Going into Labor in the Emergency Room

[belial.1980]

Is anybody out there familiar with ER protocol when it comes to a woman going into labor suddenly? Let's say she comes into the emergency room after normal hospital hours, apparently in labor. How urgently does an ER staff typically rate the situation and what sort of measures would they take to ensure a successful delivery? Does her emotional state play a role in how the situation is addressed? For example, if she's outright hysterical are they likely to admit her more quickly? Or will she have to sign the necessary insurance and liability paperwork before they'll even look at her? 

If anybody knows anything about this, or has experience, any advice is much appreciated. Thanks in advance!
 

[Snowleopard]

Not any practical experience here belial but admittance, I think, does depend on the frequency of
labor pains, how far her cervix is dilated and most importantly how high risk her pregnancy or
her own health is.  A first timer is more likely to be more closely watched then someone who's been
there before.  You might see if you could find an accommodating ER nurse or Paramedic to give you
the real scoop on procedures.

[meg_evonne]

I've got this one for you belial. My daughter-in-law is presently working delivery for methodist in des moines. Before that she worked Univ of IA mother/child floor, catching and rating the new wee ones.

I've cut and pasted your question to her and she will reply when she can.  She'll have more questions for you, I'm sure.

1. Does she have a medical history that might pinpoint possible problems?
2. Is this her first or second (or later) pregnancy? (First, no med notes--they'll wait it out I guess, but 2nd, especially if they had to play tag football in the elevator with her the first time? Immediate--assuming someone bothers to read the notes timely.)
3. Does the doctor know she's coming in prior?
4. Is there someone with her that can fill out the paperwork while she is attended, or is she on her own?
5. How full is the waiting room and the ER beds? I'm sure if you make a big enough hassle, if they have ER slots, they'll get her out of the public areas--unless they think she'll behave better in public.

Those are my first questions. My daughter-in-law will have more.

[belial.1980]

Thanks so much for your input, Meg. I feel bad because you've put so much thought into my question and I just realized I should have been more specific about what I'm looking for.

Here's the situation: Protagonist and his shape shifting demonic cohort have just gotten involved in a mystery that leads them to a hospital in the early morning, well after visiting hours. Time is of the essence so they can't dally. They need to get in there and examine the victim of a supernatural attack.

Instead of simply breaking in, it occurred to me that it would be funny for said protagonist and his familiar to pose as a pregnant couple and gain admittance through the ER. (This premise is **hopefully** a lot funnier once you know the characters.) Their plan is to get into the emergency room then sneak off into another wing of the hospital to find their victim. It's definitely not the best plan but it's just the sort of thing that they would come up with.

I've written it so that they come in with the demonic shape shifter posing as a hysterical woman in labor and the protagonist posing as her trailer trash baby daddy. They make enough of a scene that the nurse takes them back into a room where she can take the "expectant mother's" vitals and get a better bead on the situation. She immediately discovers that the expectant mother has a temperature of 106 and absolutely no blood pressure whatsoever. The puzzled nurse hastily excuses herself to grab another sphygmomanometer so she can take another BP test on her patient. This provides the opportunity for the characters to slip off into the main wing of the hospital and go searching for their victim.

I was trying to get information about ER procedure to see if the way I wrote the scene is plausible. Any thoughts or suggestions? Thanks again!

[Quantus]

Well, until we here back from Meg's DIL, lets think of it from the Con's perspective. If I were sneaking into a hospital, I'd want it so the nurses will get us out of the waiting room and into the restricted areas quickly.  But you wouldn't want the birth to seem so immanent that a bunch of hospital staff would swarm and not leave us alone.  So Id probably have the "mother" being relatively calm but obviously having the contractions water breaking etc that says teh baby is coming, while it's the "father" who is freaking.  Then they'd want to get us out of the waiting room, but just to calm him down and get him out of the way.  Mention that they'd already had a miscarriage or two and Id think they will at least take his worries seriously enough not to leave them in the waiting room (for liability if nothing else), but if the other signs (contraction timing etc) point to the birth still being a while off they wont feel so much urgency that they wont be willing to leave us alone. 

Nurse - "Lets get you into a room, and I can get you something to help you relax"
Father - "Goodgood-Wait, is that safe for the baby?!?"
Nurse - " I meant for you, sir..."


Just my 0.02, but thats all without any first-hand hospital or baby experience, so Meg will be able to tell you more details about the actual protocols they go by. 

[meg_evonne]

Here's what Lindsay sent. Hope that it helps.

Sorry it's taken me so long to reply but I wanted to answer on my regular computer which I'm not on very much. The answers to these questions will vary depending on if it is a larger hospital like methodist or the university of iowa or if it is a small town hospital that doesn't do a lot of deliveries. At Methodist, pretty much as soon as a pregnant woman walks in to the ER, she is sent upstairs to labor and delivery with someone from the ER escorting her. Once she is on our unit, she is taken to a triage room. If she looks uncomfortable at all, we hook her up to the monitors quickly and assess her but even if she's not uncomfortable, she is seen fairly quickly. The paper work waits until she is more comfortable or delivers or if there is someone with her, they will fill out the paper work if there is time. On the off chance that she waited too long to get to the hospital and is unable to be transported even by bed to our unit, our doctor and nurse will run down to the ER and deliver her there but this is extremely rare. Let me know if you need more specific information.

Lindsay

[Quantus]

My sister-in-law is currently having contractions on the first of the new generation of our family, so I might have more relevant info to share tomorrow :-D

[Fyrchick]

Hmm... adding to Meg/Lindsay said, I can add a slightly different option.

Thinking about the largest L&D/Children's hospital in my area, the BEST way to bypass normal ER admitting and security procedure is to come by EMS. (I've had 3 pre-term patients in the last 9 months-all went DIRECTLY to the floor and admitting met them there, rather than stop in the ER.) In the case of pre-term or imminent labor or delivery, the EMS crew will (ok, SHOULD) do a complete report before getting to the ED. Depending on the situation a team will meet them in the ED or we will go right to the floor. (Most ER staff is like, "Baby? Pregnant? Get the hell out of here and to L&D!!! Quick! Go!")  The trick is to have something that gets you to the floor but not under the immediate attention of the staff etc. Pregnant people in labor get A LOT of attention.
So my first suggestion would be for your protagonist to pose as an EMS crew, not the patient. They are there all day, and the private transport crews take people OUT or to and from appointments all day, from all over the hospital. That is normal and rarely questioned. You can have someone on the stretcher or not. You can have them go to the victim's room, pretend they are they to transport or whatever... then the staff will have to go check etc etc. You might even be able to check the chart that way since EMS has to do a run report with basic medical info anyway, so they usually have to see the chart... again, wouldn't normally be questioned.

Another option is the "getting lost" approach. Go in as EMS, pretend you are there to pick someone up, OR are from out of town and dropped someone off and got lost getting out. Happens all the time in the big places.
(The same applies to wheelchair van transport.)

Depending on how accurate you want it, PM me and I can answer questions if you want. 

[Snowleopard]

Hmmm, how about smaller hospital - one protagonist poses as EM and the other as a pregnant woman.  He can come in, give name of doctor that he's seen on a chart, and head "her" up to L and D.  You still maintain the humor of the 'pregnancy'.

[David one Mutts Friend]

I know when  I was working Emergency room back in the 80's when ever we had a delivery come in either by POV or ambulance, the standard question was how far apart are the contractions? Any thing over a minute they were rushed up to L and D. Under a minute a L and D nurse was dispatched down to the ER with a O2 warmer/bassinet as to transport said delivery to the nursery.
But we had a lady who every year came in and delivered in the ER lobby, three years running last year was a pool on it, got to be close to 200 dollars. Sadly I did not win it.

David

[meg_evonne]

My sister-in-law is currently having contractions on the first of the new generation of our family, so I might have more relevant info to share tomorrow :-D         SO How't go? :-)

[belial.1980]

Thanks again to everyone for all their suggestions!

My sister-in-law is currently having contractions on the first of the new generation of our family, so I might have more relevant info to share tomorrow :-D

My best wishes go out to your family and their newest member!