Latest / Wellness, Actually with Emily Oster & Perry Wilson, MD / How to Talk to Your Doctor: Navigating important conversations about your care

Transcript

How to Talk to Your Doctor: Navigating important conversations about your care · Wellness, Actually with Emily Oster & Perry Wilson, MD

• 0:01
  Speaker 1: This is parent Data. I'm Emily Oster. Today's a big
• 0:07
  Speaker 1: day at parent Data. Firstly, this week we are relaunching
• 0:11
  Speaker 1: the Pregnant Data newsletter, new and improved for twenty twenty five.
• 0:15
  Speaker 1: It's got answers to all your questions, and I know
• 0:19
  Speaker 1: you have a lot of them, so that's a big
• 0:21
  Speaker 1: thing and I hope you'll sign up. Secondly, I published
• 0:26
  Speaker 1: a book almost a year ago with my co author,
• 0:28
  Speaker 1: doctor Nathan Fox, called The Unexpected. It's all about when
• 0:33
  Speaker 1: things do go wrong, or at least get complicated, in
• 0:37
  Speaker 1: a pregnancy. And the two of these together, Pregnant Data
• 0:41
  Speaker 1: and The Unexpected, are meant to help people to help
• 0:45
  Speaker 1: you be much better prepared for what they might face
• 0:48
  Speaker 1: in their pregnancies, and to help better navigate conversations with doctors,
• 0:54
  Speaker 1: both the expected conversations and the unexpected ones. So of course,
• 1:01
  Speaker 1: to celebrate both of these things, I had to invite
• 1:03
  Speaker 1: Nate back on the parent at a podcast to chat.
• 1:07
  Speaker 2: Nate is an OBGYN and an.
• 1:10
  Speaker 1: MFM, and he is one of our favorite returning podcast guests,
• 1:15
  Speaker 1: not just because he's a great guy, but also because
• 1:18
  Speaker 1: it's really nice to have a doctor who cannot only
• 1:22
  Speaker 1: provide medical answers to questions that come up around pregnancy,
• 1:25
  Speaker 1: but also to help you have the best possible experiences
• 1:28
  Speaker 1: with your own doctor. I also just really like Nate.
• 1:32
  Speaker 1: That's why I wrote a book with him.
• 1:34
  Speaker 3: He's great.
• 1:36
  Speaker 1: We're going to talk about some big issues that come
• 1:38
  Speaker 1: up during pregnancy and the many prenatal doctor visits, about
• 1:42
  Speaker 1: the distinction between self management and calling your doctor, when
• 1:46
  Speaker 1: do you know if something is normal bad or bad bad?
• 1:50
  Speaker 1: And we'll talk about just how subjective that line actually is.
• 1:54
  Speaker 1: We talk about risks and trade offs, and about the
• 1:57
  Speaker 1: kinds of postpartum issues that are worth addressing while still pregnant.
• 2:01
  Speaker 1: I'm looking at you depression and anxiety. And you'll hear
• 2:05
  Speaker 1: about the one and only public place I ever vomited
• 2:08
  Speaker 1: while pregnant.
• 2:09
  Speaker 2: Not to be missed.
• 2:13
  Speaker 1: After the break, we welcome back doctor Nathan Fox. I
• 2:23
  Speaker 1: am delighted to welcome doctor Nathan Fox, my co author,
• 2:26
  Speaker 1: my friend, back to the Parent Data Podcast.
• 2:30
  Speaker 2: Doctor Nathan Fox, Can you introduce yourself?
• 2:33
  Speaker 3: We are friends, we are co authors, and that is
• 2:36
  Speaker 3: by far the most important thing in my professional life
• 2:39
  Speaker 3: right now. Secondary toll that I am a doctor. I
• 2:42
  Speaker 3: do see patients pretty much every day I'm an obgyn
• 2:46
  Speaker 3: and a maternal fetal medicine specialist, which some people call
• 2:50
  Speaker 3: a high risk ob colloquially. I practice in New York
• 2:54
  Speaker 3: City and that's what I do pretty much all the time.
• 2:58
  Speaker 3: On the side, I also have a podcast and I've
• 3:02
  Speaker 3: you know, other wonderful things in my life.
• 3:05
  Speaker 1: How much of the time do you spend delivering babies
• 3:08
  Speaker 1: as opposed to doing prenate all stuff.
• 3:10
  Speaker 3: It's varied over the years. You know, when our practice
• 3:13
  Speaker 3: was smaller, I was probably doing twenty percent of all
• 3:17
  Speaker 3: of our deliveries, twenty to twenty five percent. We do
• 3:20
  Speaker 3: about one thousand deliveries a year. And then as our
• 3:22
  Speaker 3: practice grew bigger, probably now on the labor floor once
• 3:29
  Speaker 3: a week, give or take somewhere there it's gone. As
• 3:32
  Speaker 3: one ages, he or she tends to do slightly fewer deliveries,
• 3:38
  Speaker 3: which is pretty typical. But I'm still actively there, like
• 3:40
  Speaker 3: I'm there a lot. I'm on call this weekend, for example.
• 3:43
  Speaker 1: Christmas babies. We're recording this before Christmas. This will be
• 3:46
  Speaker 1: Christmas babies.
• 3:47
  Speaker 3: This the New Year's babies. Those are the ones that
• 3:49
  Speaker 3: people are looking for.
• 3:50
  Speaker 4: Oh yeah, yeah, those who want the glory of delivering
• 3:55
  Speaker 4: the first baby of the new year, and those who
• 3:58
  Speaker 4: want the tax break for delivering the last baby of
• 4:00
  Speaker 4: the old year.
• 4:03
  Speaker 2: There are so many important reasons.
• 4:05
  Speaker 1: For birthdays, all right, So let's talk first about hyperamesis
• 4:11
  Speaker 1: because this, for me, is an example of a place
• 4:14
  Speaker 1: where we hit a question that's actually quite common in pregnancy,
• 4:18
  Speaker 1: which is, like, is my.
• 4:19
  Speaker 2: Experience outside the norm?
• 4:22
  Speaker 3: So?
• 4:23
  Speaker 1: You know what, Like everyone knows that vomiting, nausee and
• 4:27
  Speaker 1: vomiting is common in pregnancy, and some.
• 4:30
  Speaker 2: People vomit more than others.
• 4:32
  Speaker 1: And I guess the way I would I would say
• 4:34
  Speaker 1: this is people are worried about bothering their doctors, and
• 4:37
  Speaker 1: so they somehow want to know, like how do I
• 4:39
  Speaker 1: know if I should if I should call? How do
• 4:41
  Speaker 1: I know if things have gone off the rails or
• 4:42
  Speaker 1: if I should just sort of just suck it up.
• 4:47
  Speaker 3: I'm surprised to learn that people are worried about bothering
• 4:49
  Speaker 3: their doctors, are you? None of them, like a major
• 4:53
  Speaker 3: none of them seem to be my patients. Not I
• 4:56
  Speaker 3: mean that in a negative way. I think I don't
• 5:00
  Speaker 3: you know, I think different people are different. Maybe it's
• 5:03
  Speaker 3: a New York City phenomenon that or New York. I mean,
• 5:06
  Speaker 3: I'm from the Midwest, so I was brought up politely,
• 5:10
  Speaker 3: I would say, and then I came to New York
• 5:13
  Speaker 3: and people are just a little more assertive, I guess
• 5:16
  Speaker 3: as a way to put it right practice and not again,
• 5:19
  Speaker 3: not in a bad way. I love New York. I
• 5:22
  Speaker 3: guess that's possibly true some of it, maybe that people
• 5:25
  Speaker 3: are just they don't want to bother their doctor. But sometimes, unfortunately,
• 5:29
  Speaker 3: maybe they're conditioned to believe that because of their experiences
• 5:33
  Speaker 3: with doctors, and maybe not the person the doctor, but
• 5:38
  Speaker 3: sometimes just the way someone's office is set up. It's
• 5:42
  Speaker 3: difficult to reach a doctor, you know, the visits are short,
• 5:46
  Speaker 3: you can't get them on the phone, it's hard to
• 5:48
  Speaker 3: get them through the portal, and so you're sort of
• 5:50
  Speaker 3: turning to Google. And that's a much more global issue.
• 5:54
  Speaker 3: I would say, medicine that we're not going to solve today.
• 5:57
  Speaker 3: But you know, I think that it is definitely a
• 6:02
  Speaker 3: challenge if you don't have access to your doctor or
• 6:06
  Speaker 3: your midwife wherever that is. But I would say that
• 6:10
  Speaker 3: you know, everyone has prenatal visits, that's for sure. And
• 6:15
  Speaker 3: if you have a question that you can't get answered,
• 6:17
  Speaker 3: over the phone or over a portal or whatever it
• 6:20
  Speaker 3: might be, see if you can make a visit, like
• 6:24
  Speaker 3: just show up, right, just say I'm not feeling well,
• 6:26
  Speaker 3: and usually I mean and usually if you call and
• 6:28
  Speaker 3: say I'm not feeling well, I'm pregnant, They'll want you
• 6:31
  Speaker 3: to come in and be seen, and so you're gonna
• 6:33
  Speaker 3: get FaceTime typically.
• 6:35
  Speaker 1: Maybe, although I think what people are really struggling with
• 6:38
  Speaker 1: here on the sort of nausea pieces, like I know
• 6:41
  Speaker 1: this is there is some amount of this that's normal, right.
• 6:44
  Speaker 1: I was told it's like regular to be nauseous, and
• 6:47
  Speaker 1: so then you know, I've I've a nauseous in every
• 6:50
  Speaker 1: day I vomit and I vomit ten times a day?
• 6:53
  Speaker 2: Was that too much?
• 6:54
  Speaker 1: Is that like a too much amount of vomiting? Or
• 6:56
  Speaker 1: is like fifteen too much? Or is one too much?
• 7:00
  Speaker 5: Like?
• 7:00
  Speaker 1: How do I know that that I not just that
• 7:03
  Speaker 1: I could call the doctor, but that I should is maybe.
• 7:06
  Speaker 3: Fair a way to say it? No, that's a it's
• 7:08
  Speaker 3: a good distinction. I would say. There's sort of two thresholds.
• 7:13
  Speaker 3: And this is true with vomiting, this is true with pain,
• 7:16
  Speaker 3: this is true with really anything. The more critical threshold
• 7:22
  Speaker 3: is Am I in danger? Right? Am I in danger?
• 7:25
  Speaker 3: As my baby in danger? Something like that. So that's
• 7:28
  Speaker 3: a critical threshold where you must call right, you have
• 7:31
  Speaker 3: to be seen because there's a possibility. And so that's
• 7:34
  Speaker 3: one threshold. And the second threshold is much more subjective,
• 7:39
  Speaker 3: which is, do I feel not well and I want
• 7:43
  Speaker 3: to get better? Right? And so what the average amount
• 7:47
  Speaker 3: of vomiting is or quote unquote normal amount of vomiting
• 7:50
  Speaker 3: and nausees is completely irrelevant for the second one. Right,
• 7:53
  Speaker 3: for some people there like, yeah, I'm nauseous and I'm vomiting.
• 7:56
  Speaker 3: What's today, And that's fine. I'm okay with this. I
• 7:59
  Speaker 3: don't need to be tree and I can walk around
• 8:01
  Speaker 3: like this and be fine. And other people are like,
• 8:03
  Speaker 3: this is debilitating. I hate being nauseous all day. I
• 8:05
  Speaker 3: hate vomiting once a day. I can't work, I can't
• 8:08
  Speaker 3: take your mayor their kid, whatever it might be. And
• 8:10
  Speaker 3: so for the second threshold, I would say it's subjective.
• 8:13
  Speaker 3: If you are nauseous or vomiting to the point that
• 8:17
  Speaker 3: it's distressing you, that it's affecting your life, that you
• 8:21
  Speaker 3: want to look into ways to make it better, then
• 8:24
  Speaker 3: that is reason enough to start doing that and whether
• 8:27
  Speaker 3: that's you know, calling the nurse, calling the doctor, whatever
• 8:29
  Speaker 3: it is. In terms of the threshold the must I
• 8:32
  Speaker 3: call so for vomiting and nausea, it's generally things like
• 8:37
  Speaker 3: can I keep nothing down? Am I dehydrated? And so
• 8:41
  Speaker 3: how would you know you're dehydrated? Well, if you're not
• 8:43
  Speaker 3: peeing anymore, or when you pee it's really dark, like
• 8:46
  Speaker 3: it's the color of iced tea versus the color of
• 8:49
  Speaker 3: lemonade or water. Am I losing weight? Can I knock
• 8:54
  Speaker 3: get out of bed? Right? Those are possibly dangerous signs
• 8:58
  Speaker 3: and those need to be address. So if you're having
• 9:01
  Speaker 3: one of those things again you're not peeing, or it's
• 9:04
  Speaker 3: very very dark, or you can't keep anything down and
• 9:07
  Speaker 3: you're losing weight, you should not be waiting. You should
• 9:10
  Speaker 3: call and say I'm very sick. I need to be seen,
• 9:12
  Speaker 3: or this needs to be addressed. If it's short of
• 9:15
  Speaker 3: that and you're just not feeling well, make a decision.
• 9:18
  Speaker 3: Is this something like I'd rather take nothing and just
• 9:20
  Speaker 3: have this and sort of you know, muscle through it
• 9:22
  Speaker 3: until the end of whatever. Fine, that's okay. Whereas if
• 9:25
  Speaker 3: you're like, no, this sucks, I really want to get better.
• 9:27
  Speaker 3: Then make an appointment and that's totally fine, and that's subjective.
• 9:31
  Speaker 1: Yeah, I mean I think that's exactly right, and thank
• 9:35
  Speaker 1: you a piece of it that I think is exactly right.
• 9:37
  Speaker 1: The piece of it is that is hard, and I
• 9:39
  Speaker 1: always struggle with sort of how and I suspect you
• 9:42
  Speaker 1: struggle with how to express this to people also, is like,
• 9:46
  Speaker 1: how do you say that without it coming across like, well,
• 9:51
  Speaker 1: if you can't tough it out because you're like a
• 9:54
  Speaker 1: whiny loser, you know what I mean, how does it
• 9:57
  Speaker 1: not be like just try it until you're at the
• 9:59
  Speaker 1: edge of your like you know capacity fair.
• 10:03
  Speaker 3: No, I mean, I definitely understand how it could come
• 10:05
  Speaker 3: out that way. What I'm trying to say is actually
• 10:07
  Speaker 3: the opposite. What I'm trying to say is we're here
• 10:10
  Speaker 3: for you, Like our goal is to make you. Obviously
• 10:14
  Speaker 3: top goal is you know, healthy mother, healthy baby. Fine,
• 10:17
  Speaker 3: but the next is we want you to feel well,
• 10:19
  Speaker 3: Like it is our goal for you to feel well.
• 10:21
  Speaker 3: And Okay, if someone calls me and says they're having
• 10:24
  Speaker 3: knowledge that they're having vomiting again, not severe to the
• 10:26
  Speaker 3: point that I'm worried about their health and well being,
• 10:28
  Speaker 3: They're just it bothers them. It's upset understandably, So what
• 10:32
  Speaker 3: am I gonna be able to offer them. I'm going
• 10:34
  Speaker 3: to offer them, you know, maybe some dietary changes, which
• 10:37
  Speaker 3: rarely do that much. And then we're talking about various medications,
• 10:41
  Speaker 3: and so people sort of know from the outset. Am
• 10:43
  Speaker 3: I the type of person who would like to take
• 10:47
  Speaker 3: a medication to feel better? Am I the type of
• 10:49
  Speaker 3: person who's like, I'm out, I don't want any meds
• 10:51
  Speaker 3: unless I'm like horribly ill, I don't want to take anything.
• 10:54
  Speaker 3: And so we're here for you. If someone is not
• 10:57
  Speaker 3: feeling well and they want to try something, I don't.
• 11:00
  Speaker 3: It doesn't matter to me how not feeling well they are.
• 11:03
  Speaker 3: If it's a little bit, I'll try something because they're safe.
• 11:05
  Speaker 3: It's not like we're talking about dangerous treatments or anything
• 11:08
  Speaker 3: like that, and so any amount is totally fine on
• 11:11
  Speaker 3: my end that I don't judge people. I hate being nauseous.
• 11:14
  Speaker 3: It sucks. It's like one of the worst feelings in
• 11:16
  Speaker 3: the world. And so even if you're not vomiting, I
• 11:18
  Speaker 3: don't like God, being nauseous is terrible. And so it's
• 11:22
  Speaker 3: not like we we advise people to tough it out
• 11:26
  Speaker 3: as much as you can, and then when you hit
• 11:27
  Speaker 3: a breaking point, call us.
• 11:29
  Speaker 1: No.
• 11:29
  Speaker 3: If you're disturbed in any way whatsoever, call us and
• 11:32
  Speaker 3: we'll try to sort it out. But if you know,
• 11:34
  Speaker 3: you're the kind of person who's going to say, no,
• 11:35
  Speaker 3: I don't want any medication for it, all right, I
• 11:38
  Speaker 3: can you know, we can talk and I can try
• 11:40
  Speaker 3: to be empathetic, but not much is going to change
• 11:42
  Speaker 3: in that sense.
• 11:44
  Speaker 2: Yeah.
• 11:44
  Speaker 1: Yeah, I like this or idea of kind of thinking
• 11:46
  Speaker 1: for yourself even exanty about you know what, what are
• 11:49
  Speaker 1: the things I'm going to be willing to do here
• 11:52
  Speaker 1: and therefore, like what could come out of this conversation?
• 11:54
  Speaker 3: Yeah? Yeah, And different different people, different people feel differently
• 11:59
  Speaker 3: about this, and I don't. Again, some people are like, listen,
• 12:01
  Speaker 3: I'm just I'm just not a medication person. I'm not
• 12:03
  Speaker 3: into it. I don't, you know. Find that's perfect again,
• 12:06
  Speaker 3: unless we're in a danger situation where I have to
• 12:08
  Speaker 3: really like, listen, we gotta we gotta do this, or
• 12:10
  Speaker 3: bad things are going to happen. If someone says I'd
• 12:12
  Speaker 3: prefer to vomit once a day than take a medication
• 12:14
  Speaker 3: to not vomit, that's reasonable. I'm okay with that, And
• 12:17
  Speaker 3: as someone says, I'd prefer to take a medication rather
• 12:20
  Speaker 3: than vomit once today, I think that's reasonable. Reasonable too,
• 12:23
  Speaker 3: That's what I would choose personally, But that's me.
• 12:25
  Speaker 1: Yeah, I vomited once in my pregnancy in like an
• 12:31
  Speaker 1: ikea bathroom. Is the only one time I ever and
• 12:34
  Speaker 1: I'm like, if it happened again, I was gonna do
• 12:37
  Speaker 1: something about it.
• 12:38
  Speaker 3: My wife vomited on Lexa ninety sixth Street, which was
• 12:41
  Speaker 3: pretty gross. Uh, vomiting, people look at you. Vomiting is horrible.
• 12:46
  Speaker 3: It is. It's a horrible, horrible experience to everyone who
• 12:49
  Speaker 3: has it, and when you're pregnant you have it a lot.
• 12:51
  Speaker 3: It's it's pretty gruesome. So yeah, I'm I'm in favor
• 12:54
  Speaker 3: of helping people with it, but I don't twist people's
• 12:56
  Speaker 3: arms unless I think it's dangerous obviously, all right.
• 13:00
  Speaker 1: Second thing I want to talk about is postpartum depression
• 13:03
  Speaker 1: and and on the one hand, it is quite different
• 13:05
  Speaker 1: from from vomiting. But on the other hand, I think
• 13:08
  Speaker 1: this same general idea about sort of how do I
• 13:12
  Speaker 1: know that this is something I should get help with?
• 13:16
  Speaker 1: And I think in that case it's it's in some
• 13:18
  Speaker 1: ways even harder because it can be hard to see
• 13:22
  Speaker 1: when you're It can be hard for you to see
• 13:24
  Speaker 1: when you're depressed.
• 13:25
  Speaker 3: I don't know, you don't know you're vomiting exactly exactly.
• 13:29
  Speaker 1: And so so let me ask to begin with, because
• 13:32
  Speaker 1: I think this is something people are just confused about.
• 13:34
  Speaker 2: Do you see some depression start in pregnancy?
• 13:37
  Speaker 3: Definitely? Definitely, and so is, Yeah, there's there's everyone is
• 13:43
  Speaker 3: hopefully everyone has heard of postpartum depression. Many people have
• 13:48
  Speaker 3: heard of postpartum anxiety, right, it's sort of it's a
• 13:51
  Speaker 3: parallel to postpartum depression, just different symptoms. But there's also
• 13:55
  Speaker 3: a concept called peri natal depression and peri natal anxiety,
• 14:00
  Speaker 3: which just means instead of its starting after you deliver,
• 14:03
  Speaker 3: it starts before you deliver at some point in pregnancy.
• 14:07
  Speaker 3: And then obviously there's people who come into pregnancy with
• 14:09
  Speaker 3: sort of pre existing depression, anxiety, or any other mental
• 14:12
  Speaker 3: health condition. Doesn't have to be those two obviously, So
• 14:15
  Speaker 3: definitely can happen during pregnancy. And in fact, nowadays, not
• 14:20
  Speaker 3: only do we screen routinely for postpartum depression and anxiety,
• 14:25
  Speaker 3: they're sort of these standardized their questionnaires is how they
• 14:29
  Speaker 3: play out, But it's a standardized screen that we do,
• 14:32
  Speaker 3: and pediatricians do it. You know, a lot of people
• 14:33
  Speaker 3: do it nowadays. Fortunately, we also do one during pregnancy,
• 14:36
  Speaker 3: standardized for the same reasons, and most people will be
• 14:41
  Speaker 3: able to tell you I'm not doing well, but not
• 14:45
  Speaker 3: everybody a feels comfortable with that, and also not everyone
• 14:49
  Speaker 3: realizes that they're not doing well, because, like you said,
• 14:52
  Speaker 3: all these times are very challenging. Being pregnant is a
• 14:56
  Speaker 3: stressful time period. Having a baby's a stressful time period,
• 14:59
  Speaker 3: and it's hard for some people to understand and differentiate
• 15:03
  Speaker 3: is what I'm feeling and how I'm responding to it,
• 15:07
  Speaker 3: sort of typical slash normal, slash whatever, versus like, am
• 15:12
  Speaker 3: I in a bad place? And I think there is
• 15:16
  Speaker 3: a parallel to what I was saying about the vomiting
• 15:19
  Speaker 3: in terms of thresholds, because it's some of it is
• 15:21
  Speaker 3: similar that there are thresholds where where someone is unwell
• 15:26
  Speaker 3: and they really really need to be treated, and signs
• 15:29
  Speaker 3: like I can't get out of bed, there's nothing in
• 15:32
  Speaker 3: my life that I enjoy. It's affecting my relationship with
• 15:36
  Speaker 3: my baby or with my loved ones, or it's affecting
• 15:40
  Speaker 3: my ability to eat or to care for myself, or
• 15:43
  Speaker 3: obviously i'm feelings of self harm or harming others like
• 15:47
  Speaker 3: those are danger signs and those need to be addressed immediately,
• 15:50
  Speaker 3: and they're treatable, thank god. But then it's the same thing,
• 15:54
  Speaker 3: you know, someone's mood. There is some subjectivity to it
• 16:00
  Speaker 3: if no one has those danger signs, right if someone says,
• 16:04
  Speaker 3: you know, my mood is down, I'm feeling a little depressed,
• 16:07
  Speaker 3: or you know whatever however they express it to me.
• 16:10
  Speaker 3: But no, I can go to work every day and
• 16:12
  Speaker 3: I can function. It's not affecting my relationships. It's not
• 16:14
  Speaker 3: affecting my ability to take care of myself and to
• 16:17
  Speaker 3: eat and to exercise, and you sort of do what
• 16:19
  Speaker 3: I need to do, and I just, you know, I
• 16:21
  Speaker 3: just don't feel so great. You know. Do they need
• 16:24
  Speaker 3: to be treated? Do they not need to be treated?
• 16:27
  Speaker 3: It's you know, there's some subjectivity there, and there's some
• 16:31
  Speaker 3: patient choice there. Obviously. The one difference I would say is,
• 16:36
  Speaker 3: as opposed to nausea vomiting, you don't always have to
• 16:40
  Speaker 3: go to medication to be treated, right, you can have
• 16:43
  Speaker 3: a for lack of a better term, let's call it
• 16:46
  Speaker 3: minor mood disorder, right, it's not really a good way
• 16:49
  Speaker 3: to put it. But whatever, your symptoms are less and
• 16:51
  Speaker 3: you're functioning, and you might benefit from things that are
• 16:55
  Speaker 3: non pharmacologic, like therapy, right with the professional therapist that
• 17:01
  Speaker 3: might be beneficial, or just other things like some anxiety
• 17:06
  Speaker 3: reducing or stress reducing, you know, cognitive behavioral therapy or
• 17:09
  Speaker 3: yoga or just taking a break whatever. It might be,
• 17:12
  Speaker 3: something ranging from very small to more aggressive, but again,
• 17:16
  Speaker 3: all non pharmacologic, So there's more options, I would say,
• 17:19
  Speaker 3: than for nausee of vomiting.
• 17:22
  Speaker 1: Nick, can you just give us a little bit to
• 17:25
  Speaker 1: sort of frame this conversation about why we see prenatal
• 17:29
  Speaker 1: or postpartum depression, why that's something that happens more in
• 17:32
  Speaker 1: those time periods than maybe other parts of life.
• 17:37
  Speaker 3: Yeah, I think that, I mean, the short answers. We
• 17:40
  Speaker 3: don't know exactly why, right, No one's mapped it out
• 17:43
  Speaker 3: to like the molecular level definitively, but I think that
• 17:48
  Speaker 3: there's a lot of reasons that it is more common
• 17:52
  Speaker 3: after people deliver or you know, in towards the end
• 17:55
  Speaker 3: of pregnancy that do make a lot of sense as well.
• 17:59
  Speaker 3: People talk a lot a lot about hormones, right, and
• 18:02
  Speaker 3: you know, and pregnancy they're high and then after you
• 18:04
  Speaker 3: deliver they drop. And so you know, how could it
• 18:06
  Speaker 3: be that increasing hormones and decreasing hormones both do the
• 18:09
  Speaker 3: same thing. And I think that people's brains are used
• 18:15
  Speaker 3: to certain environments. And remember, mood and mood disorders are
• 18:21
  Speaker 3: organic brain issues. They're not like, you know, someone's fortitude
• 18:27
  Speaker 3: is harmed, right, it comes. These are organic medical problems
• 18:31
  Speaker 3: that originate in the brain, and the brain is used
• 18:34
  Speaker 3: to a certain hormonal balance, and when things change in
• 18:39
  Speaker 3: either direction, it can affect people's moods in sometimes very
• 18:43
  Speaker 3: unpredictable ways. Right, Why does one person get depression and
• 18:47
  Speaker 3: one person gain anxiety? Why does one person get nothing? Why?
• 18:50
  Speaker 3: You know, there's different things that can happen, and so
• 18:52
  Speaker 3: we don't we don't have it mapped out exactly why
• 18:55
  Speaker 3: certain changes in certain people do certain things. But it
• 18:59
  Speaker 3: makes a lot of sense. The changes can do certain
• 19:02
  Speaker 3: things to people. So that's one reason the changes of
• 19:04
  Speaker 3: sort of hormonal estrogen, progesterone and whatnot. But the second
• 19:08
  Speaker 3: is also there's a lot of other things that go
• 19:12
  Speaker 3: into mental health related to circumstances, things like stressors, right,
• 19:18
  Speaker 3: So if you have more stressors, you're more likely to
• 19:22
  Speaker 3: have one of these things. It's not that stress causes
• 19:24
  Speaker 3: anxiety and depression, but it's one of the factors that's involved.
• 19:27
  Speaker 3: So pregnancy and postpartum are very stressful times for people
• 19:32
  Speaker 3: for obvious reasons. Also, things like nutrition, exercise, sleep, things
• 19:38
  Speaker 3: that definitely impact mental health, and again hard to map
• 19:42
  Speaker 3: out exactly what they do to any given person, but
• 19:46
  Speaker 3: I don't think it's a big leap to say that
• 19:48
  Speaker 3: if you don't sleep well you're more likely to have
• 19:50
  Speaker 3: mental health issues, or if you don't eat right, or
• 19:52
  Speaker 3: if you're not able to exercise or whatever it might
• 19:54
  Speaker 3: be that they can impact it. And so I think
• 19:57
  Speaker 3: that all of those sort of come together in the
• 20:00
  Speaker 3: same time period. Your hormones change, your body physiology changes,
• 20:04
  Speaker 3: and your circumstance change, increase, stressors, decrease sleep, change in nutrition,
• 20:09
  Speaker 3: change in activity, and they happen, they like blow up
• 20:12
  Speaker 3: for people at the end of pregnancy and after they deliver,
• 20:16
  Speaker 3: and that's why many people have again not even full
• 20:20
  Speaker 3: blown postpartum anxiety or depression, but certainly they have effects
• 20:25
  Speaker 3: on their mood. You know, that people used to call
• 20:26
  Speaker 3: the baby blues or whatever it might be, that they
• 20:28
  Speaker 3: just don't feel the same, and that's all normal and
• 20:31
  Speaker 3: expected and at a certain point it probably should be treated.
• 20:34
  Speaker 2: This issue of.
• 20:35
  Speaker 1: Sort of treatment, pharmacological treatment, I think is ann comes
• 20:41
  Speaker 1: up in both of these cases, but it comes up
• 20:43
  Speaker 1: here particularly in the particularly in the in the perinatal
• 20:46
  Speaker 1: but also in the in the postpartum phase, because again
• 20:50
  Speaker 1: people sort of end up hearing like you can take
• 20:53
  Speaker 1: an SSRI, but you know, we don't know if it's
• 20:56
  Speaker 1: like we're not one hundred percent sure it's safe, or
• 20:58
  Speaker 1: you can take it if you really need it.
• 20:59
  Speaker 2: That is a phrasing that people.
• 21:02
  Speaker 1: Come sort of come back to me, say, my doctor
• 21:03
  Speaker 1: told me I can take this antidepressant if I really
• 21:06
  Speaker 1: need it.
• 21:07
  Speaker 3: Yeah, that's a bad that's a bad phrase.
• 21:08
  Speaker 1: It's a bad phrase because I think and I think
• 21:10
  Speaker 1: it's it's meant in a positive way. It's meant in
• 21:13
  Speaker 1: this way of like, you know, if you feel like
• 21:14
  Speaker 1: you like the sort of the way you put it before,
• 21:16
  Speaker 1: it's like, well, if you feel like you need it,
• 21:17
  Speaker 1: of course we want to help.
• 21:18
  Speaker 2: But it comes out.
• 21:19
  Speaker 1: As like if you feel like you actually you really
• 21:22
  Speaker 1: need it as opposed to you know, if you feel
• 21:24
  Speaker 1: like you're willing to sacrifice your baby for this, I
• 21:27
  Speaker 1: guess you can do it.
• 21:28
  Speaker 2: Yeah that's tricky.
• 21:30
  Speaker 3: Yeah, well it's tricky. It's unfortunate for a lot of
• 21:33
  Speaker 3: reasons because it's it's not the correct messaging. And again
• 21:35
  Speaker 3: I'm not impugning the doctors. They they probably don't mean
• 21:39
  Speaker 3: it to come out that way.
• 21:39
  Speaker 2: I don't think at all. I think it's help people
• 21:41
  Speaker 2: are hearing something different.
• 21:42
  Speaker 3: Yeah, I mean maybe some of them do, but I
• 21:45
  Speaker 3: assume not. I think there's a lot of reason. Number one,
• 21:48
  Speaker 3: the safety of these medications is so studied, right, there is.
• 21:54
  Speaker 3: None of the studies are perfect, obviously, but people use
• 21:57
  Speaker 3: these medications, many men. People use them for many, many years. Right.
• 22:02
  Speaker 3: And when you have that, it's exceedingly unlikely that any
• 22:07
  Speaker 3: of these is dangerous because it would come out right
• 22:10
  Speaker 3: one way or another. And so you're talking about is
• 22:13
  Speaker 3: there a one percent risk or is there not a
• 22:15
  Speaker 3: one percent risk? Like that's sort of the type of
• 22:17
  Speaker 3: numbers we're talking about, and the predominance of risk in
• 22:23
  Speaker 3: that let's call it one percent range is really if
• 22:26
  Speaker 3: you take it in the first trimester, it's not if
• 22:28
  Speaker 3: you take it at the end of pregnancy here right
• 22:30
  Speaker 3: after you deliver. And so my messaging to people is
• 22:35
  Speaker 3: not take it if you want it, but if we
• 22:38
  Speaker 3: think you need something, let's decide what it is you need.
• 22:41
  Speaker 3: Are you someone who just needs to maybe have a
• 22:45
  Speaker 3: little bit of change in your lifestyle, maybe work fewer hours,
• 22:48
  Speaker 3: or get some help at home or something like that,
• 22:50
  Speaker 3: and that's all you need? Okay, that's sort of like
• 22:52
  Speaker 3: changing your circumstances, or maybe you need some meet with
• 22:57
  Speaker 3: a mental health professional, do some therapy that could be enough,
• 23:00
  Speaker 3: or do you need that plus maybe some medication. And
• 23:03
  Speaker 3: it's not sort of like what can you tolerate? It's
• 23:06
  Speaker 3: like what's going to work for you? And when people
• 23:09
  Speaker 3: ask me about risk, I say, there's basically almost no
• 23:13
  Speaker 3: risk to any of these things, and any possible, hypothetical,
• 23:17
  Speaker 3: theoretical small risk there is to the medication is greatly
• 23:21
  Speaker 3: outweighed by the risk of you not being treated and
• 23:24
  Speaker 3: not being well. And it's not just because you don't
• 23:27
  Speaker 3: feel good, but all right, you can't take care of
• 23:29
  Speaker 3: yourself properly, you can't take care of the baby properly.
• 23:32
  Speaker 3: Not sleeping is not good for you, not eating is
• 23:34
  Speaker 3: not good for you, Like having just anxiety depression walking
• 23:37
  Speaker 3: around with those things is not good for you. And
• 23:39
  Speaker 3: so I would say it's greatly outweighed. So I don't
• 23:42
  Speaker 3: That's sort of how we try to approach it. I
• 23:45
  Speaker 3: think the other issue that people here not so much
• 23:49
  Speaker 3: the I feel like I'm a failure type of thing.
• 23:52
  Speaker 3: But there's such a stigma that people have. They feel
• 23:55
  Speaker 3: like if they take a medication, they've somehow crossed the
• 23:57
  Speaker 3: threshold and they're now a different person. And I get it,
• 24:02
  Speaker 3: like that's I'm not poo pooing that feeling, but it's
• 24:07
  Speaker 3: just so crazy because we never have that feeling with right, Yeah, Oh,
• 24:13
  Speaker 3: I don't want to take antibiotic because I don't want to
• 24:14
  Speaker 3: be called a person who has an infection. Like who
• 24:17
  Speaker 3: the hell says that? Right? No one says that, right,
• 24:19
  Speaker 3: And it's it's or anything like I have a headache
• 24:22
  Speaker 3: and I'm gonna take a pain medicine for I'm gonna
• 24:24
  Speaker 3: take up a motrain or tile and all, like no
• 24:26
  Speaker 3: one says, oh, there's a stigma now person with headaches
• 24:30
  Speaker 3: and you know, no one thinks like that. But since
• 24:33
  Speaker 3: it's depression or anxiety. People feel that somehow they're going
• 24:36
  Speaker 3: to be like branded, you know, in town square, And
• 24:40
  Speaker 3: I don't think it's like that anymore. I think that's
• 24:42
  Speaker 3: a problem with people of our generation, much more so
• 24:45
  Speaker 3: than like my kids generation. They're all much more comfortable
• 24:48
  Speaker 3: with their mental health diagnoses, which is a good.
• 24:50
  Speaker 2: Thing, Which is a good thing.
• 24:51
  Speaker 1: But I do think there's a general issue with sort
• 24:54
  Speaker 1: of medication during pregnancy, which is sure, like people, you know,
• 25:00
  Speaker 1: some medications during pregnancy are are dangerous, but so much
• 25:03
  Speaker 1: of the messaging around medication and pregnancy is sort of like, well,
• 25:06
  Speaker 1: you want to be like more cautious than usual, or
• 25:09
  Speaker 1: maybe there's some risk, but there's you know, and that
• 25:11
  Speaker 1: really puts people in a often in a situation that's
• 25:15
  Speaker 1: more brought than it should be, you know, because actually
• 25:18
  Speaker 1: in many cases, like it's fine to take tile at all.
• 25:21
  Speaker 3: Yeah, I think some listen, it's appropriate to have heightened
• 25:27
  Speaker 3: concern or awareness over medications when you're pregnant, because yeah,
• 25:30
  Speaker 3: you're you know, you're pregnant with the baby, and they
• 25:33
  Speaker 3: get what you get to some degree, and there's always
• 25:35
  Speaker 3: the possibility of risk, right, There are medications that are dangerous,
• 25:38
  Speaker 3: So it's it's not, you know, implausible that something could happen.
• 25:41
  Speaker 3: But I think the important thing, you know, sometimes people
• 25:45
  Speaker 3: think it's all or none, and this is also true
• 25:47
  Speaker 3: with doctors and the messaging. They say, well, the medication
• 25:50
  Speaker 3: has risks, and not taking the medication has risks, and
• 25:53
  Speaker 3: so someone's like, well, how the hell do I balance that? Right?
• 25:55
  Speaker 3: And so they think it's well, either I'm harming my
• 25:58
  Speaker 3: baby or I'm harming myself. Like that's sort of the
• 26:01
  Speaker 3: black and white that they hear. And so I would
• 26:03
  Speaker 3: say the important thing to ask your doctor, and hopefully
• 26:08
  Speaker 3: you know he or she can answer this for you,
• 26:10
  Speaker 3: is can you quantify that risk? Like, what are we
• 26:12
  Speaker 3: talking about here? And we talk about a risk of
• 26:15
  Speaker 3: you know, fifty percent risk my baby's going to be
• 26:17
  Speaker 3: harmed or one in one hundred, one in a thousand theoretical,
• 26:22
  Speaker 3: but unknown, like what we like, what are we talking
• 26:24
  Speaker 3: about so we can try to weigh a versus be right,
• 26:28
  Speaker 3: there's no way to walk through life with no risk.
• 26:30
  Speaker 3: I leave my house on that cross the street, there's
• 26:32
  Speaker 3: some risk that I'm going to get run over by
• 26:33
  Speaker 3: a bus. Right, It's very very small, so it doesn't
• 26:36
  Speaker 3: really come into my mind every day, and I mitigate
• 26:39
  Speaker 3: that by waiting till the light screen and looking both
• 26:41
  Speaker 3: ways and all that stuff. But it could happen. And
• 26:43
  Speaker 3: so it's the same thing when someone tells me I
• 26:45
  Speaker 3: don't want to take zoloft because I'm pregnant, I'll say, Okay, Well,
• 26:49
  Speaker 3: let's what is the risk we're worrying about. We try
• 26:52
  Speaker 3: to quantify that, and when it boils down to it,
• 26:54
  Speaker 3: it comes down to a risk somewhere between let's say
• 26:58
  Speaker 3: zero and one percent that it's going to cause something
• 27:02
  Speaker 3: in the baby. That's like, it could be zero and
• 27:04
  Speaker 3: the high end it's let's say maybe one. All right,
• 27:07
  Speaker 3: what are you going to be like if you don't
• 27:09
  Speaker 3: take it? Like I'm a wreck, I can't get out
• 27:11
  Speaker 3: of bed in the morning. I'm like, well, then it's
• 27:12
  Speaker 3: a no brainer. Then you should take it, because how
• 27:15
  Speaker 3: could you go the whole pregnancy without getting out of bed?
• 27:18
  Speaker 3: Versus if they're like, well, I don't really need it.
• 27:20
  Speaker 3: I started it when I was in college because I
• 27:22
  Speaker 3: had a bat semester and I'm on such a low
• 27:24
  Speaker 3: dose and I took it. I stopped it for two
• 27:27
  Speaker 3: years and I felt the same, and I'm back on it.
• 27:29
  Speaker 3: I'm all right, that's a person who if they don't
• 27:31
  Speaker 3: want to take any risk of pregnancy, maybe they should
• 27:33
  Speaker 3: try to come off it. But those are two very
• 27:34
  Speaker 3: different people because they have different risks on the not
• 27:38
  Speaker 3: taking it side.
• 27:44
  Speaker 1: More parent data, including Nate's tips for how to have
• 27:47
  Speaker 1: the best possible conversations with your doctor and how to
• 27:50
  Speaker 1: push back if you're actually skeptical of their advice.
• 27:53
  Speaker 2: Maybe after listening to this podcast after the break.
• 28:04
  Speaker 1: Listening to you talk about this leads me into the
• 28:07
  Speaker 1: sort of second set of things which I want to
• 28:09
  Speaker 1: talk about, which is when you and I talk about
• 28:11
  Speaker 1: this stuff, like, I get the impression that if I
• 28:14
  Speaker 1: were your patient, like, we would have interesting, nuanced conversations
• 28:18
  Speaker 1: about risks and benefits, and that would be very helpful
• 28:20
  Speaker 1: and I would feel good about making different choices. A
• 28:25
  Speaker 1: lot of people struggle to have this kind of conversation
• 28:28
  Speaker 1: with their providers. How do you think that people can
• 28:33
  Speaker 1: make the conversations they have with their doctor better and
• 28:40
  Speaker 1: to not have them feel out of people's control. So
• 28:44
  Speaker 1: I think a very common way for people to leave
• 28:47
  Speaker 1: a provider's office is to feel like I didn't get
• 28:50
  Speaker 1: I didn't think about the questions that I didn't ask
• 28:52
  Speaker 1: them right and I wasn't able to get to the
• 28:54
  Speaker 1: answer that I wanted.
• 28:57
  Speaker 2: So let's start like big picture there.
• 28:59
  Speaker 3: Yes, So that's a big, big conversation obviously, but an
• 29:03
  Speaker 3: important one, clearly. I think that first it's important for
• 29:09
  Speaker 3: everyone to sort of think about deliberately what am I
• 29:14
  Speaker 3: trying to get here? Like what am I looking for?
• 29:16
  Speaker 3: Because so you, Emily, if you were my patient, you
• 29:20
  Speaker 3: would come in, you would have very detailed data driven questions,
• 29:25
  Speaker 3: you know, asking me how to you know, navigate this decision,
• 29:28
  Speaker 3: or you'd have no questions because you were to know
• 29:29
  Speaker 3: what you're doing. But whatever it is, it would be
• 29:31
  Speaker 3: very because you know you you're like, I want the data.
• 29:34
  Speaker 3: I want to look at it, I want to analyze it.
• 29:36
  Speaker 3: I want to make a decision that's right for me
• 29:37
  Speaker 3: and my family, And that's what you're looking for. Other
• 29:40
  Speaker 3: people are terrified of that, and other people don't want
• 29:42
  Speaker 3: to talk about these things because it just scares them.
• 29:45
  Speaker 3: And so some people want to just be told I
• 29:47
  Speaker 3: literally had this conversation with someone yesterday because it happens
• 29:50
  Speaker 3: all the time, because I was asked here, you know,
• 29:52
  Speaker 3: we have this conversation about something and she said to me,
• 29:55
  Speaker 3: you know what, these kinds of conversations just freak me out, right,
• 30:00
  Speaker 3: So is it okay if we just go about doing
• 30:04
  Speaker 3: things sort of regularly and you tell me if I
• 30:07
  Speaker 3: need to change something, right? And I was like, yeah,
• 30:09
  Speaker 3: that's fine with me. Like that works. I could do that,
• 30:12
  Speaker 3: like and the same thing, she was trying to decide
• 30:15
  Speaker 3: if she wanted a doulah in labor, right, and so
• 30:17
  Speaker 3: she's like, what are your thoughts on doula's. I'm like,
• 30:19
  Speaker 3: duelahs are great, you know. And we go through this
• 30:20
  Speaker 3: and this and this, and she said she spoke to
• 30:23
  Speaker 3: doula and the duela's giving her all this information and
• 30:24
  Speaker 3: it actually freaked her out. She goes, I don't want
• 30:27
  Speaker 3: a lot of information, Like I just want to show
• 30:29
  Speaker 3: up in labor and I want you to tell me
• 30:31
  Speaker 3: want to push, and I want you to tell me
• 30:33
  Speaker 3: if I need a C section. I want you to
• 30:34
  Speaker 3: tell me if there's a problem with the baby and
• 30:36
  Speaker 3: what I need to do. I'm like, I could do that, like,
• 30:38
  Speaker 3: no problem, right, So I'm fine. That's what she wanted
• 30:42
  Speaker 3: to get out of this, Whereas other people are very
• 30:44
  Speaker 3: very different obviously, So I think the first thing is
• 30:46
  Speaker 3: get us, like, do some introspecttion, like who am I?
• 30:49
  Speaker 3: What am I looking for? Am I looking to try
• 30:51
  Speaker 3: to make a lot of decisions on my own? Be
• 30:53
  Speaker 3: given choices, choose A versus B versus C, to know
• 30:56
  Speaker 3: the risk and benefits or all them? Or do I
• 30:58
  Speaker 3: just want to be told what to do right? And
• 31:00
  Speaker 3: I don't. I'm fine with all of these options, Like,
• 31:03
  Speaker 3: different people feel differently about their healthcare, and I think
• 31:06
  Speaker 3: that you also need to make sure your providers flexible
• 31:10
  Speaker 3: with that. Some providers really like one model versus the other,
• 31:14
  Speaker 3: and I think everyone needs to sort of try to
• 31:16
  Speaker 3: tailor it to what the patient wants and needs and not,
• 31:22
  Speaker 3: you know, to what someone expects or something like that.
• 31:24
  Speaker 3: So I think that'd be number one and number two.
• 31:27
  Speaker 3: If you have specific questions that you want answered, they
• 31:31
  Speaker 3: don't understand, write them down, write them down, write them
• 31:35
  Speaker 3: down on paper, put them on your phone, tattoo them
• 31:38
  Speaker 3: to your arm, Go with someone and give them the
• 31:41
  Speaker 3: list and say don't let me forget, like because time
• 31:44
  Speaker 3: with doctors are limited, and prioritize the questions you want.
• 31:48
  Speaker 3: So you may have six questions and you're like four,
• 31:50
  Speaker 3: five and six. I could probably google, but one, two,
• 31:52
  Speaker 3: and three I need to answer. I need to ask
• 31:54
  Speaker 3: this doctor it's very important to me, or I need
• 31:57
  Speaker 3: a precise answer. I need to know what he or
• 31:58
  Speaker 3: she thinks specifically. And when you start to visit, tell them.
• 32:03
  Speaker 3: I have six questions, right so, and I always tell
• 32:09
  Speaker 3: them first, like before we begin. I just want you
• 32:11
  Speaker 3: to know I've got five or six questions. Some are important,
• 32:14
  Speaker 3: some are minor. Do you think we can get to
• 32:16
  Speaker 3: them today? Because otherwise you're let's say, have a fifteen
• 32:20
  Speaker 3: minute WIZO of someone and we're doing this, and we're
• 32:21
  Speaker 3: bantering and blah blah bah, and the examine this, and
• 32:24
  Speaker 3: fourteen and a half minutes in she pulls out a
• 32:26
  Speaker 3: twelve page list of questions. Right, I'll say, like, listen,
• 32:30
  Speaker 3: we don't have time for that right now. I got
• 32:31
  Speaker 3: someone waiting to see me. Well, I mean, if I'm nice,
• 32:34
  Speaker 3: I'll do the best I can and try to schedule
• 32:36
  Speaker 3: something else. But if she told me on the front end,
• 32:38
  Speaker 3: I could cut out some of the banter. You know,
• 32:40
  Speaker 3: you can sort of maybe tailor it best. So have
• 32:45
  Speaker 3: an agenda when you come in. What do you And
• 32:47
  Speaker 3: you might want nothing? If you want nothing, fine, go in,
• 32:49
  Speaker 3: be seen, and go home. That's cool.
• 32:51
  Speaker 1: Also, okay, I'm now going to give you this is
• 32:54
  Speaker 1: a great overview, and I've now had an idea which
• 32:57
  Speaker 1: I'm going to give you some harder questions about, like
• 33:00
  Speaker 1: to navigate a situations that people tell me like I
• 33:05
  Speaker 1: didn't know what to do in this part of the conversation.
• 33:07
  Speaker 2: Okay, so are you are you ready?
• 33:10
  Speaker 3: Hit me? This is like this like speed round and
• 33:12
  Speaker 3: like Jeopardy speed Round or something sort of.
• 33:14
  Speaker 1: We're gonna all right, try first of all, in order
• 33:17
  Speaker 1: to ask you this question, I need to know what
• 33:19
  Speaker 1: is something in pregnancy where you think doctors often recommend
• 33:23
  Speaker 1: something but it's definitely not right, Like I was gonna say,
• 33:25
  Speaker 1: bed rest.
• 33:26
  Speaker 2: Can we agree bed rest is not a good idea?
• 33:29
  Speaker 3: I think yes, I think it's being recommended less and
• 33:31
  Speaker 3: less but fair. Yes.
• 33:32
  Speaker 1: Okay, So let's say let's say your doctor, you come in,
• 33:35
  Speaker 1: you say I've been having some you know, more Braxton
• 33:37
  Speaker 1: Hicks contractions, and your doctor says, what I recommend for
• 33:40
  Speaker 1: you is that you go on bed rest. You're thirty
• 33:43
  Speaker 1: two weeks, Just lay down in your bed, don't go
• 33:45
  Speaker 1: to your job, just lay down because I Braxton Hicks
• 33:47
  Speaker 1: contractions have some have some bed rest, and you know,
• 33:50
  Speaker 1: because you have read something or you're aware that that
• 33:54
  Speaker 1: is not a good recommendation, what do you say to
• 33:56
  Speaker 1: your doctor?
• 33:59
  Speaker 3: All right, yeah, all right, now we're getting really we're
• 34:03
  Speaker 3: getting We're getting in it. I'm rolling up my sleeves here.
• 34:04
  Speaker 3: So yeah, I think the short answer is it depends, right,
• 34:11
  Speaker 3: So it depends on your relationship with this person, It
• 34:15
  Speaker 3: depends on the nature of the practice you're seeing, and
• 34:20
  Speaker 3: it depends on are you the type of person who
• 34:24
  Speaker 3: is comfortable not listening to your doctor, Like just some
• 34:28
  Speaker 3: people like, yeah, yeah, whatever, I'm not doing that right,
• 34:30
  Speaker 3: you know? Are you that person You're like, no, my
• 34:32
  Speaker 3: doctor says it, and I will like not sleep at
• 34:34
  Speaker 3: night if I'm not listening to him or her. So, meaning,
• 34:38
  Speaker 3: if you have a very good relationship with the doctor
• 34:40
  Speaker 3: and this is someone who you know and you trust
• 34:43
  Speaker 3: and you've spoken to before, and you really have a sense,
• 34:45
  Speaker 3: you can push back a little and you could say
• 34:48
  Speaker 3: I hear you, thank you. Question, is this something you're
• 34:53
  Speaker 3: just advising because you think it's going to make my
• 34:55
  Speaker 3: life easier or do you think this is actually going
• 34:58
  Speaker 3: to prevent me from having a pre term birth. You
• 35:01
  Speaker 3: could say, because I've read a lot that people are
• 35:07
  Speaker 3: questioning the efficacy of bed rest, and you could say,
• 35:10
  Speaker 3: you could push all your covets. I'm not trying to,
• 35:12
  Speaker 3: you know, question you. I'm not saying that I know
• 35:14
  Speaker 3: more than you at whatever, but basically you know I'm
• 35:18
  Speaker 3: and you can say, can I push back a little
• 35:20
  Speaker 3: on that and ask and just politely very you know,
• 35:22
  Speaker 3: if you have a relationship with the person, and then
• 35:24
  Speaker 3: they might say to you, if they're good doctors, they
• 35:28
  Speaker 3: might say, yes, you're right, I don't think it's actually
• 35:32
  Speaker 3: going to cause you to stay pregnant longer. But in
• 35:34
  Speaker 3: my experience, a lot of people feel better, or they
• 35:39
  Speaker 3: feel like they're doing something, or it just seems to
• 35:42
  Speaker 3: have been helpful to many of my patients. And then
• 35:44
  Speaker 3: you can say, okay, I appreciate that. If I'm the
• 35:47
  Speaker 3: type of person who really doesn't want to be on
• 35:49
  Speaker 3: bed rest because it would drive me crazier because I
• 35:53
  Speaker 3: have a I have to do some sort of work,
• 35:55
  Speaker 3: or I have a kid to take care of. Do
• 35:57
  Speaker 3: you think it'd be dangerous if I did didn't go
• 36:00
  Speaker 3: on bed rest, or if I did if we found
• 36:02
  Speaker 3: somewhere in the middle, and if they were a good doctor,
• 36:03
  Speaker 3: they say, no, that sounds perfectly fine. Let's come up
• 36:05
  Speaker 3: with something and then boom, you've had a productive conversation
• 36:09
  Speaker 3: leading to a individualized plan of care for yourself. On
• 36:14
  Speaker 3: the other hand, if this is someone you don't know,
• 36:17
  Speaker 3: you don't trust, you never met before, you could either
• 36:21
  Speaker 3: try to have that conversation and you don't know how
• 36:24
  Speaker 3: it's going to play out, right they you could offend them,
• 36:27
  Speaker 3: you know, obviously unintentionally, or it could end up the
• 36:30
  Speaker 3: same way. Or maybe there's another doctor in that practice
• 36:34
  Speaker 3: who you trust, and you'll say, listen, I met and
• 36:38
  Speaker 3: you know he or she said this, and I'm I'm
• 36:40
  Speaker 3: not trying to question them, but it just seemed a
• 36:42
  Speaker 3: little bit aggressive for the situation. Can you give me
• 36:45
  Speaker 3: a second opinion and again, old on politely and if
• 36:48
  Speaker 3: you have a relationship with somebody that they'll probably help you.
• 36:50
  Speaker 3: If you're in a group where the doctors always just
• 36:53
  Speaker 3: say do this and this and this, and you know that,
• 36:55
  Speaker 3: or have a very strong sense that those recommendations are
• 36:59
  Speaker 3: maybe outdated or not evidence based, or they're not explaining
• 37:02
  Speaker 3: to you, well, maybe you need a new practice. Maybe
• 37:04
  Speaker 3: they're not the right people for you. And that's obviously
• 37:06
  Speaker 3: another big thing. How do you switch? When you switch? Right?
• 37:09
  Speaker 3: Is it worth it to switch? I mean, that's that's
• 37:11
  Speaker 3: a big thing. And I'm not advocating people switch. I
• 37:13
  Speaker 3: think for most doctors, at least that I know, and
• 37:17
  Speaker 3: most patients, if they had the conversation I was talking
• 37:21
  Speaker 3: about in a way that's you know, polite, not you know,
• 37:24
  Speaker 3: not combative, but just hey, can we talk about this.
• 37:28
  Speaker 3: Most doctors know enough to be able to have the conversation.
• 37:33
  Speaker 3: It's just hard to have that conversation with everybody on
• 37:36
  Speaker 3: day one, and so you make a recommendation of what
• 37:38
  Speaker 3: you think is best, and if the person pushes back
• 37:40
  Speaker 3: in a play way, you find a way that works
• 37:42
  Speaker 3: for them. And I think most doctors would be very
• 37:44
  Speaker 3: receptive to a conversation like that, and if they're not,
• 37:47
  Speaker 3: that's usually a red flag about how they, you know,
• 37:50
  Speaker 3: just address patients in general.
• 37:52
  Speaker 1: I mean, I think they're for a certain kind of question,
• 37:54
  Speaker 1: a certain kind of patient. Eventually, I think you have
• 37:56
  Speaker 1: to realize it's it's your fault. I had a I
• 37:59
  Speaker 1: have a colleague who at some point, you know, was
• 38:02
  Speaker 1: having something about what like when were they going to
• 38:04
  Speaker 1: induce and so on, and he and he texted me
• 38:06
  Speaker 1: and he was like, I don't think these doctors are experts.
• 38:09
  Speaker 2: In a basy and statistical updating. And I was like,
• 38:13
  Speaker 2: they're not. That's your job, but like they will be
• 38:16
  Speaker 2: delivering the baby, and.
• 38:17
  Speaker 1: It seems like maybe I should just listen to them.
• 38:19
  Speaker 1: At this point, Yes, I would have just want to
• 38:22
  Speaker 1: listen to them. And I was like that sounds great.
• 38:25
  Speaker 3: Right, I mean, there's there's definitely you know, that's actually
• 38:27
  Speaker 3: a really good point because sometimes people expect doctors to
• 38:30
  Speaker 3: get out of their comfort zone. So for example, like
• 38:33
  Speaker 3: there's certain things that are done routinely, they're done by everybody,
• 38:35
  Speaker 3: they're recommended by everybody, and then someone brings in, like
• 38:38
  Speaker 3: I want you to do it differently, and they bring
• 38:40
  Speaker 3: it forty five research papers because this is how they're
• 38:43
  Speaker 3: doing it in France and this or this or this,
• 38:44
  Speaker 3: and it's and then you sort of you've now elevated
• 38:48
  Speaker 3: the conversation to like an academic one, right, And for
• 38:52
  Speaker 3: most doctors, like they need to just take care of you,
• 38:55
  Speaker 3: like they need to do what they're comfortable with and
• 38:57
  Speaker 3: what they're used to. You're like you don't want to
• 38:58
  Speaker 3: try to push your doctor out of their box, right
• 39:01
  Speaker 3: out of their comfort zone, because nobody, nobody wins in
• 39:06
  Speaker 3: that situation. And so at a certain point you have
• 39:10
  Speaker 3: to just say, this is the these are the parameters
• 39:13
  Speaker 3: my doctor has for better or worse, and if we're
• 39:17
  Speaker 3: going outside those, it's probably just not going to work
• 39:19
  Speaker 3: anymore because they're just not going to be comfortable. And
• 39:22
  Speaker 3: you don't want a doctor who's uncomfortable in the situation
• 39:24
  Speaker 3: that's not good for your care.
• 39:26
  Speaker 1: Okay, I have one more question for you, and then
• 39:28
  Speaker 1: I think Tamor has a question.
• 39:29
  Speaker 2: Uh So mine is the following.
• 39:32
  Speaker 1: I imagine I'm at the doctor and they say something
• 39:35
  Speaker 1: and I don't understand what it is or what it
• 39:39
  Speaker 1: means in the moment. The question is sort of when
• 39:42
  Speaker 1: do I how do I try to come back from that?
• 39:43
  Speaker 1: So let me give you a specific example. So sap
• 39:46
  Speaker 1: into a friend of mine recently. The doctor's measuring the
• 39:50
  Speaker 1: fundel height and they they're thirty person thirty four weeks
• 39:54
  Speaker 1: along and the doctor's measuring the funnel height and she says, I,
• 39:56
  Speaker 1: you're measuring thirty two, and then she moves on and
• 39:59
  Speaker 1: she just says her measurement is thirty two, and she
• 40:01
  Speaker 1: doesn't say what that number is, how it relates, whether
• 40:04
  Speaker 1: they're considered just to measuring you thirty two, everything's fine.
• 40:07
  Speaker 1: And then reflecting on this later, my friend was like,
• 40:11
  Speaker 1: does that like, I'm thirty four?
• 40:13
  Speaker 2: Should it have been thirty four? What does this number
• 40:15
  Speaker 2: actually mean?
• 40:16
  Speaker 1: And you know that particular example, you could you could
• 40:20
  Speaker 1: sort of look it up. But the question of if
• 40:22
  Speaker 1: somebody says something I don't understand, how do I pull
• 40:25
  Speaker 1: it back into something I do understand?
• 40:28
  Speaker 2: How do I ask that?
• 40:29
  Speaker 3: Yeah? I mean I think in that precise situation. You know,
• 40:33
  Speaker 3: if I were the patient and the doctor said that
• 40:35
  Speaker 3: to me, I would just say, pardon me? Is is
• 40:41
  Speaker 3: thirty two good? Is thirty two bad? Right? What thirty two? What? Right?
• 40:45
  Speaker 3: Thirty two? What? And is that a good or bad thing?
• 40:47
  Speaker 3: And the doctor say say, oh, I'm measuring your the
• 40:48
  Speaker 3: height of your uterus and it's thirty two centimeters and
• 40:51
  Speaker 3: usually it's around the same as you're just acial agent weeks.
• 40:54
  Speaker 3: But if it's within two or three, that's perfectly fine,
• 40:56
  Speaker 3: and that's normal and everything looks good. Right, So thirty
• 40:58
  Speaker 3: if you're thirty four and it's measuring thirty two, thirty three,
• 41:00
  Speaker 3: thirty four, thirty five, thirty six. We don't make much
• 41:03
  Speaker 3: of it. It's very imprecise. That's a perfect screen. That's it.
• 41:06
  Speaker 3: That's all it takes.
• 41:07
  Speaker 2: And I think in partly there is just like I
• 41:09
  Speaker 2: think people.
• 41:10
  Speaker 1: Are just the message of like not being reluctant to ask,
• 41:14
  Speaker 1: just like if somebody says something, you know, understand to
• 41:16
  Speaker 1: be like what, sorry, excuse me, what does that mean?
• 41:18
  Speaker 2: And she has anything from it?
• 41:19
  Speaker 3: Yeah? Again, doctors, you know, we're we're an interesting bunch doctors, right,
• 41:25
  Speaker 3: So we have a lot of things we got to do.
• 41:27
  Speaker 3: We got a lot of things on our mind. There's
• 41:29
  Speaker 3: a lot of things that we're trying to do. In
• 41:30
  Speaker 3: every visit. We're always you know, not always, we're almost
• 41:33
  Speaker 3: always you know, busy or in a rush or this
• 41:35
  Speaker 3: or that. But we also want to take good care
• 41:38
  Speaker 3: of people and we want people to understand what's going on.
• 41:41
  Speaker 3: And we don't like it's not our intention to confuse people.
• 41:45
  Speaker 3: We just confuse people because we're not perfect people, right,
• 41:48
  Speaker 3: and so sometimes we say things and for us it's
• 41:52
  Speaker 3: it's like common sense or nature. We've done it a
• 41:54
  Speaker 3: million times in the past week. And we forget that
• 41:56
  Speaker 3: it's not like that for the person on the other end.
• 41:58
  Speaker 3: And again, because we're we're fallible, we're humans, and so
• 42:02
  Speaker 3: we don't always communicate in the way we're trying to.
• 42:05
  Speaker 3: But the goal is so that the person understands what
• 42:08
  Speaker 3: the hell we're talking about. And so if I'm saying
• 42:10
  Speaker 3: something and someone just like you know, interrupts me or
• 42:13
  Speaker 3: raises their hand and says, can I ask you a question?
• 42:15
  Speaker 3: And they say, I really don't understand what you're talking about,
• 42:18
  Speaker 3: or can you explain that again? Or I have a
• 42:20
  Speaker 3: question about what you said or this, I'm like great, Like,
• 42:23
  Speaker 3: thank you for telling me that. Let me explain it
• 42:25
  Speaker 3: in a way you understand, because I don't want you
• 42:27
  Speaker 3: to walk out of here confused. Number one, like, that's
• 42:31
  Speaker 3: not good for anybody. Number two, I wouldn't feel good
• 42:33
  Speaker 3: about myself. And number three, it's definitely not going to
• 42:37
  Speaker 3: work in the long run because you're gonna come back
• 42:38
  Speaker 3: with questions or you're going to like it. Confusion is
• 42:40
  Speaker 3: not good for anyone, even the doctor. No one wins.
• 42:43
  Speaker 1: Yeah, And I think one of the issues here is
• 42:45
  Speaker 1: just an issue of language that, like when you are
• 42:47
  Speaker 1: doing something all the time, you develop a shorthand, you
• 42:50
  Speaker 1: develop a jargon, you develop a set of words, and
• 42:52
  Speaker 1: you use them, and sometimes you forget that like, not
• 42:56
  Speaker 1: everyone is managed this too. I told my team the
• 42:58
  Speaker 1: other day that I thought something was orthogonal to something else,
• 43:01
  Speaker 1: and they were like, that's not a word that like regular,
• 43:04
  Speaker 1: that's not how the regular people talk.
• 43:06
  Speaker 2: And it was like, what is that?
• 43:07
  Speaker 1: And I was like, Oh, isn't that That's not how it's.
• 43:10
  Speaker 3: I would say that if again, if someone knows that
• 43:14
  Speaker 3: they're the type of person again who likes to understand
• 43:16
  Speaker 3: what's going on and be sort of on top of everything,
• 43:20
  Speaker 3: one of the ways to combat this issue is again
• 43:23
  Speaker 3: to ask questions and feel comfortable to ask questions, which
• 43:25
  Speaker 3: is greatly encouraged. But I would say the other one
• 43:28
  Speaker 3: is do a little prep work on the front end,
• 43:31
  Speaker 3: meaning sort of have a general sense of what's going
• 43:34
  Speaker 3: to happen in the prenatal visits. And that could be
• 43:36
  Speaker 3: from a bajillion sources. Again, whether it's one of your
• 43:39
  Speaker 3: terrific books, whether it's from this podcast, my podcast, a website,
• 43:43
  Speaker 3: you like, a book, you like whatever, anything that sort
• 43:46
  Speaker 3: of is useful to you and speaks to you. Have
• 43:50
  Speaker 3: a sense, like what normally gets done in the first trimester,
• 43:53
  Speaker 3: what normally gets done in a prenatal visit, what typically
• 43:55
  Speaker 3: happens when you're in labor and delivery, just general general
• 43:59
  Speaker 3: general stuff. Some people take classes like birth classes, Like no,
• 44:02
  Speaker 3: they're very rarely anymore like lamas because people since ninety
• 44:07
  Speaker 3: plus percent of people get up at durals, people don't
• 44:09
  Speaker 3: need all the like pain training stuff. So birth classes
• 44:12
  Speaker 3: now are very much like birth one on one. It's
• 44:15
  Speaker 3: like just education comes out of yeah baby and so yeah,
• 44:20
  Speaker 3: so like those types of things. So if you so,
• 44:23
  Speaker 3: if someone walked in knowing that measuring the height of
• 44:26
  Speaker 3: the uterus is something doctors do and what it means
• 44:29
  Speaker 3: and what's normal it's not normal, they would have then said, oh,
• 44:32
  Speaker 3: thirty two on thirty four, that's good, and they wouldn't
• 44:34
  Speaker 3: even had a question. And so that's another way to
• 44:37
  Speaker 3: try to combat that is a little bit of prep
• 44:39
  Speaker 3: work might reduce some of those confusions.
• 44:43
  Speaker 1: So tomorrow is about seven months pregnant, and tomorrow do
• 44:47
  Speaker 1: you have questions for me?
• 44:49
  Speaker 2: Do I?
• 44:50
  Speaker 3: Yes?
• 44:50
  Speaker 5: I did?
• 44:51
  Speaker 3: Do I?
• 44:54
  Speaker 5: Well, this was actually this was this was a good segue. Well,
• 44:58
  Speaker 5: in talking a lot about kind the fear of the unknown,
• 45:01
  Speaker 5: you know, I mean, these are a lot of new mothers.
• 45:04
  Speaker 5: You know, these are mothers who haven't been pregnant before,
• 45:07
  Speaker 5: and so all of this feels very brand new. And
• 45:12
  Speaker 5: the more kids you have, I've actually discovered, and the
• 45:16
  Speaker 5: more pregnancies you go through. I'm on my third right now,
• 45:20
  Speaker 5: some things I'm much more relaxed about, and others it
• 45:24
  Speaker 5: feels like this is just like more bites of the
• 45:27
  Speaker 5: apple for what could go wrong, and that I don't
• 45:30
  Speaker 5: want to get too comfortable thinking that I know pregnancy
• 45:33
  Speaker 5: and thinking that I know my body. And I've been
• 45:36
  Speaker 5: actually really surprised this time around how anxious I've been that,
• 45:40
  Speaker 5: you know, I've had two healthy pregnancies, but it could
• 45:43
  Speaker 5: all go to hell with this third, and I'll be
• 45:46
  Speaker 5: completely unprepared because I thought I knew how I you know,
• 45:50
  Speaker 5: what it was going to be like. And so I wonder,
• 45:54
  Speaker 5: you know, what do you say to your pregnant women
• 45:57
  Speaker 5: knew who This isn't their first rodeo, but they've still
• 46:01
  Speaker 5: come to you with these kinds of anxieties. Is it
• 46:03
  Speaker 5: a different kind of conversation? Do you kind of still
• 46:07
  Speaker 5: have to have the conversation about low risk. It's not
• 46:11
  Speaker 5: really a lightning round kind of question, but I'm curious
• 46:14
  Speaker 5: kind of you know, how do you handle people who
• 46:18
  Speaker 5: are still anxious even though they kind of know the
• 46:21
  Speaker 5: nuts and bolts of what's going on.
• 46:23
  Speaker 3: So I don't think that what you're describing or experiencing
• 46:28
  Speaker 3: is particularly uncommon. I think that one of the joys
• 46:35
  Speaker 3: of being youthful is you're ignorant of all the things
• 46:39
  Speaker 3: that could happen in this world. And as we age,
• 46:42
  Speaker 3: and as we have more kids, and as we have
• 46:44
  Speaker 3: more life experiences, you start to realize, oh, dear, like
• 46:50
  Speaker 3: there's you know, things can happen. And that's true from
• 46:52
  Speaker 3: our own experiences and from family and friends. And so
• 46:58
  Speaker 3: while your knowledge might be greater now than it was then,
• 47:04
  Speaker 3: your experience is much different now than it was then.
• 47:08
  Speaker 3: And this comes up for example, this happens a lot
• 47:11
  Speaker 3: actually with like genetic screening. Right, So someone in their
• 47:15
  Speaker 3: first pregnancy might say, you know, all my screening tests
• 47:18
  Speaker 3: were normal. The chance this baby has a genetic condition
• 47:21
  Speaker 3: is very, very low. I'm done. I'm not doing an
• 47:23
  Speaker 3: invasive test, a CBS or an amnio, perfectly reasonable choice.
• 47:27
  Speaker 3: Second pregnancy, all my tests are normal. My screening test
• 47:30
  Speaker 3: is normal. Everything looks good, my chance having a baby,
• 47:33
  Speaker 3: the genetic abnormality is very low. I'm not going to
• 47:35
  Speaker 3: do an invasive test. And in the third pregnancy screening
• 47:39
  Speaker 3: tests are normal, everything looks great. Chance of having a baby,
• 47:42
  Speaker 3: the genetic abnormality is exact same, very very low. And
• 47:44
  Speaker 3: they're like, you know what, I'm doing an invasive test
• 47:47
  Speaker 3: and why, Well, you know, I've lived a little I've
• 47:51
  Speaker 3: got two kids and the impact of my family would
• 47:54
  Speaker 3: be different, or a friend of mine had a baby
• 47:57
  Speaker 3: with this and that, and so now I just think
• 47:59
  Speaker 3: of the world different or whatever it is. And that's
• 48:02
  Speaker 3: totally normal. Your risk hasn't changed, your knowledge is anything
• 48:07
  Speaker 3: is higher, but your experiences lead you to make different
• 48:10
  Speaker 3: decisions because you have different things that were you right.
• 48:14
  Speaker 3: So you might not be as worried about let's say,
• 48:17
  Speaker 3: you know this complication, but you're more worried about this
• 48:19
  Speaker 3: complication and that's totally normal. So definitely, I wouldn't have
• 48:25
  Speaker 3: any like angst over the fact that you feel that way,
• 48:27
  Speaker 3: because that's very typical, or maybe not very typical, but
• 48:30
  Speaker 3: it's common. A lot of people have that, and so
• 48:33
  Speaker 3: addressing is really being very focused, like what is it
• 48:37
  Speaker 3: you're concerned about right this time around, and trying to
• 48:40
  Speaker 3: address it and say, Okay, is it a concern that
• 48:43
  Speaker 3: has always been there and you just never knew about it,
• 48:46
  Speaker 3: and or is it something that's actually new, or is
• 48:50
  Speaker 3: it something where we can do something to mitigate that
• 48:53
  Speaker 3: that we didn't do previously, Like maybe in your first
• 48:57
  Speaker 3: pregnancy you had visits once a month and in this
• 49:00
  Speaker 3: pregnancy you'd rather have them every two weeks, you know,
• 49:02
  Speaker 3: or vice versa. Right, anything could be in any direction.
• 49:05
  Speaker 3: You can sometimes tailor some of the aspects of your
• 49:09
  Speaker 3: prenatal care to address your specific concerns in this pregnancy,
• 49:13
  Speaker 3: And that's totally fine, because concern is not always that
• 49:17
  Speaker 3: the data has changed. It could just be that your
• 49:20
  Speaker 3: impression or your analysis of the data has changed, because
• 49:24
  Speaker 3: a lot of it is subjective.
• 49:25
  Speaker 5: Yeah, when I was actually trying to get pregnant, I
• 49:28
  Speaker 5: had a conversation with Emily about it because I'm forty
• 49:33
  Speaker 5: one now and it took just a little longer than
• 49:38
  Speaker 5: it did when I was thirty five, and Emily gave
• 49:41
  Speaker 5: me creat she's really her outs right now. She gave
• 49:45
  Speaker 5: me great advice, which is that the data and risk
• 49:48
  Speaker 5: don't care about juju, like it didn't care about how
• 49:53
  Speaker 5: I kind of felt like there was some sort of
• 49:55
  Speaker 5: karmic fear that you know, your luck runs out at
• 50:01
  Speaker 5: a certain point, and I needed to hear that.
• 50:04
  Speaker 2: And then you immediately got pregnant, like the next day.
• 50:06
  Speaker 3: Yeah, I like, so.
• 50:10
  Speaker 1: There you go, Nate, this is a delight. Oh we
• 50:18
  Speaker 1: had a little prenatal visit. We had a little data.
• 50:21
  Speaker 1: Thank you for being here.
• 50:22
  Speaker 3: It's my pleasure tomorrow. Feel well, you look great.
• 50:24
  Speaker 5: Thank you.
• 50:27
  Speaker 3: What a love louis saying?
• 50:29
  Speaker 5: How much lovely.
• 50:33
  Speaker 3: Having my favor?
• 50:37
  Speaker 5: What a love louis.
• 50:39
  Speaker 3: Say, Let you think of.
• 50:44
  Speaker 1: Parent Data is produced by tamorro Avishai with support from
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• 50:48
  Speaker 2: Team and pr Rex.
• 50:50
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  Speaker 1: you next time.