Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / How to Talk to Your Doctor About Risk: Lessons from our book, “The Unexpected”

Transcript

How to Talk to Your Doctor About Risk: Lessons from our book, “The Unexpected” · Wellness, Actually with Emily Oster & Perry Wilson, MD

• 0:00
  Speaker 1: This is parent Data. I'm Emily Oster. Many years ago
• 0:09
  Speaker 1: I got an out of the blue email from a
• 0:12
  Speaker 1: doctor in New York and he said, Hey, I'm ann Obi,
• 0:17
  Speaker 1: a maternal fetal medicine specialist actually, and one of my
• 0:20
  Speaker 1: patients gave me your book, and I really think we
• 0:23
  Speaker 1: would like each other. I think we agree on a
• 0:25
  Speaker 1: lot of things. And he attached a paper he had
• 0:28
  Speaker 1: been writing that agreed with a lot of what I
• 0:30
  Speaker 1: said in Expecting Better, and he said, next time you're
• 0:33
  Speaker 1: in New York, let's have lunch. And so a few
• 0:36
  Speaker 1: months later, I found myself sitting at lunch eating pete
• 0:39
  Speaker 1: and hummus, across the table from doctor Nate Fox. And
• 0:45
  Speaker 1: indeed we did see to eye on many things, and
• 0:48
  Speaker 1: beyond that, we really liked each other. Nate and I
• 0:53
  Speaker 1: have stayed in touch since then. We wrote a paper
• 0:56
  Speaker 1: together in a journal, and a couple of years ago,
• 1:00
  Speaker 1: when I thought about writing a fourth book about complications
• 1:04
  Speaker 1: after pregnancy, I knew who I would call, and I
• 1:08
  Speaker 1: called Nate and I remember walking around outside on the
• 1:12
  Speaker 1: phone pitching him in this idea, Hey, let's write a
• 1:16
  Speaker 1: book together about pregnancy complications. I don't know exactly what
• 1:19
  Speaker 1: it'll look like. I don't know exactly how it should
• 1:21
  Speaker 1: be structured. I don't know exactly what should be in it,
• 1:24
  Speaker 1: but I know that you're the person I should write
• 1:26
  Speaker 1: it with. And Nate is always game. Without asking any
• 1:31
  Speaker 1: more questions, he said yes. And now on April thirtieth,
• 1:37
  Speaker 1: twenty twenty four, that book is out. The book is
• 1:41
  Speaker 1: called The Unexpected Navigating Pregnancy During and After Complications, and
• 1:46
  Speaker 1: I invited Nate on the podcast. This is actually his
• 1:49
  Speaker 1: second time on the Parent Data podcast to talk about
• 1:53
  Speaker 1: our book, to talk about why we like to work together,
• 1:56
  Speaker 1: and to answer some of the questions that people have
• 1:58
  Speaker 1: asked us about navigating complicated pregnancy. In this conversation, Nate
• 2:05
  Speaker 1: and I will talk about some of the complications in
• 2:07
  Speaker 1: the book, will answer some questions, but we're also going
• 2:10
  Speaker 1: to talk about some bigger picture issues. How do you
• 2:15
  Speaker 1: have good conversations with your doctor, How do you talk
• 2:19
  Speaker 1: about especially these hard things when you're both bringing different
• 2:23
  Speaker 1: kinds of expertise to the table. We're also going to
• 2:27
  Speaker 1: talk about risk and how we communicate about risk, and
• 2:32
  Speaker 1: why it's hard to help people understand what a number
• 2:36
  Speaker 1: like one third or one percent means. Nate and I
• 2:41
  Speaker 1: have different takes on exactly how to do this, but
• 2:45
  Speaker 1: just like working on the book together, I feel like
• 2:47
  Speaker 1: we got to a good place. Nate's one of my
• 2:50
  Speaker 1: favorite people to talk to. I call him all the time,
• 2:53
  Speaker 1: and I'm delighted he came on this podcast, but even
• 2:56
  Speaker 1: more delighted to have him as a partner in this book.
• 2:58
  Speaker 1: So I hope you enjoy this conversation after the break,
• 3:05
  Speaker 1: doctor Nathan Fox. Nate Fox, Welcome back to the podcast.
• 3:19
  Speaker 1: Last time you were here, we talked about the Arrived Trial,
• 3:22
  Speaker 1: and we are now talking about our new book. You
• 3:27
  Speaker 1: are my co author and my friend. You're the first
• 3:30
  Speaker 1: co author I've ever had on this podcast because I
• 3:33
  Speaker 1: don't write books with other people except for you, So welcome.
• 3:38
  Speaker 2: I'm delighted to be here. You're the first co author
• 3:41
  Speaker 2: I've ever been on a podcast with. So that's a coincidence. Yeah,
• 3:46
  Speaker 2: I since I don't write any books nor go on
• 3:49
  Speaker 2: many podcasts. So two for two, two for two.
• 3:52
  Speaker 1: All right, So we're going to talk about our new book,
• 3:54
  Speaker 1: The Unexpected. Uh, We're going to talk about some complicated
• 3:58
  Speaker 1: pregnancy situations. We're going to get into all of it.
• 4:01
  Speaker 1: But before we do that, could you introduce yourself? Tell
• 4:03
  Speaker 1: us who you are.
• 4:04
  Speaker 2: I am a Nate Fox. I am a Obigu, I
• 4:08
  Speaker 2: n and maternal fetal medicine specialist. I practice in New
• 4:12
  Speaker 2: York City. I live in New Jersey. I have a wife,
• 4:15
  Speaker 2: four children, and two dogs. And you are my hero.
• 4:20
  Speaker 2: And I actually wanted to throw something at you.
• 4:23
  Speaker 1: Your payment is in the mail for that, Thank you, Nate.
• 4:25
  Speaker 2: Yeah, Professor, I want to throw something at you. How
• 4:28
  Speaker 2: did that taste going up? Having to share a book
• 4:30
  Speaker 2: with someone? Okay, so let's you're kind of a control
• 4:35
  Speaker 2: kind of person with your writing. Not in a bad way,
• 4:39
  Speaker 2: I mean in a good way. You're amazing. But we've
• 4:41
  Speaker 2: never had to do this before, to sort of work
• 4:43
  Speaker 2: with someone, So I'm curious how that worked for you.
• 4:46
  Speaker 1: Okay, so listen to back up. Nate and I have
• 4:50
  Speaker 1: a new book together. It's called The Unexpected Navigating Pregnancy
• 4:54
  Speaker 1: During and After Complications, and it's about navigating pregnancy complication
• 5:00
  Speaker 1: ranging from miscarriage to hyperemesis to preterm birth. And the
• 5:06
  Speaker 1: origin of this book is, so I want to write
• 5:09
  Speaker 1: this book because people ask me about these things quite
• 5:12
  Speaker 1: a lot, and I did not think that I could
• 5:15
  Speaker 1: write it by myself because there's a lot of complicated
• 5:18
  Speaker 1: medical stuff in Aaron. Actually, it turns out I think
• 5:21
  Speaker 1: what you brought to the table is very different than
• 5:22
  Speaker 1: what I thought you would bring to the table, which
• 5:25
  Speaker 1: I can say more about, but it's very But you're right.
• 5:29
  Speaker 1: I am not a group project kind of girl, you know.
• 5:33
  Speaker 1: I'm more of a like tell everyone a job that's
• 5:37
  Speaker 1: not important, and then they do it, and then you
• 5:39
  Speaker 1: do the whole thing and put the small numbers of
• 5:42
  Speaker 1: things that they did. You know, like, do you work
• 5:44
  Speaker 1: on group projects in middle school?
• 5:47
  Speaker 2: That was like my moo, yeah, I've been in that predicament.
• 5:51
  Speaker 2: I've gotten I have improved over my lifetime in group projects,
• 5:57
  Speaker 2: because medicine is a lot of group projects, like in
• 6:00
  Speaker 2: a good way, but when I was in middle school
• 6:02
  Speaker 2: it's the same way. I was like, can you just
• 6:04
  Speaker 2: all get out of my way and let me do
• 6:06
  Speaker 2: my thing and we'll do fine.
• 6:08
  Speaker 1: So that's my own I feel that I've improved over time,
• 6:10
  Speaker 1: but I'm not sure that other people would necessarily say that.
• 6:14
  Speaker 1: But you were the first person I thought of to
• 6:17
  Speaker 1: write this book with because we've written together before. We've
• 6:19
  Speaker 1: written a paper together, and I think you're great and
• 6:24
  Speaker 1: you're actually you turned out to be like far easier
• 6:26
  Speaker 1: to work with than I thought you would be. And
• 6:28
  Speaker 1: the main thing is that you're very fast. Ah, you're
• 6:32
  Speaker 1: like you do always do the things. You're not a
• 6:35
  Speaker 1: like a malingerer.
• 6:37
  Speaker 2: I'm not a doctor. What you're saying, No, listen, I agree.
• 6:42
  Speaker 2: I think that we had a very good working rapport
• 6:45
  Speaker 2: because a lot of things about us are similar. We
• 6:48
  Speaker 2: both answer our emails too quickly. Like before, is.
• 6:53
  Speaker 1: We're like in our email we're like living in our computers.
• 6:56
  Speaker 2: Yes, yeah, so we answer emails quickly and we do
• 6:58
  Speaker 2: things well before the deadline, and we're both like that.
• 7:02
  Speaker 2: But it's it is interesting. I will say, just from
• 7:05
  Speaker 2: my perspective, I loved writing the book with you. First
• 7:09
  Speaker 2: of all, you're you're a professional. You're really good at this.
• 7:11
  Speaker 2: I'm not blowing smoke up here, but everyone knows you're
• 7:13
  Speaker 2: awesome at this. And so it's a little intimidating to
• 7:17
  Speaker 2: work with someone who's so good at this because I'm
• 7:21
  Speaker 2: I'm not down on myself. I'm a lovely person. I
• 7:23
  Speaker 2: think I'm a bright guy. I'm a good doctor, but
• 7:25
  Speaker 2: I'm not a writer. Like it's not what I do,
• 7:27
  Speaker 2: and so it's a little intimidating to go into a
• 7:29
  Speaker 2: process with someone. I'm like, oh my god, I'm gonna
• 7:31
  Speaker 2: be terrible, I'm gonna suck. I'm on to like colder
• 7:33
  Speaker 2: back and this or that. But whether I did or didn't,
• 7:36
  Speaker 2: you were very gracious and you're always very encouraging and
• 7:41
  Speaker 2: did not make me feel that way. Either because I
• 7:44
  Speaker 2: didn't deserve to feel that way, or because you were
• 7:45
  Speaker 2: kind enough not to make me feel the way, I
• 7:47
  Speaker 2: don't really care. Either one is fine. But it was
• 7:50
  Speaker 2: really a delight, And I could say that I've actually
• 7:53
  Speaker 2: always toyed around with writing a book. Years ago, I
• 7:57
  Speaker 2: said I want to write a book, but you know,
• 8:00
  Speaker 2: I mean, well, I'm not gonna write a book, right,
• 8:01
  Speaker 2: So I thought I would, and I was one of
• 8:04
  Speaker 2: the things I really really wanted to talk about in
• 8:06
  Speaker 2: a book was not so much like nuts and bolts
• 8:10
  Speaker 2: medical type books. I've written medical chapters before for textbooks,
• 8:14
  Speaker 2: but not that that's not writing that's like that's horrifying,
• 8:17
  Speaker 2: but writing to people who see doctors to try to
• 8:22
  Speaker 2: give them an insight as to like how do you
• 8:25
  Speaker 2: know what to do? Like what to ask? How do
• 8:28
  Speaker 2: you know if your doctor is any good? Right, how
• 8:31
  Speaker 2: do you know if like this is productive or not,
• 8:34
  Speaker 2: Because I mean, you know if your doctor's nice, and
• 8:37
  Speaker 2: you know if their office is clean, and you know
• 8:38
  Speaker 2: if they run on time, and you know if they're
• 8:40
  Speaker 2: building departments annoying like you know those things, but you
• 8:42
  Speaker 2: have no idea if your doctors any good. You could
• 8:45
  Speaker 2: see a diploma on the wall, but the correlation between
• 8:48
  Speaker 2: that and a good doctor is very minimal, right, And
• 8:53
  Speaker 2: it's hard legitimately, Listen, I'm I'm also a patient, rite
• 8:56
  Speaker 2: and my wife's a patient, my kids are patients. I
• 8:59
  Speaker 2: don't know if are doctors are good. It's very, very hard.
• 9:01
  Speaker 2: And so that was something I always wanted to do,
• 9:04
  Speaker 2: and when this project came along, it actually worked out
• 9:07
  Speaker 2: perfectly because it's what we both wanted to do from
• 9:10
  Speaker 2: different angles, and so I think one of the reasons
• 9:12
  Speaker 2: it was really fun in that sense for me.
• 9:15
  Speaker 1: So let me give people a little bit of a
• 9:17
  Speaker 1: sense of what the book is. What the book is like.
• 9:20
  Speaker 2: The book is awesome.
• 9:22
  Speaker 1: Well, first of all, it's great, So I mean, so
• 9:25
  Speaker 1: this is a book about navigating pregnancy after complications, and
• 9:29
  Speaker 1: I think we really have written it with the idea
• 9:30
  Speaker 1: that you know, people have had a complication in one
• 9:33
  Speaker 1: pregnancy and thinking about how to navigate another one. And
• 9:36
  Speaker 1: we say this in the book, but about fifty percent
• 9:38
  Speaker 1: of pregnancies either ended or include one of the complications
• 9:42
  Speaker 1: that we talk about here, so it's a pretty large
• 9:43
  Speaker 1: share of pregnancies. And what the book does is there's
• 9:48
  Speaker 1: some sort of general material at the top to try
• 9:50
  Speaker 1: to help people think about what kinds of information they
• 9:52
  Speaker 1: should have out of their medical records and how to
• 9:54
  Speaker 1: kind of navigate their way into that. And then there
• 9:56
  Speaker 1: are a series of chapters which in which first sort
• 10:00
  Speaker 1: of there's the there's Emily talking about the answers to
• 10:04
  Speaker 1: many of the questions I get, which are like, will
• 10:07
  Speaker 1: this happen again, what's the risk of recurrence? What kind
• 10:09
  Speaker 1: of treatments are there? Can you help me just understand
• 10:12
  Speaker 1: what this complication is? And then there's your part of
• 10:16
  Speaker 1: the chapter, which is about how do I have a
• 10:18
  Speaker 1: conversation about this with my doctor? In the case of
• 10:22
  Speaker 1: many of these complications, probably all of them, there's not
• 10:26
  Speaker 1: like one answer. It's not like if this happened, like
• 10:29
  Speaker 1: for sure, this is what we'll do next time, and
• 10:31
  Speaker 1: everything will be fine, and you know, thanks for the data.
• 10:35
  Speaker 1: A lot of it is about the nuances of a
• 10:37
  Speaker 1: particular case and the just the details of how to
• 10:42
  Speaker 1: move through it. And so this the thing that I
• 10:45
  Speaker 1: think we get out of your parts of the book
• 10:47
  Speaker 1: are just how to navigate those conversations. And I will
• 10:51
  Speaker 1: say I had a conversation the other day with someone
• 10:53
  Speaker 1: who who sort of works in birth trauma and who
• 10:56
  Speaker 1: was very influential for me and thinking about writing this book.
• 11:00
  Speaker 1: She said, I started reading this book and I thought,
• 11:03
  Speaker 1: you know, this is going to be kind of like
• 11:04
  Speaker 1: expecting better but for complications, and this is going to
• 11:07
  Speaker 1: be a great resource. And I'm you know, I'm glad
• 11:09
  Speaker 1: that this is going to be available. And then she said,
• 11:11
  Speaker 1: but actually the book is so much better than that,
• 11:13
  Speaker 1: because Nate's parts are so great, and like your parts
• 11:17
  Speaker 1: are fine, I expected them to be like they are.
• 11:19
  Speaker 1: But this additional piece is the most important thing in
• 11:23
  Speaker 1: the book. So for me, that's it's part of what
• 11:26
  Speaker 1: I didn't expect you to bring to the table. And
• 11:29
  Speaker 1: I do think it's probably among the strongest pieces of
• 11:31
  Speaker 1: the book.
• 11:32
  Speaker 2: Oh that's very touching, you know. I think that in
• 11:37
  Speaker 2: terms of the book itself, it seems like it's written
• 11:41
  Speaker 2: for people who had a pregnancy that didn't go well
• 11:45
  Speaker 2: or had a bump in the road and they're trying
• 11:47
  Speaker 2: to figure out what to do next time around. That's
• 11:49
  Speaker 2: sort of like I would say, the surface level, and
• 11:51
  Speaker 2: that's probably the bulk of people who are going to
• 11:53
  Speaker 2: get this book. It's for that reason, but I would
• 11:56
  Speaker 2: argue that, in fact, it's much more than that. And
• 12:00
  Speaker 2: number one, if someone is fortunate enough to never have
• 12:03
  Speaker 2: had a pregnancy with a complication, which is actually unusual,
• 12:07
  Speaker 2: but let's say that's the case, everyone knows someone who
• 12:09
  Speaker 2: had a pregnancy with a complication. Everybody knows someone it
• 12:12
  Speaker 2: may be their sister or their friend, whatever. And I
• 12:16
  Speaker 2: think that this book is also written in a way
• 12:19
  Speaker 2: to help people understand what their circle of people have
• 12:24
  Speaker 2: gone through and to just give an appreciation for that
• 12:26
  Speaker 2: and what they're thinking and what their fears are and
• 12:28
  Speaker 2: what their concerns are. And I think also just in general,
• 12:33
  Speaker 2: since the complications are so ubiquitous, we're talking about. This
• 12:38
  Speaker 2: is not crazy things that no one's ever heard of,
• 12:40
  Speaker 2: or talking about miscarriage, pre term birth, like bleeding. I
• 12:45
  Speaker 2: mean things that so many people have in pregnancy, and
• 12:49
  Speaker 2: people talk about this really gives people an understanding of
• 12:53
  Speaker 2: them or of pregnancy at a much higher level. So
• 12:55
  Speaker 2: even someone has never been pregnant or is never going
• 12:57
  Speaker 2: to be pregnant, it's sort of interesting in that sense
• 13:00
  Speaker 2: to understand it. And I think on the deepest level,
• 13:03
  Speaker 2: what I was trying to bring to the table is
• 13:07
  Speaker 2: also even for someone who's not literally never going to
• 13:11
  Speaker 2: be pregnant. Right, you're talking about the single guide, right,
• 13:13
  Speaker 2: whatever it is. It really I try to get into
• 13:17
  Speaker 2: that concept of what's happening when you're with your doctor
• 13:21
  Speaker 2: and why it's so complicated and why it's so rich,
• 13:25
  Speaker 2: Like it's a relationship. It's not like chat GBT when
• 13:30
  Speaker 2: you plug something in and you get back a response.
• 13:32
  Speaker 2: It involves personalities, it involves emotions, it involves nuance. And
• 13:38
  Speaker 2: although this is related to pregnancy obviously, and that's sort
• 13:41
  Speaker 2: of the framework we use, the principles are very broad
• 13:46
  Speaker 2: and that's sort of when I was thinking, it's not
• 13:48
  Speaker 2: just you know, nuts and bolts, it's sort of high
• 13:51
  Speaker 2: level what's happening in these meetings, And this would be
• 13:55
  Speaker 2: I would think relevant for anybody about to see a
• 13:58
  Speaker 2: doctor for a question, how do I think about it,
• 14:00
  Speaker 2: How do I talk about it? What am I looking for?
• 14:02
  Speaker 2: How do I know if they're answering my questions? Because
• 14:05
  Speaker 2: that's that's like the golden question out there.
• 14:08
  Speaker 1: I mean, I think there's a sense in which patients
• 14:10
  Speaker 1: bring one kind of expertise and doctors bring in other
• 14:13
  Speaker 1: kinds of expertise, and some of these conversations are about
• 14:15
  Speaker 1: kind of how do we bring those together, And it's
• 14:19
  Speaker 1: hard to bring those together if patients don't know about
• 14:23
  Speaker 1: what's going on, and it's hard to bring those together.
• 14:25
  Speaker 1: On the other side of doctors are kind of not
• 14:28
  Speaker 1: prepared to have nuanced conversations that involve patient preferences. And
• 14:32
  Speaker 1: so I think the book is the book is a
• 14:34
  Speaker 1: little bit about scaffolding those conversations, as you say, like
• 14:37
  Speaker 1: in any setting, all though you know the particular examples
• 14:40
  Speaker 1: are in this complicated pregnancy space. I don't know. I
• 14:43
  Speaker 1: feel like it's kind of interesting for the two of
• 14:45
  Speaker 1: us to write that, because that is effectively what we
• 14:47
  Speaker 1: try to do working together, is like recognize that, like
• 14:50
  Speaker 1: you have a set of expertise that I don't have
• 14:52
  Speaker 1: it I have a set of expertise that you don't have,
• 14:54
  Speaker 1: and like we're trying to bring them together to kind
• 14:56
  Speaker 1: of work as a team.
• 14:57
  Speaker 2: Yeah, I mean it's part of the you know, this
• 15:01
  Speaker 2: very loaded and confusing term that people use, which is
• 15:05
  Speaker 2: shared decision making, right, And in medicine, that's like a
• 15:09
  Speaker 2: that's a big thing now, right, I hear it, you know,
• 15:12
  Speaker 2: with the residents and the med students, the shared decision making.
• 15:14
  Speaker 2: And I always say, like, what do you mean by that,
• 15:17
  Speaker 2: Like that's a very sounds great, right, We're sharing, sharing
• 15:21
  Speaker 2: is caring, right, it sounds delightful, But how does that
• 15:24
  Speaker 2: work in practice? Because in practice, you know, the patient
• 15:29
  Speaker 2: is the person who knows herself the best, her personality,
• 15:32
  Speaker 2: her wants, her wishes, her fears, her experiences. I don't
• 15:37
  Speaker 2: know anything about that, right. I may have an insight
• 15:39
  Speaker 2: just by talking to her and knowing her, but she
• 15:41
  Speaker 2: knows herself way better than I know her, and I
• 15:44
  Speaker 2: know the medical side, right. I don't expect her to
• 15:46
  Speaker 2: know the medicine like she may have been a great Googler,
• 15:48
  Speaker 2: but you know, I went to medical school at the
• 15:51
  Speaker 2: training I do this for a living. And so the
• 15:53
  Speaker 2: best part of shared decision making is she brings to
• 15:57
  Speaker 2: the table her expertise, about herself, and I bring to
• 16:01
  Speaker 2: the table my expertise about the medical side, and we
• 16:04
  Speaker 2: try to use both of those expertise together to come
• 16:08
  Speaker 2: up for the right answer for what to do for her,
• 16:11
  Speaker 2: to individualize it. That's how it should be. But what
• 16:14
  Speaker 2: ends up happening is people say share decision making, and
• 16:17
  Speaker 2: then what ends up happening is the doctor says, well,
• 16:20
  Speaker 2: you can do AB or C and it's your choice,
• 16:23
  Speaker 2: and some people are like, great, I get to choose,
• 16:25
  Speaker 2: and other people are like, what the hell I don't know?
• 16:26
  Speaker 2: Like how am I supposed to know? Like if my
• 16:28
  Speaker 2: plumber sets, you can't you go to a business caol
• 16:30
  Speaker 2: Like I mean literally, if my plumber set to me, well,
• 16:33
  Speaker 2: you know, we could use copper pipes or we can
• 16:35
  Speaker 2: use plastic pipes, what do you want? I'd be like,
• 16:38
  Speaker 2: what do I look like a plumber? Like, I have
• 16:39
  Speaker 2: no idea. You tell me what's better. Now, if the
• 16:41
  Speaker 2: plumber set to me for my expertise, the copper pipes
• 16:44
  Speaker 2: and maybe false, but the copper pipes are more expensive,
• 16:48
  Speaker 2: but they're gonna last ten years, whereas the plastic pipes
• 16:50
  Speaker 2: are less expensive in the last three years. And I
• 16:53
  Speaker 2: know how much money I have whether I'm leaving house
• 16:55
  Speaker 2: in three years, how much it bothers me to have
• 16:57
  Speaker 2: a plumber come back. And so that's shared decision making.
• 17:00
  Speaker 2: We've just said, here are your choices, let me know
• 17:01
  Speaker 2: what you want. That's not shared decision making, and that's
• 17:04
  Speaker 2: what ends up happening a lot, and it's very frustrating
• 17:07
  Speaker 2: both for doctors and for patients when it's not done
• 17:11
  Speaker 2: in the ideal setting or an ideal way.
• 17:13
  Speaker 1: I would say, yeah, I think one of the nuances
• 17:16
  Speaker 1: of those conversations is that who's whose expertise should get
• 17:21
  Speaker 1: more weight depends quite a lot on what is the
• 17:24
  Speaker 1: decision that you are making. So you know, if I'm
• 17:27
  Speaker 1: in the this experience, you know eight months ago where
• 17:30
  Speaker 1: I was in the er, like I had a bike accident,
• 17:32
  Speaker 1: like an accident with a bike. I was running, they
• 17:34
  Speaker 1: were biking, and I ended up in.
• 17:36
  Speaker 2: The hospital with liked by a bike.
• 17:38
  Speaker 1: That makes it sound like it was the bike's faut,
• 17:40
  Speaker 1: whereas it was really more of a joint fault. But anyway,
• 17:42
  Speaker 1: I ended up in the hospital with an elaceration in
• 17:44
  Speaker 1: my head, and in that moment, like I don't my
• 17:47
  Speaker 1: expertise in my own feelings about like my head and
• 17:50
  Speaker 1: so on, it's really not relevant. Like the question is
• 17:52
  Speaker 1: like somebody used to figure out if you have a
• 17:55
  Speaker 1: skull fracture or not, and that's the that's the doctor's expertise,
• 17:58
  Speaker 1: and you kind of have to defer. And then there
• 18:01
  Speaker 1: are settings in which it's almost entirely about patient preferences.
• 18:04
  Speaker 1: One of the ones we've talked about various places is
• 18:06
  Speaker 1: like what kind of genetic testing people want? So, if
• 18:08
  Speaker 1: you're pregnant, you want some genetic testing, that's really a
• 18:12
  Speaker 1: lot about what would you do with that information? What
• 18:14
  Speaker 1: are the you know, what are your feelings about the
• 18:17
  Speaker 1: results out of that? And the doctor can provide information
• 18:19
  Speaker 1: about what you learn from the test, but ultimately the
• 18:21
  Speaker 1: patient preferences really win. And then there are many things
• 18:24
  Speaker 1: in the middle where there's a combination of kind of
• 18:27
  Speaker 1: expertise about your medical situation and what's possible with you know,
• 18:30
  Speaker 1: what does patient preference look like?
• 18:33
  Speaker 2: Yeah, one hundred percent. And I think that again, it
• 18:36
  Speaker 2: always depends on the context. When I'm teaching the residents
• 18:39
  Speaker 2: and they have a patient who's coming in AND's got
• 18:42
  Speaker 2: some problem, and I always say to them, what do
• 18:45
  Speaker 2: you want to do? Right? Because they'll present the patient
• 18:48
  Speaker 2: and the goal of it is not for them presented
• 18:51
  Speaker 2: to me to tell them what to do. It's like teaching,
• 18:53
  Speaker 2: says he what would you like to do? And frequently
• 18:56
  Speaker 2: what I get back as well, we could do this,
• 18:58
  Speaker 2: we could do this, or we could do this, And
• 19:00
  Speaker 2: I would say, okay, I'm aware of the choices, tell
• 19:04
  Speaker 2: me what do you want to do? And they get
• 19:08
  Speaker 2: very uncomfortable, right, because what happens is earlier medical training,
• 19:12
  Speaker 2: you know, many many years ago, it was very paternalistic, right,
• 19:16
  Speaker 2: and doctors were basically trained you're the doctor, you're the professional.
• 19:21
  Speaker 2: You're going to tell your patient what to do, and
• 19:23
  Speaker 2: he or she's going to listen to you or they're
• 19:25
  Speaker 2: horrible people, right, And that's sort of how the it
• 19:27
  Speaker 2: went in medicine, and there has been a pushback against that,
• 19:30
  Speaker 2: I think in a good way. But now I think
• 19:32
  Speaker 2: it's the pendulum is sort of gone the other way
• 19:34
  Speaker 2: where people are being trained in medicine patient autonomy. He
• 19:39
  Speaker 2: should make the choice, she should make the choice. You know,
• 19:41
  Speaker 2: present them with options and they'll choose. But neither is
• 19:45
  Speaker 2: really correct. It depends on the circumstances, right, And so
• 19:49
  Speaker 2: if the patient's hemorrhaging. I'm not going to say, you know,
• 19:53
  Speaker 2: which medication would you like for me to help you
• 19:55
  Speaker 2: stop hemorrhaging? Like then I'm an idiot, right and like
• 19:59
  Speaker 2: I'm a terrible doct But for things like genetic testing,
• 20:02
  Speaker 2: if I tell her you're going to do a B
• 20:04
  Speaker 2: and C, that's also really not good. And so you
• 20:07
  Speaker 2: have to sort of know the situation. You got to
• 20:10
  Speaker 2: read the room in a sense like you have to
• 20:12
  Speaker 2: read the room is what does he or she want
• 20:14
  Speaker 2: do they want you to be a little bit more
• 20:16
  Speaker 2: tell me what to do versus give me choices, and
• 20:19
  Speaker 2: what is the decision that we're making call for?
• 20:21
  Speaker 1: So there's a sort of class example of shared decision
• 20:24
  Speaker 1: making I want to talk about here, which is sort
• 20:25
  Speaker 1: of how should people think about a vback about a
• 20:28
  Speaker 1: vaginal birth after cesarean And so this is a case
• 20:31
  Speaker 1: in which someone has had at least one let's say
• 20:34
  Speaker 1: they've had one cesarean section with their first birth. They're
• 20:37
  Speaker 1: thinking about the what to do birth wise for the
• 20:42
  Speaker 1: second birth. So there's an option which is to try
• 20:45
  Speaker 1: for a vaginal birth. There's another option to have a
• 20:47
  Speaker 1: REPEATZ section, And this is something we talk a lot
• 20:49
  Speaker 1: about in the book to a little bit different than
• 20:51
  Speaker 1: some of the other complications in the book because it's
• 20:53
  Speaker 1: not a cesarean section, is not sort of properly a
• 20:56
  Speaker 1: pregnancy complication the way preterm birth or preclampsia is. But
• 21:00
  Speaker 1: it is something we wanted to include because many people
• 21:03
  Speaker 1: wonder about this in a subsequent pregnancy when they've had
• 21:05
  Speaker 1: a C section the first time. So let's just let's
• 21:09
  Speaker 1: do a little doctor. Let's do a little doctrine eight.
• 21:11
  Speaker 1: So I come in, I say, you know, I've had
• 21:14
  Speaker 1: I had a C section in my first berth. I'm
• 21:15
  Speaker 1: trying to decide about this next berth. What are you
• 21:19
  Speaker 1: asking me?
• 21:20
  Speaker 2: Right? So? I mean, essentially this is the paradigm of
• 21:24
  Speaker 2: the shared decision making, because there is something medical that
• 21:29
  Speaker 2: I need to know and I need to weigh in on. So,
• 21:31
  Speaker 2: for example, what kind of sea section did you have? Right?
• 21:35
  Speaker 2: Meaning what kind of incision on the uterus? Ninety nine
• 21:38
  Speaker 2: percent of people have a sea section have what we
• 21:40
  Speaker 2: call a low transverse incision, which means it was low
• 21:43
  Speaker 2: down on the uterus, I meaning towards the bottom of
• 21:45
  Speaker 2: uterus versus towards the top, and transverse means the incision
• 21:48
  Speaker 2: goes side to side versus up and down. If you
• 21:51
  Speaker 2: had that type of incision, then in the next pregnancy,
• 21:55
  Speaker 2: if you try to labor, your risk of a uterine
• 21:57
  Speaker 2: rupture is bullpark one percent slightly less, but let's just
• 22:00
  Speaker 2: say one percent because it's an easy number. Versus if
• 22:03
  Speaker 2: you had the other type, it's much higher. So I
• 22:06
  Speaker 2: need to know that right from a medical side to
• 22:08
  Speaker 2: tell you whether it's even on the table to try
• 22:11
  Speaker 2: to deliver vaginally, because whether it's possibly safe or unsafe.
• 22:15
  Speaker 2: Next is what were the circumstances of your sea section?
• 22:18
  Speaker 2: Why did you have the C section? Was it because
• 22:20
  Speaker 2: you had a six pound baby and pushed for eight
• 22:22
  Speaker 2: hours and the baby didn't come out right? That's a
• 22:24
  Speaker 2: little bit like sort of doesn't sound as good for
• 22:28
  Speaker 2: your future prospects, although it's not definitive versus I had
• 22:32
  Speaker 2: totally healthy pregnancy, but since it was twins and they
• 22:35
  Speaker 2: were both breached, they said to do a sea section.
• 22:37
  Speaker 2: And no, that's not so much related to the risk
• 22:41
  Speaker 2: in the next pregnancy, but the likelihood of success in
• 22:44
  Speaker 2: the next pregnancy, meaning with success being defined as a
• 22:47
  Speaker 2: vaginal delivery, although obviously success is healthy mother, healthy baby,
• 22:50
  Speaker 2: but we're talking specifically about this. So for me, based
• 22:54
  Speaker 2: on her history, based on maybe reviewing her records, maybe
• 22:57
  Speaker 2: an examination her, maybe an ultra whatever, some tests I'm
• 23:01
  Speaker 2: going to what I bring to the table is, all right,
• 23:03
  Speaker 2: here's the likelihood that if you tried, you would be successful.
• 23:08
  Speaker 2: Is it fifty percent, seventy percent, ninety percent, whatever it is.
• 23:11
  Speaker 2: And what is the risk to you if you tried?
• 23:15
  Speaker 2: Is it in that one percent rangers and much higher?
• 23:17
  Speaker 2: That's what I bring to the table. But what she
• 23:19
  Speaker 2: brings to the tables what does she want?
• 23:22
  Speaker 3: Right?
• 23:22
  Speaker 2: And so I always ask her at the beginning of
• 23:24
  Speaker 2: this an addition to those questions, I say, what are
• 23:26
  Speaker 2: you looking for? Like, what is it you're trying to
• 23:28
  Speaker 2: get here? Are you looking to try to have a
• 23:30
  Speaker 2: vagual delivery? Are you looking for a repeat C section?
• 23:34
  Speaker 2: Do you have no idea? And you want to sort
• 23:36
  Speaker 2: of learn about each of those. And I need to
• 23:37
  Speaker 2: see what she wants and what are her fears, and
• 23:40
  Speaker 2: I'll have the same sort of clinical circumstances. Let's say,
• 23:44
  Speaker 2: and one person says, I really really want to try
• 23:47
  Speaker 2: v back and I'm willing to accept certain risks and
• 23:50
  Speaker 2: certain you know, likely to success. And son Elsa's like,
• 23:53
  Speaker 2: I want no part of that. I want to repeat
• 23:54
  Speaker 2: C section. And those are both good decisions right in
• 23:57
  Speaker 2: my opinion. So you have the same facts on the
• 24:00
  Speaker 2: table from my end, but they lead to different decisions
• 24:03
  Speaker 2: because the facts on the table from her end are
• 24:06
  Speaker 2: different what she wants and vice versa. I could have
• 24:09
  Speaker 2: two women who want the same thing, but they're going
• 24:13
  Speaker 2: to have different numbers on my end, and one of them,
• 24:14
  Speaker 2: I'll say, you have a fifty percent chance of success,
• 24:16
  Speaker 2: and the other one you have a ninety plus chance
• 24:19
  Speaker 2: of success, and so then they may decide differently. And
• 24:21
  Speaker 2: so that's really how shared decision making is supposed to work,
• 24:26
  Speaker 2: and unfortunately it doesn't either because the doctor's not doing
• 24:32
  Speaker 2: their job by getting the right information or inquiring what
• 24:36
  Speaker 2: does she wanted and getting her opinion, or because potentially
• 24:40
  Speaker 2: it's trying to be done. But let's say the hospital
• 24:43
  Speaker 2: doesn't have an option for vback, so it's it's irrelevant
• 24:45
  Speaker 2: almost in a sense. And there's a lot of stuff
• 24:47
  Speaker 2: that goes into that. But that's what we're trying to
• 24:50
  Speaker 2: get at this book, to help people create those kinds
• 24:53
  Speaker 2: of conversations or find someone who can have that conversation
• 24:58
  Speaker 2: with you so you can come to a good desis.
• 25:00
  Speaker 1: So how long do you think that conversation should take?
• 25:04
  Speaker 2: Should it? Literally? It could take It could be as
• 25:07
  Speaker 2: short as five to ten minutes. It does not have
• 25:09
  Speaker 2: to be very long. If someone doesn't want to labor
• 25:12
  Speaker 2: and just wants to repeat sea section, it could be
• 25:15
  Speaker 2: two minutes, just because I have to make sure she
• 25:16
  Speaker 2: understands that there's risks to a sea section, that it's
• 25:18
  Speaker 2: not you know, you know, unicorns and rainbows like sea sections.
• 25:22
  Speaker 2: She should know she had a prior sea section, but
• 25:23
  Speaker 2: just you know, for example, I'll say how many kids
• 25:28
  Speaker 2: do you want to have? If she says nine, right,
• 25:30
  Speaker 2: then the second delivery, whether it's a vaginal or sea section,
• 25:33
  Speaker 2: is going to have a lot more implication for her
• 25:35
  Speaker 2: future health because if she has her second, she'll end
• 25:38
  Speaker 2: up with nine sea sections, where if she delivers vaginally,
• 25:40
  Speaker 2: it might be one sea section followed by eight vaginal birds.
• 25:43
  Speaker 2: So but short of that, it could be very very short.
• 25:46
  Speaker 2: Sometimes it's very very long. Sometimes we're working through what
• 25:49
  Speaker 2: does she wants, what are the risks, what does this mean,
• 25:51
  Speaker 2: what does that mean? What would happen if what would
• 25:53
  Speaker 2: happen if and that's fine, and it's rarely not that long.
• 25:57
  Speaker 2: If everyone comes to the table with sort of a
• 26:00
  Speaker 2: mutual understanding and what we're trying to do.
• 26:03
  Speaker 1: And I think for me, that is a lot of
• 26:04
  Speaker 1: what I'm trying to deliver with this book, because it
• 26:09
  Speaker 1: feels often as a patient that once time is quite limited.
• 26:13
  Speaker 3: You know.
• 26:14
  Speaker 1: I think if there are circumstances in which you can
• 26:16
  Speaker 1: get much more time with your doctor, but a lot
• 26:18
  Speaker 1: of us we're looking at, you know, fifteen minutes at
• 26:21
  Speaker 1: a visit, and that's not very much time. And if
• 26:23
  Speaker 1: you come in better informed, with a sense of your
• 26:27
  Speaker 1: questions and a sense of what you are trying to
• 26:29
  Speaker 1: get out of the visit or what the choices even
• 26:33
  Speaker 1: might be, it can make those conversations, yeah, more productive.
• 26:37
  Speaker 2: And I think this book is.
• 26:38
  Speaker 1: Really about kind of okay, let's get enough background knowledge
• 26:41
  Speaker 1: and kind of come into that conversation in the right way.
• 26:44
  Speaker 2: You and I are both lovers of efficiency, and so
• 26:48
  Speaker 2: it definitely makes it more efficient. One of the nice
• 26:50
  Speaker 2: things about vback is it's rarely something that has to
• 26:55
  Speaker 2: be made on the spot, meaning you can have that
• 26:57
  Speaker 2: conversation early and see how it evolves also part of
• 27:00
  Speaker 2: the ongoing data. Right. Someone might normally be someone who
• 27:05
  Speaker 2: wants to have a feedback, but then they find out
• 27:06
  Speaker 2: later and pregnancy the estimated weighs ten pounds, and they
• 27:09
  Speaker 2: may feel differently about that, or vice versa. They may
• 27:12
  Speaker 2: be someone who said, you know what, I really don't
• 27:14
  Speaker 2: want to take that risk or that and I really
• 27:16
  Speaker 2: prefer a sea section. But then a week before her
• 27:18
  Speaker 2: schedule see section, she comes in labor and she's eight
• 27:20
  Speaker 2: centimeters dilated and the head's like low on the pelvist.
• 27:23
  Speaker 2: So like, wait, like now the data has changed, we
• 27:25
  Speaker 2: can maybe revisit this. There are other conversations at a
• 27:28
  Speaker 2: little more time specific, like genetic testing. And I'll tell
• 27:32
  Speaker 2: you that when I lecture a lot about genetic testing,
• 27:35
  Speaker 2: and it's like one of the things I talk about,
• 27:37
  Speaker 2: and so many people they say, and it's true, this
• 27:40
  Speaker 2: is so hard, like this is such complex stuff. No
• 27:43
  Speaker 2: one understands this. How could you possibly have a conversation
• 27:47
  Speaker 2: with your doctor or doctor of a conversation with patient
• 27:50
  Speaker 2: and put them in a level that they can understand
• 27:52
  Speaker 2: this And the answer is they can't. That's true. You
• 27:55
  Speaker 2: know you need an hour, let's say, But if someone
• 27:58
  Speaker 2: has a basic understanding what we're talking about, and the
• 28:02
  Speaker 2: person who's doing the counseling, the doctor, the genet counselor
• 28:05
  Speaker 2: really is focusing on what we're trying to answer, it
• 28:10
  Speaker 2: doesn't take that long because you can sort of hone
• 28:12
  Speaker 2: in on the question, you know, like if your risk
• 28:15
  Speaker 2: were one percent, does that number seem scary to you
• 28:18
  Speaker 2: or reassuring to you? Like it's a very simple question
• 28:21
  Speaker 2: that people can answer, and I'll tell them, like, you know,
• 28:23
  Speaker 2: if all your testing is normal, you're non evasive testing,
• 28:25
  Speaker 2: you're ultrasound this your risk of a baby with Down
• 28:27
  Speaker 2: syndrome is very very low, one in ten thousand, but
• 28:29
  Speaker 2: your risk of any genetic conditions one percent? Does that
• 28:33
  Speaker 2: number reassure you or scare you? And if it reassures you,
• 28:37
  Speaker 2: get up and leave like you're done, have a good day.
• 28:39
  Speaker 2: Whereas if that terrifies you, you should be thinking about
• 28:41
  Speaker 2: a CBS or an amnio. And that's a very straightforward
• 28:45
  Speaker 2: question that most people can answer. Not everybody. Some people
• 28:47
  Speaker 2: like I don't know how I feel about one percent, Fine,
• 28:49
  Speaker 2: think about it, get back to me. But it requires
• 28:53
  Speaker 2: a lot to get to that question. And so again
• 28:56
  Speaker 2: it's on the doctor, it's on the patient, it's on
• 28:58
  Speaker 2: everybody to try to make these more productive. And I
• 29:01
  Speaker 2: hope that this book is very helpful with that.
• 29:03
  Speaker 1: No, but I think you're right that sort of we
• 29:05
  Speaker 1: have this idea that like, to do that, you would
• 29:07
  Speaker 1: need to have somebody understand like all of the incredible
• 29:10
  Speaker 1: you know, details about how exactly we're running these tests
• 29:12
  Speaker 1: and what exactly all of these just genetic things mean
• 29:15
  Speaker 1: and so on. But that's not really if you can
• 29:17
  Speaker 1: get to the question, yeah, that is relevant for decision making,
• 29:20
  Speaker 1: it may actually be that that is much simpler than
• 29:25
  Speaker 1: and you know, college level course in genetics.
• 29:27
  Speaker 2: Yeah, Like for vback, I often tell people, you know,
• 29:30
  Speaker 2: there's really there's three ways this can go, right. You
• 29:33
  Speaker 2: can try for a V back and have a successful
• 29:35
  Speaker 2: v back. That's sort of the best option. You can
• 29:38
  Speaker 2: try for a V back and not have a successful
• 29:41
  Speaker 2: v back, which might be the worst option unless someone
• 29:43
  Speaker 2: feels like I'd rather try and fail than not try.
• 29:46
  Speaker 2: And then there's the middle option, which is sort of
• 29:47
  Speaker 2: like I don't do eat, I don't try to just
• 29:49
  Speaker 2: have a C section. And I would say to them,
• 29:50
  Speaker 2: when you go for a V back, you're going to
• 29:52
  Speaker 2: get the best or the worst. You're not going to
• 29:54
  Speaker 2: go to the middle. So you the type of person
• 29:56
  Speaker 2: who would roll the dice a little bit, so to speak,
• 29:58
  Speaker 2: to try to get the best op, knowing you may
• 30:01
  Speaker 2: backfire again, not backfire like die, but like you know
• 30:04
  Speaker 2: whatever in terms of maybe overall outcome. Or you're the
• 30:07
  Speaker 2: type of person who really I'd rather just do the
• 30:09
  Speaker 2: middle of the road. And people can wrap their heads
• 30:11
  Speaker 2: around that they know who they are, and so that's
• 30:14
  Speaker 2: we try to help people make these decisions by framing
• 30:17
  Speaker 2: the questions in a way that if you're this type
• 30:21
  Speaker 2: of person, you're likely to go this direction, whereas if
• 30:24
  Speaker 2: you're this type of person, you're like this type of direction.
• 30:27
  Speaker 2: And that I found to be helpful over the years
• 30:29
  Speaker 2: to try to let people give them that context to
• 30:33
  Speaker 2: make complicated decisions.
• 30:41
  Speaker 1: More parent data after the break. All right, so let's
• 31:01
  Speaker 1: test this out for a minute. We're going to see
• 31:03
  Speaker 1: where the rubber meets the road. I've invited Tamar, my producer,
• 31:07
  Speaker 1: in to ask Nate Nice some questions.
• 31:09
  Speaker 2: Hello, Hi Tamorrow. All right, so we were not given
• 31:12
  Speaker 2: the questions in advance. This is not like quish.
• 31:15
  Speaker 1: Let's do it.
• 31:15
  Speaker 4: Okay, so I have tested positive as a cystic fibrosis carrier.
• 31:21
  Speaker 4: My husband still needs to be tested. We have the
• 31:24
  Speaker 4: appointment in another week. How much should I be freaking out?
• 31:28
  Speaker 2: Uh? Minimally is the answer. How much you should be
• 31:31
  Speaker 2: freaking out? Essentially, with carrier screening, which is what we're
• 31:36
  Speaker 2: talking about, we're checking to see if the couple has
• 31:41
  Speaker 2: usually autosomal recessive conditions, which are the kind that you
• 31:44
  Speaker 2: can carry and out of a condition, and to see
• 31:47
  Speaker 2: if they both have the same one. So when we
• 31:48
  Speaker 2: do a full panel, it's hundreds and hundreds of conditions.
• 31:51
  Speaker 2: And you tested positive for cystic fibrosis. Okay, you yourself
• 31:56
  Speaker 2: have no cystic fibrosis, no medical issues, You would never
• 32:00
  Speaker 2: know you had this in your entire life. It's only
• 32:02
  Speaker 2: relevant if the person with whom you are approcreating also
• 32:06
  Speaker 2: has a mutation for cystic fibrosis. So the question is
• 32:09
  Speaker 2: what is the chance of that. I believe the population
• 32:13
  Speaker 2: frequency depends on is ancestry, but let's say it's one
• 32:17
  Speaker 2: in fifty two percent, So the chance that you're a
• 32:20
  Speaker 2: couple that both carry cystic fibrosis is two percent. And
• 32:25
  Speaker 2: if he carries systic fibrosis, then each of your kids
• 32:29
  Speaker 2: has a twenty five percent chance of having it, which
• 32:32
  Speaker 2: you could either get pregnant and test and find out,
• 32:34
  Speaker 2: or do IVF and test the embryos and only put
• 32:38
  Speaker 2: in embryos who don't have cystic fibrosis. So all that's
• 32:41
  Speaker 2: available to you. But I'm glad you're doing the testing.
• 32:43
  Speaker 2: It's good to know. But minimally is what I would
• 32:45
  Speaker 2: say in terms of how much to freak out. And
• 32:49
  Speaker 2: when you undergo advanced and comprehensive genetic screening, more than
• 32:55
  Speaker 2: fifty percent of people will get back a positive, quote
• 32:59
  Speaker 2: unquote abnormal result, meaning you have a mutation that's very,
• 33:01
  Speaker 2: very common. It's not unexpected, it's not a problem, it's
• 33:04
  Speaker 2: not a health issue. It's not any issue whatsoever, unless
• 33:08
  Speaker 2: you happen to be prograding with someone who has the
• 33:11
  Speaker 2: same mutation, which is unlikely.
• 33:14
  Speaker 4: Okay, this one's for Emily. Are kick counts just torture
• 33:19
  Speaker 4: devices for Type A.
• 33:20
  Speaker 1: Personalities, So data on ky counts a little mixed. So
• 33:25
  Speaker 1: the idea behind KIT counting is that it is a
• 33:28
  Speaker 1: method to prevent stillbirth, which is one of the complications
• 33:31
  Speaker 1: we talked through in the book. The idea is that
• 33:35
  Speaker 1: you would count for some period of time every day,
• 33:37
  Speaker 1: particularly towards the end of pregnancy. You would look for
• 33:41
  Speaker 1: some number of movements in an hour or count until
• 33:44
  Speaker 1: you get to some number. There's a few different methods
• 33:46
  Speaker 1: for this, and it's a structured way to detect abnormal
• 33:51
  Speaker 1: changes in movement which could indicate a problem with the baby.
• 33:57
  Speaker 1: The evidence Theoretta it seems like this could help do
• 34:03
  Speaker 1: that kind of detection. In practice, the evidence to support
• 34:08
  Speaker 1: this as an important method for preventing stillbirth is quite weak,
• 34:13
  Speaker 1: and part of the issue is that stillbirth will more
• 34:18
  Speaker 1: common than many people think, is still very rare, and
• 34:21
  Speaker 1: so it's very difficult to run a large trial that
• 34:25
  Speaker 1: would actually detect changes in stillbirth, just because the overall
• 34:29
  Speaker 1: prevalence is low, and so any changes you need a
• 34:32
  Speaker 1: lot of data to detect them statistically. So I think
• 34:37
  Speaker 1: this is one of the cases where it actually depends
• 34:40
  Speaker 1: a little bit on how someone's going to kind of
• 34:42
  Speaker 1: come to it emotionally. So for some people this is
• 34:45
  Speaker 1: very reassuring, and it's like I'm going to do this,
• 34:47
  Speaker 1: I'm going to put it on my calendar, I'm going
• 34:48
  Speaker 1: to do it every day. You know, that'll sort of
• 34:51
  Speaker 1: be a positive experience, and for some people it's super
• 34:54
  Speaker 1: anxiety provoking.
• 34:56
  Speaker 2: We do get more visits.
• 34:57
  Speaker 1: To doctors as a result of this becauseeople want reassurance.
• 35:01
  Speaker 1: So I'm not sure there's one hundred percent answer to
• 35:05
  Speaker 1: whether this is the right thing for everybody.
• 35:08
  Speaker 2: No, I mean, I listen, I agree. I think the
• 35:10
  Speaker 2: issue is, yes, if a baby is moving or appears
• 35:15
  Speaker 2: to be moving less than expected, that usually means nothing,
• 35:21
  Speaker 2: but it's something we want to know about, and so
• 35:22
  Speaker 2: we have people come and check it out. Fine, every
• 35:26
  Speaker 2: now and again, we do see something that's real and
• 35:28
  Speaker 2: we intervene and we think, you know, it improved the outcome.
• 35:32
  Speaker 2: The question is whether it's valuable to tell everyone who's
• 35:35
  Speaker 2: pregnant do some sort of formal test at home to
• 35:38
  Speaker 2: make sure your baby's moving. Okay, are you going to
• 35:40
  Speaker 2: quote unquote save any babies compared to the many, many,
• 35:44
  Speaker 2: many people You're going to freak out?
• 35:46
  Speaker 3: Right?
• 35:46
  Speaker 2: And so it's that is the question that's quite unclear.
• 35:50
  Speaker 2: So I don't typically recommend kick counting as a routine,
• 35:54
  Speaker 2: but I tell people if they feel their babies moving
• 35:58
  Speaker 2: abnormally one day, right, because most people know they're babies. Right,
• 36:02
  Speaker 2: is some babies are very active. Somebodies are less. Somebody's
• 36:04
  Speaker 2: moving night, somebody's move in the morning. Right, there's you know,
• 36:06
  Speaker 2: babies have personalities just like adults do. And so if
• 36:09
  Speaker 2: you think there's a change and something's unusual and you're concerned,
• 36:13
  Speaker 2: then I will say, all right, lie down, close your eyes,
• 36:15
  Speaker 2: focus on the baby. Wait thirty minutes. If you feel
• 36:18
  Speaker 2: three movements of it's okay. And if you don't, let
• 36:20
  Speaker 2: us know. But as a routine, I don't anyone who's
• 36:23
  Speaker 2: high risk enough for still birth. I haven't come to
• 36:25
  Speaker 2: the office once or twice a week for like formal testing,
• 36:28
  Speaker 2: whether it's a biophysical profile or a non stress test,
• 36:31
  Speaker 2: so we can really get, you know, something with data
• 36:33
  Speaker 2: on it and something really can see whereas someone is
• 36:36
  Speaker 2: at lowers for stillbirth, I generally just say just keep
• 36:39
  Speaker 2: an eye on your baby and if everything seems normal,
• 36:41
  Speaker 2: you're good to go.
• 36:44
  Speaker 4: As a migraine sufferer during pregnancy, I was really like,
• 36:49
  Speaker 4: I always had my tile and all at the ready,
• 36:52
  Speaker 4: but I was googling and I noticed that it actually
• 36:56
  Speaker 4: depends at least shaking your head at my googling, that
• 37:01
  Speaker 4: taking ibuprofen or an end said during pregnancy is actually like,
• 37:06
  Speaker 4: it's different when in the pregnancy you take it. Is
• 37:09
  Speaker 4: it the kind of thing that has just blanket never
• 37:11
  Speaker 4: take ibuprofen during your pregnancy, or does it actually matter
• 37:14
  Speaker 4: when it matters?
• 37:16
  Speaker 2: So thilanol and ibuprofen are different, just to be clear,
• 37:19
  Speaker 2: because you first said tylanol and then you said ibuprofen,
• 37:22
  Speaker 2: so thailanol. You can also google some bad things about tileanol,
• 37:26
  Speaker 2: but basically the overwhelming evidence evidence is that tylanol is safe.
• 37:31
  Speaker 2: And the studies that seem to scare people about tilanol
• 37:35
  Speaker 2: are very complicated because it could be the reason somewhat
• 37:38
  Speaker 2: took talanol like which is usually fever, illness, this or that.
• 37:41
  Speaker 2: So tilanol is separate ibuprofen, which is like motrin, which
• 37:46
  Speaker 2: is like an advil, or another end said like neproxin
• 37:50
  Speaker 2: or a leive there. It's not a concern as far
• 37:53
  Speaker 2: as you know in terms of birth defects like early
• 37:55
  Speaker 2: in pregnancy, later in pregnancy, and sort of the mid
• 37:58
  Speaker 2: to late third trimester, there is a risk of it
• 38:00
  Speaker 2: affecting one of the blood vessels in the baby's heart,
• 38:03
  Speaker 2: so we tell people not to take it in the
• 38:05
  Speaker 2: third trimester. The reason we tell people not to take
• 38:09
  Speaker 2: it in the first and second trimester is prenominantly because
• 38:12
  Speaker 2: we don't want people to sort of get confused, which
• 38:15
  Speaker 2: one because people always confuse, like you know, just we
• 38:18
  Speaker 2: just heard Talento motor and advil, and so we tell
• 38:20
  Speaker 2: them not to take that sort of ever, so they
• 38:23
  Speaker 2: don't end up taking the third trimester. But if someone
• 38:26
  Speaker 2: needed it at eighteen weeks, they could take it and
• 38:29
  Speaker 2: we tell them, you know this, and so we sort
• 38:31
  Speaker 2: of do give it to people for certain circumstances. But yes,
• 38:35
  Speaker 2: later in pregnancy becomes definitely don't take it later in pregnancy.
• 38:39
  Speaker 2: But that's that's exactly when exactly how much it's a
• 38:42
  Speaker 2: little bit complicated, which is why there's more of a
• 38:44
  Speaker 2: blanket statement not to take ibuprofen because it will become dangerous.
• 38:49
  Speaker 2: But there are a lot of nuances to that.
• 38:53
  Speaker 4: Yeah, I will say like as a as a chronic
• 38:55
  Speaker 4: pain sufferer, that made pregnancy really scar like it was
• 38:59
  Speaker 4: the ultimate like me or my baby. You know, it's
• 39:01
  Speaker 4: like how can I get.
• 39:02
  Speaker 3: Through the day.
• 39:03
  Speaker 2: Each medication requires a conversation and you know, a discussion.
• 39:07
  Speaker 2: But there are options for people with pain, and there
• 39:10
  Speaker 2: are options with people with migraine pain. And I think
• 39:13
  Speaker 2: that sometimes people feel like they can't take anything because,
• 39:15
  Speaker 2: like you said, it's me versus the baby, which is
• 39:18
  Speaker 2: actually the exception. It's very unusual that there's a me
• 39:21
  Speaker 2: versus the baby conversation. It happens so rarely. It's almost
• 39:25
  Speaker 2: always what's good for the mother is good for the baby.
• 39:27
  Speaker 2: Or there's three options that are good for the mother,
• 39:30
  Speaker 2: and we'll pick the one that save us for the baby.
• 39:32
  Speaker 3: Okay, okay, last one, do doctors suggest ce sections, you know,
• 39:39
  Speaker 3: to make their tea times? Is that a really like
• 39:42
  Speaker 3: outdated worry that doctors kind of jump to suggest ce
• 39:47
  Speaker 3: sections in order to make it faster for them.
• 39:53
  Speaker 2: Loaded I will so for the record, I do not golf,
• 39:58
  Speaker 2: so I would never do it for tea time. Listen,
• 40:02
  Speaker 2: are there doctors who make recommendations because it's easier for
• 40:07
  Speaker 2: them than the patient. I'm sure, I'm sure they exist, right,
• 40:10
  Speaker 2: I mean, there's there's I don't know how many doctors
• 40:11
  Speaker 2: there are in the United States, a million, I don't
• 40:13
  Speaker 2: know what the number is. Many, many, many doctors, right,
• 40:15
  Speaker 2: And I'm sure there are ones that make recommendations that
• 40:18
  Speaker 2: are not in the best interest of their patients. I
• 40:20
  Speaker 2: would say, in my experience of knowing doctors, talking to doctors,
• 40:24
  Speaker 2: meeting doctors, and working with doctors, very rare. It's just
• 40:28
  Speaker 2: it doesn't work like that typically. And I would say
• 40:31
  Speaker 2: that especially in the field of obstetrics, the way things
• 40:35
  Speaker 2: have evolved, you rarely have that solo practitioner who's deciding
• 40:41
  Speaker 2: between a tea time and a birth right. So, like,
• 40:43
  Speaker 2: take my schedule, for example, if I'm covering the labor floor,
• 40:47
  Speaker 2: I'm on the labor floor from seventy am to seven pm.
• 40:50
  Speaker 2: It makes no difference to me whether someone has a
• 40:52
  Speaker 2: vaginal birth or a C section from my convenience, like
• 40:55
  Speaker 2: whatever's best for hers, best for her. And similarly, I'm
• 40:59
  Speaker 2: being relieved by someone at seven pm who is fresh
• 41:02
  Speaker 2: and you know, slept and capable and had dinner and
• 41:05
  Speaker 2: as someone I trust. And so whether someone has a
• 41:08
  Speaker 2: C section at six pm, or we wait and they
• 41:09
  Speaker 2: have it at nine pm, or they deliver vaginal lever
• 41:11
  Speaker 2: and it doesn't matter to me, there's no upside or
• 41:14
  Speaker 2: downside to me. So I think nowadays that type of behavior,
• 41:18
  Speaker 2: if it existed, or to what degree existed, must be
• 41:23
  Speaker 2: much less because there's there aren't the same time pressures
• 41:26
  Speaker 2: on obstetricians that there may have used to be.
• 41:30
  Speaker 1: I think can I make one Can I say one
• 41:35
  Speaker 1: one thing?
• 41:35
  Speaker 2: No, No, you cannot.
• 41:38
  Speaker 1: Because you have a tea time to get to. So
• 41:41
  Speaker 1: I think one piece related to this is about inductions,
• 41:46
  Speaker 1: which comes up a lot, and you and I have
• 41:47
  Speaker 1: talked about this that basically labor induction can be very
• 41:51
  Speaker 1: slow and.
• 41:52
  Speaker 2: So right, but the doctor doesn't have to be there.
• 41:54
  Speaker 1: Is that the doctor, yes, but just for people a
• 41:56
  Speaker 1: kind of point related to like you're getting from an
• 41:59
  Speaker 1: induction to to a C section like something I think
• 42:02
  Speaker 1: it's really important for people to understand is that labor
• 42:04
  Speaker 1: induction itself can be extremely slow. And so if you
• 42:07
  Speaker 1: are going to have an induced labor and you're planning
• 42:10
  Speaker 1: for a vaginal barth at the end of that, which
• 42:12
  Speaker 1: would be typical you and your doctor they will be
• 42:16
  Speaker 1: prepared because doctors know this, but you should be prepared
• 42:19
  Speaker 1: that it will be very that it will be very slow.
• 42:22
  Speaker 2: Yeah. I would say that the one thing that sadly
• 42:27
  Speaker 2: does drive a lot of decisions regarding mode of delivery,
• 42:32
  Speaker 2: right cea section versu. The vaginal is the either the
• 42:37
  Speaker 2: actual fear of getting sued of litigation, or even if
• 42:42
  Speaker 2: it's not actual, it's sort of built into the system.
• 42:45
  Speaker 2: There are so many safeguards built into the system that
• 42:51
  Speaker 2: end up increasing the risk of ce sections that we're
• 42:54
  Speaker 2: not even aware of in a certain sense, and they're
• 42:57
  Speaker 2: built in there because of fear of lawsuits. It's not
• 43:00
  Speaker 2: just the doctor that's afraid of getting sued. The nurses
• 43:03
  Speaker 2: are afraid of getting sued, the hospital is afraid of
• 43:05
  Speaker 2: getting sued, the hospital's insurance carrier is afraid of getting sued,
• 43:09
  Speaker 2: and so sadly that is sort of cooked into the
• 43:13
  Speaker 2: numbers sometimes and it's unfortunate, it just is, but it's
• 43:18
  Speaker 2: a reality. And I'm not saying that from like a
• 43:20
  Speaker 2: political reason about what to do about it, because there
• 43:22
  Speaker 2: isn't a great solution. But I think that definitely doctors
• 43:26
  Speaker 2: sometimes consciously or subconsciously worry about well, the chance of
• 43:32
  Speaker 2: something going wrong is very low, and medically it's probably
• 43:35
  Speaker 2: okay to continue if she wants to. But if something
• 43:38
  Speaker 2: were to go wrong, it's not going to look good
• 43:40
  Speaker 2: on paper, and I'm going to be in big trouble
• 43:44
  Speaker 2: and either that means I'll get sued or the hospital's
• 43:46
  Speaker 2: gonna come down on me because they're gonna get sued
• 43:48
  Speaker 2: or they're going to strict my privileges. And again I'm
• 43:50
  Speaker 2: not saying that to complain. It's a reality of the system,
• 43:53
  Speaker 2: and it's just it's it's hard. I don't know what
• 43:56
  Speaker 2: the solution is, but it's that is probably a more
• 43:59
  Speaker 2: prevalent and factor than the doctor's tea times or show
• 44:04
  Speaker 2: tickets or dinner reservations or whatever, you know, whatever the
• 44:07
  Speaker 2: doctors are supposedly doing in high society that the regular
• 44:13
  Speaker 2: people aren't. So yeah, we're probably going home to our
• 44:16
  Speaker 2: second job, is what we're doing.
• 44:20
  Speaker 3: Okay, Well, thank you both. I will see myself.
• 44:22
  Speaker 1: Up, thank you tomorrow. So I had I had a
• 44:27
  Speaker 1: last top I want to talk about because I think
• 44:29
  Speaker 1: it is something that that we don't agree on, and
• 44:35
  Speaker 1: there are very few things like this, well me and you. Yeah,
• 44:38
  Speaker 1: And it is about how people how much detailed people
• 44:42
  Speaker 1: want on risks. So one of the things I spend
• 44:45
  Speaker 1: a lot of time on in like in my in
• 44:48
  Speaker 1: my work, in my book and so on, is trying
• 44:49
  Speaker 1: to be like super precise about you know, is the
• 44:52
  Speaker 1: risk of recurrence of this condition? You know, sixteen percent
• 44:56
  Speaker 1: or twenty percent or twenty five percent, And I in
• 45:00
  Speaker 1: even writing this book, I spend a huge amount of
• 45:02
  Speaker 1: time in that space of like, let's be you know, really,
• 45:06
  Speaker 1: let me try to like get as close as I
• 45:07
  Speaker 1: can to some you know, precise number and understand how
• 45:11
  Speaker 1: much variation there is and so on. And you came
• 45:14
  Speaker 1: into this, I think, with an idea that there are
• 45:18
  Speaker 1: kind of three categories of risk that you like to
• 45:21
  Speaker 1: explain to people. There's like, probably this won't happen again.
• 45:25
  Speaker 1: You know, most of the time this is kind of
• 45:26
  Speaker 1: pretty aosyncratic, so it's probably not gonna happen again. It
• 45:30
  Speaker 1: might happen again, but you don't really know, or it's
• 45:33
  Speaker 1: you should assume it's going to happen again, and if
• 45:35
  Speaker 1: it doesn't, you're lucky, I think, is how you put it.
• 45:38
  Speaker 1: So you're kind of like pooh pooed my precision around risk.
• 45:43
  Speaker 1: And I think part of that is I think part
• 45:45
  Speaker 1: of it comes from the clinical maybe this sort of
• 45:47
  Speaker 1: expertise of talking to people and saying like people don't
• 45:49
  Speaker 1: really like fundamentally, the difference between sixty five and seventy
• 45:53
  Speaker 1: percent isn't actually very meaningful when people make decisions, So
• 45:57
  Speaker 1: I don't think we disagree.
• 46:00
  Speaker 2: I think that it's more so the practicality of it,
• 46:03
  Speaker 2: meaning I'm also I'm a data person. I love data.
• 46:06
  Speaker 2: I think that there's two issues with trying to get
• 46:09
  Speaker 2: that precise number. One, the research we have in almost
• 46:15
  Speaker 2: all of these aspects is so limited that the difference
• 46:18
  Speaker 2: between sixteen percent and twenty one percent is usually nothing
• 46:22
  Speaker 2: because the brackets around them are wide enough that it
• 46:24
  Speaker 2: really doesn't There is no actual difference between those numbers,
• 46:27
  Speaker 2: which you understand better than I do, but sort of statistically.
• 46:30
  Speaker 2: So that's one issue. The second is, I don't think
• 46:34
  Speaker 2: most people think like you think, right, So I think
• 46:38
  Speaker 2: there are people, and I certainly take care of them,
• 46:41
  Speaker 2: come across them, have some in my family this who
• 46:43
  Speaker 2: they're like? No, I want to know is it closer
• 46:45
  Speaker 2: to sixteen or closer twenty one? And fine, I'll tell you,
• 46:48
  Speaker 2: like God bless, we'll go to the decimal point whichever,
• 46:50
  Speaker 2: however many sing figs you want, we'll go there, right,
• 46:53
  Speaker 2: no problem. But most people don't think like that, right.
• 46:56
  Speaker 2: Most people, when they're thinking about risk, they categorize in
• 47:00
  Speaker 2: their brain like high risk, low risk, medium risk. Right
• 47:03
  Speaker 2: where am I? And so I sort of usually break
• 47:06
  Speaker 2: it down again based on the risk into something like
• 47:09
  Speaker 2: less than ten, ten to fifty or more than fifty. Again,
• 47:14
  Speaker 2: it depends on Sometimes all of them are under ten,
• 47:16
  Speaker 2: and it's like, all right, less than one, one to five,
• 47:18
  Speaker 2: five to ten, like it depends on the But try
• 47:20
  Speaker 2: to give them a sense so they can wrap their
• 47:23
  Speaker 2: head around the statistics because most people, the average person
• 47:27
  Speaker 2: is functioning at you know, I don't know, a middle
• 47:30
  Speaker 2: school level when it comes to toss. That's not an insult.
• 47:33
  Speaker 2: That's like high functioning people who are very bright and
• 47:36
  Speaker 2: working in the world. That's the level of statistics they're
• 47:39
  Speaker 2: usually working at. The exception are the people who are
• 47:42
  Speaker 2: very very into data on one and know the exact decimals,
• 47:45
  Speaker 2: and God bless them, but they're the exception. They're the outliers,
• 47:49
  Speaker 2: I would say. And so for me, if you get
• 47:52
  Speaker 2: into very very precise numbers on people with people, you
• 47:56
  Speaker 2: lose them in counseling. Now with reading, it might be
• 48:00
  Speaker 2: because it's a reference versus a conversation. They hear seventeen percent,
• 48:05
  Speaker 2: what does that mean to them? And also the other
• 48:08
  Speaker 2: thing is people think about math differently, So I always
• 48:11
  Speaker 2: have to say those numbers twice, I'll say your risk
• 48:15
  Speaker 2: is thirty percent, your risk is about three out of ten,
• 48:19
  Speaker 2: about one out of three. Like, you have to say
• 48:21
  Speaker 2: it in so many different ways because people hear things differently.
• 48:23
  Speaker 2: Some people don't get percentages. When I tell people one
• 48:26
  Speaker 2: in ten thousands, some people don't get what that means.
• 48:28
  Speaker 2: And again not that they don't understand it, it's just
• 48:30
  Speaker 2: they're hearing it, and they may be more of a
• 48:33
  Speaker 2: verbal learner. And you have to write something down or
• 48:36
  Speaker 2: it's it's it's fascinating. The human brain is fascinating, and
• 48:39
  Speaker 2: so we see all comers. And that's sort of what
• 48:43
  Speaker 2: I was getting at, not so much that it doesn't matter,
• 48:45
  Speaker 2: but that it's usually not practical.
• 48:48
  Speaker 1: Yeah, no, I think that's fair. The question of how
• 48:50
  Speaker 1: people understand probabilities, particularly small probabilities, is like incredibly interesting one,
• 48:55
  Speaker 1: Like how do you how do you help somebody understand
• 48:57
  Speaker 1: one in ten thousands, since like most of the time
• 48:59
  Speaker 1: you won't expl experience something, And how is one in
• 49:02
  Speaker 1: ten thousand different from one in one hundred thousand, Like
• 49:04
  Speaker 1: those booth You're never going to see either of those
• 49:06
  Speaker 1: right in your life.
• 49:07
  Speaker 2: I tell people that, you know, when we talk about
• 49:10
  Speaker 2: I'll go back to the genetic screening thing where I'll
• 49:13
  Speaker 2: tell people their risk is one percent, right, and if
• 49:16
  Speaker 2: they do an amnuur CVS, their risk of a miscarriage
• 49:19
  Speaker 2: is let's say, one in five hundred, little less than
• 49:21
  Speaker 2: one percent. And I'll tell them, all right, you have
• 49:23
  Speaker 2: two options here. You're going to do a procedure, you're
• 49:26
  Speaker 2: not gonna do a procedure. And I said, think about it.
• 49:29
  Speaker 2: You can close your eyes and flip a coin and
• 49:32
  Speaker 2: make this decision, and whether the coin leads heads or tails,
• 49:36
  Speaker 2: ninety nine plus percent of the time, you're not gonna miscarry,
• 49:40
  Speaker 2: and you're gonna have a healthy baby. I said, no
• 49:42
  Speaker 2: matter what, right, if you do a CVS ninety nine
• 49:44
  Speaker 2: plus percent of the time, you're not gonna miscarry. You're
• 49:46
  Speaker 2: gonna have a healthy baby. And if you don't do a
• 49:48
  Speaker 2: CVS ninety nine plus percent of the time, you're not
• 49:50
  Speaker 2: gonna misscarre. You're gonna have a healthy baby. How often in
• 49:53
  Speaker 2: your life do you get to make a decision that's
• 49:55
  Speaker 2: important to you or ninety nine plus percent of time
• 49:58
  Speaker 2: is going to work out no matter what you do.
• 50:00
  Speaker 2: So don't lose too much sleep over this. As I
• 50:02
  Speaker 2: go with your gut. If it's one percent versus eight percent,
• 50:05
  Speaker 2: then I'll you know, then it's different.
• 50:07
  Speaker 3: Right.
• 50:07
  Speaker 2: But when it's really really small numbers, it doesn't matter
• 50:11
  Speaker 2: to the individual, matters to the population. And so I
• 50:14
  Speaker 2: try to help them not worry too much about the
• 50:16
  Speaker 2: decision because it won't matter for almost everybody, and they
• 50:19
  Speaker 2: have to do, like, say, you have to sleep at night, right,
• 50:22
  Speaker 2: So whatever's going to make you sleep a night, that's
• 50:24
  Speaker 2: what you should do because you have to live with
• 50:26
  Speaker 2: yourself the rest of the pregnancy, So pick that one.
• 50:29
  Speaker 2: So again you have to break it down in a
• 50:30
  Speaker 2: way that's sort of manageable for people.
• 50:34
  Speaker 1: All right, Well, I just want to end Nate by
• 50:36
  Speaker 1: saying thank you. I don't, as I said at the top,
• 50:40
  Speaker 1: I don't like group projects, and doing this group project
• 50:44
  Speaker 1: with you was just a treat and I'm really grateful
• 50:48
  Speaker 1: for I'm really grateful we did together.
• 50:50
  Speaker 2: Well, now it's my turn. I have to say I
• 50:55
  Speaker 2: got turned on Emily from reading your book Right Expecting,
• 51:00
  Speaker 2: which is recommended by a patient. I never read pregnancy
• 51:04
  Speaker 2: books ever, Right, why would ever read them? I'm like,
• 51:06
  Speaker 2: this is ridiculous. I read yours, loved it. Loved it.
• 51:10
  Speaker 2: Cold called you said, I'm a guy in New York.
• 51:13
  Speaker 2: We have to meet. Yeah, And you've been just in
• 51:18
  Speaker 2: general before we did this book, you've been so like
• 51:21
  Speaker 2: friendly and gracious and we've had a great relationship. And
• 51:24
  Speaker 2: as your fame has grown, you never sort of like
• 51:29
  Speaker 2: ditched me or dumped me like we always maintained that relationship,
• 51:32
  Speaker 2: which is I appreciate that. But then also when we
• 51:35
  Speaker 2: decided to write this book, like I said, you're you're
• 51:38
  Speaker 2: a well known author. You do this, You're very very
• 51:41
  Speaker 2: good at it, You're very successful. A lot of people
• 51:42
  Speaker 2: listen to you. And you could not have been more
• 51:45
  Speaker 2: gracious in doing this in a way that made me
• 51:47
  Speaker 2: feel like a partner. You know that you know, even
• 51:51
  Speaker 2: partners whatever you want to say, It is like that
• 51:53
  Speaker 2: we worked together on this and I really really enjoyed it.
• 51:56
  Speaker 2: I learned a tremendous amount from you and from the process.
• 51:59
  Speaker 2: I'm very proud of the book, really like I'm proud
• 52:03
  Speaker 2: of it. I think what we did was great. I
• 52:04
  Speaker 2: think is gonna hopefully help a lot a lot of people.
• 52:08
  Speaker 2: I'm going to again display it proudly, and it's really
• 52:13
  Speaker 2: something I'm gonna cherish that we did for a long time.
• 52:16
  Speaker 2: That's great meat.
• 52:18
  Speaker 1: Thanks Nate, Thank you. The Unexpected Navigating Pregnancy During and
• 52:30
  Speaker 1: After Complications is out April thirtieth, twenty twenty four. You
• 52:34
  Speaker 1: can get it anywhere that you buy books. Parent Data
• 52:38
  Speaker 1: is produced by Tamar Avishai with support from the parent
• 52:41
  Speaker 1: Data team and PI Rex. If you have thoughts on
• 52:44
  Speaker 1: this episode, please join the conversation on my Instagram at
• 52:47
  Speaker 1: prof Emily Ostar, and if you want to support the show,
• 52:51
  Speaker 1: become a subscriber to the parent Data newsletter at parentdata
• 52:54
  Speaker 1: dot org, where I write weekly posts on everything to
• 52:57
  Speaker 1: do with parents and data to help you make better,
• 53:00
  Speaker 1: more informed parenting decisions. There are a lot of ways
• 53:04
  Speaker 1: that you can help people find out about us. Leave
• 53:06
  Speaker 1: a rating or review on Apple Podcasts, Text your friend
• 53:09
  Speaker 1: about something you learned from this episode. Debate your mother
• 53:12
  Speaker 1: in law about the merits of something parents do now
• 53:15
  Speaker 1: that is totally different from what she did. Host a
• 53:19
  Speaker 1: story to your Instagram debunking a panic headline of your own.
• 53:22
  Speaker 1: Just remember to mention the podcast too. Write Penelope right, mam.
• 53:27
  Speaker 1: We'll see you next time.