Latest / The Birth Lounge Podcast / Ep. 479: Let’s Talk About Low Amniotic Fluid: The Nuance Nobody Talks About with Dr. Lawren Honken

Transcript

Ep. 479: Let’s Talk About Low Amniotic Fluid: The Nuance Nobody Talks About with Dr. Lawren Honken · The Birth Lounge Podcast

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  I was literally crashing out crying, um, in private, mostly in private 'cause I was at work when I found this out and called my husband and like I really didn't wanna be induced and I-- And not necessarily because there's anything like bad about induction when it's indicated.
• I think it just my, I didn't want my plan to change.
• It was more about the control and like when you feel like things are out of control, or when I do, that's when I get anxious.
• Hello, and welcome back to another episode of The Birth Lounge Podcast.
• All right, there's a bunch of diagnosis that can come your way in pregnancy.
• We know this, right? Seems like pregnancy is sometimes a minefield.
• Sometimes it feels as if we are just dodging diagnosis left and right.
• I often hear this in my DMs.
• People will say, "You know, I was really close to being diagnosed with this," or, "I got diagnosed with this, and now I'm just hoping that it's my only one.
• I hope I don't get another diagnosis."
• And, you know, here's what I will say.
• Pregnancy is a time where your body is going through so much.
• So much is changing.
• Your blood volume changes.
• Your body is growing.
• Your organs are shifting.
• You've got this baby that is developing inside of you, and, and your body is genuinely in such a transitional phase.
• Now, in terms of, you know, our whole life, it's a small blip on our radar.
• It's just nine to 10 months.
• But when you're deep in it, it can feel like every day is so long.
• And if you have already gotten a diagnosis, then sometimes it can be very anxiety-provoking thinking about, "Am I going to get another diagnosis?" One of the things that I love to address on this podcast are, well, what are the different diagnosis that may pop up for you in pregnancy? And of course, you know, everybody is gonna have a different experiences with diagnosis.
• So some people are gonna make it through pregnancy, and you're not gonna have any, and then some people are gonna have more complicated pregnancies and you might have a slew of diagnoses that are part of your journey.
• My job here is to help you understand, what are those diagnosis? What do we do in order to diagnose them? How are they going to impact your pregnancy? And Also, how might they impact your birth experience? Plus, I wanna understand, are there any long-term risk or complications that may follow you or your baby, depending on the diagnosis? So today, we're gonna do exactly that.
• We're talking about oligohydramnios, and that's just a really fancy term, a medical term, for low fluid This is a really special episode to me because I have been trying to track down our guest today for a long time, and when I say track down, we are Instagram friends and I love her so much and we, we talk a lot over on Instagram, and when we first tried to plan this, I was pregnant, and then I had a baby, and now she's pregnant.
• And so our timelines have finally lined up and I'm so excited to bring you Dr.
• Lawren Honken.
• You may know her as Your Friend, the OBGYN on Instagram.
• Dr.
• Honken is a board-certified OBGYN, a certified menopause practitioner, a surgeon, a mom of four, and the creator of, well, Your Friend, the OBGYN.
• She is passionate about helping women understand their options through evidence-based education so that you can make informed decisions that align with your values and your goals and your unique circumstances.
• In today's episode, you're gonna hear us dive into, briefly, but we do cover it, how individualized care really makes such a difference, and if we begin to see a world where individualized care is prioritized over let's call it blanket statement care, one size fits all type of care, we could probably really reduce our rates of birth trauma in the US.
• I love Dr.
• Lawren so much, uh, because her approach really emphasizes patient autonomy, shared decision-making, compassionate, individualized care, which we all know makes such a difference.
• Some of the things we're gonna talk about is, well, what actually constitutes low fluid? Obviously, we all have a certain amount of fluid and, and it's a range, right? So, like, how much fluid I have is not gonna be the same as how much the next person has, but it should be within a standard range.
• What does it mean when you actually have low fluid? What are the risks that are associated with that? How do you go about having a nuanced conversation with your provider to figure out whether induction is right for you, or whether there are other options to maybe increase the amniotic fluid that you do have? And then if you do get diagnosed, what steps do you take from there? Are you being induced that day? Do you need to be on bed rest? What about amnioinfusion? How accurate is it when we get a diagnosis, and how are we getting that diagnosis? What types of tests and procedures are you going to go through in order to see if your amniotic fluid is at the correct amount or if it is too low? I'm so stoked for today's conversation.
• It's such a good one, and again, I just love how much Dr.
• Honken puts things in perspective, but in a non-scary way.
• She helps you really understand risk and benefits, and then has this really casual but comforting conversation with you where you really are empowered to make the decision that feels best to you, and you don't experience any sort of fear-based care along the way.
• So all right, you guys, without further ado, Dr.
• La Thank you so much for having me.
• I'm so excited.
• Oh my gosh, no, actually, you have no idea how excited I am.
• We've been trying to get this going for a while.
• At first, I was pregnant, and now you're pregnant, and our timelines have finally overlapped.
• I'm so excited for this, and also because this is a topic that a lot of people are asking for.
• And, and I think that this is one of the things that probably a lot of people don't know can happen.
• Um, we never really think about our fluid getting low.
• We just think, like, "All right.
• I've got amniotic fluid, and it is what it is."
• But we can have too much.
• We can have too little.
• So we're really trying to strike that balance, right? Tell us what oligohydramnios is.
• It's too little fluid, but what does it actually mean in terms of pregnancy? So yeah, oligohydramnios basically means that the amniotic fluid surrounding the baby inside the uterus is low, and we define that in a few different ways you can.
• So one is by we're using ultrasound, so we're measuring either the single deepest pocket of fluid that we can find, and it needs to be bigger than two centimeters, or we're calculating up the total amniotic fluid index, which this is basically you're dividing the belly into four quadrants, and you're trying to get a pocket, the deepest pocket in each one, and you kind of calculate that up, and that should be greater than five.
• Five or greater, um, is considered normal fluid for an AFI.
• Or there are some, um, specialists that would use like a percentile.
• So they would say, for your gestational age, you should be above this percentile of amniotic fluid, and below that they would consider to be low fluid.
• So but we know the best way to measure it is the single deepest vertical pocket.
• From one quadrant, or we're looking at the entire belly, and we're trying to find that, that very deepest pocket, and that's how we measure that.
• Yes.
• So basically looking at the entire belly, all the fluid that's inside the uterus, finding the deepest pocket that you can that doesn't contain an umbilical cord.
• So that's another thing because on the ultrasound, the umbilical cord, if you don't have the color flow on, can look dark.
• So it looks like, you know, okay, maybe that's a big fluid pocket, but if you put the color flow on, then there's an umbilical cord there, and you can't count that part.
• Or it can't have like, you know, you're not measuring like any part of the baby.
• It's really only the fluid.
• Now, what's the margin of error here? What are the chances that you get a reading that says like, "Uh-oh, we've got some low fluid," and then actually it's really not low at all, it's normal? Yeah, that's a great question.
• I don't have like an exact number or statistic, but that is why now it's recommended to use the single deepest vertical pocket because we did use to use AFI, which was all the four quadrants.
• But if you think of it from kind of like a logical perspective, obviously your baby is inside, like moving around, and you're over here measuring a pocket, then you're moving down here, then you're over here, then you're over here, and it's like, well, is, is the baby moving, and the baby was down there.
• Now the baby's up here.
• So it looks like your fluid's low because the baby moved.
• Also, too, the plane that you're measuring in, so you're holding an ultrasound probe should be kind of straight down, and if you angle it can look a little bit different.
• So that's why you know, they study the single deepest vertical pocket because that's kind of the, the least Like variables.
• Yeah Yeah 'cause with the other one you have so many variables that can kind of impact that.
• That makes so much sense.
• Now, what about maternal hydration? I hear a lot of people say, like, "All right, I'm going in for an ultrasound, I'm drinking a lot of water."
• H- I think logically that's, like, a great idea.
• You're like, yeah, I want to have a lot of fluid.
• If I'm dehydrated when I go in, does that increase my chances of a false positive maybe reading like I have low hydration and/or if I over-hydrate, could that hide a problem? So I would say no, uh, no for over-hydration.
• Okay.
• I would say if you know, as long as you're not, like, you know, to, like, a water toxic level, which you wouldn't, which you ideally wouldn't be.
• But yeah, just normal, you know, trying to stay well-hydrated I think is a great idea.
• Also, through pregnancy also, I'm just saying this 'cause I live in South Carolina and it's like 100 degrees outside, especially when it's hot outside, I mean, yeah, hydration is never a bad idea.
• But maternal hydration can affect a fluid measurement, so if you are dehydrated, potentially your fluid could be lower.
• And so, and we have seen that if we give people IV fluids or if they orally hydrate a lot, sometimes that can change the fluid level.
• But the other thing to know is the biggest thing that you want to figure out is, like, why is my fluid low and is there something else going on too? Because let's say you are a low-risk pregnancy and your fluid's low, you don't have anything else like high blood pressure or preeclampsia, your baby's growth is normal, all these things are normal, then that is where we'd be more likely to go like, "Okay, maybe you're dehydrated."
• However, if your blood pressure is high, if something else is going on, then we see usually low fluid as a marker of the placenta not working as well as it should So that's scary.
• Yeah, that's really scary.
• What does it typically indicate, that your placenta is just, like, becoming weaker or that it's shutting down or that it's not filtering things as well or kind of all the above? Yeah, so I really, I really like-- I feel like we don't know enough about placentas honestly.
• I agree with that.
• Yeah, no, no.
• Um- She's, she's elusive yeah.
• She's an elusive lady.
• Yes.
• Yes.
• Um, and she just hasn't been studied enough.
• So, um, I, I really love the account, like measure the placenta, and I just l-- I-- and I think I actually stole this analogy from there.
• I stole it from someone.
• It's not mine.
• But considering the placenta like the gas tank of the pregnancy.
• So your placenta is the gas tank.
• When gas runs out of your car, like, your trip's over.
• That's it.
• And so the goal at the end of pregnancy is to, you know, make sure that the placenta is still, the gas tank still has some gas in it to get you to the point of delivery because we're always trying to balance, like, okay, especially if we're recommending a medical induction, we're always trying to balance, like, what is the risk of the baby coming early, earlier than your body intended for the baby to come? What's the risk of that versus the risk of you staying pregnant and then this kind of going down a different road if it is actually, like, a pathology or, like, a problem that your fluid is low? So we're just always-- we're trying to figure that out.
• Like, is your fluid just low 'cause it's, like, maternal hydration and otherwise your pregnancy is healthy? Or is your fluid low because something else is going on? What could be some of those other things that might be going on? Uh, like a small baby, preeclampsia, gestational diabetes, m- high blood pressure, things like that? What about, like, HELLP syndrome, PUPS, any of that? So yeah, so there are a lot of different things that can affect the fluid during a pregnancy.
• If you are, you know, further away from your due date, let's say like in the second trimester around the time you are getting your anatomy scan before kind of the Tdap in that window and the fluid is low, that is more concerning to us.
• So if you're early on and your fluid is low, then that may indicate that the baby could have issues with kidney function because the amniotic fluid is the baby's pee essentially.
• So the baby is peeing, which my kids think this is like the coolest fact, they love to tell everyone this, that the baby is peeing and that's the amniotic fluid, is baby pee.
• And then the baby swallows essentially their pee, and also when they're practicing breathing towards the end of pregnancy and but also the second trimester, amniotic fluid is really important for adequate lung development.
• So that's why pregnancies where there's no fluid around 20 weeks or so, a lot of times don't make it or either the baby is gonna have a lot of consequences as far as breathing problems and stuff like that after delivery.
• So that's really kind of the timing of when it's diagnosed helps us determine, like, what, why is this or what is going on, what's causing this.
• So, and a lot of times for like pathologies in pregnancy or something going on that's not exactly right, we kind of think of three buckets that could be the, the originating problem.
• So the placenta, the baby, or the mom.
• So like basically just helps my brain to think of like, okay, what could be causing this? So like the baby for fluid being low, if there's a kidney issue or some other essentially, like, anomaly that could be causing issues with the fluid being made, basically.
• I th- I know what I was gonna say, and that's why my brain was like, "Eh."
• But because, um, like, swallowing and stuff, the baby has to be able to do that, but that would be more of, like, causing high fluid if that was an issue, because the baby can't swallow the fluid.
• The other thing is that a lot of times on the ultrasound they will look at the baby's bladder, and so if the bladder is full, that means probably the baby is gonna pee soon.
• That could raise your fluid level a little bit.
• So, then as far as, like, maternal stuff, so bloo- and s- maternal and placental things are really interconnected as far as, like, blood pressure stuff goes.
• Um, so anything with high blood pressure, like if you have high blood pressure at baseline, which we call chronic hypertension before you get pregnant, if you just develop it at the end and have gestational hypertension or more severe forms like preeclampsia, severe preeclampsia, HELLP, all those things definitely can affect fluid levels.
• Also just the baby being small in general is, like, is that a chicken or an egg? Is it that the placenta was not really giving enough nutrients to the baby or able to give enough nutrients to the baby to get the baby to be, like, a normal size? So is that more of, like, a placental thing or a baby thing? That, and then that's more concerning when the fluid gets low because you're like, "Okay, this seems like it's a placental thing."
• The high blood pressure preeclampsia, it seems like it's a placental thing usually.
• So- Yeah yeah, a bunch of different things.
• It can be cyclical, right? It's like, eh, the chicken or the egg, it's like, well, does it really matter if it's the chicken or the egg because now everything is- Yeah being impacted, which is so tough.
• Okay, so talk to us a little bit about...
• Actually, I wanted to say something.
• Isn't it so funny how your baby can pee, swallow pee again, swallow constant pee, and not come out with an infection? That's so weird.
• If we all were drinking pee, I feel like we would be sick as a dog, but your baby is just like Our bodies are just so phenomenal That's- I think about that all the time.
• Like, how do all babies not have an infection? Honey, you've been drinking- Yeah urine for nine months.
• Yeah.
• That's crazy.
• Well, actually, medically speaking, urine is sterile.
• Oh.
• So- There you go then even if...
• Yes.
• So even if, um, like frequently, you know, we, we learn to do circumcisions, uh, in residency and stuff, so if the baby's peeing while you're doing it, it's not really an issue of messing up the sterile field because urine is sterile.
• So yeah.
• Yeah.
• But it's really more the bacteria on the skin and stuff that causes, like, a...
• Or, you know, that contributes to, like, infections and stuff.
• It's more about the poop.
• Poop's definitely not sterile.
• Yeah, poop is dirty.
• Dirty, dirty- Yeah dog.
• That's disgusting.
• Um, okay.
• Now I've heard, or not even heard, I've seen.
• We've, we've had a lot of clients that, And not a lot because it is common.
• A lot because just the volume of patients that of clients that we serve, okay? I don't want anyone listening being like, "Oh, my God, you see it all the time."
• We don't, by any means.
• Um, but I've been a doula for 11 years now, so I've seen it a, a number of times.
• Amnioinfusion.
• Talk to us about re-inflating the amniotic sac with hydration.
• Is it something that can be done before we're in labor? Do we need to be in labor? And do we have to, uh, like, break our waters in order to do it? Yeah, I would say, you know, generally speaking, a general OBGYN like myself that- that's kind of my bread and butter, like delivering, taking care of pregnant people, delivering babies, doing GYN surgery, taking care of women.
• We would only do an amnioinfusion in labor, and the purpose is because we think of amniotic fluid as kind of cushioning the baby.
• And what happens when your water is broken whether it breaks on its own or we break it in labor, is that the cord, the umbilical cord can get kind of squished or compressed because there's not that fluid cushion around it.
• When that happens, that can cause the baby's heart rate to drop, and so that's concerning to us if we're seeing that on the monitor.
• And so, and if that happens repetitively over a long period of time, that can cause the baby to become distressed, where they're not able to tolerate labor.
• So in those cases, we would do an amnioinfusion where we put like a little catheter or tube into the uterus sterily, as sterily as we possibly can, and then we kind of infuse saline or like kinda like the bag of fluid that you get through your IV to kind of try to put the cushion back basically.
• So that would be the goal, to help correct, give the baby more reserve so that they're able to continue to labor so you can have a vaginal delivery.
• Now, there are some like super rare things and cases that I would say is definitely not the standard of care but babies who have something where they have like a significant anomaly with their kidneys from the very beginning of pregnancy and like basically have no fluid, there's this idea that like, well, if we could give them fluid, that would help their lung development.
• That may help them to make it to delivery.
• That hasn't, as far as I know, hasn't been shown to be helpful, but there are some like subspecialists, like maternal fetal medicine specialists that might do that.
• We, where I trained, there was a a lady that did that for some patients.
• It's not evidence-based.
• She was not looked on very fondly by the OBGYNs.
• But I think, you know, when you see patients like that in a situation, obviously their baby's health or life is in danger.
• They're, it's a really desperate situation, and you really wanna be able to offer an- absolutely anything you can to help.
• So I think that's where she was coming from, which was well-intentioned.
• But yeah, I would say no, not routinely.
• And especially, you know, the majority of your patients, I'm sure, are kind of like getting close to their due date and then finding out they have low fluid.
• And so we definitely, at that point, that would be way too risky to try to do that before labor, 'cause you could just really break the water essentially.
• So then the conversation would switch to induction, right? Should we induce? Should we wait? Let's have that conversation right here.
• So if you were counseling somebody, what type of things are you considering? Obviously, what comes to my mind is how low are we? Are we kind of a little low, and we think maybe some maternal hydration might come up? Are you saying like, "Yep, this is just a little low.
• Let's have you go home, hydrate, come back tomorrow for an ultrasound"? Are you saying like, "No, anybody below that number, you absolutely need to be induced"? How do we balance, especially knowing that the majority of women don't wanna be induced, right? And so we don't want to induce you if you don't want that for yourself, but we also wanna keep you and your baby safe.
• So there's a lot of nuance to this discussion.
• Yes.
• There is this, I feel like it's such a difficult discussion to have, and, you know, deserves a much longer visit than the normal like three minute- Bye bye.
• you know, that, that's right, yeah.
• Baby looks good.
• Okay, see you later.
• Because there's a lot of anxiety involved obviously for the mom just around the baby's health, her health, if she's choosing to do the right thing, and then also that's kind of battling with like how she thought things were gonna go.
• So which I definitely have experienced myself because I know we were talking a little bit before this, but my first, I ended up needing to be induced after my due date because the fluid was low and it was very low.
• And also my blood pressure was starting to go up a little bit and I wasn't feeling the baby move as much.
• So it was more from like a health perspective for the baby.
• But I will say, I think my eight-year-old taught me this, um, phrase, crashing out.
• I was literally crashing out crying, um, in private, mostly in private 'cause I was at work when I found this out and called my husband and like I really didn't wanna be induced and I-- And not necessarily because there's anything like bad about induction when it's indicated.
• I think it just my, I didn't want my plan to change.
• It was more about the control and like when you feel like things are out of control, or when I do, that's when I get anxious.
• Probably there's some deep-rooted thing about why I became a doctor in there 'cause I can, you know, you can control a lot of things when you're a doctor, or at least you think you're controlling it, but you're not.
• So yeah, no, it's definitely a hard conversation to have.
• So I usually start with like th- this is, you know, what's going on.
• So let's say, you know, whatever reason you had an ultrasound.
• Most people don't really need an ultrasound later in pregnancy unless they need it for some indication like to check on the baby's growth, if they had low fluid in a prior pregnancy, things like that.
• So first of all, you know, I'm looking at why is the reason that they got the ultrasound.
• Was it just to look at the baby again? Was it their measurement was off, but now their-- but their growth is totally fine and they're low risk? And so that matters a lot.
• So I usually am like looking at that, looking at the fluid, like, "Okay, this is, you know, this is what your fluid is today, and this is how it was measured."
• And so I talk to them about AFI versus deepest vertical pocket, and I say, "The best way that we determine fluid is by the deepest vertical pocket, which needs to be over two, and yours today was either, you know, just under two or there was no fluid," or something like that.
• And so And then I say, you know, a lot of times what we're looking at fluid as a marker for us as function of the placenta.
• And then I say my little gas tank thing about like, you know, placenta is the gas tank.
• Once the gas is gone, the pregnancy is over, and our job is to catch anything that's gonna make the gas run out faster or to try to, you know, we wanna be able to do something and intervene before anything else happens or it causes another issue.
• And so technically, The recommendation by ACOG is induction of labor between 36 and 0 and 37 and 6 if you're diagnosed with isolated oligohydramnios, which means otherwise you have an uncomplicated pregnancy.
• There's nothing else going on.
• The baby's growth is normal.
• You don't have high blood pressure or anything like that.
• So I basically just kind of lay out like, this is what ACOG says."
• And then I say, you know, "But it's important for us to figure out why this is happening."
• And it also depends on how far along they are, right? Because if you're 36 and 0 and you have isolated allo- oligohydramnios, and I'm telling you you need to have a baby, then we also need to be considering the risk of having a baby that is preterm, even though late preterm.
• So you're gonna have an increased risk of NICU admission, of the baby having issues with breathing, that it might need help transitioning.
• They're definitely gonna need more help than a baby at, let's say, 38 weeks would.
• So some of that depends on on that too, the gestational age.
• But if I do have a patient who's really, like, dead set against, like, "I don't wanna get induced no matter what," I certainly would say, and let's say they have isolated oligohydramnios, I certainly would say, yeah, the, one of the options is to hydrate.
• You could go to, you know, labor and delivery triage, get an IV.
• You could orally hydrate at home, come back tomorrow.
• And ACOG does mention that if the patient is gonna continue the pregnancy, not get induced or delivered, that you bring them back twice weekly to check the fluid, make sure that fetal status and everything is okay, that their blood pressure's okay, all that kind of stuff, because that would also change recommendations for management.
• But I mean, certainly at 36 and 0, personally, if I were diagnosed with oligohydramnios, I, I would be very upset about having to deliver at 36 weeks.
• So I definitely understand that, and I think it's totally reasonable if you have a low-risk pregnancy and your fluid is low but it's not zero to kind of hydrate and come back for a recheck.
• Yeah, and just have a reasonable- But the more- conversation with your doctor about like- Mm-hmm look, these are my goals.
• I'm obviously not trying to put myself or my baby in danger, but I also really don't want to be induced unless we absolutely- Yeah know that it is medically necessary.
• So if there's anything that we can try, or if I can even buy myself 12, 24, 36, 48 hours, I would love to try that a- assuming that that choice- Mm-hmm is not going to make myself or my baby be in danger, right? Mm-hmm.
• Mm-hmm.
• Mm-hmm.
• Um, I think it's really unfortunate 'cause I think a lot of people wanna have these conversations, and it's, it's what I teach in The Birth Lounge.
• I teach you how to have these conversations.
• The caveat though, the piece that is out of your control is having a provider that's willing to do that.
• And it sucks so bad when you have the tools, you have the words, you have the knowledge to have this, and then you're f- you're sitting in a room with a provider who won't have this conversation with you, and they're not willing to go there and give you that individualized care, which is what I actually love so much about the doctor that you talked about in residency, where she kinda went off script of evidence-based care that's not evidence-based, but she was using evidence-based medicine in an individualized way, and she was tailoring that to the person, to the mom, to the family, and the baby sitting in front of her.
• And she probably, fingers crossed, was telling them, "Listen, this is not standard of care.
• This isn't what typically we do, but it is an option, and if you're willing to have the risk, if you're willing to take on those risk, we could try this even though it's not what we typically do.
• How does that feel to you?" And I think that, I think that when you get in a scary situation like this, you're getting a diagnosis that you may not have ever heard of, you didn't expect it to be part of your story, it is changing your birth plan, it's changing the expectations of how you thought you would go into labor, how you thought you would probably labor, even maybe the outcome of your labor, having those type of...
• Ooh, I just got chills.
• Having those type of conversations with a provider can mean the difference between birth trauma and not birth trauma.
• Yeah, no, I totally agree with that, and I think a big piece of birth trauma, whether you undergo, like, an actual medical, you know...
• Yes, oligohydramnios is a medical complication, but I mean, like, you undergo an actual, like, medical issue like those, the big things out there, like you have a hysterectomy around your delivery, you have an AFE.
• The, those kinds of s- really, really scary things that are super, super, super rare.
• Like, we expect those things to cause birth trauma.
• I think collectively everybody does.
• But I think the things that don't get recognized are, I mean, a lot of times trauma is a disconnect between just the reality, what you, or, and what you expected, but also just not being heard because I think People can totally emotionally walk through something like this without any trauma if they feel like they're being heard and if they feel like they have options.
• But I think that's what's difficult is when you feel backed into a corner of like, "This is the only decision that I have, but there are other things telling me that this might not be the best decision for me."
• Or maybe, "This might be the best decision and I might arrive at this decision, yes I have to...
• You know, I'm gonna be induced, but I just need a minute to work through it, and I need someone to understand where I'm coming from and just validate the fact that, like, this sucks," you know? Because I think also, too, in medicine, we tend to see, we see all kinds of stuff, and so I think that sometimes reduces people's experience to like, "Oh, well, you should just be happy that you don't have it like this person that I just took care of," or, "You're, you should be happy that you're not in this situation."
• But everyone's experiences is totally valid, and it's totally normal to be upset when your plans change, even if, you know, it wouldn't be as bad for someone else.
• You know, all that is still, is still a very valid experience, and it also can still cause birth trauma, 'cause I think that's a lot of the things, too, that I talk to about patients is they're like, you know, "I feel like I shouldn't be as upset or as traumatized as I feel by what happened, because it really wasn't...
• You know, it was like someone made a dismissive comment, someone..."
• Like, something like that.
• And it's like, no, that's still, that's still valid.
• Like, I mean, everyone deserves to feel safe when they're, you know, having their baby, making choices around building their family.
• I mean, all that is so important, and I think that's where we got it wrong as a medical community, and that's what's driving people out of the hospital to have birth because they don't feel listened to inside the hospital.
• Yeah.
• Yeah.
• It, um- It's all relative, right? Like, what's traumatizing to one person is not traumatizing to the next, and I'll give you a little personal anecdote here.
• I've shared with you guys that, you know, between two and three days postpartum, we had to take Saggy to the ER, and I had a lot of trauma around that, and my husband walked away with basically no trauma, and I just couldn't understand, how did we experience the same exact thing? How did we live through that same exact experience and he walked away, not unfazed, but, like, the trauma didn't sit with him the same way it sat with me.
• And I just got done with therapy.
• I'm very proud of that.
• But, um, when I first went into therapy, I...
• All I could say was, like, the ER, the ER, the ER trip was, like, traumatizing to me.
• I don't know really what it was, but it was traumatizing.
• And as I worked through trauma I did EMDR trauma and, and, and as I did the EMDR therapy, I was able to nail it down to one provider, and I can see her so clearly.
• She was leaned up against the wall.
• She had her leg up.
• Her hands were behind her back.
• She was so nonchalant and casual, and she was Just speaking to us like we were dumb.
• And I didn't realize, but that is what made me feel traumatized.
• I obviously, there was expected trauma.
• It was very traumatizing to go into the ER with a brand-new fragile baby.
• It was very traumatizing to hear how sick Saggy Boy was.
• But my residual trauma that I was being stuck in a loop actually came from a provider speaking to me as if I was just du- I mean, she just, like, berated me, and it, it felt like that.
• My husband did not have that same experience.
• He did not feel like she was speaking to him in that same way.
• And so I think being gentle with yourself and recognizing, like, "It's okay for me to feel traumatized by this, and it's also okay that somebody else doesn't understand that trauma," or they may not have experienced trauma from that experience.
• What they experience trauma with is gonna be something for you a non-issue.
• You would just move through that experience and be like, "Yeah, that wasn't traumatizing."
• So I just, um, you know, while we're on here on the topic of trauma, always wanna just hold space for, like, whatever is traumatizing to you is very valid, and don't let someone dismiss that.
• And if you're being seen by a provider who is dismissive, think about changing providers.
• What my husband and I did, we just simply asked for that provider not to give us care anymore, and we never saw her again.
• She was not part of our care team going forward.
• And I I mean, it, it stuck with me.
• It really stuck with me, the way that she spoke to us and the way that she spoke about Saggy and the way that she just...
• Her demeanor.
• It was horrible.
• It was horrible.
• Um, but don't forget that you always have the right to say, like, "You know, I really, I don't want that person to give me care anymore."
• Hey, quick little interruption because I want to put you into labor.
• No, seriously.
• Imagine this, your water breaks, you're not having contractions.
• What do you do? Are contractions coming? Do you head to the hospital? Should you be doing something to get contractions started? Then contractions do start, but hours later, and they're still really far apart.
• Now what do you do? Do you take a nap? Do you stay home? Do you go into the hospital? Do you do something at home to get them closer together? Do you know what questions to ask yourself, and then once you get to the hospital, your team, before you make decisions in labor? One of the things I continue to see is that people will take all these childbirth ed classes, they read all the books, they listen to all the podcasts, yet when they're in the moment, in labor, they're not able to access all of that information.
• That's what I'm doing with Labor Live.
• This is an interactive, real-time birth simulation.
• I think it's the first ever.
• I am actually going to step you through what it's like to be in labor.
• You're going to be able to experience an entire labor as it unfolds.
• And you know what? You're not going to know what's coming next, just like you're not going to know what's coming next in your labor.
• You're going to get each scenario.
• You'll be able to look at your options, think about what you want to do, and then make your decision.
• And then I'm going to talk you through that option.
• What does the evidence say, plus what the things you should be asking your provider are so that you can make the most informed decision.
• Then labor keeps going You've spent all this time learning about birth.
• Now let's actually practice navigating birth Labor starts on September 1.
• You can consider that your due date.
• Once you are inside, your spot is saved for you, and from there, we just go through birth together.
• How exciting.
• You'll experience labor via updates that are delivered directly to your phone one at a time every so often, just like the real thing.
• Head to thebirthlounge.com/laborlive
• to put your birth date on the calendar right now.
• You may not be able to predict exactly how your birth will unfold, But you absolutely can practice navigating labor before you're actually in it.
• I'll see you in labor on September 1.
• Dr.
• Lawren, does your baby's position in your belly, can that impact the readings of the ultrasound and give us a false positive of too high or too low fluid? I mean, ideally if it shouldn't, if we're going by the single deepest vertical pocket.
• Okay.
• So I would say it should not.
• Um, you should be able to, you know, just confirming that the cord is not in the pocket, in that deepest vertical pocket, but it should not influence that.
• And what about other diagnoses? I'm thinking primarily baby diagnoses, things like Down syndrome, APERT fragile X, Klinefelter.
• When we see babies that have diagnoses in utero, are we also seeing an increased number of either high or low fluid in those cases? So I would say that would be primarily influenced by what else the baby has going on.
• Got it.
• So it's not necessarily, like, the fluid.
• It's more like the fluid is probably a sign of something else.
• Like for instance, Down syndrome, you can have duodenal atresia, where your, like, part of your gut doesn't develop appropriately, and so you can't truly swallow the fluid for it to pass through.
• I mean, you can swallow it, but it doesn't pass through.
• So then it kind of, like, you end up with a lot more fluid.
• Um, so but that more is a function of, like, not because of Down syndrome, but because of, like, an, an anomaly that can be associated with Down syndrome.
• Or for instance, like, if you do have a baby that has a chromosomal abnormality, they are gonna be more at risk likely to be small.
• So if their growth is small, that also could indicate an issue with the placenta, which may end up causing low fluid.
• So I would say more, more about not necessarily the fluid, but the underlying thing.
• Yeah, what else is going on.
• Okay, and then let's talk about risk.
• You mentioned briefly if we've got too low fluid, we might have that cord compression, which I feel like everybody in my community is very well kind of versed on that.
• We obviously want the cord to be nice and cushioned, really supple.
• What else are we looking at in terms of risk when it comes to low fluid for either mom or baby? So yeah, a little bit of that depends on too, you know, is it just low fluid that's isolated in a low-risk pregnancy versus is there something else going on? So I mean, certainly there is an increased risk in stillbirth if the fluid is low.
• And so that is something that is really scary when you hear something like that quoted because it basically is like seven times more likely to happen if you have low fluid.
• However, when you separate it out, the patients that have isolated oligohydramnios, they have low-risk pregnancies, it really is just a low fluid reading.
• They don't have preeclampsia, you know, the baby's small the baby has an, an anomaly, nothing like that going on.
• That those people were all included in the study with all the other people that showed an increased risk of stillbirth.
• So there's no study unfortunately, that shows just people with only oligohydramnios.
• I was looking up before our conversation because I thought that might be where things would go because also too because I'm curious and I like to, I like to know these things.
• But the, like the isolated oligohydramnios, there was a study that was done in 2017 where a doctor tried to kind of look at a bunch of different studies in patients who had other things going on with oligohydramnios, and then people who just had isolated oligohydramnios.
• And actually, in that study, there wa- there-- the rate of stillbirth was so low it wasn't enough to be able to like compare the two, which is good and reassuring.
• So I would say, you know, I wouldn't attribute like sure, somebody could say the risk of stillbirth is higher if you have low fluid, which technically is true, but logically that probably is coming from the people in that group that also have other things that increase the risk of stillbirth.
• So I wouldn't necessarily make my decision based on just that if you have isolated oligohydramnios, is what I'm trying to say, I guess.
• Um- Yeah, yeah.
• And what about long-term risks? Are there any long-term risks that we're thinking about like, I guess NICU stays or are we seeing anything happen to children born to low, low fluid 10 years down the road, 20 years down the road, 50 years down the road? Have any of those studies been done? So not anything that I had found or seen.
• There is a slightly increased risk if you have lower fluid, even if it's isolated, that those babies tended to have more meconium aspiration syndrome.
• So basically, where the baby has a bowel movement in the womb, and then at delivery, as they're kind of taking their first breath, then some of those particles can go into their lungs.
• And that can happen with a totally normal, uneventful delivery as well.
• It's super rare, but it can happen, and that's why we like to know when your water breaks, was it clear fluid or was it colored? 'Cause that tells us that, basically.
• So, um, more meconium aspiration syndrome.
• Also, an increased risk of cesarean delivery, and the reason for that being more of, like, the fetal heart rate tracing because you're more likely to have a questionable fetal heart rate tracing if you have low fluid because of that cushion is not really there anymore.
• So you're gonna have more fetal heart rate abnormalities that are more likely to lead to a cesarean delivery or an expedited delivery because there's concern about the baby's wellbeing.
• And are there certain things...
• So let's say you get a diagnosis of, um, oligohydramnios, and it's not necessarily where we need to induce, and you and your provider have had a informed consent discussion, and together you've decided that you're gonna stay pregnant.
• Let's talk about bed rest.
• Are we recommending bed rest? From my understanding, ACOG really doesn't recommend bed rest for much because we know that activity level is good.
• But then you're thinking, if I have low fluid, should I be balancing? Should I be reducing? My activity level probably matters.
• I don't really wanna be sweating if you're in South Carolina like you are.
• Or I was just down in Alabama, and I sweated my buttocks off.
• Like, you know, you probably don't want to spend, spending a lot of time outside.
• Like, what do we need to know about activity level and finding that balance of not being sedentary, but not overexerting ourself? Yeah, I would say I definitely wouldn't recommend bed rest basically for pretty much almost anyone in pregnancy.
• It's just been shown to increase risk of depression and risk of a blood clot, which is gonna cause a lot more problems down the line.
• So I would say, you know, continue your activity as tolerated.
• Maybe if you were, you know, trying to run a marathon in 100 degree heat, like, don't do that, or don't do things that are gonna, like, actively, um, dehydrate you, but otherwise, I think that's fine.
• The other thing that I didn't really mention earlier, I think, is just confirming whenever someone has low fluid, we always wanna confirm that their water's not broken.
• So if, you know, don't be surprised if you have low fluid if someone is asking you, like, "Do you think your water's broken? Have you noticed any leakage?" Anything like that.
• And even if you say no, we may still wanna do an exam to do the testing to see if your water has broken just so that we can confirm, especially if you're gonna choose to be on the side of expectant management because that then is gonna increase your risk if your water actually is broken.
• Yeah.
• And I just feel the need here to say two different things.
• Dr.
• Lawren is definitely a doctor for sure, but she's not your doctor, so just make sure that you're taking- Yes this conversation back to your doctor, someone who knows you, has followed your pregnancy, and have that conversation with them.
• And then the second thing is, um, I love to quote Dr.
• Florescue, who is also heavily involved in measuring the placenta.
• Oh, yes.
• You know, she says, when you go in to your doctor or your midwife or whoever's caring for you, do not leave until you feel comfortable with the answers that you have gotten, right? Even if your, if your staff is saying, like, "All right, you're good to go," if you still have questions, if you still have concerns, if you've got even this nudging little instinct deep down in your belly and you're like, "I don't know, I just don't feel comfortable leaving," say that.
• Share that.
• Do not leave the hospital or your midwife office before you feel comfortable because your maternal instinct, you guys, it is so smart.
• I mean, she's dead on.
• She knows what she's doing, and I really want you to, like, I want you to feel empowered to lean into that.
• And you should be supported by your staff.
• If you're telling them, "I still don't feel comfortable, I still don't feel like I have all the answers," you should be surrounded by staff that says, like, "Okay, we've done all the tests that we typically do.
• What other questions do you have? What is still bothering you? What other answers are you looking for? Let's see if we can run some of those tests or do some of those procedures to help you feel comfortable."
• Um, and you know, you get this here a lot, but there's no shame in choosing induction.
• If you feel more comfortable being induced and that would help you be less anxious than going home and having it swirl around in your head, like, "Is my baby okay? Is there enough fluid?" Then you should confidently feel okay choosing induction.
• I, I want you to hear that, 'cause I think online a lot of times it can feel like, "No, don't choose induction.
• Never choose induction.
• Don't choose that road."
• But you should.
• You should choose that road.
• If it feels more comfortable to you, if it's gonna bring you less anxiety, if it's gonna bring you peace, if this is a choice that you know is gonna help you relax and have the labor that you want, I want you to hear it from me.
• I hope that you can hear my voice in your head when you're sitting there in that triage room getting care, like, "HeHe says it's okay to choose induction if it feels good to me."
• I want you to, like, really hear that, so I'm just gonna say it again.
• I want you to choose induction if it feels good to you and that feels like the safest choice, and I want you to, like, do that confidently and feel empowered to do that.
• And have a discussion with your provider about, like, "No, I want this."
• Um, 'cause just as much as you, you can have the discussion of I don't want to be induced, you can also have the discussion of I'm actually choosing to.
• I want this.
• I, I think it would make me feel better.
• Yeah, absolutely, and I would absolutely say that.
• And you know, where I was almost eight years ago now and just, uh, going through the delivery and everything and looking back, I'm like, w- I mean, I get why I was upset.
• Like, that's totally valid.
• But I'm like I'm so glad that I chose to be induced.
• There were just so many things that, you know, were pointing in that direction, and I kind of knew deep down what I should do and what I needed to do.
• It was just more on the surface of feeling the anxiety of not being in control of the outcome or something unexpected happening where I was being...
• You know, where I didn't really see this, and then being worried about the baby's wellbeing because of the fluid.
• But yeah, I mean, I certainly think, especially, you know, if you're close to your due date and the fluid is low, and it's persistently low.
• So let's say, like, you do choose hydration.
• You go home and hydrate, you get an IV and hydrate, and then you come back, the fluid's still low.
• I mean, yeah, that would be more concerning to me for, like, there may be something underlying going on.
• But yeah, just like HeHe said I am a doctor, but not your doctor, so you definitely need to...
• That's why everybody should be able to have individualized care, someone who knows you and either knows your preferences or wants to know your preferences and, like, kind of support you explaining the risks and benefits and kind of help you through that and make your decision and feel empowered in the decision that you make.
• And I totally agree with the maternal instinct, and that's what I tell everyone.
• And, you know, if you're about to leave the office but you feel concerned or you don't feel reassured then for sure speak up.
• And if you're dismissed or if they say, you know, all the labs are normal.
• Everything we did is normal.
• You're good.
• Your baby's fine.
• You're just kind of anxious or whatever.
• You can go home," and you get in the car to go home and you're like, "I just still don't feel right," go back in.
• Go to triage.
• I mean, that's w- what I tell everyone.
• You know, the ER, notoriously we At least from like a, a doctor perspective are like, I will not go to the ER unless I'm actively dying, and I will not be showing up there for anything unless I'm ac- but OB triage is not like that.
• It is so easy to go in and be checked out and make sure everything's okay.
• Get put on a monitor, have any labs done, get your blood pressure checked, all of that.
• I mean, so, so much of that can provide so much reassurance that everything's okay.
• And then I think I just see so many people that come in for fetal movement concerns or just concerns that something wasn't feeling right.
• They get up there, the baby looks totally fine.
• Everything checks out, and then they're like, "Oh, okay.
• I actually..."
• I actually had that experience recently myself, but they were like, "Oh, okay.
• I'm actually okay," like everything's okay, and they feel so much better.
• That is worth so much more than, you know, being at home, not being able to sleep because you're worried about your well-being or the baby's well-being, or you're worried about looking dumb for going in and then, oh, everything's fine.
• I should have never come.
• Like, I don't want anybody to ever feel like that, and I always say the same thing.
• Yeah, that, and I learned this the same way you did.
• Like the, I have the algorithm printed off, and any time I have one of our OB nurses come to me or anybody come to me with decreased fetal movement yeah, it's like, okay, this is where we're starting.
• We're getting all these tests to make sure that everything's okay, and then I always ask afterwards, "Do you feel reassured?" Before I send anyone home from triage, I'm like, "Do you feel okay? Do you feel like everything is okay?" And if they say no, then, you know, I keep them for monitoring.
• We just keep you on the monitor until, until either we see something that kind of reinforces how you feel and we're like, "Oh, wow, okay, we do need to deliver."
• Or until you feel reassured, and you're like, "Okay, everything actually is okay."
• 'Cause sometimes that's all, that's really all it takes.
• Yeah.
• Oh my God, I'm getting a little teary-eyed just thinking like What kind of difference it would make for so many people who have lost their babies if they just had somebody that said like, "How do you feel?" And instead of being like, "All right.
• Well, I don't feel good.
• I don't feel..."
• But like the doctor in front of me is saying I'm, I'm okay, and then they go home and something bad happens.
• I just, um, I wish that every doctor would come back and say like, "I feel good.
• The tests are telling me everything's good.
• But you know your body, your body best.
• You know this baby.
• Like, I've never met this baby.
• You're h- you're housing this baby.
• How do you feel? Let's work together to make sure that when you go home, everyone, your team, and you, and your partner are feeling good about this decision."
• Do we see increased NICU stays with babies who have low amniotic fluid? Um, yes, but mostly from transition or like the meconium aspiration.
• But yes, that's what I was seeing too when I looked up the the studies on that.
• But then also just to touch on what you just said, I can definitely come across as like I have always been like this and have always offered this to patients, but there definitely was a time where I didn't.
• Mm-hmm.
• And there definitely was a time where I was the doctor who said, you know, "Your...
• All your testing looks good."
• And also, y- you know, I think in healthcare, burnout is super common.
• Just being busy, being tired, exhausted, not having enough time to take care of people well or to take care of people the way you want to.
• And so I definitely have thought or even said, you know, in residency, which is embarrassing, but like, you know, this person's just anxious or like everything looks fine.
• I don't know why she doesn't feel reassured.
• Or like, yeah, she just needs to go home.
• Like, no, we're not keeping her for longer kind of thing.
• And thankfully, as far as I know, nothing bad outcome wise ever came from those things.
• But also just, you know, as you grow and learn more as a physician, or you just see more, or you yourself experience more, it just opens your eyes to be that much more able to give compassion and also to realize that, like, sometimes we get conditioned to treat people a certain way or to manage things a certain way because that's what's been taught to us or what's been handed down, and it is always okay to change the way that you do things, especially if it's in, you know, in the name of taking better care of people.
• Okay.
• I'm gonna put you on the spot a little bit here, but if there is a doctor or a nurse or a midwife or, um, we've got a lot of healthcare professionals in some capacity here, ultrasound tech, who that is their default to say like, "Oh, this person's just anxious.
• Like they just need to go home and relax."
• If they came to you and said like, "All right.
• This is my default, but I don't want to do that anymore," what advice do you have to them, for them? Oh gosh.
• I would just say don't.
• I mean, the, um, I, I really, really like the algorithm that Dr.
• Florescue has, that it just makes it so easy because it tells you exactly what to do.
• And it's like, "Okay, we're gonna do an NST.
• Your NST is reassuring.
• Do you feel reassured? The NST tells us the baby is moving, the baby is safe, you know, the baby is not acidotic in any way.
• But do you feel reassured?" And if the patient says yes, great.
• You get to go home, and we'll see you at your next appointment.
• If the patient says no, then now we're gonna do an ultrasound.
• We're gonna check your fluid level.
• We're gonna check the baby's growth.
• We're gonna look at everything.
• Okay, everything looks fine.
• Do you feel reassured? And if they say no, then you go to the next step.
• So you just kind of continue this until, you know, the patient is like, "Okay, I do feel reassured."
• And sometimes that takes some time.
• Sometimes that doesn't take any time at all.
• Some- I feel like most of the time people show up and they're more embarrassed because they're like, "Literally, as soon as I pulled in the parking lot, I felt the baby start moving," or whatever, or, "I felt better."
• Or, "As soon as I got up here and I got on the monitor, I saw my first blood pressure was normal.
• I saw the baby was fine on a monitor.
• I felt fine, and I just feel silly for coming in."
• That's usually what happens.
• So I'm usually telling people, like, "Do not ever feel silly.
• Do not ever feel..."
• And then I'm, you know, the other thing that I've learned from Dr.
• Florescue is, like A lot of times other healthcare professionals, just because of the way that we all get trained together really, is like, "Oh, you're, you don't feel like your baby's moving that much? Drink some cold water.
• Put your feet up.
• Drink a Coke.
• Eat something sweet.
• Put an ice bag on your belly," that kind of thing.
• And I tell patients also, too, because that gets, has been handed down for so long, that a lot of patients have, you know, their mom, their grandma, their aunt, somebody is saying like, "No, this is what you're supposed to do."
• And they, and they trust that person, obviously, and they do that.
• I'm like, "Do not do that.
• You are welcome to drink a Coke on the way to the hospital, but you better be in the car coming to the hospital, not doing anything else.
• Just come straight in."
• It's way easier and to make sure everything's okay.
• I mean, yeah, don't ever feel silly.
• Here's the thing.
• Pregnancy is so different even with each pregnancy, so regardless if it, whether you're a first-time mom or a eight-time mom, we don't expect you to know all the answers.
• Our doctors don't even know all the answers.
• That's why we have technology.
• That's why we have tests to rule things out.
• That's why we have procedures to, to make sure everything is good or to confirm like, yes, there is a complication here that we need to be looking into.
• You are not responsible for knowing every answer.
• You are responsible for knowing if your baby is moving as normal.
• You're the only person that can know that, and then just seeking help.
• And, and if you are getting care by someone who's making you feel silly, well, not only should you know, change providers, but definitely report that.
• I mean, that is, that's just not a safe provider.
• You should not be being seen, nobody should be being seen by someone who makes them feel silly for seeking out reassurance that your baby is healthy, especially in the end of pregnancy where things definitely have the potential to get a little hairy.
• For my advice, uh, 'cause obviously I can't hold my tongue I just want you guys to remember that no mom chooses to be anxious, right? That, that feeling sucks.
• You feel helpless.
• You feel embarrassed.
• There's a lot of shame in feeling anxious.
• Nobody comes to the hospital and is like, "Well- I'm just gonna, like, be anxious today.
• I've got nothing else to do on my to-do list.
• Like, I don't know a single person out there that has nothing on their to-do list and would rather just, like, hang out at the hospital.
• So just remember that when you're walking into a patient care room, and, you know, your, your instinct or your default is to say, like, this person is just anxious.
• They need to go home and relax.
• Just remember, this is more of an inconvenience for them than it is for you.
• You were already scheduled to be at the hospital.
• This is your job.
• You're getting paid to be here.
• You were gonna be here 8:00 to 5:00 anyway, 7:00 to 7:00 anyway, 6:00 to 6:00 regardless.
• This person has now had to derail their whole day to be there.
• So just remember that.
• That, that anxiety is not chosen.
• They are not choosing to be anxious.
• They are here truly seeking some reassurance.
• And so if you can remember that, I think it brings a little bit more humanness back into the conversation.
• All right, Dr.
• Lawren, my very final question is, if someone is having this discussion with their provider about oligohydramnios, what type of questions do we need to be asking? First and foremost, in my mind is, how did we test my amniotic fluid? Was it the deepest vertical pocket, or did we use AFI? What else should they be asking their provider? Yes, 100% I would wanna know you know, I'm just thinking of, like, if I had a friend that called me and was like, "Hey, uh, someone...
• You know, I'm at the doctor and they told me my fluid's low and I'll have to be induced, and blah, blah," which is kind of where my Instagram name came from, but the, that's another story.
• The, so I would probably say "Okay, figure out, like, what was your fluid? Was that your total fluid? Was that the deepest vertical pocket?" And then, like, okay, if the deepest vertical pocket was less than two, what was, did they do a, an AFI? Because they should have done a total one.
• You should have fluid measured appropriately.
• Then the other thing I would ask is there something underlying that's causing the fluid to be low? Do you have high blood pressure? Do you have preeclampsia? What's your blood pressure at your visit today? Why does the doctor think your fluid is low? And then how far along are you? And are they recommending induction and why? What are the risks to being induced this early or at this gestational age? What are the risks of continuing the pregnancy if the fluid is low? What are the risks if I decide to say no to induction, go home? What if I try to rehy- like hydrate and then come back? And that, those are kind of the main questions that I would ask.
• Thank you so much.
• This has been so, so informative.
• Okay, my last question is, where can people connect with you? How can they learn from you? Where can they follow along online? Do you have free resources to share with people? 'Cause you do so much more than just, obviously, pregnancy.
• You, you're an OBGYN, so you do the whole spectrum.
• What kind of resources do you have for people, and how can they learn from you? Yes.
• So I do all of, all of women's health.
• I really like perimenopause and menopause, and I have some training in integrative medicine, which I love.
• But you can find me at YourFriendTheOBGYN on basically all social platforms, so Instagram, YouTube, Facebook, TikTok.
• Um, and then I have a website, YourFriendTheOBGYN.com,
• and I have some free resour- sources on that including, um, a period guide and some other things that yeah, can just help you.
• Um, uh, my DMs are open, so yeah, message me anytime.
• Yeah, absolutely.
• And I, um, I'll just throw you a little bone here.
• I think you're hilarious.
• I love watching your stuff.
• Oh, you're so nice.
• Because you always make me giggle.
• Thank you.
• Um, and your stories are so funny to me, and I love getting to know your, your family, and I just, um, I appreciate you and I appreciate your time, and thank you so much for being here- You're so sweet and sharing your wisdom.
• Yeah, absolutely.
• Yeah.
• No, thanks for having me.
• I really appreciate it.
• Yeah, absolutely.
• All right, you guys, I will see you in the next episode.
• Be sure to follow Dr.
• Lawren on social media, and you can find me at TranquilitybyHeHe and at the.birth.lounge.
• Until next time, head to your app store and download The Birth Lounge app for evidence-based childbirth education and data-driven postpartum support delivered straight to your phone.
• Bye.
• Thank you so much for tuning in today.
• I love hanging out with you and it is an honor to be your go-to gal when it comes to preparing for your baby.
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• I'm HeHe and this is the Birth Lounge Podcast.