and delivery department. He said they are holding talks with the University of Maryland to set up a resident program in the nursery for a neontologist, although funding for such a project has not yet been determined. He said the hospital plans to boost the facilities in labor and delivery areas by adding a recovery room and possibly a Level 2 nursery in the future.