Amanda Wilde (Host): When you're pregnant, one of the best resources to know about is the Obstetrics Emergency Department. Just ahead, Labor and Delivery RN, Ashley Thomas, with St. Joseph's Medical Center explains how it works.

This is Hello Healthy, a Dignity Health podcast. I'm Amanda Wilde. Ashley, thank you for being here.

Ashley Thomas: Thank you for inviting me. I appreciate it.

Host: Well, let's walk through the logistics of this. Is the OB triage available 24/7? Do we need to make an appointment? How does it work in terms of those logistics?

Ashley Thomas: It is absolutely open 24/7, 365, all holidays. We are located in the Patient Pavilion Building that is right across the street from the main entrance of St. Joseph's Hospital in Stockton, California. Patients are welcome to come in at any time if they have any concerns regarding their pregnancy to be seen with the nurse and also our in-house doctors regarding any concerns they have regarding themselves or their pregnancy.

Host: So, it sounds like I don't need to necessarily make an appointment. I can walk in.

Ashley Thomas: Absolutely. Concerns happen 24/7, so nobody has to have an appointment to be seen.

Host: Okay. Well, will there always be a staff available to answer questions? And is there always a doctor available?

Ashley Thomas: There's always nurses and doctors available. Some patients may want to call the unit and ask a nurse over the phone if they should be seen, but we always recommend for patients to come in and be seen if they have any concerns. That way, we can physically assess the patient and the baby as well, and the doctor sees every patient that comes through our triage area.

Host: Which makes sense to come in rather than call. Although you can call first, as you said, but you really have to be seen. And that's what the triage is for, real people looking at real people. How long are the wait times to be seen and how long does a visit take?

Ashley Thomas: Wait times are variable, but I will say we work very quickly in our triage area to get moms seen in less than five minutes upon arrival. If we can, we accommodate every mama that comes in through our door. And it depends on the patient complaint of how long it will take to be seen and make sure patients are okay, either one to be discharged home or to be admitted and be observed overnight or have a baby.

Host: Well, I was going to say what will happen if I get admitted, but it sounds like almost anything.

Ashley Thomas: Absolutely. Babies control the show.

Host: And is it okay to bring a support person along?

Ashley Thomas: Unfortunately, in our triage area due to privacy, you know, in respect of other moms and women that come through our triage area, we don't have any visitors back there. But in any event that a patient gets admitted, we quickly try to move them to a room so they can have a support person with them.

Host: So maybe bring one along, but they might not come in with you just at first. And then, we'll see what happens next as far as whether one would stay in the emergency area, go to the hospital or go home.

Ashley Thomas: Absolutely correct.

Host: So, let's say I do get admitted, what can I expect to happen then as far as tests and things?

Ashley Thomas: it depends on what's going on. But as nurses and doctors, I feel like we work great explaining to the patient what the plan of care is for them, so they know what to look for during their visit. We do have those unfortunate situations when emergencies do happen and things do go quickly, but we still try to stay on top of letting the patient know why we are doing whatever test, admission, or any type of care that we're providing to them. We explain to them in great detail why and the benefit that they will have for themselves and their babies.

Host: And is there an opportunity to talk to our own doctor at that point if we are at that point with the emergency obstetrics department?

Ashley Thomas: We do have the opportunities for that. There's several groups and doctors that do come to St. Joseph's that we're very blessed to have on our team. If it comes to a point that some patients, they do want to speak to their own doctors and not our hospitalist that stays in house, and we try to do our best to accommodate that if possible and if the doctors are available.

Host: And we talked just a second ago about tests and you said that kind of depends on what's going on. So, I am now going to shoot you in sort of a lightning round some really common questions. Is that okay?

Ashley Thomas: Yes, ma'am.

Host: Okay. Here's the first one. How can I tell if my water broke?

Ashley Thomas: That is a very common question that we get from a lot of patients. Most people are used to seeing or think they're going to see that big gush of water that they drop the pail of water on the floor like what happens in movies. And it does not always happen like that. That is kind of rare that it may happen that way. Some moms may have like a slow trickle that they notice, like "I know I cannot be peeing on myself. This is just constantly coming out." And we do tell moms, you know, put a pad on so that way they can assess. But any mom that's concerned that they think their water broke, we always tell them to come in, and we can do a test. The doctor can visualize and look. And if it's positive for the test that we do, then hey, we have a baby. And if not, then at least moms can be at home and at rest to either know it's regular pregnancy discharge or, you know, those good old active babies can hit that bladder one good time and that can happen as well

Host: Okay. How do I know if I'm actually in labor?

Ashley Thomas: Labor is very variable. Some moms that have had babies before, they know what their body feels like when they're going to have a baby if they've had babies before. But typically, a good labor pattern is about every five minutes that are very painful. Moms are breathing through them or kind of ready to kill their partner because the pains are so strong. That's what we typically want to see in like these term moms that are 37 weeks and more. But for our preterm mommies, the category kind of changes a little bit. If they having a lot of cramping that they can't get to go away with rest and drinking fluids, we want those mommas to come in sooner than later. So that way, we can hopefully stop that labor if it's preterm labor going on.

Host: How do I know if I'm dilating, which is part of labor, or is that considered pre-labor?

Ashley Thomas: That can be a very hard question to answer to some mamas, because, you know, we can't check services over the phone because some moms call and ask about that. However, we do tell moms if they notice any bleeding that is more than just spotting, or if they had a recent exam in the office. But some mamas can have some bleeding that can be a sign that that cervix is starting to open as well. So, we do tell mamas to look out for that.

Host: Well, that was my next question, actually. Is it normal to have bleeding? Are there other times where you may have bleeding other than the one you just described when you're starting to dilate?

Ashley Thomas: Absolutely. Some moms again, they may have bleeding after a vaginal exam because the cervix is very sensitive in pregnancy, so that can happen if they have a vag exam in the office, also any recent intercourse, and sometimes even having a vaginal infarction. infection can even be a reason for bleeding to happen. But, you know, it's a very scary thing to happen when you're pregnant. So, we just tell moms, if they're concerned about it to come in and get checked. That way, they can either go home and be at peace, especially if that happens 3:00 in the morning, moms are scared to go to sleep. So if anything that is concerning for our moms, it's concerning to us when we want to take care of it.

Host: What if it feels like the baby is not moving very much? Is that normal?

Ashley Thomas: It depends on how long babies are allowed to sleep. A typical baby sleep cycle is about 40 minutes or less. What we do tell moms if they're drinking fluid, something sweet, eating, and cannot get the baby to move at least 10 movements in an hour or two, we tell them to come in and be seen. Because babies being able to move at home is mom's way of knowing that baby's doing okay in there. Baby's saying, "I'm okay if I'm moving." So if mommies are doing everything they can to get their babies to move and it's not happening, we tell them to come in immediately. Don't wait another day or wait until your doctor's appointment tomorrow or a few days, just come in and be seen.

Host: Okay. That's a great strategy. And I think I know what you're going to say to this last question. But if I don't feel right, but I'm just not sure, you know, what's going on, what should I do in that case?

Ashley Thomas: Same thing. We tell mamas to come in. Our OB emergency department is dedicated to our mamas. And sometimes we just do have those inkling feelings like something is not right. And there's been plenty of scenarios that moms came in like I don't know what it is, but something's not right, and it actually has been a true emergency that has came from it.

So, I say trust your intuition. If you feel like something's not right with yourself or your baby, come in and get seen. Because sometimes unfortunately, there are things that are going on that we do have to take care of immediately. And if not, then, you know, like I said, you know you're okay, but trust your instinct because it will not fail you.

Host: Yeah. That is great advice. Even though pregnancy is such a normal process, there are so many unknown, unexpected things that can happen. So, it's just so reassuring to know that you're there, that there is an obstetrics emergency department to back us up. So, thank you, Ashley, for this great information.

Ashley Thomas: Oh, thank you for allowing me to share it. sometimes patients don't get to have that opportunity to get all this information out there and their OB visits, because it's a lot of mommies out there that are pregnant. So if it's anything, I can help these mommas to know what's going on with their bodies and that we do have a team dedicated for them when they have concerns. I am here for it.

Host: That was Labor and Delivery RN Ashley Thomas with St. Joseph's Medical Center. For more information, please visit dignityhealth.org/stockton/maternity. If you found this podcast helpful, please share it on your social media. And thanks for listening to Hello Healthy, a podcast from Dignity Health.