“Nights and Weekends: How do I know if it is an emergency?” – with Dr. Stephanie Melka

Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Women,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Melka, welcome back to the podcast. It’s been a while.

Dr. Melka: It’s been way too long.

Dr. Fox: You’ve been dodging me. You’re ditching, ducking, dodging, diving…

Dr. Melka: Ducking and dodging.

Dr. Fox: …and dodging. The five Ds. Well, it’s great to see you back in the podcast studio, and as you know, you’re a popular person on this podcast. People tune in to hear what Melka has to say.

Dr. Melka: I’m so excited.

Dr. Fox: You’re high up on the rankings, and you know, best podcasts or most listened to podcasts of all time. So…

Dr. Melka: Sweet.

Dr. Fox: …very good. So, it’s an interesting topic. We’re basically talking about, “Hey, like how do I know if this is an emergency? Like should I be calling, should I be going to the hospital? Should I wait till the next day?” And yeah, people don’t always know.

Dr. Melka: Yeah. Very often, I get a call at night and, you know, for us, when you call the office, there’s this ominous message. If this is an extreme emergency and you need the doctor on call, and then I get a very confused patient that’s like, “I’m so sorry, I didn’t know if this was an emergency. I think I need to talk to somebody.” So, we wanted to do this to try and clear things up a little bit.

Dr. Fox: Yeah. And obviously, some of this is gonna be unique to how we practice, but obviously, most of our listeners are not in our practice, and it’s different everywhere. And so what we say may not be sort of accurate for your own practice, or your doctor, or midwife, or whoever. So, you know, we’ll talk about that in our disclaimer section that this doesn’t always apply to everyone, but just again, this is sort of a thought process. I mean, you know, in general, when you’re pregnant, you have regularly scheduled visits every month, every week, every two weeks, whatever it is based on the circumstances. And that’s obviously a time not only for us to evaluate you and the baby, but a time for you to come with your questions, right? So, things that you write down, you have a list, things you wanna know.

And that’s sort of the best time for non-urgent questions that can wait. Things that aren’t relevant for another month or two or whatever it is. And then obviously if things come up, you could also have additional visits, right? “Hey, you know, something has been bothering me, it’s not a big deal. Maybe I can come in this week.” Stuff like that. And so we’re talking about something that is like new and comes up and the office is closed, right? It’s night, it’s the weekend, it’s a holiday. So, that’s what we’re talking about. And how does it work? I mean, I know how it works, but I’m asking you to explain to our listeners how does it work in terms of like someone being on call? Like what does that even mean?

Dr. Melka: So, for our practice, we have one physician on call that handles all of the deliveries, rounding, seeing patients in the hospital, and then any emergencies or phone calls that come up.

Dr. Fox: Right. And that’s sort of like nights, weekends, and it’s a rotating basis.

Dr. Melka: Correct.

Dr. Fox: And that’s obviously a big job, right? I mean you could have several people in labor and it could also be quiet. Like it could be Sunday, and there’s no one in labor, and you’ve done all your rounds, and you could be…

Dr. Melka: Your rounds and you go home.

Dr. Fox: …hanging out. And there’s a few things that’s important about that. First is that person is available, right? Their only job is to be on call, right? And to be available for emergencies. And again, in our field that includes labor and delivery, which I wouldn’t call an emergency, but it’s something that needs attention. You know, right away obviously. And so that person is available. They’re available nights, they’re available weekends, we rotate it, you know, they’re off the next day so if they’re up all night, it’s fine. But on another hand, you know, saying like, we’re not like the time life operators who are just sitting there with headphones waiting for phone calls. You know, if there’s nothing going on, we might be home sleeping, or we might be doing something, or we might be eating, or we…

Dr. Melka: When you’re on call, you don’t sit with this podcast set up.

Dr. Fox: Yeah. Ready.

Dr. Melka: The headphones on and the microphone ready to call. It’s [crosstalk 00:03:59]

Dr. Fox: Right. And there are circumstances where, for example, the doctor on call is automatically physically in the hospital on the labor floor. Like that’s not how we do it. But there are places where it’s like that. And so, for example, like one practical difference is I always tell patients like, “If you think you’re in labor, don’t just show up to the labor floor because I might not be there, right?” I might be there, right? And there’s maybe even a good chance I’ll be there, but I’m not definitively gonna be there. So, call. So, A, we can decide if it’s the right thing to do, but B, even if it’s obvious it’s the right thing to do, I can let them know and I can myself make my way in. Otherwise, that’s in our practice, the time sort of deliveries get “missed.” Meaning someone delivers and we’re not there, because usually we didn’t know they were coming. That’s typically the circumstance.

Okay. So, some disclaimers about this podcast. This is not definitive. Like we’re not here to tell people what they absolutely must call for, absolutely must not call for. It’s different for every person, it’s different for every practice, it’s different for every doctor, different for a midwife. So, that’s not the point of this. Even if our own practice, these are just like general principles. I would hate for someone to hear this podcast and think like, “There’s a rule that they said in one direction or another.” Because that’s not the point. And everyone’s practice is different. So, you know, make sure to be clear with your own doctor.

Like, “How does it work? You know, how do you cover nights and weekends? Are you physically there? Are you not physically there? Are there things you do want me to call for? Or don’t want me to call for?” And ultimately do what they say, right? We’re just a podcast. There is some disclaimer at the end of this podcast too that this is not like meant to be definitive medical advice. We’re here to talk, that’s all. Okay. So, what’s a good example of a call that you got that probably could have awaited till the next day? Just so people get like context on this. You can either tell me typical ones or even if you have a funny one.

Dr. Melka: Medication refills on weekends are challenging where you don’t have a chart in front of you, you don’t often know what… Like everything’s electronic now. Like I can’t easily log onto my app and see what medication you’re on, what pharmacy it goes to, when were you last seen in the office. So, it’s hard when those come up. I mean, people forget, you know, all of a sudden it’s Friday night and you realize, “I never got my refill.” And medically, you can’t always wait. Like it happens sometimes, but it’s tough on the weekend when you’re getting those.

Dr. Fox: Yeah, that’s a tough one. That’s a common one I would say also. I got… This is not in this practice. Back when I was a fellow and I was moonlighting, I remember two calls that were just brilliant. One, I got a call at about 1:00 or 2:00 in the morning. I got…back then we had pagers, I’d get paged. I got this. I got a phone number to call back, “Hi, Dr. Fox. Nathan Fox on the call. Can I help you?” And the person on the line said, “Great. I was just checking what the response time is.”

Dr. Melka: Wow.

Dr. Fox: So, I said…

Dr. Melka: Bold move.

Dr. Fox: …”How was my response time?” They’re like, “Very fast.” I was like, “Can I go back to sleep now?” They’re like, “Yes.” So, I tried to hide my irritation. That was not cool. And the other one, I remember this vividly, I was at home on call…actually, I guess it may have been for this practice. Very, very early, I got a page and someone said, “You know, I’m pregnant, I’m 20 weeks.” I’m like, “Okay.” She goes, “I have a runny nose.” It’s like, what? At 2:00 in the morning. I said, “Excuse me?” She goes, “My nose is running. What do you think I should do?” So I said, “Have you tried tissues?”

Dr. Melka: You did not.

Dr. Fox: I did. And she said, “Okay.” And that was it. That was the call. It was just…I don’t know, maybe they were in a different time zone. I’m not sure. That’s happened. People sometimes call from other countries when they’re on vacation, Steph. Remember the time zone difference? We may not be on your time. I remember that was DeAndres [SP], like, you got a call and someone’s like, “You know, this, this.” And he’s like, “Well, you should come to the hospital.” She’s like, “I’m in Jerusalem.” He’s like, “Okay.”

Dr. Melka: “Go to the hospital there.”

Dr. Fox: Yeah. [inaudible 00:07:39]. So, those are the ones that maybe can wait. What about the opposite? Have there ever been times where someone, the next day or whatever it is, like comes to the office, you’re like, “Oh, my God, I can’t believe you didn’t call overnight for this?”

Dr. Melka: “I’ve been leaking fluid for two days and it wasn’t a big gush so I didn’t think it was my water that broke. So, I’ve been waiting.”

Dr. Fox: Yeah, that’s one.

Dr. Melka: And then it sort of adds up over time, and then it’s like 1:00 a.m., 2:00 a.m. they’re awake and they’re like, “I don’t know, it’s just been going on so long.”

Dr. Fox: Yeah. I’ve got the one where I would get a text at like 6:00 in the morning from someone in my cell phone. Like, “Hey, I’ve been bleeding all night.” I’d be like…you know, it’s like [inaudible 00:08:16]. I was like, “Oh, my God, please tell me you called the doctor on call.” Like, “No, I was waiting for you to wake up so I could text you.” I was like, “Oh, my God.” Everything was okay. Thank God. No problem. Her and the baby are fine, but that’s not great. You know, it’s not always intuitive so we’re here to help, rght? So, what are some like general rules of thumb? And we’ll get into specific examples, but just sort of like general principles that people can maybe take away when considering whether they should be calling at night or on the weekend?

Dr. Melka: If you feel like you are sick and there’s something wrong and you need to go to the hospital and see a doctor, you should call.

Dr. Fox: Yeah. And that’s even if it’s not pregnancy related.

Dr. Melka: Correct.

Dr. Fox: Right.

Dr. Melka: And it’s hard to put strict rules on it, but when I break it down, I typically break it down to term or close to term, and then first and second trimester.

Dr. Fox: Yeah. I mean, if someone is sick enough that they would normally go to a hospital, or an urgent care, or whatever they have locally, you should call. Because number one, we may be able to help you over the phone, right? Maybe it’s not that bad. Maybe we could sort that out. But number two, if it really is that bad, we need to know about it, right? Either we can direct you to the right place or at least we can know what’s going on. Or if there’s a question about what medication can you take or not take or whatever it might be. And I usually tell people like, when you’re pregnant and you have a medical emergency, regardless of the emergency, we’re your first call. If we’re not your first call, we’re your second call. Like you have to call. Sort of like if you get arrested, you call your lawyer. Like if you’re pregnant and there’s something going on that you’re about to head to a hospital, call your obstetrician.

I mean, someone’s like, “I think I have food poisoning, I got appendicitis, I think I broke my leg.” Like whatever it is, I need to know. Like call me even if I’m not the one who’s gonna be fixing your broken leg, I need to know that you might have one and you’re pregnant. And so absolutely call your obstetrician for this. I think in general if you think it’s an emergency and it needs to be addressed before the office opens, call, right? Anything that you think needs to be addressed before, whatever that is, 8:00 a.m., 9:00 a.m., 7:00 a.m., tomorrow, you should call. Or if you’re not sure if it’s an emergency but you think your doctor thinks it’s an emergency, also call, right? Because not everyone agrees with what their doctor or midwife thinks is an emergency. But if you think your doctor or midwife thinks it’s an emergency, please call.

Dr. Melka: I get that sometimes. “I didn’t wanna call because I knew you’d tell me to go in and I don’t wanna go in,” and then they tell me whatever it is and I’m like, “You know what I’m gonna say. Like yes, you know your baby’s not moving normally the way it was, of course, you have to go in. I’m sure you think it’s fine and I’m sure it’s going to be fine. But if you know I’m gonna tell you to go in, then call and go in.”

Dr. Fox: Right. And we don’t have an automatic response at any phone call that comes in, we tell them to go to the hospital. Frequently we tell them not to. Like, “That’s normal, that’s this, try this, wait an hour, do this.” Like there’s a lot of things we can do to help sort of triage whether you need to come into the hospital, or you know, do you have to be in the office first thing in the morning or do you not. And so a phone call to us does not always mean, “I’m heading to the hospital.” You know, we wanna know what’s going on. If you’re worried enough you think it’s an emergency. And the flip side, if you’re highly confident, this does not need to be addressed until the next day, then you don’t need to call, you can just call the next morning.

I mean, some practices would rather you call at a certain time, so we can get you on the schedule. And that’s unique to each practice. But essentially if you’re highly confident, like you know, medication refill, “I don’t have to have this overnight, it’s not an emergency.” We’ll do it tomorrow, call your office, and someone will pick it up and take care of it for you. Now, what if someone doesn’t know, right? “Well, I have something and I don’t know if it’s an emergency,” which is tough. You don’t always know. What would you advise that person?

Dr. Melka: I generally advise call.

Dr. Fox: Yeah, it’s…

Dr. Melka: Some of it is a liability thing and I don’t want somebody sitting on a concerning symptom for longer than they should because they felt bad about calling.

Dr. Fox: Yeah. I tell people the same. I say, “Listen…” like the person called, “This is what we do. Like, this is our job.” Not in a bad way. This is why we’re here. And so, if you’re not sure, I’d much rather you call and I tell you either, “No, that’s not a problem, you’re fine.” Or, “Yes, that’s a problem, let’s do A, B, and C.” I’d rather just know about it early. And it’s not embarrassing. And we don’t get upset if you say, “Hey, this is going on. I don’t know if this is an emergency.” We can usually sort that out in 20 seconds. I mean, it doesn’t take too long. And we’d much rather know because there’s several times where there is something going on and for the times that it’s not, fine, you’re reassured, you go to sleep, you’re okay and you know that we can deal with this whenever it might be.

The only thing I would say is if you’re in that sort of, “I don’t know what to do,” situation, make that decision early. Like don’t waffle until like 3:00 in the morning and say, “All right, now I’m gonna call,” right? And you knew that this was going on at 7:00, 8:00, 9:00 at night. Generally, a better time to you know, hash that out with the doctor on the call than at 3:00 in the morning. That’s just a public service announcement, you know, for your friendly doctor on call. But again, really, I tell people if you don’t know whether to call, just call. This is what we do, these are the calls we take. Like this is fine, this is all good. It helps us understand what’s happening, and it’s part of good care, and it’s our pleasure. Like that’s why we’re doing what we do.

And particularly if we know that the person calling is sincere, like, “I’m worried, I don’t know if I should be worried.” Great. Like, let me help you. And that’s usually very easy. That is the overarching principles and our disclaimers. Let’s get specific. So, I thought we’d break this down, like you said, sort of by stage of pregnancy. So, let’s talk about early pregnancy, right? So, either someone is pregnant and they haven’t seen us in the office yet, or they’ve been to the office, but it’s still like first-trimester stuff. What are the typical things that are related to pregnancy? Obviously, someone could have pneumonia at any time in their life or whatever. But related to pregnancy, what are the phone calls that typically would be emergent nights and weekends or first-trimester stuff?

Dr. Melka: Typically, bleeding, pain, nausea, vomiting. I think that’s all of the first-trimester calls.

Dr. Fox: Yeah. Probably in that order. Yes. So, you know, bleeding’s an interesting one, you know, because it can be a significant emergency. And it can be nothing and everything in between, which is tough. I think the rule of thumb is if you’re bleeding, the default is you should call. But the caveat that is on our end when we get that call, which bleeding phone calls are you going to say, “I need to see you ASAP.”

Dr. Melka: Anyone bleeding heavily where like hemorrhaging. You know, what I personally use for patients is soaking through two thick pads in an hour. Like really soaking through pads. I think you should come in. You know, if it’s a miscarriage in process, there’s nothing to do about it. But you might need an emergent D&C if things don’t pass. If it’s somebody very early, like five, six weeks and they’re miscarrying at home, you know, I think you can sometimes talk them through and have them stay at home. But it’s hard if someone calls you with that level of bleeding. You sort of…you have to…you know, you should be seen for that.

Dr. Fox: Yeah. I mean, that’s true. Bleeding from any part of your body at that volume is typically an emergency. I think one of the other hard things is the one sort of bleeding complication that we get really worried about is if they have an ectopic pregnancy. And so if once we’ve seen you in the office, and you have an ultrasound, and the pregnancy’s in the uterus, it’s not ectopic or highly confident, it’s not ectopic. And so that sort of like lowers the level of risk significantly in whatever kind of bleeding call’s gonna come in. But if someone hasn’t been in yet, or they came in and they’re sort of one of these people to have watch for a possible ectopic, that’s someone we’re gonna bring in earlier. Because bleeding, especially if it comes along with severe pain, and the belly’s gonna be much more concerning to us about a possible ectopic.

So, again, if it’s early pregnancy, and you haven’t been seen yet, and there’s bleeding along with pain, that’s generally something we’re gonna wanna check out either right away or overnight, or, “Hey, we need you in the office first thing in the morning.” You know, based on what time it is and sort of what resources are available in your office versus do your ultrasounds in your office, you send them to the emergency room in the hospital. You know, there’s a lot of variation in these things, but that generally needs to be evaluated pretty quickly, even if not like immediately. And then the bleeding again. Yeah, it’s usually, you know, people call for bleeding, they tell them to call for bleeding and that is the correct thing to do, but typically it’s a very light amount of bleeding that’s not…it’s itself dangerous and we’re pretty confident it’s not an etopic, there’s not much we can do if we see you.

Sometimes we can give some reassurance, do an ultrasound to show there’s a heartbeat, but to go to an emergency room to do that is fine, but it’s a lot of weight, sometimes a lot of costs, sometimes a lot of frustration. Whereas coming to the office and getting it done there. If it’s available in your office is usually just easier for you, the patients. For us, if they go to the emergency room, it’s not hard on us, it’s, you know, emergency room staff. But again, it’s tough. So, bleeding, typically, people call, but we frequently will not bring them in overnight or on the weekend unless we really had to. And then, you know…

Dr. Melka: The emergency room is very good for emergencies. But it’s a tough place to be. It’s very crowded. There’s a long wait, you’re often in a stretcher next to other people or you have a curtain. And to be diagnosed with a miscarriage or a possible miscarriage, like it’s hard for women. It’s hard for people to go through that.

Dr. Fox: Yeah. And some of this is also, again, resources. Some practices say some solo gynecologists, they might not have 24/7 coverage, and for them it’s ER or nothing. And okay, if that’s the option, then you have to make a decision, “Do I wanna go to the ER or not?” And again, hopefully, someone can guide you what to do, but depends, again, on what’s available, and what the options are, and how soon could you be seen otherwise.

Dr. Melka: Yeah. Sometimes I actually ask patients like, “Do you think you need to go to an emergency room for this?” And it sounds kind of silly, but I think it can help patients see the perspective of like, “Do I need to be seen immediately at 3:00 a.m. for this or do I think I can wait till 8:00 a.m.?”

Dr. Fox: Yeah, exactly. And again, also sometimes this changes whether it’s Friday at 5:00 p.m. when the office opens, Tuesday after the long weekend versus Sunday night, Monday morning at 4:00 a.m. when the office opens in 3 hours. All right, so there’s gonna be some differences based on that. Nausea, vomiting is something people actually…I probably added to the list of things people don’t call about, but they should. You know, someone’s like, “I’m pregnant, I’m supposed to be this sick.” But they haven’t eaten in two days. They’re passing out, they’re like dizzy and weak, completely dehydrated. And they’re like, “Well, no, this is normal.” No, that’s not good. Like it’s something that really can hopefully be addressed. And I would consider that an emergency, even if it’s not something we can necessarily cure, we could potentially improve and help people with. And also a lot of times people, it’s not just nights and weekends, they’re sort of like, “Well, I gotta wait till my first visit in three weeks.”

I got a phone call from a friend recently who was telling me…I assume it was their daughter, they were kind of anonymous about this. Well, someone I know is early pregnancy, and is very, very sick. You know, she hasn’t eaten in two days. She’s, you know, really weak. She’s throwing up 12 times a day and this and this, this. And she goes, “What medication should I get for it?” And I was like, “Well, you know, there’s A, B, and C.” I said, “But has she seen her doctor yet?” And she goes, “Well, no, she’s like, only six or seven weeks. Her first visit isn’t for three or four weeks.” I said, “Have you even called them?” She’s like, “Well, no.” I was like, “Call, like, they should see her today, tomorrow. Like, they need to see her and see what’s going on.”

We don’t typically see people that early, but if someone’s not well, of course, they should be seen earlier. And listen, this person, she’s a doctor. She just had no idea that that’s even like done in OB circles. And so it’s something…that is another one, severe. I mean, if you’re a little bit nauseous you can call, and usually they’ll give you a prescription even without seeing you. But if you’re severely sick, you need to be seen. All right. So, now let’s move on to the middle of pregnancy. So, the second trimester, and third trimesters, not quite in the full-term period. Calls are kind of all over the place here in terms of what, you know, there could be bleeding, there could be a pain. Things that, “Is this labor, is this preterm labor? Am I feeling the baby moving? Am I not feeling the baby moving?” There’s a lot of stuff that sort of like overlapped from the first trimester leading to the end. But basically, how do you address those calls, or what are the things that are really emergencies to you in the middle of pregnancy?

Dr. Melka: I mean similar things, pain and bleeding. You start getting into questions of fetal movement, where you might not feel movement till 20, 22 weeks. You might go a day that you only feel one movement. You might have a day, you feel more, a day, you feel less. And so you’ll get some calls about that as well.

Dr. Fox: Yeah. I mean, fetal movement is something that generally before like 23, 24 weeks, we’re not so focused on it in that sense because not everyone has the baby moving or feels the baby moving. The babies are moving, but they’re not generally felt until that point. You know, sadly there’s not much you could do if the baby’s not moving well that early. Again, it’s very rare when that happens. And so usually someone calls in a second trimester with issues about the baby moving. We just reassure them and say, “Hey, come into the office tomorrow, this week, just so we can show you everything’s okay.” Just a peace of mind. Not so much as they need to do.

In the third trimester, that’s a big deal. Like we take that very seriously. And so that’s something we need to know about. So, let’s talk about that. So, let’s talk about fetal movement. Someone calls in the third trimester, the 30 weeks, right? So, it’s not full term, but they normally feel the baby movement every day and they say, “Hey, I just realized, you know, I got home from work and I started paying attention, and now it’s like 8:00, 9:00 at night. It’s been three, four hours, I haven’t felt the baby move at all.” How do you address that?

Dr. Melka: I have a very low threshold for bringing people in for this. You know, the compromise to sort of try to get somebody to induce movement is drink something cold and sweet like juice, eat a little piece of chocolate, make sure you’re sitting in a quiet room, hands on the belly, like paying attention to movement. But if it’s really like, “It’s been all day and I’ve felt nothing,” you gotta go in.

Dr. Fox: Yeah. I do the same. I almost always give them the same like, “You know, lie down, close your eyes, focus on the baby. If you feel two or three movements in a half hour, everything’s okay, you’re good. And if you truly don’t, we should see you.” And that means come in and I tell people 99% of the time it’s gonna be fine and we know it’s gonna be fine, but we need to know because it might not be, right?

Dr. Melka: And we’d rather have 99% of those women come in, and schlep to the hospital, and be seen, and be sent home, than one person not come in, and she should have.

Dr. Fox: Yeah. And so that’s agreed. It’s considered an obstetrical emergency if you don’t feel the baby moving. Again, with the usual understanding, the babies don’t move continuously. And if you’re very early, you don’t always feel it. But at that point, like when you’re already feeling the baby moving every day, when there’s a significant change and you can’t feel the baby moving despite sort of the tricks we’re talking about, yeah, definitely call and we’re bringing in. And that’s something even if we’re not there. Like I could be at home say, “Go, like go now, you know, just go there, get the baby in the monitor, make sure everything’s okay.” And you may even go home and I won’t even see you.” Like I’ll just, “Fine…” Get on the phone, say, “You’re fine. You’re good, baby looks great. Go home.”

So, that is definitely one. And that’s true pretty much full term as well. I think that in that middle of pregnancy, like 20 to 36 weeks or whatever it is, there’s also a lot of stuff like, “Is this a sign of preterm labor?” Like we said pain, “I’m having some contractions, I’m having some cramping, having some pressure.” How would someone know, again, whether that’s something they need to call about at night versus wait till their next visit versus call the next day, right? Because again, that’s a wide range also.

Dr. Melka: Yeah. Anything really severe, like you’re doubled over in pain, you can’t sleep, you should go in for. What I’ll tell people is you get more uncomfortable at the end of the day. You get more uncomfortable if you’re a little dehydrated. So, if you’re cramping, hydrate, sit, try to sleep. If you fall asleep, you’re not gonna wake up with a baby in the bed because you slept through contractions. Like if you can fall asleep, that’s a good sign. This isn’t an emergency but hydrate, try and rest. If the pain is keeping you up, call me back. We’ll send you in.

Dr. Fox: Yeah. And this isn’t a perfect rule either because, again, if you’re concerned that you’re having preterm labor, just call and, you know, we can talk you through it on the phone and decide…

Dr. Melka: I’ll happily send someone in. If they call and they’re worried, I’m never gonna refuse to send someone. Like you can go in and get checked. It’s more about trying to be kind to the patient, not send them in just because they called.

Dr. Fox: Yeah. I mean, generally, people do get contractions in the second and third trimester, as long as they’re sort of sporadic, not particularly painful, they come and they go, you know, here and there, they go away with rest, then that’s not something that’s gonna be preterm labor. But generally, if they’re getting closer together, they’re getting stronger, they’re not going away.

Dr. Melka: If you’re having bleeding. [crosstalk 00:24:18]

Dr. Fox: Yeah. Certainly with bleeding. Yeah. Then we’re gonna send you in. And so again, it’s one of these things where if you’re not really sure, just call and that’s a very easy phone call. We’ll ask you four questions, and we’ll know right away whether you need to come in now, or whether it’s okay to wait and see how it goes.

Dr. Melka: And I’d be more likely to send someone in that’s at higher risk for preterm birth.

Dr. Fox: Sure. Yeah.

Dr. Melka: So, twins, collage [SP], prior preterm birth, any of that, you know, more likely to go in.

Dr. Fox: Yeah, absolutely. Definitely. Because again, the chance that it’s real is just gonna be higher. And also the same thing, like where do they live? You know, all these things, like how long did it take you to get here? Again, these are questions we just like boom, boom, boom. It’s not gonna take very long to us to figure this out. And this is definitely one of those better-safe-than-sorry phone calls. Because the last thing you wanna do is, you know, I’ve been contracting all night and then you wait till the morning. That’s just not, you know… And also people are worried about it. They don’t need to be sitting worried. That’s not necessary. Another thing is what if someone thinks their water may have broken?

Dr. Melka: That’s a tricky one. Most of the time people know for sure.

Dr. Fox: Yeah. It’s obvious.

Dr. Melka: You know, it’s obvious. We send them in, we actively manage our prom, our ruptured membranes before labor. If they’re not sure, I’ll usually tell them, “Put on a clean pad, walk around for a few minutes. If there’s more fluid leaking out, go in.” But if not, it was probably just discharge or a little bit of urine that came out. So, that I’m more comfortable with somebody staying home.

Dr. Fox: Yeah. I mean, I would say at any point in pregnancy, if you think your water broke, call. Like, call definitely. And that is 24/7, right? If you think your water’s broken, you should call. Now when we pick up the phone, 9 out of 10 times, it’s obvious your water’s broken. And we’ll tell you what to do. Again, if you’re preterm, we’re gonna send you to the hospital right away. If you’re full term, we are gonna send you to the hospital not as emergently, like we’d say, “Yes, if the baby’s moving, you can take a shower, get your stuff.” But basically, we’re gonna be sending you in. But there are times when it’s not so clear, like you said, “Like not sure. Maybe it is, maybe it isn’t.” And then that’s a situation where, based on the circumstance, we’ll either bring you in right away to evaluate, like if you’re very preterm, or maybe do some things at home to sort of figure out what to do. And we’re more likely to do those, obviously someone who’s full term because the stakes aren’t so high necessarily for waiting. But if you think your water’s broken, definitely call.

Dr. Melka: And also somebody who lives an hour and a half away, has had five babies and always delivers fast, I’m gonna say, “I think you should come in. Like, get in the car, and start making your way in.” Like I’d rather you have the false alarm by coming in and it’s nothing than staying home and waiting too long.

Dr. Fox: Exactly. And you know, a term, it’s the same calls, almost always. It’s contractions, water breaking, baby not moving, or bleeding.

Dr. Melka: Bleeding. Yes.

Dr. Fox: Like those are the big four. And we wanna know about all four of those at full term. Again, at night, a few contractions where it’s pretty obvious you’re not in labor, you’re welcome to call, but no one’s gonna send you in if you’re, you know, at your due date and you’re having a contraction every 15 minutes. Like that’s nice to know, but you’re not in labor yet. And so I would say, you know, you could probably wait and see what happens. So, you’re, yeah…

Dr. Melka: Something with light spotting. Like a little bit of light spotting at term. Like you can give it time.

Dr. Fox: Right. Especially if you’re in the office that day and they examine you, where it’s like expected to get some spotting. And so again, like I tell people, you’re welcome to call. Like it’s no problem, but the chance I’m gonna send you to the hospital for a contraction four times an hour at your due date, unless something else is going on, is very, very low. Unless maybe they were five centimeters dilated in the office that day and they lived two hours away. All right. Sure. Then that person, fine. But again, it’s one of these things where the things that are more concerning, like a baby’s not moving or significant bleeding, we’d wanna know right away and water breaking. We’re gonna wanna know, but based on how obvious it is and what’s going on, how soon we’re gonna need you to act. And contractions are the same way.

What about people who’ve already delivered and gone home? Sometimes they forget that we’re still their doctors. You know, like, “Hey, you know, just because you’re not pregnant, we’re still here to take care of you.” I mean, certainly through the postpartum visit, and you know beyond if we’re your gynecologist as well. And so what are the types of things that people should probably remember to call for at nights or weekends if they’re postpartum?

Dr. Melka: Generally again, heavy bleeding, pain severe, not improved with pain medication, and fevers. And I throw fevers in there.

Dr. Fox: Yeah. We need to know about those. You know, if you wake up at 5:00 in the morning with a fever, could you wait till 7:00 or 8:00 to call? Yeah, probably. But whatever, I mean, fine. They called at 5:00 also. But that’s something we’re gonna wanna see. That’s pretty important. Preeclampsia is a condition that can happen after delivery when you go home, and it’s a real, and it’s problem. It’s hard though because there aren’t really great symptoms to pick it up or to rule it out. And so things like headaches that are new we wanna know about. Again, doesn’t mean it’s preeclampsia. Sometimes it’s just not sleeping from having a newborn. Sometimes it’s related to the epidural, sometimes it’s preeclampsia. But that’s something we’re gonna wanna know about. Particularly if it’s getting worse and worse, you know, just call, like it’s okay. Like that’s something we want to know about. That’s another one.

Also, certain things like new symptoms. Like, “I’m severely short of breath when I wasn’t earlier today or wasn’t before.” Like sometimes complications happen that are rare and people forget like, “We need to know, we’re still your doctor, you know, we’ll make sure everything’s okay.” And again, if we get the call and say, “You know what, it doesn’t sound like much, but we’ll see you in the office tomorrow just to be sure.” Versus, “Yeah, this seems pretty serious, maybe you should come in.” And it’s a big deal to get called back into the hospital after you deliver. Because frequently, that’s not with your baby. Sometimes it is, again, depends on the hospital, depends on all the various circumstances. But it could be you’re not with your baby, and it could be if you are with your baby, that’s a big, “How does that work,” right? And then you’re nursing, like it’s a thing and we know that, but if we’re gonna send you in, it’s gonna be for a real reason, which means we really need to see what’s going on. Yeah. Wow. I think we covered it.

Dr. Melka: I think we did.

Dr. Fox: Nights and weekends. I was gonna title this podcast “Call Me Maybe,” but I didn’t wanna give people the negative connotation, you know, that we’re trying to tell people not to call us. So, I don’t think we’re gonna use that. We’ll pick another snappy title to the podcast that is worthy of us as a play-on-words type of people. I know, I see the wheels…

Dr. Melka: The wheels are going.

Dr. Fox: …are turning in Melka’s brain for all the various, you know…

Dr. Melka: I had something but it’s not appropriate. It would get censored.

Dr. Fox: Got it. Check. Fair. All right. Melka, thanks for coming on. Thanks for talking about this, appreciate it.

Dr. Melka: Happy to be here, as always.

Dr. Fox: All right. We’ll see you again. Thank you for listening to the “Healthful Woman Podcast.” To learn more about our podcast, please visit our website at www.helpfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. The information discussed in “Healthful Woman” is intended for educational uses only, and does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health, and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.