Scott Webb: Having a baby is a joyous time for most, especially when they deliver at a baby friendly hospital with a team of highly trained and compassionate labor and delivery experts working to ensure the best outcomes for everybody. And joining me today is Julie Vasher, she's the Director of Perinatal Services at Salinas Valley Health.

Scott Webb (Host): This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb.

Scott Webb: Julie, it's so nice to have you here today. We're going to talk about essentially maternity services at Salinas Valley Health. So let's start there. Tell us about the maternity, labor and delivery services at Salinas Valley Health Medical Center.

Julie Vasher, DNP, RNC-OB, APRN-CNS, C-EFM: When a pregnant patient comes to Salinas Valley Health to have their baby, they're surrounded with a wonderful professional health care team who provide the new family and baby with excellent care, while placing the patient at the center of the decision making in a process called team birth.

This ensures that they will have the experience that they hope for. We also offer TOLAC, which is the trial of labor after cesarean. The old adage of once a cesarean, always a cesarean is no longer the case. Our providers discuss these options with their patients in the clinics to encourage them to have a successful VBAC, a vaginal birth after cesarean, and we support them in whatever endeavor they have when they come in to have their baby.

Host: That's really interesting. That was, uh, I guess the old school way because both of my kids were delivered via C section and it was definitely at that time, once you've had a C section, you'll be having another one. Thank you very much. So, uh, good to know that things have changed, certainly at Salinas Valley Health and just wondering if you can walk us through what parents can expect when they're delivering at Salinas Valley Health.

Julie Vasher, DNP, RNC-OB, APRN-CNS, C-EFM: When a pregnant person and their family and support people have questions about being in labor or any other concerns, we encourage them to come to our OB Emergency Department on the second floor. Interestingly, Salinas Valley Health has the only licensed OB Emergency Department in Monterey County.

They will be evaluated by a trained registered nurse and a Board Certified OBGYN who is in-house 24 hours a day. If it is determined that the patient needs to be admitted, they will go to a private labor suite, where their registered nurse will ask several questions, evaluate their progress and the status of their labor along with their unborn baby.

Once the newborn is here, we place the baby skin to skin or we initiate what many call kangaroo care. Whether it is born vaginally or by cesarean section, we don't differentiate. We feel like babies and mothers need to be together no matter how they're born. There will be a recovery period after the delivery, which is usually about two hours.

Then the patient will be transferred to our postpartum unit, where they will reside in a private room and meet their new nurses who will care for them and their new baby.

Host: Yeah, and how about labor discomfort? I know that that's common for many women. How do you help women with that? How do you help them cope with that labor discomfort?

Julie Vasher, DNP, RNC-OB, APRN-CNS, C-EFM: You know, labor pain is a purposeful pain. It's not like breaking your foot or something. There's a goal at the end. Um, so we do like to talk about it in terms of coping because it's inevitable. As part of our ongoing discussions with the patients, as I mentioned earlier, we will talk about these options as they present and progress during their labor.

It's all individualized to the patient's needs. All of our registered nurses have been trained in what we call high touch labor support, including massage, aromatherapy, hot cold therapy, and different positions for comfort. Additionally, patients can choose to use nitrous oxide, which is an inhaled gas that helps labor patients cope with the anxiety or the discomfort of their contractions, similar to the dentist office.

It's a little bit less of a strength of the mix that you get in the dentist's office, but it feels similar. They can also opt to receive medication through their IV, and they can also request an epidural. We have anesthesiologists that are here 24 hours a day that can also help with their needs in addition to our registered nurses.

Host: That's great. And you see why the word cope is so appropriate. We touched a little bit on C sections there. You know, sometimes labor goes as planned and sometimes it doesn't go as anticipated. So what happens if a C section is needed and how quickly can the medical staff pivot?

Julie Vasher, DNP, RNC-OB, APRN-CNS, C-EFM: There are a lot of reasons why a C-section might be needed. These include that the baby doesn't quite fit either because of their size or their position as they try to descend. Or the baby is not tolerating the stress of labor and we want to deliver the baby quickly.

We have two operating room suites right on our unit, that we can get to very quickly. If emergent, we can be in the OR ready to deliver your baby in minutes.

Host: Yes, I was going to ask you about the emergency situations, you know, God forbid, of course, but, you know, maybe talk a little bit about how your team is really prepared to respond.

Julie Vasher, DNP, RNC-OB, APRN-CNS, C-EFM: We've worked really hard on providing a timely response to a number of issues. There are times when unexpected emergency arise as you mentioned. Um, some of these might include a postpartum hemorrhage, high blood pressure, severely high blood pressure, sepsis, infection, or other fetal concerns.

Our team of nurses and physicians frequently practice these situations together and follow protocols to ensure the best outcome for the laboring patient and their newborn. Additionally, we train on identifying these emergencies quickly so that we can provide the best treatment in an appropriate way.

This not only includes, taking care of the labor patient, but also the newborn, and getting our highly trained NICU team available right away to assist with any needs that the newborn may have.

Host: So, after a baby is born, what are the procedures the newborn will undergo? I was reading a little bit about the APGAR score and what that is, so maybe you can explain that. What is that, and what is the vitamin K injection for?

Julie Vasher, DNP, RNC-OB, APRN-CNS, C-EFM: There are a lot of things that happen to that new little person. Um, all newborns are assigned APGAR scores. This is a scale from 0 to 10. There are 5 areas scored with a score of 0, 1, or 2 based on the newborn baby's response. These areas are muscle tone, skin color, not all babies are born pink like you see in the movies, heart rate, respiratory effort, and reflexes. Additionally, typically, newborns receive medications that are recommended by the American Academy of Pediatrics, and these do include vitamin K. Vitamin K helps with the newborn's ability for their blood to clot. When newborns are born, they typically might have some issues with that.

So, vitamin K helps nudge that along. They also receive eye ointment, it's antibiotic eye ointment, to protect from certain types of infections the baby may encounter while being born. Additionally, a hepatitis B vaccine series begins right, pretty quick after birth. Newborns also receive during their stay a critical congenital heart disease screen, newborn blood tests that screen for genetic diseases of metabolism, and a newborn hearing screen.

There might be more, but your health care team will keep you informed, the parents informed of what those are and why they're necessary.

Host: Yeah, as you were saying earlier, it's patient centered, obviously a lot of communication, transparent, open, honest, timely, all that good stuff. Let's talk about the diverse population, that you have there and how do you meet the needs of that very diverse population?

Julie Vasher, DNP, RNC-OB, APRN-CNS, C-EFM: Yes, meeting the needs of a diverse population is very important to us. All of our team participates in education annually to better understand the needs of our diverse population. We provide respectful care to all, regardless of their background or situation. We understand hearing information and conversation in our patient's preferred language is important to them.

It's also important to making sure that we understand each other and are providing the best care that we can. We use in person interpreters when we are able and also have access to an online language line, where certified interpreters are able to communicate in a number of languages.

Additionally, we ask each patient their individual preferences and what matters most to them during their admission, whether it be support during labor, unique cultural preferences, pain management, anything that is important to them, we want to know and work in partnership to achieve.

Host: That's great. Let's talk about tours. I did this with my wife, for our first child and then we didn't need to, you know, do it a second time because we'd already sort of been there, done that, but does Salinas Valley Health offer tours for expecting parents and how do you go about scheduling something like that?

Julie Vasher, DNP, RNC-OB, APRN-CNS, C-EFM: Yes, that was one of the first things we wanted to get going again after COVID, because it is such an interesting topic for a lot of new families. We offer maternity tours once a month and they can schedule by calling our Health Promotions Department at 831-759-1890 or go on our website at www.salinasvalleyhealth.com and look under Events and Classes and Maternity Tours is scheduled there.

In addition to that, we've been working on a video tour that will be up on our website very soon so people can watch it over and over and over.

Host: Excellent. And hopefully they'll listen to this podcast perhaps over and over and over. We, uh, a host, host can dream, of course. You touched on this earlier about the NICU. So let's have you talk about the Salinas Valley Health NICU and if you have any partnerships or anything like that.

Julie Vasher, DNP, RNC-OB, APRN-CNS, C-EFM: Oh, we do. We have a very robust NICU. NICU is a Neonatal Intensive Care Unit. We have a Level 3 Community NICU in partnership with Stanford Medicine Children's Health. We work with Stanford trained neonatologists and expertly trained registered nurses and other team members to provide excellent care for our babies and allow them to stay close to home.

Host: Yeah. And, uh, you know, breastfeeding is a topic that often comes up in these types of podcasts and sometimes parents, moms have a difficulty with breastfeeding. So what kind of assistance do you provide maybe even after they've left the hospital?

Julie Vasher, DNP, RNC-OB, APRN-CNS, C-EFM: Sure, it is a big concern for new parents. All of our nursing staff receive extensive training and education on breastfeeding and how to help our new parents establish a good start. If there are complications with breastfeeding, our nursing staff can enter a referral to see a board certified lactation consultant while they're in the hospital.

In addition, after they get home and questions may arise, they can call our lactation consultant, ask them any questions that they have. And if they'd like to schedule lactation consultation, outpatient, they can come into the hospital and meet with one of our lactation consultants where they will evaluate the newborn's feedings and preferences and provide our patients with hands on assistance.

Host: You know, I know that Salinas Valley Health is a baby friendly hospital. I can just tell from just speaking with you today, how baby friendly it is. So what does that mean exactly? And why is this so important?

Julie Vasher, DNP, RNC-OB, APRN-CNS, C-EFM: It is, it's a big achievement for our hospital. The World Health Organization sponsors the baby friendly designation which requires hospitals to have practices in place that enhance mother baby bonding, offer optimal care for infant feeding, and ensure that the baby's nutritional needs are adequately met, regardless of whether a mother chooses to breastfeed or formula feed her baby.

It is very important that it assists hospitals, staff, and providers in giving mothers the information, confidence, and skills necessary to successfully start and continue breastfeeding or feeding successfully their babies.

Host: Well, you know, this has been fun today, educational, informational, and fun, as you would expect when we're talking about, you know, babies and newborns and all that good stuff. Always brings a smile to my face, of course. I'll just give you a chance here at the end. Final thoughts and takeaways when we're thinking about maternity services at Salinas Valley Health.

Julie Vasher, DNP, RNC-OB, APRN-CNS, C-EFM: I think it's fun too. Um, we know this is one of the most important, exciting, and sometimes overwhelming days in a family's life. We know that they have been looking forward to this day with a lot of anticipation and want to acknowledge and celebrate this event with them by providing excellent patient and family centered care.

We feel it is such a privilege to be part of this important event and we look forward to seeing everyone in the future.

Host: Well, I appreciate all this information. I'm sure listeners do as well. Appreciate your passion, your expertise, the whole team there. So thank you so much.

Julie Vasher, DNP, RNC-OB, APRN-CNS, C-EFM: Thank you very much.

Host: And for more information on our maternity services, please visit SalinasValleyHealth.com/maternity.

 And to listen to more of our podcasts, please visit salinasvalleyhealth.com/podcasts. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor or family member. And subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.