After Hours Guidance
Women’s Healthcare in Middletown, Dover, Milford, and Rehoboth
The guidance offered below is not meant to be all inclusive or apply to all medical scenarios.
It is impossible to provide direction in advance for every medical scenario. If at any time you feel you need to be seen by a doctor, you should come to the emergency room or call an ambulance irrespective of the guidelines below.
Pregnancy-related issues
Term
If you are at least 37 weeks (within 21 days of your due date), you should come to the hospital if you:
- have leakage of fluid from the vagina more than your usual discharge
- have bleeding more than a smear or a tablespoon of bloody mucus
- have painful contractions every five minutes from the beginning of one contraction to the beginning of the next
- have a severe headache or visual changes such as seeing spots or blurry vision
- are feeling the baby move less
- have new abdominal pain that is not a contraction
- have been struck in the belly or fell and hit your belly or have been in a car accident
- are not able to hold down food or drink
- have one sided leg pain
- have chest pain
- have shortness of breath
Pre-Term
If you are less than 34 weeks (more than 42 days before your due date), you should come to the hospital if you:
- have more than 4 contractions every hour for two hours
- experience leakage of fluid from the vagina more than your usual discharge
- experience any bleeding
- have a severe headache or visual changes such as seeing spots or blurry vision
- feel the baby move less than is normal for you
- have been struck in the belly or fell and hit your belly or have been in a car accident
- cannot hold down food or drink
- have one sided leg pain
- have chest pain
- have new shortness of breath
Late Term
If you are 34 weeks to 36 6/7 weeks (42 days to 22 days before your due date), you should come to the hospital if you:
- have more than 8 painful contractions every hour for two hours
- have any leakage of fluid from the vagina more than your usual discharge
- have any vaginal bleeding
- have a severe headache or visual changes such as seeing spots or blurry vision
- are feeling the baby move less than is normal for you
- have new abdominal pain
- have been struck in the belly or fell and hit your belly or have been in a car accident
- cannot hold down food or drink
- have one sided leg pain
- have chest pain
- have new shortness of breath
Pregnancy Non-Emergency
Pregnancy related things that typically can wait to discuss until the office is open during a weekday (please use MyChart to message your provider):
- Passage of mucus plug if you are more than 34 weeks (fewer than 42 days left before your due date)
- Discussing test results
- Refill on prescriptions other than blood pressure medicines or diabetes medicines
- Cold symptoms such as stuffy nose, sore throat, slight cough, as long as you are not short of breath
- Vaginal itching or sores
- Mild nausea
- Yeast infection
- Nipple discharge
- Numbness in both your hands
- Constipation
- Skin rash
Post-Partum Emergency
You should come to the hospital if you have:
- Persistent bleeding heavier than a period (passage of a single clot, even up to golf ball size, is generally ok as long as it is not accompanied by heavy bleeding)
- Fever
- Severe headache or vision changes
- Area of breast pain or redness such that there might be a breast infection
- Worsening pain of the vaginal tear or episiotomy
- Worsening pain or drainage or redness of cesarean section incision
- Severe depression or thoughts of suicide
- Chest pain
- New shortness of breath
Post-Partum Non-Emergency
Postpartum issues related things that typically can wait to discuss until the office is open during a weekday (please use MyChart to message your provider):
- Discussing test results
- Refill on prescriptions other than blood pressure medicines or diabetes medicines
- Cold symptoms such as stuffy nose, sore throat, slight cough, as long as you are not short of breath
- Vaginal itching or sores
- Mild nausea
- Mild to moderate depression (but no thoughts of harming yourself or others)
- Sore nipples
- Breastfeeding questions other than possible breast infection
- Birth control questions
- Cesarean section incision itches
Non-pregnancy related issues
If you have had a gynecologic procedure or surgery within three weeks, you should come to the hospital if you:
- have a fever
- have severe pain at the surgery site
- have drainage or redness at the surgery site
- have bleeding more than a period
- cannot hold down food or drink
- have one sided leg pain
- have chest pain
- have shortness of breath
If you are not pregnant and have not had a gynecologic procedure or surgery, you should come to the hospital if you:
- have bleeding heavy enough to soak a pad or tampon for two hours in a row
- have severe lower abdominal pain
- have a painful bump on the vagina or vulva bigger than a nickel that you think is infected
Non-pregnancy related issues that typically can wait to discuss until the office is open during a weekday (please use MyChart to message your provider):
- A late period or early period as long as your pregnancy test is negative
- Bleeding in between periods or a period that is longer than 10d as long as your pregnancy test is negative
- Bleeding after menopause as long as not soaking a pad every hour for two hours
- Bleeding after sex
- A yeast infection
- Vaginal discharge
- A herpes outbreak
- Birth control issues
- Test result questions
- Vaginal itching
- Vaginal odor
- A breast lump if you are not breast feeding
- Nipple discharge
- A bump on the vulva or vagina unless it is very painful and you think it is infected
- Cannot feel your iud strings
- Cannot feel your Nexplanon, or feel it has moved or is broken
- Screening for a sexually transmitted disease
