Chat with a Provider: Labor and Delivery with Emily Farkas, PA-C

Chat with a Provider: Labor and Delivery with Emily Farkas, PA-C

Even though I am a healthcare provider, when I became pregnant I knew there was so much more information that I wanted (and needed) to learn (especially since I have never worked in women’s health). Having amazing resources to help with understanding the whole process into motherhood can bring not only comfort but the knowledge to make informed decisions for one’s self.

In regards to the birthing process, many hospitals offer childbirth classes which can be helpful and also provide knowledge specific to that hospital or facility. They will often go through information such as the stages and phases of labor (this information is something that every mama-to-be should be aware of and can also be found in books or electronic resources) and well as tips for labor and the postpartum period. Most women and partners find these classes very helpful and I would recommend at looking into them.

My hope for this space is that it empowers woman with support for one another and the knowledge to make choices that create ease. Emily Farkas, a friend and colleague of mine, has spent her career working in the Pittsburgh area in Woman’s Health, more specifically Labor and Delivery. I asked her some questions about the process to get great information for first time mothers and experienced mothers alike!

Emily’s Bio:
Hey there 🙂 My name is Emily Farkas. I am a Physician Assistant and have worked in women’s health for the past 8 years. I have spent the last 6 years of my life helping women with (arguably) the most exciting time in their lives – delivering their babies! I am passionate about what I do and would love to answer a few FAQs regarding the birthing process. Everything stated below is my personal opinion. This advice should not take the place of your healthcare provider’s recommendations. Please always contact your healthcare provider with any concerns, questions or need for further elaboration or clarification.

What do you recommend for pain control during labor? Unmedicated or use of medication? Epidural or IV meds?
These are great questions and the answer is individual for every patient. I would say 95% of our patients use some form of analgesia for labor pain control, with the vast majority being an epidural. There are a few schools of thought on this, but there are to three primary routes that patients go:

1-Epidural

2-IV pain medication: Nubain, Stadol, nitrous gas (not available in most birthing facilities and specific medications may vary)

3-Unmedicated

I recommend having an open mind! Labor is difficult and painful, at the end of the day, as providers, we want a healthy mom and a healthy baby. The situation can change very quickly during labor, so having an open mind and being adaptable to what your provider is recommending at that time is best for you! When it comes to an unmedicated birth, I have found moms that succeed have a strong “game plan” going in. I have witnessed a some very well controlled labors where moms are able to control their pain by listening to music, doing meditation, doing reiki-like exercises or by other structured means, including the use of other support providers like midwives or doulas. I also recommend prenatally informing your provider if you desire an unmedicated birth so that they can help you and give resources/recommendations. I work with an excellent group of midwives that have great success if women choose no medical pain control. From my experience, I’ve seen that moms who go in with a more “willy nilly” approach and do minimal research or planning often have a more difficult time going naturally and often will go on to get an epidural.

Ok Em, enough with the political answers, what do you think personally: epidural or no epidural?

At the end of the day, as a provider I am only worried about two things – a healthy mom and a healthy baby. I have seen the majority of moms laboring with an epidural SLEEPING through the active phase of labor (6-10cm) and I would much prefer that as both the provider and the patient, myself. At the end of the day whether you get an epidural or not you still get a baby out of it – so especially if you’re like me and tend to have LOOOOOOONG labors, why not relax while the baby takes their good old time coming down the birth canal? I can’t stress enough though, if you are one of my patients that prefers to deliver naturally (unmedicated) I 100% will support you and your choice. If this is something you desire, considering finding a provider that is willing to support you in this, whenever possible and safe.

What should we expect when walking into labor and delivery?
I always say, take a deep breath and relax. I like to remind my mommas and mommas-to-be they are in good hands and are EXACTLY where they need to be! The more comfortable you are, the better the experience is likely to be. Whether you are at the hospital because you are having contractions, your water broke, or for a scheduled induction, there is an entire labor and delivery staff there to take care of you. We (as in the hospital staff in the labor and delivery suite) do this all day every day! Although this is brand new and scary for you, we are here to guide you through this very exciting time of bringing new life into this world. As you enter the labor suite, you will likely be greeted by a triage nurse. You will then be assessed by a provider, for example a PA (me, duh!,) physician, resident, or midwife. If the decision has been made to proceed forward to be admitted, you may have a quick bedside abdominal sonogram to assess for baby’s position and/or an external or internal exam. You will likely also have an IV placed: IV placement is both for access for emergent need of medications to be administered as well as typical IV fluids to keep you hydrated during labor. You will also meet a certified registered nurse anesthetist (CRNA) or another member of the Anesthesiology team to discuss your pain medication options.  You may also meet the baby nurse in advance (the nurse who will be present at the birth to do the newborn assessment). Your labor and delivery nurse, the nurse who will be caring for momma during the labor, will become your best friend throughout your labor course [And, I’m not just saying this because my bestie happens to also be my L&D nurse ;)]. She/He will guide you through your latent and active labor phases and through the actual delivery process.

Who will be in my labor/delivery room?
The staff included in most labor suites include your labor nurse, baby nurse, delivering physician/physician assistant/nurse practitioner/midwife, and a surgical tech to help with delivery materials. Throughout the less active times of your labor, you and any support persons (if you are able and choose to have them), may be alone in the room or with only your labor nurse. The amount of support persons you are permitted to have may vary from hospital to hospital. (With the Covid -19 pandemic policy, most facilities allow 1 support person in labor and postpartum floors, however this is constantly changing). As you approach the second stage of labor (pushing and delivery), it may seem daunting and feel like so many people are in the room: Remember they are all here for you and your baby! At times of distress in labor, additional providers such as an extra baby nurse/provider or extra nurses to assist in documenting or caring for you may be called in. Again, this is okay and they are all there to help! There also can be students in the room depending on the facility you are in.

My daughter is interested in labor and delivery, can she watch?
This is a valid question we get all the time! Is your daughter over 15 years old? Most hospitals do not let children under 15 in the labor suite. The other thing to consider is that policies have totally changed with Covid-19, as stated above allowing often only one support person.

What should I bring to the hospital?
Plan to be in the hospital for three days. One day in labor and one to two days postpartum. As I have previously mentioned things rarely go as planned in my line of work so labor may be a few hours or closer to a day, and “postpartum” can turn into “post op”if a c-section is required, which requires a three days length of stay. I recommend a “go bag” of a few loose fitting comfortable outfits and toiletries packed and ready at the 34 week mark – just to be safe. You are welcome to bring your breast pump with you, though not necessary as the hospital will have a hospital pump for you to use if it becomes necessary. Also if you take any home medications that may be difficult for our pharmacy to get in you are welcome to bring them as well as being aware of the doses you take – you will just need to let the staff know. (Don’t worry, a hospital bag packing list is soon to come!)

What is the best learning/prep for delivery?
100% any of the classes your hospital offers. We all talk to our friends about their experiences, but truly no two women will have the same experience. PLEASE be sure to include your partners on these conversations and classes, whether they are online or in person. Your partner/spouse/mother/whomever is that designated support person needs to be prepared as well and should know your preferences so that they can best help you!

I am beyond thankful for Emily and her amazing answers for all the mamas of this community! If you have any questions for either of us, please drop them below!

Let’s talk soon,
Al



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