Planning for Your Next Pregnancy with Emily Oster, PhD

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<v SPEAKER_1>At a time when change is constant, and we are pulled in far too many directions, we need a way to stay present to life and to increase our ability to remain calm, think clearly, and maintain our well-being.

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<v SPEAKER_1>Many studies indicate mindfulness improves our mental, emotional, and physical health.

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<v SPEAKER_2>If you're a nurse or future nurse, you know how challenging and rewarding this career can be.

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<v SPEAKER_3>One of the phrases I often like to tell people is data is not bossy.

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<v SPEAKER_3>If you're looking for data to answer your question, you're rarely going to get what you want.

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<v SPEAKER_3>But what it can do is help you more directly frame the decisions you're making.

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<v SPEAKER_4>Hey there, I'm Katie Ferraro, registered dietitian, college nutrition professor and mom of seven, specializing in baby-led weaning.

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<v SPEAKER_4>Here on the Baby-Led Weaning With Katie Ferraro Podcast, I help you strip out all of the noise and nonsense about feeding, giving you the confidence and knowledge you need to give your baby a safe start to solid foods using baby-led weaning.

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<v SPEAKER_4>Pregnancy complications are, well, complicated, especially when they're called unplanned pregnancy complications.

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<v SPEAKER_4>Like, of course they're unplanned.

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<v SPEAKER_4>Nobody plans to have a complicated pregnancy.

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<v SPEAKER_4>And this is coming from the mouth of someone who had a quadruplet pregnancy.

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<v SPEAKER_4>That wasn't planned.

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<v SPEAKER_4>That was certainly complicated.

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<v SPEAKER_4>You're not planning to have a miscarriage or preterm birth or uncontrollable vomiting while pregnant.

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<v SPEAKER_4>Today, Emily Oster is here on the Baby-Led Weaning podcast to talk about pregnancy complications and how you can use data in preparation for your next pregnancy.

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<v SPEAKER_4>Emily Oster is a professor of economics at Brown University.

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<v SPEAKER_4>She authors the email newsletter and is in charge of the website and social media accounts, Parent Data.

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<v SPEAKER_4>She's the author of pregnancy books such as Expecting Better, which I realized today.

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<v SPEAKER_4>That book is exactly as old as my oldest child who's just turning 10.

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<v SPEAKER_4>It's the only book I read when I was pregnant with her.

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<v SPEAKER_4>I know you guys are subject to a lot of so-called parenting experts, and you're always hearing advice from this influencer or that thought leader.

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<v SPEAKER_4>And I just want to say something about Emily Oster ahead of the interview.

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<v SPEAKER_4>And that is that she is one of the most genuinely kind, informed, and well-intentioned people in our space.

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<v SPEAKER_4>You are going to pick up on some of this in the interview today, but Emily Oster is known as the Parent Data person, right?

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<v SPEAKER_4>She's literally an economist trying to help us sort through data.

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<v SPEAKER_4>And does there or does there not exist data to support this or that decision that we are making as parents, which are important decisions.

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<v SPEAKER_4>And at the end of the day, as she's going to say in the interview, data isn't bossy, okay?

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<v SPEAKER_4>It's not going to tell you what to do or make the parenting decision for you about whether you should have another baby or if you should do Montessori preschool or whether or not you're going to do spoonfeeding or do baby-led weaning.

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<v SPEAKER_4>Okay, there is a personal element in all of the parenting decisions that we make, and Emily Oster reminds us that we're the ones who know our baby's best, right?

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<v SPEAKER_4>You have to choose the best doctor for your family or the best birth plan, but the data can help guide your decisions.

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<v SPEAKER_4>And in this interview today, we are talking about pregnancy complications, topics like stillbirth and preterm birth, miscarriage, and other events that may be hard to hear about, especially for some of those of you listening who may have been experiencing or have had in the past their own loss and their own grief.

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<v SPEAKER_4>And if that's you, then you might want to skip this episode.

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<v SPEAKER_4>But if you did have an unexpected pregnancy complication and you are interested in knowing why it happened and whether it will happen again, and then what can be done to lower risk, I most certainly recommend Emily Oster's book called The Unexpected, Navigating Pregnancy During and After Complications.

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<v SPEAKER_4>It's co-authored by Emily Oster and Nathan Fox, who's a medical doctor.

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<v SPEAKER_4>When you listen to podcasts, just heads up, spoiler alert, a lot of time the hosts, they haven't even seen the book, let alone read the book of the author that they're interviewing.

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<v SPEAKER_4>And not so here.

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<v SPEAKER_4>I read every book of everyone I interview all the way through.

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<v SPEAKER_4>I was cramming to finish The Unexpected before this interview today.

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<v SPEAKER_4>But I love the outline of it and the execution so much.

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<v SPEAKER_4>The book is really succinct.

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<v SPEAKER_4>It's to the point.

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<v SPEAKER_4>I like that it's co-written with a medical doctor because that is important, given the gravity of the pregnancy complications that the book covers.

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<v SPEAKER_4>I personally could not read in depth the stillbirth and the episiotomy section, so I skimmed those.

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<v SPEAKER_4>I still cried.

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<v SPEAKER_4>But if you're planning another pregnancy, even if you didn't have complications in your last pregnancy, I do think Emily Oster's book, The Unexpected, is an important read if for nothing else other than learning how to talk to your friends and your family members and people you encounter in the world who will have gone through these pregnancy complications.

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<v SPEAKER_4>So with no further ado, here is Emily Oster talking about planning for your next pregnancy, especially if you've had previous pregnancy complications.

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<v SPEAKER_3>Thank you for having me.

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<v SPEAKER_4>Your newest book seeks to bring maternal health complications to light, and that's a hard task because of course, nobody thinks of themselves when they're pregnant.

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<v SPEAKER_4>It's like, oh, I wonder what's going to go wrong.

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<v SPEAKER_4>I like that you said that you hope that nobody has to read your book, The Unexpected, for themselves, but that you want everyone to read it to better understand the experience of others.

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<v SPEAKER_4>In what way does knowing about maternal health complications help us to be more empathetic to those who have experienced these situations?

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<v SPEAKER_3>It might be useful to start with why I wrote the book, which is almost an answer to that question, which is, I wrote Expecting Better, which is my first book, like a decade ago.

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<v SPEAKER_3>And I've been very lucky that a lot of people have read that book, and they've reached out and they've talked to me about their experiences.

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<v SPEAKER_3>And there were so many of those conversations, which were about, you know, I loved your book, and this thing happened to me, and will it happen again?

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<v SPEAKER_3>And can you help me answer this question about, I had a miscarriage or I had preeclampsia, and I wanted an answer to those people.

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<v SPEAKER_3>And so this book is written partly or largely to help the set of people who I think would like the answer to the question, I had a complicated pregnancy, will it happen again?

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<v SPEAKER_3>How can I navigate it?

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<v SPEAKER_3>How can I make things better on a second time around?

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<v SPEAKER_3>But then also to help other people see this in a way that I was able to see it when I was hearing from people about their experiences, because I didn't have any of these experiences myself.

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<v SPEAKER_4>I was just thinking about your book, Expecting Better.

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<v SPEAKER_4>So my oldest daughter turns 10 on July 28th, and your book came out like a month before that.

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<v SPEAKER_4>And I remember like a month before having the baby, I was like, oh crap, I haven't read any books.

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<v SPEAKER_4>So I know most people say like, oh, I read all the books.

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<v SPEAKER_4>Like yours was literally the only pregnancy book that I read.

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<v SPEAKER_4>And I really appreciated it because, oh, I did try to start one other one about natural childbirth.

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<v SPEAKER_4>And I was like, I cannot do this.

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<v SPEAKER_4>This is not for me.

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<v SPEAKER_4>But I loved your data-based approach.

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<v SPEAKER_4>So I also can't believe that that was 10 years ago.

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<v SPEAKER_4>So congratulations on a decade of writing these books.

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<v SPEAKER_4>But I love that you're also, okay, we need to talk about the fact that not everything is beautiful and turns out perfectly in pregnancy.

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<v SPEAKER_4>And I think you guys did a really nice job of writing that.

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<v SPEAKER_4>And I also want to add that you have a co-author who is a medical doctor.

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<v SPEAKER_4>How was that experience, because I can imagine coming from your economic side and the data that maybe doesn't always match up with exactly what they're doing in practice?

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<v SPEAKER_4>How was that experience of having a co-author?

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<v SPEAKER_3>So I love my co-author on this book.

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<v SPEAKER_3>I wish he was everyone's doctor.

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<v SPEAKER_3>And he and I are in many ways very aligned.

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<v SPEAKER_3>He was super easy to work with.

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<v SPEAKER_3>His name is Nate Fox.

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<v SPEAKER_3>He's like a genius and incredibly empathetic and like one of the nicest people you could possibly ever hope to meet.

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<v SPEAKER_3>And when I decided to write this book and it was pretty clear that I needed a doctor and as we sort of worked through the book, what really became clear is actually like from the standpoint of answering the question, you know, will this happen again?

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<v SPEAKER_3>You know, what happened to me?

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<v SPEAKER_3>That's a data question.

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<v SPEAKER_3>And that's something I'm very comfortable with.

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<v SPEAKER_3>That's my expertise.

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<v SPEAKER_3>You know, what did the large data sets say about treatments and about, you know, recurrence risks?

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<v SPEAKER_3>What Nate really brings here, and I think it's so incredibly important, is the question of how to have the conversation with your doctor.

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<v SPEAKER_3>Like, where is your doctor coming from?

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<v SPEAKER_3>What are the questions you should ask?

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<v SPEAKER_3>And he's just gifted at that.

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<v SPEAKER_3>And so working with him was super fun and I think makes the book much, much better than it could possibly, much more useful than it could possibly be if I did it alone.

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<v SPEAKER_4>I love that your co-author, Dr.

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<v SPEAKER_4>Nate Fox, and you both provide scripts and templates for conversations to have with your provider.

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<v SPEAKER_4>You're like, okay, you got to ask what happened.

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<v SPEAKER_4>And then why did it happen to me?

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<v SPEAKER_4>And then is it going to happen again?

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<v SPEAKER_4>And what could have been done to prevent this from happening again?

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<v SPEAKER_4>Do you have any tips though for actually starting these discussions with your care provider?

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<v SPEAKER_4>They just always seem to be in such a rush.

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<v SPEAKER_3>Yeah, so this is a tough question because the answer is like, find someone you can talk to, which of course isn't like, is a place of privilege that some people have and some people don't have.

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<v SPEAKER_3>I think some of our goal with the scripts is to get to a place where you can have a more productive conversation in a shorter amount of time.

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<v SPEAKER_3>So when we think about what's hard about these conversations, it's almost always the amount of time you have, that you really need an hour to talk about this and you have 15 minutes.

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<v SPEAKER_3>And if you spend those 15 minutes trying to get to the question you're trying to answer, then your time is all gone.

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<v SPEAKER_3>So coming in with a little more knowledge, a little more preparation, a little bit more of a script can at least make that time more productive.

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<v SPEAKER_3>If your provider is just not listening to you, that's much more of a thing where we'd say like you kind of, maybe you need to think about is there, does it make sense to switch to somebody else?

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<v SPEAKER_4>Hey, we're going to take a quick break, but I'll be right back.

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<v SPEAKER_4>This episode is sponsored in part by Ritual Prenatal Vitamins.

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<v SPEAKER_4>Are you still taking your prenatal vitamin?

00:11:01.658 --> 00:11:06.498

<v SPEAKER_4>As a dietician, I know I always continued my prenatal even after I gave birth.

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<v SPEAKER_4>In fact, the World Health Organization recommends continuing your prenatal until you start weaning.

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<v SPEAKER_4>But not all prenatals are created the same, and Ritual's Essential for Women prenatal supplements contain science-backed formulas, third-party testing for heavy metals and microbes, as well as traceable ingredients.

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<v SPEAKER_4>All Ritual products are rigorously tested and they're clean-label project certified.

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<v SPEAKER_4>You deserve to know exactly what you're putting into your body, especially when it comes to prenatal vitamins.

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<v SPEAKER_4>Start Ritual or add Essential for Women Prenatal to your subscription today.

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<v SPEAKER_4>Again, that website is ritual.com/weaning for 25% off.

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<v SPEAKER_4>What about switching providers?

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<v SPEAKER_4>How do you know if it's time to select a new provider?

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<v SPEAKER_4>Is there national level provider data that you can look up as to like your OBGYN's performance-based outcomes?

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<v SPEAKER_4>Does that even exist?

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<v SPEAKER_3>Not really, but also I wouldn't ask the question like that because I think that gets people into a question of like, is my doctor a good doctor?

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<v SPEAKER_3>And actually, your doctor could be a great doctor, but not for you.

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<v SPEAKER_3>And I think the question should really be, is this the right person for me?

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<v SPEAKER_3>And that framing is important because this is a hard relationship to end.

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<v SPEAKER_3>So if somebody delivers your baby, you had this whole like even if you didn't like them that much during the pregnancy, like it's hard to be like, ma, you're not for me because it sounds like you're a crummy doctor.

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<v SPEAKER_3>And in fact, that's not what you're saying.

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<v SPEAKER_3>You're saying, this is not the doctor relationship for me.

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<v SPEAKER_3>And so I think when people are feeling like, you know, I didn't feel listened to or I didn't have the experience I wanted, that's a place where at least you want to explore.

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<v SPEAKER_3>And sometimes that means exploring like a midwife, if you want to really sort of slightly different kind of experience or exploring other doctors or there's like a whole range of this, but just coming into it as like, not my goal is to find out if my doctor is a good doctor because who cares?

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<v SPEAKER_3>The question is, are they a good doctor for you?

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<v SPEAKER_4>I read in your book that about 8% of US infants are delivered by midwives.

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<v SPEAKER_4>And midwives are of course, wonderful allies and partners for low risk pregnancies.

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<v SPEAKER_4>But what sort of risk factors in a pregnancy might make one consider using an OB-GYN instead?

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<v SPEAKER_3>So it's actually up to about 12%, which in the last couple of years.

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<v SPEAKER_3>So there's been actually even more of a shift to midwife births.

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<v SPEAKER_3>And I think one thing it's important to be clear on here is the vast majority of midwife-assisted births are in hospitals.

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<v SPEAKER_3>So a lot of people, when you say, like, consider a midwife, people are like, will I be birthing in a tub, in my basement?

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<v SPEAKER_3>And it's like, actually, that's that...

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<v SPEAKER_3>Most of those births are attended by midwives, but the vast majority of midwife-attended births are just in hospitals.

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<v SPEAKER_3>It's just with a different kind of provider.

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<v SPEAKER_3>And there are some circumstances, some complications, which would mean that you wouldn't want to...

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<v SPEAKER_3>This wouldn't be a good consideration.

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<v SPEAKER_3>So someone who has very high blood pressure or coming into a pregnancy or uncontrolled diabetes, those are the kinds of conditions which you're going to need a doctor to sort of manage.

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<v SPEAKER_3>There's actually a pretty wide range of people who would potentially be eligible for a midwife birth, particularly for midwives who work with an obstetrician group.

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<v SPEAKER_3>So if you thought you might need a C-section, the obstetricians are there, but you can get prenatal care from a midwife.

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<v SPEAKER_3>And some of that is just about kind of what's the feel that people want.

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<v SPEAKER_3>Midwives often have more time, and sometimes that can be helpful, particularly if you had actually complications before and you want someone who's going to just have a little more time to spend talking about what's going on.

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<v SPEAKER_4>Preparation is an important subtext in your book, and a lot of our listening audience has had at least one baby.

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<v SPEAKER_4>Some of them are going to be done with their families, but I would guess that a lot of the others who are listening may be considering expanding their families.

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<v SPEAKER_4>Just curious, how can parents and future parents use data to help them in the preparation phase before they even conceive, and especially so if they've had a previous complicated pregnancy?

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<v SPEAKER_3>One of the phrases I often like to tell people is data is not bossy.

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<v SPEAKER_3>If you're looking for data to answer your question, you're rarely going to get what you want, but what it can do is help you more directly frame the decisions you're making.

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<v SPEAKER_3>So tell people your decision is probably, should I have another baby now or later, or should I wait to decide, or should I have another one or not at all?

00:16:04.578 --> 00:16:13.158

<v SPEAKER_3>So you're explicit about your question, and then there is a bunch of data that you want for that, which is things like, will it happen again?

00:16:13.158 --> 00:16:19.978

<v SPEAKER_3>That's for a complicated pregnancy, that's almost always the number one question people ask me is just, what's the chance of this happening again?

00:16:19.978 --> 00:16:26.278

<v SPEAKER_3>A lot of the book is spent on the question of what's the recurrence risk, and what could you do to treat it?

00:16:26.278 --> 00:16:30.878

<v SPEAKER_3>Those are kind of the two key data pieces in anything, is like, what's the chance of it will happen again?

00:16:30.878 --> 00:16:33.458

<v SPEAKER_3>And is there anything I could do about it?

00:16:33.458 --> 00:16:44.018

<v SPEAKER_3>And then with that, then you have to make a decision, and always very hard to make decisions, because none of these are gonna have an answer that's like, for sure you should do it, for sure you shouldn't do it.

00:16:44.018 --> 00:16:47.998

<v SPEAKER_3>It's gonna be about your preferences and your values on top of the data.

00:16:47.998 --> 00:16:54.938

<v SPEAKER_4>I have a colleague who had such insanely bad vomiting throughout the entirety of her one and only pregnancy.

00:16:54.938 --> 00:17:00.938

<v SPEAKER_4>She vowed she was never gonna have another baby, and everyone says that, but like this one, she actually did not do it.

00:17:00.938 --> 00:17:07.998

<v SPEAKER_4>For moms who experienced hyperemesis in their previous pregnancy, is it for sure going to happen in their next?

00:17:07.998 --> 00:17:10.458

<v SPEAKER_3>It's not for sure gonna happen again.

00:17:10.458 --> 00:17:15.018

<v SPEAKER_3>There are a lot of variation in kind of what we'd estimate as the recurrence risk.

00:17:15.238 --> 00:17:22.578

<v SPEAKER_3>So in like a hospital data, where you're basically asking the question, do you end up with another diagnosis of hyperemesis?

00:17:22.578 --> 00:17:24.158

<v SPEAKER_3>That recurrence risk is about 25%.

00:17:24.998 --> 00:17:45.618

<v SPEAKER_3>If you talk to, and this is like a place where Nate would say, you know, if you sort of think about what this is experiencing in practice, his view is like whether it's a diagnosis or not, if you've had hyperemesis in a first pregnancy, it's better than 50%, you'll have at least significant nausea whether in vomiting, whether it will be as sort of technically hyperemesis or not, is less clear.

00:17:45.618 --> 00:17:50.038

<v SPEAKER_3>So in the book, we put this in a category we call like sort of more, like more likely than not.

00:17:50.038 --> 00:17:54.318

<v SPEAKER_3>Like it's, if it doesn't happen to you, that's lucky, but you should expect it.

00:17:54.318 --> 00:18:01.718

<v SPEAKER_3>And the thing about hyperemesis though, is people often do figure out some things that help in a first pregnancy.

00:18:01.718 --> 00:18:08.518

<v SPEAKER_3>So not everybody, but for some people, there's a kind of like you've sort of gotten dialed in a little bit.

00:18:08.518 --> 00:18:14.798

<v SPEAKER_3>And so being ready in an next pregnancy to dial that in immediately is one thing that's really valuable.

00:18:14.798 --> 00:18:16.498

<v SPEAKER_4>I love the vignette in your book.

00:18:16.498 --> 00:18:20.478

<v SPEAKER_4>The woman was hospitalized and receiving fluids for perfused vomiting during pregnancy.

00:18:20.478 --> 00:18:23.338

<v SPEAKER_4>She got a text from her friend that said, oh, I was nauseous too.

00:18:23.338 --> 00:18:25.098

<v SPEAKER_4>Just try the ginger gummies from Whole Foods.

00:18:25.098 --> 00:18:27.118

<v SPEAKER_3>It's like Trader Joe's has ginger gummies.

00:18:27.118 --> 00:18:28.738

<v SPEAKER_3>And it was just like, you're not listening.

00:18:28.738 --> 00:18:30.138

<v SPEAKER_4>Everybody has that front.

00:18:30.138 --> 00:18:36.558

<v SPEAKER_4>But if you experience or are experiencing pregnancy complications, any tips on how to deal with insensitive comments like that?

00:18:36.558 --> 00:18:38.078

<v SPEAKER_4>Like, do you block her forever?

00:18:38.418 --> 00:18:39.178

<v SPEAKER_4>I mean, that's...

00:18:39.178 --> 00:18:41.518

<v SPEAKER_4>She's in the hospital, for god's sakes.

00:18:41.518 --> 00:18:43.158

<v SPEAKER_3>I mean, I think that one may be yes.

00:18:43.158 --> 00:18:48.258

<v SPEAKER_3>But, you know, I mean, I think this is part of, like, part of my advice is just for the other person, like, hey, your friend's...

00:18:48.418 --> 00:18:51.878

<v SPEAKER_3>Like, there's somebody you know who's experiencing some of these pregnancy complications.

00:18:51.878 --> 00:18:54.538

<v SPEAKER_3>Like, it's good for you to know what that means.

00:18:54.538 --> 00:19:02.998

<v SPEAKER_3>And, you know, this book, other resources are a good way for you to, like, just be a little aware before you open your mouth.

00:19:02.998 --> 00:19:05.118

<v SPEAKER_4>And I think having the conversation is part of it.

00:19:05.118 --> 00:19:11.878

<v SPEAKER_4>Like, books like your book and other experts actually talking about this, it does, for people who do want to talk about it, it kind of opens the door to that.

00:19:11.878 --> 00:19:13.358

<v SPEAKER_4>I know, I'm the oldest of six kids.

00:19:13.358 --> 00:19:19.978

<v SPEAKER_4>My mom and her best friend, who has four kids, they would always talk like, oh, we had 10 pregnancies, no problem, no miscarriages.

00:19:19.978 --> 00:19:24.318

<v SPEAKER_4>And I was like, did you really, like, first trimester miscarriage a lot of times?

00:19:24.318 --> 00:19:28.098

<v SPEAKER_4>I mean, she's like, and even if we did, we would never talk about it like you guys do.

00:19:28.098 --> 00:19:31.898

<v SPEAKER_4>So with regard to first trimester miscarriage, how common is it?

00:19:31.898 --> 00:19:33.158

<v SPEAKER_4>What tends to cause it?

00:19:33.158 --> 00:19:38.538

<v SPEAKER_4>And do you think that public figures discussing their pregnancy losses is helpful to other women who have experienced the same?

00:19:38.538 --> 00:19:43.438

<v SPEAKER_4>Or is it sometimes, like, it's just causing a lot of noise that's causing even more hurt and grief and trauma?

00:19:43.438 --> 00:19:49.118

<v SPEAKER_3>The first trimester miscarriage is extremely common, depending on, you know, where you would date.

00:19:49.118 --> 00:19:59.038

<v SPEAKER_3>So some estimates would suggest that sort of from, like, fertilization, it's like 50%, but from kind of initial, like, when you'd be able to detect a pregnancy, it's perhaps 25%.

00:19:59.758 --> 00:20:07.198

<v SPEAKER_3>So, you know, as you go along in pregnancy, and this is actually part of why historically, I think people might have coded this as less common.

00:20:07.198 --> 00:20:11.118

<v SPEAKER_3>It's like if you can't detect a pregnancy until six weeks, actually, you're down quite a bit.

00:20:11.118 --> 00:20:18.558

<v SPEAKER_3>Like, a pregnancy that's viable at six weeks is actually quite a bit lower miscarriage risk than a pregnancy that's detected at four weeks.

00:20:18.558 --> 00:20:25.338

<v SPEAKER_3>We start detecting them, you know, five days before your missed period, then we're going to see more losses.

00:20:25.338 --> 00:20:31.838

<v SPEAKER_3>The vast majority of those, like 90%, are a result of chromosomal abnormalities.

00:20:32.158 --> 00:20:40.738

<v SPEAKER_3>So something which, sort of a chromosomal issue, too many chromosomes, not enough chromosomes, things crossing over, which would be incompatible with life.

00:20:40.738 --> 00:20:43.718

<v SPEAKER_3>And that's, you know, more common as people age.

00:20:43.718 --> 00:20:48.698

<v SPEAKER_3>There are a few other factors that can make that more likely, although age is by far the most important.

00:20:48.698 --> 00:20:55.838

<v SPEAKER_3>And that 90%, like, that's really important because it is so, so common for people to be like, what did I do?

00:20:55.838 --> 00:21:03.758

<v SPEAKER_3>You know, and I had a conversation with someone once who, like, had gotten pregnant sort of unexpectedly with a later child, like, they weren't planning for it.

00:21:03.758 --> 00:21:10.198

<v SPEAKER_3>And then, you know, I think she had some, was ultimately excited about it, but initially had some feelings of ambiguity, and then she miscarried.

00:21:10.198 --> 00:21:19.398

<v SPEAKER_3>And she said, you know, I can't, like, I know, I know that it's chromosomes, but I can't help but feeling that maybe I just didn't want it enough.

00:21:19.398 --> 00:21:23.378

<v SPEAKER_3>And that feeling, like, that's basically like, made me cry talking about it.

00:21:23.378 --> 00:21:28.698

<v SPEAKER_3>Like, that is what I think we need people to, we need to try to combat that feeling.

00:21:29.178 --> 00:21:32.578

<v SPEAKER_4>And that, again, that's not going to show up in the data, that feeling right there.

00:21:32.578 --> 00:21:41.518

<v SPEAKER_4>And so it's the combination of being educated about science and facts, but also understanding that this is like a highly emotional experience.

00:21:41.518 --> 00:21:44.298

<v SPEAKER_3>I mean, she was in front of me, I was like, you know, that's not true.

00:21:44.298 --> 00:21:50.098

<v SPEAKER_3>She's like, I know, I know it's not, but it's almost not about knowing, you know, it's about it's about feeling.

00:21:50.098 --> 00:21:53.378

<v SPEAKER_4>Hey, we're going to take a quick break, but I'll be right back.

00:21:57.238 --> 00:22:01.758

<v SPEAKER_2>Are you dreaming about becoming a nurse or maybe you're already in nursing school?

00:22:01.758 --> 00:22:08.398

<v SPEAKER_2>I'm Nurse Mo, creator of the Straight A Nursing podcast, and I want you to know that I'm here for you.

00:22:08.398 --> 00:22:10.578

<v SPEAKER_2>I know nursing school can be challenging.

00:22:10.598 --> 00:22:13.998

<v SPEAKER_2>I've been there, but it doesn't have to be impossible.

00:22:14.598 --> 00:22:27.458

<v SPEAKER_2>Sometimes the key to succeeding in nursing school is to hear the concepts explained clearly and simply, which is exactly what you get with weekly episodes of the Straight A Nursing podcast.

00:22:27.458 --> 00:22:35.218

<v SPEAKER_2>Each Thursday, I teach a nursing concept or share tips and advice to help you succeed in school and at the bedside.

00:22:35.218 --> 00:22:43.118

<v SPEAKER_2>My goal is to help you improve how you study, get more done in less time, pass your exams, and feel more confident and clinical.

00:22:43.658 --> 00:22:51.698

<v SPEAKER_2>And if you're already a practicing nurse, these episodes are for you too, because as nurses, there's always something for us to learn.

00:22:51.698 --> 00:22:56.478

<v SPEAKER_2>So, subscribe to the Straight A Nursing podcast and I'll see you on Thursday.

00:23:03.835 --> 00:23:11.135

<v SPEAKER_4>When I was pregnant with my quads, which 50% chance of major handicap in a quadruplet pregnancy, and it was certainly not what we had planned for.

00:23:11.135 --> 00:23:12.795

<v SPEAKER_4>Ironically, I didn't even transfer.

00:23:12.795 --> 00:23:15.675

<v SPEAKER_4>I was doing medications for IVF, having a bad round.

00:23:15.675 --> 00:23:19.295

<v SPEAKER_4>The doctor was like, listen, you're not even gonna get any embryos out of this because I'm not seeing hardly any eggs.

00:23:19.295 --> 00:23:21.435

<v SPEAKER_4>I see three eggs here on your ultrasound.

00:23:21.435 --> 00:23:24.355

<v SPEAKER_4>And I was like, well, give me that medicine that tells me exactly when I'm gonna ovulate.

00:23:24.355 --> 00:23:25.855

<v SPEAKER_4>And she's like, you know, you diagnosed infertility.

00:23:25.855 --> 00:23:26.755

<v SPEAKER_4>You're not gonna get pregnant.

00:23:26.755 --> 00:23:28.115

<v SPEAKER_4>Sure, but be careful.

00:23:28.115 --> 00:23:29.295

<v SPEAKER_4>There's three eggs on that ultrasound.

00:23:29.295 --> 00:23:30.975

<v SPEAKER_4>You might get pregnant with triplets.

00:23:30.975 --> 00:23:31.515

<v SPEAKER_4>Yeah, whatever.

00:23:32.015 --> 00:23:34.955

<v SPEAKER_4>I went to Santa Barbara, like, got pregnant the old-fashioned way.

00:23:34.955 --> 00:23:39.795

<v SPEAKER_4>And then there was four eggs there and they all stuck and they all stayed.

00:23:39.795 --> 00:23:49.155

<v SPEAKER_4>And I remember when I went back for the 12-week follow-up, I was praying that they would have reduced on their own because then there's a discussion of, well, now we want you to reduce down to two.

00:23:49.155 --> 00:23:50.275

<v SPEAKER_4>And that was the recommendation.

00:23:50.275 --> 00:23:59.095

<v SPEAKER_4>And when all four were still there, I remember feeling guilty about feeling bad that they were all still there and that wishing that they had reduced on their own because then I wouldn't have to make this decision.

00:23:59.095 --> 00:24:01.095

<v SPEAKER_4>And you're like, like, I didn't want this in the first place.

00:24:01.195 --> 00:24:04.515

<v SPEAKER_4>Now I have, it's like, the emotions that are surrounded by it.

00:24:04.515 --> 00:24:07.475

<v SPEAKER_4>But at the end of the day, I didn't really have any control over that.

00:24:07.475 --> 00:24:11.155

<v SPEAKER_4>And so I think sometimes for parents, that's where science can be really helpful.

00:24:11.155 --> 00:24:12.755

<v SPEAKER_4>It's like, listen, you don't actually have control over this.

00:24:12.755 --> 00:24:19.355

<v SPEAKER_4>Or if this, like you said, is a chromosomal abnormality, that it kind of took care of itself, which I don't think that's a very medical term.

00:24:19.355 --> 00:24:23.155

<v SPEAKER_4>But I think for a lot of parents, that can be really comforting to know-

00:24:23.155 --> 00:24:24.475

<v SPEAKER_3>To know it's not something you did.

00:24:24.475 --> 00:24:24.855

<v SPEAKER_3>I mean, I think-

00:24:24.855 --> 00:24:25.915

<v SPEAKER_4>Exactly.

00:24:25.915 --> 00:24:31.875

<v SPEAKER_4>But then of course you always think, you know, what's with that glass of wine, what's with the coffee, the tuna, all the things that we worry about, especially early on in pregnancy.

00:24:31.875 --> 00:24:34.575

<v SPEAKER_4>And I know we talked about the first trimester miscarriage.

00:24:34.575 --> 00:24:38.635

<v SPEAKER_4>You always hear like the second trimester, that's supposed to be the golden age of pregnancy.

00:24:38.635 --> 00:24:46.575

<v SPEAKER_4>A lot of the annoying first trimester symptoms and many people have subsided, you actually start to look pregnant, you believe that this might turn into a viable baby.

00:24:46.575 --> 00:24:53.735

<v SPEAKER_4>What sort of complications are more towards the second and the third trimester that you studied and covered in your book?

00:24:53.735 --> 00:24:56.455

<v SPEAKER_3>There are a lot of complications that arise later.

00:24:56.955 --> 00:25:01.935

<v SPEAKER_3>There are some which are sort of more like things you would just manage.

00:25:01.935 --> 00:25:09.555

<v SPEAKER_3>So like gestational diabetes is a good example of something where like everyone gets screened for that sort of typically towards the end of the second trimester.

00:25:09.555 --> 00:25:11.275

<v SPEAKER_3>It's actually quite common.

00:25:11.275 --> 00:25:12.735

<v SPEAKER_3>It's very manageable.

00:25:12.735 --> 00:25:17.535

<v SPEAKER_3>So it's not like many, it's never fun to be diagnosed with something.

00:25:17.535 --> 00:25:20.295

<v SPEAKER_3>And the test for gestational diabetes is incredibly unpleasant.

00:25:20.295 --> 00:25:30.895

<v SPEAKER_3>But it's an example of something where like medicine really has a way to kind of dial this in and generally outcomes for pregnancies are sort of no worse than they would be otherwise.

00:25:30.895 --> 00:25:45.475

<v SPEAKER_3>And then there are things, so like preeclampsia is a reasonably common complication that arises towards the second and third trimester and can be really devastating because it almost pits the health of the mom against the health of the baby.

00:25:45.475 --> 00:25:48.915

<v SPEAKER_3>And so the solution to preeclampsia is delivery.

00:25:48.915 --> 00:25:56.515

<v SPEAKER_3>And so sometimes you're just kind of waiting till like to try to get the baby as viable as possible while monitoring the health of mom.

00:25:56.515 --> 00:26:08.815

<v SPEAKER_3>So that's one where there's a little bit of good news, which is that we have that actually the risk of preeclampsia can be reduced with regular taking of baby aspirin, which is now a very common prescription.

00:26:08.815 --> 00:26:13.815

<v SPEAKER_3>But if it does occur, it is complicated to manage, requires a lot of management.

00:26:13.815 --> 00:26:17.155

<v SPEAKER_4>Can we talk about the role of race in pregnancy complications?

00:26:17.715 --> 00:26:23.415

<v SPEAKER_4>How do maternal mortality rates differ among black, Hispanic, and non-Hispanic white women?

00:26:23.415 --> 00:26:28.075

<v SPEAKER_4>Is this due to health care access or prenatal care or are there other factors at play?

00:26:28.075 --> 00:26:37.675

<v SPEAKER_3>So the most striking fact in this space is that maternal mortality rates for black women are two to three times as high as they are for the average for white women.

00:26:37.675 --> 00:26:40.955

<v SPEAKER_3>Hispanic women have an elevated rate also, but not nearly as much.

00:26:41.055 --> 00:26:45.475

<v SPEAKER_3>And so that is sometimes called the black maternal mortality crisis.

00:26:45.475 --> 00:26:54.995

<v SPEAKER_3>Why that is occurring, I think, is there are many factors which seem like they contribute and no single answer.

00:26:54.995 --> 00:27:02.595

<v SPEAKER_3>So the risk to black women seem to not be fully explained, maybe a bit explained by demographic differences, but certainly not fully explained.

00:27:02.735 --> 00:27:12.175

<v SPEAKER_3>So mortality complications or maternal complications for black women at the top of the income distribution actually are worse than basically white women at the bottom of the income distribution.

00:27:12.175 --> 00:27:18.115

<v SPEAKER_3>So it's not income or not completely income, it's not completely education.

00:27:18.115 --> 00:27:20.815

<v SPEAKER_3>There was a lot of talk about structural racism in hospitals.

00:27:20.815 --> 00:27:23.095

<v SPEAKER_3>I think that that almost certainly plays some role.

00:27:23.095 --> 00:27:24.155

<v SPEAKER_3>How much of it?

00:27:24.155 --> 00:27:27.275

<v SPEAKER_3>So that's something that's very easy to evaluate.

00:27:27.275 --> 00:27:36.715

<v SPEAKER_3>When we talk about this, I think it's almost always most valuable, not so much to talk about like, why is this occurring, but to talk about what could we do, like what are some solutions?

00:27:36.715 --> 00:27:40.395

<v SPEAKER_3>And so one that I think is always really valuable to highlight is doulas.

00:27:40.395 --> 00:27:51.215

<v SPEAKER_3>So a doula during birth, which is just because they're not a midwife, it's a person who is not going to deliver the baby, but as a birth will help, they are there doing various things.

00:27:51.215 --> 00:27:58.515

<v SPEAKER_3>It turns out that that really improves birth outcomes across the board and is a very good idea.

00:27:59.135 --> 00:28:09.795

<v SPEAKER_4>Okay, not to downplay the importance of race in maternal mortality rates, but across the board in the United States, don't we generally have higher maternal mortality rates than in other developed countries?

00:28:09.795 --> 00:28:12.075

<v SPEAKER_3>We have a higher maternal mortality rate.

00:28:12.075 --> 00:28:19.035

<v SPEAKER_3>This is a source of a lot of fairly esoteric discussions, actually quite a hard number to measure.

00:28:19.035 --> 00:28:25.055

<v SPEAKER_3>But by most of the measures we would have, our maternal mortality rate is worse than our peer countries.

00:28:25.055 --> 00:28:38.835

<v SPEAKER_4>If you had a complicated previous pregnancy and then you're considering getting pregnant again, you in your book, Emily, advise parents to fact find, whether that's finding support in your area or making professional accommodations at your job.

00:28:38.835 --> 00:28:40.375

<v SPEAKER_4>What are some good resources?

00:28:40.375 --> 00:28:44.475

<v SPEAKER_4>Or where should people look when they're seeking out these facts?

00:28:44.475 --> 00:28:48.455

<v SPEAKER_3>I'm going to give one answer, which is that the book, I think, is good for a lot of those questions.

00:28:48.455 --> 00:29:01.755

<v SPEAKER_3>But I do think these complications are so specific to individuals, like the sort of details of your complication are so relevant, that the best source for this is going to be your doctor and your medical records.

00:29:01.755 --> 00:29:05.755

<v SPEAKER_3>So before even, like, you should have access to your medical records.

00:29:05.755 --> 00:29:08.935

<v SPEAKER_3>That should be part of how you prepare for thinking about another pregnancy.

00:29:08.935 --> 00:29:13.075

<v SPEAKER_3>And you should be able to talk with your doctor about the details of what happened to you.

00:29:13.075 --> 00:29:16.255

<v SPEAKER_3>because things like, we were talking about preeclampsia.

00:29:16.255 --> 00:29:24.935

<v SPEAKER_3>So whether preeclampsia is likely to happen again and how significant it is depends tremendously on the circumstances of your preeclampsia last time.

00:29:25.255 --> 00:29:35.815

<v SPEAKER_3>So preeclampsia at 28 weeks is really different than preeclampsia at 38 weeks in terms of the recurrence risk, the likelihood of a serious recurrence again, etc.

00:29:35.815 --> 00:29:43.695

<v SPEAKER_3>And so your doctor and your own history is way more important than any average data that you might be able to.

00:29:43.695 --> 00:29:49.155

<v SPEAKER_4>And that sounds so basic, like, yeah, get copies of your records, but like, I don't think I did that.

00:29:49.155 --> 00:29:50.395

<v SPEAKER_3>Very few people do that.

00:29:50.395 --> 00:29:52.875

<v SPEAKER_3>You're entitled to them, but almost nobody does.

00:29:53.415 --> 00:29:54.455

<v SPEAKER_4>Exactly.

00:29:54.455 --> 00:30:00.195

<v SPEAKER_4>I was a diabetes educator for many years, so I was happy to see you included a whole chapter on gestational diabetes.

00:30:00.195 --> 00:30:02.995

<v SPEAKER_4>Could you just cover the known risk factors for gestational diabetes?

00:30:02.995 --> 00:30:08.515

<v SPEAKER_4>I mean, it sounds so scary and parents are like, does this mean I'm going to have diabetes for the rest of my life and my baby's going to have it?

00:30:08.515 --> 00:30:16.235

<v SPEAKER_4>How is gestational different from what I think a lot of people just understand to be, you know, just your basic, not run-of-the-mill, but type 2 diabetes that does not have to do with pregnancy?

00:30:16.235 --> 00:30:24.155

<v SPEAKER_3>Yeah, so gestational diabetes is actually kind of a poor name because it ends up being basically two different things.

00:30:24.155 --> 00:30:35.935

<v SPEAKER_3>So there are some people who have diabetes before pregnancy and it's not diagnosed, and then the first time it gets diagnosed is during pregnancy because that's when they're seeing their doctor.

00:30:35.935 --> 00:30:49.615

<v SPEAKER_3>And it turns out that is both likely to persist post-pregnancy because it was kind of there before pregnancy, and it's also associated with slightly higher rates of complication because it suggests just more uncontrolled blood sugar to begin with.

00:30:50.055 --> 00:30:59.895

<v SPEAKER_3>So for this reason, doctors will sometimes try to screen people who they think are at risk very early in pregnancy before the traditional screening to try to see if they have undiagnosed diabetes.

00:30:59.895 --> 00:31:10.495

<v SPEAKER_3>The typical thing we think about, and actually the majority of what ends up as called gestational diabetes is diagnosed in the second trimester and is a result of pregnancy.

00:31:10.495 --> 00:31:19.075

<v SPEAKER_3>So the experience of pregnancy, the hormones, placenta, their insulin resistance changes, and then people can get diabetes during pregnancy.

00:31:19.915 --> 00:31:28.815

<v SPEAKER_3>There are some risk factors like BMI and other demographic features, but a lot of people are diagnosed with this.

00:31:28.815 --> 00:31:38.535

<v SPEAKER_3>Like a lot of these risk factors are just going to be genetic, and plenty of people who exercise all the time and are at a healthy weight and end up with gestational diabetes.

00:31:38.535 --> 00:31:48.275

<v SPEAKER_3>And then it resolves post-birth and you're managing during pregnancy with either changes in diet or insulin, and then it resolves after birth.

00:31:48.795 --> 00:31:59.615

<v SPEAKER_3>One thing I will say is, if you have gestational diabetes during pregnancy, you are at higher risk for type 2 diabetes later, and that probably reflects some sort of common genetic component.

00:31:59.615 --> 00:32:10.535

<v SPEAKER_3>And so one of the things we say in the book is, when you have a conversation with a new primary care or somebody after, when you get older, you should always mention any of these complications you had during pregnancy.

00:32:10.535 --> 00:32:14.315

<v SPEAKER_3>That's an important part of your medical history for them to know about.

00:32:14.315 --> 00:32:26.175

<v SPEAKER_4>I was interested to learn that sirclage, so putting a suture or a stitch around the cervix to prevent it from dilating too soon, is an old, well-known treatment but has no large-scale randomized trial evidence for its efficiency.

00:32:26.175 --> 00:32:33.035

<v SPEAKER_4>Are there other standard practices and obstetrics that you came across that just like get done because we've always done them that way?

00:32:33.035 --> 00:32:36.035

<v SPEAKER_3>I mean, there are some that we know don't work but still get done, like bedrest.

00:32:36.035 --> 00:32:44.595

<v SPEAKER_3>Bedrest is like a thing which is very commonly prescribed and there's very few, if any, complications for which it's actually shown to prevent preterm birth.

00:32:45.155 --> 00:32:49.315

<v SPEAKER_3>I'm trying to give anything else in this category of like we just do it.

00:32:49.315 --> 00:32:50.475

<v SPEAKER_4>Bedrest is massive.

00:32:50.475 --> 00:32:53.455

<v SPEAKER_4>Like anytime you have multiple pregnancy, like, did they put you on bedrest?

00:32:53.455 --> 00:32:55.615

<v SPEAKER_4>And I was like, I wish, like no.

00:32:55.615 --> 00:32:56.795

<v SPEAKER_3>I would love to lie down.

00:32:56.795 --> 00:32:59.035

<v SPEAKER_3>You shouldn't lie down too much, you get bed sores.

00:32:59.035 --> 00:33:03.075

<v SPEAKER_3>And so, yeah, I mean, I think circlage is a good example.

00:33:03.115 --> 00:33:10.175

<v SPEAKER_3>I mean, there are other places where I think we're like, our evidence is more complicated than is sort of able to really be summarized.

00:33:10.175 --> 00:33:12.395

<v SPEAKER_3>Like Nate talks a bunch in the book about episiotomy.

00:33:13.035 --> 00:33:19.495

<v SPEAKER_3>So we sort of know that like routine episiotomy, sort of cutting to make it easier for the baby to come through.

00:33:19.495 --> 00:33:22.195

<v SPEAKER_3>We know that routine episiotomy is not a good idea.

00:33:22.195 --> 00:33:34.715

<v SPEAKER_3>And Nate sort of makes the case in the book that like, there are circumstances in which it is a good idea, and we don't actually have all of the data we'd like to sort of understand if what if any of those are real.

00:33:34.715 --> 00:33:40.735

<v SPEAKER_4>I had to skip the part on episiotomy because I remember like, I was pregnant with my first baby, and you do like the hospital tour and stuff.

00:33:40.735 --> 00:33:42.975

<v SPEAKER_4>And when they started talking about it, my husband looked at me like, I'm out.

00:33:42.975 --> 00:33:45.695

<v SPEAKER_4>And he just like left the tour, and I was like, oh, this bodes well.

00:33:45.695 --> 00:33:48.775

<v SPEAKER_4>Like you can't even handle them talking, but it's not even actually happening.

00:33:48.775 --> 00:33:50.495

<v SPEAKER_4>Like this is gonna be great.

00:33:50.495 --> 00:33:52.735

<v SPEAKER_4>So since then, it's like that.

00:33:52.735 --> 00:33:54.395

<v SPEAKER_4>But again, it's like, they still do that?

00:33:54.395 --> 00:33:55.635

<v SPEAKER_3>Like, yeah.

00:33:55.635 --> 00:33:56.455

<v SPEAKER_3>Sometimes, yeah.

00:33:56.455 --> 00:34:15.615

<v SPEAKER_3>When we had our first baby, we went to like the birthing class at the hospital, and they showed this, like they had this like illustration, I don't know, of like what happens when the baby comes through, and it was like there was a turtle neck, and there was like a doll, and they were like pushing the turtle neck through the doll, my husband was like totally freaked out, and then they were like, do you have any questions?

00:34:15.615 --> 00:34:27.095

<v SPEAKER_3>And this other couple was like, what, like we heard that, we've heard conflicting reports about whether you can get the baby's footprint put on, like stamped onto that day's newspaper.

00:34:27.095 --> 00:34:31.635

<v SPEAKER_3>And I thought my husband was just going to get up and be like, did you see where it comes out of?

00:34:34.495 --> 00:34:35.715

<v SPEAKER_3>You just like couldn't believe it.

00:34:36.115 --> 00:34:46.655

<v SPEAKER_4>And that's like, we focused so much on getting to the point where you have the birth and then getting through the birth and then, I know a lot of new moms are actually surprised like, oh my god, it's so much bad after the birth.

00:34:46.655 --> 00:34:49.475

<v SPEAKER_4>There's so much stuff that can go wrong.

00:34:49.475 --> 00:34:55.135

<v SPEAKER_4>Not to scare people who haven't had their baby yet, but what are some common recovery complications just to be aware of and maybe educate yourself about?

00:34:55.135 --> 00:34:57.015

<v SPEAKER_4>So if they happen to you, you know how to handle them.

00:34:57.015 --> 00:34:57.215

<v SPEAKER_3>Yeah.

00:34:57.215 --> 00:35:04.815

<v SPEAKER_3>So I think the first thing people should understand is that you will keep bleeding after birth for some period of time, even if you've had a C-section.

00:35:04.915 --> 00:35:06.775

<v SPEAKER_3>I think it's often very surprising.

00:35:08.055 --> 00:35:19.475

<v SPEAKER_3>Some people think of the bleeding as a result of the vaginal birth issues, but no, actually, it's the inside of the loci of the uterus is sloughing off.

00:35:19.475 --> 00:35:24.655

<v SPEAKER_3>So that will happen for potentially up to six weeks after birth.

00:35:24.655 --> 00:35:30.875

<v SPEAKER_3>But the one thing I think is really important for people to have their eye on is postpartum mental health.

00:35:31.295 --> 00:35:36.735

<v SPEAKER_3>So 10 to 15% of people will experience postpartum depression that's diagnosed.

00:35:36.735 --> 00:35:40.535

<v SPEAKER_3>That's going to be more than that for many people.

00:35:40.535 --> 00:35:45.955

<v SPEAKER_3>And it gets often dismissed or under treated.

00:35:45.955 --> 00:35:49.455

<v SPEAKER_3>We don't, I think, screen enough for this.

00:35:49.455 --> 00:35:56.395

<v SPEAKER_3>We kind of assume people are going to get screened like when they show up at their doctor, their six-week visit, not everybody has that visit.

00:35:56.395 --> 00:36:04.095

<v SPEAKER_3>That's actually not a great time to screen in the sense that people are up and out of the house, and maybe that's, you know, they're in front of their doctor.

00:36:04.095 --> 00:36:08.435

<v SPEAKER_3>It's like, it's not a time that maybe really is fully capturing how they're feeling.

00:36:08.435 --> 00:36:23.795

<v SPEAKER_3>So one of the things I will always recommend people do is like have a plan to fill out this depression screen like every other week for all the adults in the household, because that is a way to figure out like, how are things going?

00:36:23.795 --> 00:36:26.355

<v SPEAKER_4>Hey, we're going to take a quick break, but I'll be right back.

00:36:31.455 --> 00:36:35.415

<v SPEAKER_5>Ever dreamed of traveling the world with your children without leaving your home?

00:36:35.415 --> 00:36:41.255

<v SPEAKER_5>Tune in to Culture Kits podcast to embark on an incredible adventure right where you are.

00:36:41.255 --> 00:36:54.255

<v SPEAKER_5>At Culture Kits, we collaborate with cultural organizations, authors and educators from all over the world to expand our children's horizons, inspiring them to embrace our differences while bridging communities worldwide.

00:36:55.195 --> 00:36:57.295

<v SPEAKER_5>And that's Culture Kits podcast.

00:36:57.295 --> 00:36:58.315

<v SPEAKER_5>Here's your passport.

00:36:58.315 --> 00:36:58.735

<v SPEAKER_5>Let's go.

00:37:07.349 --> 00:37:12.109

<v SPEAKER_4>In closing, I wanted to ask, the chapter on stillbirth was, I mean, I was crying the whole time.

00:37:12.109 --> 00:37:31.509

<v SPEAKER_4>It never happened to me, but as someone who talks to moms who've had lots of complications as part of your work and your students, and what do you say or not say if you haven't gone through that yourself, but you want to express empathy, but sometimes it's, what are the words that you say to a mom that just had a stillbirth who's your friend?

00:37:31.509 --> 00:37:47.029

<v SPEAKER_3>So I've asked this a lot of times to people, and what I get a lot is what not to say, which is things like, well, everything happens for a reason, or it's lucky you already have a child.

00:37:47.029 --> 00:37:48.769

<v SPEAKER_3>That one's particularly grim.

00:37:48.769 --> 00:37:55.989

<v SPEAKER_3>But just things, I think our instinct when we're talking to someone is to try to say something positive.

00:37:55.989 --> 00:38:01.609

<v SPEAKER_3>And in fact, the best thing to say may be, I am so sorry this happened.

00:38:01.609 --> 00:38:02.689

<v SPEAKER_3>I am here with you.

00:38:03.689 --> 00:38:09.169

<v SPEAKER_3>And there may be nothing more that one really can say.

00:38:09.169 --> 00:38:10.789

<v SPEAKER_3>There may be nothing more that one can say.

00:38:10.789 --> 00:38:12.289

<v SPEAKER_3>And then people say, what should I do?

00:38:12.289 --> 00:38:14.969

<v SPEAKER_3>And the answer is, drop off food.

00:38:14.969 --> 00:38:16.789

<v SPEAKER_3>Things that don't require anything of them.

00:38:16.789 --> 00:38:18.349

<v SPEAKER_3>Don't ask if they need food.

00:38:18.349 --> 00:38:19.949

<v SPEAKER_3>Put food outside their house.

00:38:19.949 --> 00:38:21.469

<v SPEAKER_3>Text them and say there's food outside your house.

00:38:21.469 --> 00:38:23.329

<v SPEAKER_3>If they don't want the food, they'll throw the food in the trash.

00:38:23.329 --> 00:38:23.629

<v SPEAKER_3>It's fine.

00:38:24.309 --> 00:38:32.329

<v SPEAKER_3>Like, you know, sort of be the, try not to ask things of people and also try not to make things feel better.

00:38:32.329 --> 00:38:33.789

<v SPEAKER_4>It's not okay.

00:38:33.789 --> 00:38:35.109

<v SPEAKER_3>It's just not okay.

00:38:35.109 --> 00:38:36.429

<v SPEAKER_3>It's a terrible thing.

00:38:36.429 --> 00:38:37.109

<v SPEAKER_4>It's a terrible thing.

00:38:37.109 --> 00:38:38.089

<v SPEAKER_4>It's a hard thing to write about.

00:38:38.089 --> 00:38:39.489

<v SPEAKER_4>It's a hard thing to teach about.

00:38:39.489 --> 00:38:46.689

<v SPEAKER_4>Thank you so much for putting this book in the world because I think if we don't go into pregnancy thinking, there's a tendency to think like, what's the worst thing that's gonna happen?

00:38:46.689 --> 00:38:52.109

<v SPEAKER_4>But it's like, well, instead of just wondering about it, like you should educate yourself about it and here's some things that might happen and how to deal with it.

00:38:52.469 --> 00:38:56.489

<v SPEAKER_4>And if it's happened to you before, I know for a lot of parents, they're scared to expand their families.

00:38:56.489 --> 00:39:03.629

<v SPEAKER_4>And so I love the data about, listen, there is a risk, it's this much, and you also need to put your own personal touch on all of these decisions yourself.

00:39:03.789 --> 00:39:10.049

<v SPEAKER_4>And as much, it's funny, because as much as you are like the parent data person, a lot of it is like, at the end of the day, the data is not gonna answer for you.

00:39:10.049 --> 00:39:13.669

<v SPEAKER_4>I mean, here's a path to look at, but it's ultimately up to you.

00:39:13.669 --> 00:39:15.309

<v SPEAKER_4>So where can our audience go?

00:39:15.309 --> 00:39:17.269

<v SPEAKER_4>Where do you prefer them to get the book from?

00:39:17.269 --> 00:39:18.849

<v SPEAKER_4>I always like to ask authors.

00:39:18.849 --> 00:39:23.109

<v SPEAKER_3>I am delighted for people to buy the book anywhere that they can find it.

00:39:23.109 --> 00:39:29.149

<v SPEAKER_4>And where can our audience go to learn more and listen to you teach about a variety of topics related to pregnancy and parenting?

00:39:29.149 --> 00:39:35.529

<v SPEAKER_3>parentdata.org is where we have all of our resources on pregnancy, parenting, there's 1,500 articles.

00:39:35.529 --> 00:39:39.689

<v SPEAKER_3>It is all your parenting, pregnancy, and reproductive health questions.

00:39:39.689 --> 00:39:41.349

<v SPEAKER_4>Your new site is beautiful, by the way, too.

00:39:41.349 --> 00:39:43.869

<v SPEAKER_4>So not only is it informative, but it's also pleasant to look at.

00:39:43.869 --> 00:39:45.449

<v SPEAKER_3>beautiful pictures.

00:39:45.449 --> 00:39:46.789

<v SPEAKER_4>Okay, I have to ask you one final question.

00:39:46.789 --> 00:39:56.429

<v SPEAKER_4>Last time I interviewed you, I was blown away because I think you were talking about summer camp preparation and that you would make an asana task for your husband and then he would actually do them.

00:39:56.529 --> 00:39:59.069

<v SPEAKER_4>Are you guys still doing asana with each other?

00:39:59.069 --> 00:40:00.029

<v SPEAKER_4>because that's awesome.

00:40:00.029 --> 00:40:02.389

<v SPEAKER_3>We haven't used as much task management.

00:40:02.389 --> 00:40:12.429

<v SPEAKER_3>We've really, because the kids are a bit bigger, and we're not in the middle of any large projects, but we do have a very elaborate email, ongoing email and Google Doc system.

00:40:12.429 --> 00:40:17.529

<v SPEAKER_3>Although I realized recently, now my oldest kid is 13, and we recently realized she's only using the Google auto replies.

00:40:18.109 --> 00:40:25.229

<v SPEAKER_3>And so, if she doesn't, sometimes you'll think she's read an email because you'll get something back that's like, thanks for letting me know about this.

00:40:25.229 --> 00:40:28.289

<v SPEAKER_3>But that's actually what Google suggests.

00:40:28.289 --> 00:40:29.829

<v SPEAKER_4>There will be a quiz on this email.

00:40:29.829 --> 00:40:35.549

<v SPEAKER_4>We're about to start a yard project for our kids, and I was thinking about putting together an Asana board.

00:40:35.869 --> 00:40:47.949

<v SPEAKER_4>You know, he has a corporate job, and respond to like, how can you always be on time for that conference call, yet I asked you to come in at this time and help me with dinner, and you can't, but maybe just using the tools from corporate world in your personal life would help.

00:40:47.949 --> 00:40:50.169

<v SPEAKER_3>Yeah, you need the calendar invites.

00:40:50.169 --> 00:40:54.149

<v SPEAKER_3>I mean, my husband really likes a calendar invite, and you know, that works out.

00:40:54.149 --> 00:41:02.489

<v SPEAKER_4>We moved to a shared calendar for kids' sports because like, it's insane, and I said I would never do it, and it changed my life, so you can teach an old dog new tricks, it turns out.

00:41:02.489 --> 00:41:03.809

<v SPEAKER_4>Well, thank you so much for the conversation.

00:41:03.809 --> 00:41:04.789

<v SPEAKER_4>I really appreciate it.

00:41:04.789 --> 00:41:07.129

<v SPEAKER_3>Thank you so much for having me.

00:41:07.129 --> 00:41:09.689

<v SPEAKER_4>Well, I hope you enjoyed that interview with Emily Oster.

00:41:09.689 --> 00:41:12.269

<v SPEAKER_4>I love how succinct and down-to-earth she is.

00:41:12.269 --> 00:41:20.669

<v SPEAKER_4>Like, she's got the economist vibe, we're like, she's all business, but then she also is like a real life mom and has those experiences to share as well.

00:41:20.669 --> 00:41:26.829

<v SPEAKER_4>I'm gonna share all of the resources that Emily covered in this episode in the show notes, which those will be online at blwpodcast.com/fourfivefour.

00:41:29.849 --> 00:41:32.409

<v SPEAKER_4>A special thank you to our partners at Airwave Media.

00:41:32.409 --> 00:41:39.709

<v SPEAKER_4>If you guys like podcasts that feature food and science and using your brain, check out some of the podcasts from Airwave or online at blwpodcast.com.

00:41:39.709 --> 00:41:41.149

<v SPEAKER_4>Thanks for listening and I'll see you next time.