Dear Dr. Bill,
Many years ago, my ex-husband and I had a clinic in very rural Mexico. It was a four hour ride on washboard roads to the nearest paved road. We did have access to a short-band radio to call for a small plane in extreme emergencies, unless it was raining and the canyon was full of water rushing at a pace to carry boulders, cars, animals, etc. On this note:

It was a dark and stormy morning when Juanita came to the clinic to deliver her sixth child. We had no provisions for performing c-sections and so she labored unproductively for twelve hours. The canyon roared outside our window. No chance of crossing the torrent, even if a plane could land in the caliche mud. The landing strip was on the other side of the canyon. Juanita never cried out in pain but I could measure her contractions by her clicking fingernails. We finally started a pitocin drip. We monitored her vitals every 15 minutes all through the night. Her cervix had been scarred so badly that it would no longer dilate. Finally, my husband manually dilated her and Esperanza was born nearly 24 hours after Juanita arrived at the clinic. Soon after, the rain ceased. Juanita had her tubes tied the next month.