No Room At The Inn

12.23.10: What happens if your maternity unit is full or there aren't enough nurses?


Imagine you’re nine months pregnant and in early labor with your first baby. You’re traveling far from home because some pesky governmental tax-census thingie demands you show up at the bureau office in person. Your car is out of gas and the wagon’s missing a wheel so you end up taking the donkey. Your back hurts, contractions are getting closer and you’re kind of fuzzy on what exactly you’re going to do when your water breaks. Your husband said he’d handled all the lodging issues and packed everything you’d need to deliver the baby.

As you lumber towards your late-night destination, your husband breaks the news: “Uh, hon…I totally forgot to make reservations at the inn. Don’t worry about it though because I’m sure my cousin’s wife has an extra bed. If not, then I’m positive my college buddies will clear off the couch or, we could stay at a bed and breakfast. That’d be nice, right? Right? Are you mad? Are you sure you’re having that baby tonight ‘cuz, seriously, tomorrow would be a lot more convenient.” You burst into tears (which totally makes your husband feel worse) and tell him, “You better figure something out pronto, buddy, because this kid’s coming and I’m not having him on the side of the road. Got it?”

Well, you know the story. The cousin’s wife had her own problems. The college buddies didn’t have a couch anymore and that B&B? Everybody else had the same idea. No room at the inn. So, they hunkered down in a barn (well, technically a manger), piled up some clean straw, got into a side-lying position and did what had to be done. We never find out what they did with the placenta, if there were any tears, complications or if, in fact, the husband really had packed all the birth supplies. Despite the odds, the couple apparently maintained a close and loving relationship for the rest of their days, and that whole “birth in a barn” thing made for a great story, even if it was eventually overshadowed by their son’s career and accomplishments. Still, they give us a little perspective on how to have a baby when the setting isn’t exactly perfect.

What happens if there’s no room at the inn you’ve booked for your perfect delivery? It doesn’t happen very often fortunately and rarely (if ever) in the biggest hospitals, but occassionally, the hospital maternity unit fills up. There aren’t enough rooms or nurses available. Nobody’s happy when this happens – not the patients, doctors, midwives, nurses, hospital, families…it’s a mess and yet…it happens. Here’s what hospitals do.

When the maternity unit reaches maximum capacity, there aren’t enough nurses to keep everyone safe, or there aren’t enough patients going home in time to make space, then the hospital can’t admit new patients. So, the nurse manager starts making calls. They clear space in other areas of the hospital, (like the medical/surgical or gynecology departments) and transfer their “oldest” patients (the ones who delivered a day or two ago; not the ones most recently delivered). They call patients scheduled for non-emergency inductions and c-sections and postpone them. This really annoys patients and their families, but what else can we do? We can’t exactly kick patients out to make space for new ones.

We contact maternity units at other nearby hospitals to find out which ones have available beds and nurses Then we call the midwives and obstetricians and give them the bad news: “Don’t send any laboring patients our way.” Oh, this makes them so mad, but again…what else can we do? Those doctors/midwives have to divert their patients to other hospitals where they can deliver them. If they don’t deliver anywhere else, their patients may still have to use a different hospital, but they’ll be cared for by the obstetrician-on-call. Nobody likes this. Believe me, it’s not intentional. We’d much rather keep our own patients then send them off to deliver at an unfamiliar hospital, but sometimes it’s all we can do.

In cases where there is no other hospital, staff scrambles to piece things together. We call in extra nurses, management staff and nurses from other departments. Nurses who are already working stay overtime for the next shift or for as long as they can before they become exhausted and unsafe. They take on extra patients and fly around like superheroes, attending birth after birth and doling out pain medicine here and breastfeeding advice there.

Years ago I worked in a crazy-busy, giant-sized, inner-city hospital and there were many nights when we worked in “old woman in the shoe,” mode. We delivered so many babies we didn’t know what to do - in hallways, emergency rooms, and operating rooms; basically anywhere we could find clear space.

It’s not uncommon during nasty weather that many nurses can’t get to work on time. On more than one snowy night, my team of nurses worked a twelve-hour night shift and when 7AM finally arrived, there was literally no relief in sight. We just kept working, fueled by donuts, caffeine and adrenaline. It’s not a perfect situation, but hey… somebody has to deliver the babies, and it certainly beats birthing in a barn. If our patients can cut us some slack, it helps a lot. Try not to get too mad at us if we can’t make things perfect. We’re doing our best and we’re all in it for the same thing: A safe birth and a healthy mom and baby.

Happy Holidays everyone and may your births be safe, blessed and remembered for generations to come.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to and it may be answered in a future blog post.

This Fit Pregnancy blog is intended for educational purposes only. It is not intended to replace medical advice from your physician. Before initiating any exercise program, diet or treatment provided by Fit Pregnancy, you should seek medical advice from your primary caregiver.