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San Luis Valley Hospital Delivers When Families Need Obstetric Care
9th April 2024 • Advancing Health • A Podcast from the AHA
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Rural hospitals in the United States are struggling to maintain obstetric services, and in the last five years more than 300 birthing units across the country have shut down. San Luis Valley Hospital is fighting this trend, implementing creative strategies to keep obstetric services open for their communities. In this conversation, San Luis Valley Hospital's Monica Hinds, R.N., director of emergency services and obstetrics, and Stephanie Posorske, certified nurse midwife, discuss their approach to cross-training units with minimal resources, and partnering with community stakeholders to keep the lights on for new and future families.

Transcripts

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Tom Haederle

Changing demographics and financial pressures pose challenges for hospitals, especially those in rural communities, to maintain obstetric services. In the last five years, more than 300 birthing units across the country have shut down.

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Tom Haederle

Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Despite today's many challenges, some hospitals are implementing creative strategies to maintain necessary obstetric services for their communities. San Luis Valley Hospital in rural central Colorado is cross-training its clinical staff and partnering with community stakeholders to keep serving their community. Julia Resnick, AHA's director of Strategic Initiatives, recently spoke with Monica Hinds, an RN and director of Emergency Services and Obstetrics and Stephanie Posorske, a certified nurse midwife, about their approach to maternal care for the San Luis Valley community.

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Julia Resnick

So, Monica, Stephanie, thank you both so much for joining me. Let's start with some background about each of you and San Luis Valley Health. Monica, I'll start with you.

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Monica Hinds, R.N.

I am new to nursing. I've been a nurse for about ten years. This is my second career. and I attribute my nursing drive to OB, actually. When I had my kids, the OB nurses here at San Luis Valley Health were awesome, and I felt like that's what I wanted to give back to the community. So that was a little bit about myself.

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Monica Hinds, R.N.

I have been overseeing the OB department for the last 4 to 5 years, I think is when I took over. I was, originally, an emergency room nurse. Became director of the emergency department, and then just sort of, fell into the OB leadership position as well.

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Julia Resnick

So can you tell me a just a little bit about the community that is in the Valley?

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Monica Hinds, R.N.

Alamosa is the central hub of the Valley. We do service several communities throughout the area, the San Luis Valley. And we are the only location that does labor and delivery. And so everyone does come to us, or they go outside of the valley for their OB needs.

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Julia Resnick

Got it. And what kind of pregnancy care does your hospital provide?

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Monica Hinds, R.N.

We pretty much do everything. Because even if we cannot manage the patients here, we make sure that we get them to that higher level of care. So we do have the C-sections, we do induce, we do have a local midwife that does deliver outside that we do support as well for her needs.

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Julia Resnick

And tell me a little bit about the community stakeholders and partners that you work with, both for prenatal care and postpartum care.

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Monica Hinds, R.N.

So we do have valley wide. They are also part of our labor and delivery department. They do manage their own patients. Do their own deliveries, do their postpartum care as well. And then we do have our ObGyn clinic here that, manages our patients for our hospital.

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Julia Resnick

So turning to you, Stephanie. I know that there are a lot of challenges faced by rural communities, especially in terms of maternal care. So can you talk about some of the challenges, that expectant and postpartum moms are facing in your community?

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Stephanie Posorske

So, interestingly enough, I think that social media has changed this significantly in the last ten years in the sense that everybody knows what's out there, and then what's that availability here? So they're, you know, they want to know, like, can I have an epidural? And yes, they totally can. And being able to meet those needs.

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Stephanie Posorske

I think that we do a really good job of finding the niches that are really important. For example, women really worry about being able to have a lactation consultation. And while we don't have a specific lactation counselor, that that's just what they do. I'm our hospital's lactation counselor, on top of being a certified nurse midwife, so that we can still meet those needs without, you know, having to expend our resources.

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Julia Resnick

Got it. And, you know, every day we're hearing about more OB units closing down unlimited access in rural communities. But you all are some of the rare ones who are managing to keep yours up and running and serving your community. So can you tell me about what strategies you're implementing that's able to keep your maternity unit open and thriving?

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Monica Hinds, R.N.

We are seeing a decrease in, deliveries per year as well. And to be able to make our department managable as far as financial, we've really had to think outside of the box on what we're going to put on that unit. So we have expanded our unit to that surge overflow unit. We have implemented pediatric patients on part of our unit.

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Monica Hinds, R.N.

We do some post-surgicals that are not Ob-Gyn related on our unit. So we really have grown our OB nurses into well-rounded nurses that do everything. And so we give them a lot of credit for the knowledge that they've had to obtain over these last few years just to be able to care for our patients in our community.

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Julia Resnick

That's really wonderful. Stephanie, anything else you want to add?

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Stephanie Posorske

Yeah, I think that there has come a lot of flexibility and changing our expectations of what works for people, and that that's what like all these units that have been able to stay open have had to do...is that we've had to become more flexible as an employee, but also the employer has had to become more flexible on what meeting the needs of everybody's situation so that we can keep this resource available.

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Julia Resnick

That's great and wonderful that you're all willing to be so adaptable as you're trying to make your way through this. So besides clinical services, we know that a lot of rural women are also experiencing challenges around behavioral health, such as substance use, and other issues related to social determinants of health. So how are you addressing those issues in your community

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Julia Resnick

especially for pregnant and postpartum women?

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Stephanie Posorske

I think I can answer that. So I prescribe Suboxone, which is for people that use opiates. And on top of that, like being a great resource for people that use opiates so that they can hopefully get off opiates, it also opens the door for all avenues of people knowing that we're open to doing that and what we can do to help.

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Stephanie Posorske

I think we really want to get out there this idea of like, we want you to come in, we want you to get care. Despite all of these challenges, whether it's for behavioral health or because you use some substance, we want to be the doors are open because this is an opportunity for us to capture people that are using

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Stephanie Posorske

and it's when they're going to be most motivated to make a change in their lives. And so keeping that door wide open is the best way to do that and hopefully is working.

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Julia Resnick

Monica, anything you want to add?

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Monica Hinds, R.N.

So I would really like to add we do depression screening on all of our patients - no matter if they're observation patients or inpatients, postpartum in the middle of their pregnancy - just so we can try to catch these patients early enough to be able to give them the resources that they need. We have also really focused on our social determinants and making sure that we're asking those hard questions of patients, you know, do they need some help with housing?

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Monica Hinds, R.N.

Do they need transportation? Is food a difficulty for them at this point in time? And we have great care coordination that actually will follow up on all of those patients prior to them being discharged to make sure that they're providing them the resources in the community that they need.

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Julia Resnick

And yeah, I think you're both really getting at this idea that, like, these are sensitive questions and sensitive topics for people and keeping that door open so that they feel comfortable coming to you and asking for the support they need is just so crucial. So we always love stories that can really bring this to life. Do you have any stories from your hospital or patient stories, that can help bring to life the work you're doing?

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Stephanie Posorske

I have a patient. She's had a baby already. Her and her partner have had times where they've used either fentanyl or opiates. And that door has stayed open to them, despite their not always being as compliant as we would like them to be. But they continue to come see us. Another provider in my clinic sees her husband so that we are both taking care of both of them and their substance use.

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Stephanie Posorske

It's just lovely for them, like to have their baby, and for us to be continuing to work on this medical problem that they have. And it's not black and white and it's not it's not super easy. But every time they bring that little baby in and that they're still together and that they're still coming is exactly why that that door has to stay open.

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Julia Resnick

Absolutely. And clearly the motivation is there. Yeah. And it's wonderful that you embrace them. Monica, any stories from your world?

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Monica Hinds, R.N.

I don't have any specific patients. I mean, we do see when those those patients come in that have that substance use and and we're able to, you know, get them the resources that they need and be able to get them reunited with their baby, even if they aren't able to leave with them at discharge. But to be able to help them get that custody back.

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Monica Hinds, R.N.

We see it, you know, not daily, but we see it a lot. It warms our heart that we can help those patients get back with their babies.

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Julia Resnick

That is wonderful. So for other rural hospitals that are considering different creative avenues for providing maternal care, what advice do you have for them? What have you learned along the way?

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Monica Hinds, R.N.

I'm going to say that you have to listen to your staff. It's been very difficult making that transition from just being a labor and delivery nurse and moving into other fields. It's definitely a lot easier with the newer nurses that are coming out, because that has expectations set forth on employment. But for those those experienced labor and delivery nurses, taking that time to listen to them, about their concerns and what kind of education that they need to make sure that they feel comfortable in providing the care to patients that they haven't cared for, you know, since nursing school, probably.

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Monica Hinds, R.N.

So just stopping and listening to concerns is something that I feel that we can really learn throughout this transition.

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Julia Resnick

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Stephanie Posorske

Stephanie I mean I think that's really important. And like listening to your staff is how we will make changes together and not be like get all that pushback. And just like the adaptability like we talked about, we have to all be adaptable. We had to be adaptable in the sense that we brought these patients to our unit,

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Stephanie Posorske

that we sometimes have some med surge patients on our unit. But depending on what's going on on labor and delivery, we have to be able to change that. And I think all of our expectations have changed, and we've all learned to evolve with the situation. And that's the true heart of nursing and medicine is that we have to be able to evolve and change based on the patient.

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Stephanie Posorske

But big picture: How we evolve and have adapted and changed for our unit as a whole has been really how this has worked.

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Julia Resnick

That is an incredibly powerful message that I think we all need to to take in to the work that we do, that, you know, the world changes and we need to change along with it to make things work. So to wrap up, what's next for you all? And SLVH's is work in maternal health?

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Monica Hinds, R.N.

I'll let you go first, Stephanie.

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Stephanie Posorske

Well, you know, I mean, Monica knows that I always have all kinds of ideas and some of them work and some of them don't. But we, you know, we all move forward and with our ideas and, you know, like, I'd like it if we had nitrous is an option for our patients. And I think we're totally on the brink of getting that. We want to meet to the need of everybody

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Stephanie Posorske

which is a wide variety of people really here. And so finding ways that keep us safe and financially feasible, but also our meetings and needs and make us also feel like maybe we aren't as Podunk as sometimes we think, even.

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Monica Hinds, R.N.

Yeah. And I would definitely agree with what Stephanie is saying. We we do try to stay up with the times, but making sure that we are providing that safe environment for our patients and for our staff as well, and giving them those opportunities to continue to learn and grow in the field.

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Julia Resnick

Well, it's clear how dedicated you all are to your patients and your community and really making sure that door stays open to them. So I just want to thank you for the great work that you're doing to to support moms in your community and really appreciate your taking the time to talk with us today about your work.

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Julia Resnick

Thank you so much.

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Stephanie Posorske

Thank you for having us.

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Monica Hinds, R.N.

Yeah, thank you for sure.

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Tom Haederle

Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.

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