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<v Speaker 1>This is parent Data. I'm Emily Oster. Many years ago

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<v Speaker 1>I got an out of the blue email from a

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<v Speaker 1>doctor in New York and he said, Hey, I'm ann Obi,

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<v Speaker 1>a maternal fetal medicine specialist actually, and one of my

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<v Speaker 1>patients gave me your book, and I really think we

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<v Speaker 1>would like each other. I think we agree on a

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<v Speaker 1>lot of things. And he attached a paper he had

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<v Speaker 1>been writing that agreed with a lot of what I

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<v Speaker 1>said in Expecting Better, and he said, next time you're

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<v Speaker 1>in New York, let's have lunch. And so a few

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<v Speaker 1>months later, I found myself sitting at lunch eating pete

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<v Speaker 1>and hummus, across the table from doctor Nate Fox. And

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<v Speaker 1>indeed we did see to eye on many things, and

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<v Speaker 1>beyond that, we really liked each other. Nate and I

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<v Speaker 1>have stayed in touch since then. We wrote a paper

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<v Speaker 1>together in a journal, and a couple of years ago,

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<v Speaker 1>when I thought about writing a fourth book about complications

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<v Speaker 1>after pregnancy, I knew who I would call, and I

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<v Speaker 1>called Nate and I remember walking around outside on the

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<v Speaker 1>phone pitching him in this idea, Hey, let's write a

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<v Speaker 1>book together about pregnancy complications. I don't know exactly what

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<v Speaker 1>it'll look like. I don't know exactly how it should

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<v Speaker 1>be structured. I don't know exactly what should be in it,

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<v Speaker 1>but I know that you're the person I should write

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<v Speaker 1>it with. And Nate is always game. Without asking any

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<v Speaker 1>more questions, he said yes. And now on April thirtieth,

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<v Speaker 1>twenty twenty four, that book is out. The book is

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<v Speaker 1>called The Unexpected Navigating Pregnancy During and After Complications, and

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<v Speaker 1>I invited Nate on the podcast. This is actually his

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<v Speaker 1>second time on the Parent Data podcast to talk about

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<v Speaker 1>our book, to talk about why we like to work together,

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<v Speaker 1>and to answer some of the questions that people have

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<v Speaker 1>asked us about navigating complicated pregnancy. In this conversation, Nate

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<v Speaker 1>and I will talk about some of the complications in

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<v Speaker 1>the book, will answer some questions, but we're also going

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<v Speaker 1>to talk about some bigger picture issues. How do you

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<v Speaker 1>have good conversations with your doctor, How do you talk

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<v Speaker 1>about especially these hard things when you're both bringing different

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<v Speaker 1>kinds of expertise to the table. We're also going to

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<v Speaker 1>talk about risk and how we communicate about risk, and

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<v Speaker 1>why it's hard to help people understand what a number

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<v Speaker 1>like one third or one percent means. Nate and I

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<v Speaker 1>have different takes on exactly how to do this, but

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<v Speaker 1>just like working on the book together, I feel like

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<v Speaker 1>we got to a good place. Nate's one of my

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<v Speaker 1>favorite people to talk to. I call him all the time,

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<v Speaker 1>and I'm delighted he came on this podcast, but even

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<v Speaker 1>more delighted to have him as a partner in this book.

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<v Speaker 1>So I hope you enjoy this conversation after the break,

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<v Speaker 1>doctor Nathan Fox. Nate Fox, Welcome back to the podcast.

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<v Speaker 1>Last time you were here, we talked about the Arrived Trial,

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<v Speaker 1>and we are now talking about our new book. You

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<v Speaker 1>are my co author and my friend. You're the first

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<v Speaker 1>co author I've ever had on this podcast because I

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<v Speaker 1>don't write books with other people except for you, So welcome.

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<v Speaker 2>I'm delighted to be here. You're the first co author

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<v Speaker 2>I've ever been on a podcast with. So that's a coincidence. Yeah,

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<v Speaker 2>I since I don't write any books nor go on

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<v Speaker 2>many podcasts. So two for two, two for two.

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<v Speaker 1>All right, So we're going to talk about our new book,

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<v Speaker 1>The Unexpected. Uh, We're going to talk about some complicated

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<v Speaker 1>pregnancy situations. We're going to get into all of it.

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<v Speaker 1>But before we do that, could you introduce yourself? Tell

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<v Speaker 1>us who you are.

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<v Speaker 2>I am a Nate Fox. I am a Obigu, I

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<v Speaker 2>n and maternal fetal medicine specialist. I practice in New

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<v Speaker 2>York City. I live in New Jersey. I have a wife,

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<v Speaker 2>four children, and two dogs. And you are my hero.

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<v Speaker 2>And I actually wanted to throw something at you.

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<v Speaker 1>Your payment is in the mail for that, Thank you, Nate.

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<v Speaker 2>Yeah, Professor, I want to throw something at you. How

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<v Speaker 2>did that taste going up? Having to share a book

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<v Speaker 2>with someone? Okay, so let's you're kind of a control

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<v Speaker 2>kind of person with your writing. Not in a bad way,

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<v Speaker 2>I mean in a good way. You're amazing. But we've

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<v Speaker 2>never had to do this before, to sort of work

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<v Speaker 2>with someone, So I'm curious how that worked for you.

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<v Speaker 1>Okay, so listen to back up. Nate and I have

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<v Speaker 1>a new book together. It's called The Unexpected Navigating Pregnancy

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<v Speaker 1>During and After Complications, and it's about navigating pregnancy complication

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<v Speaker 1>ranging from miscarriage to hyperemesis to preterm birth. And the

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<v Speaker 1>origin of this book is, so I want to write

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<v Speaker 1>this book because people ask me about these things quite

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<v Speaker 1>a lot, and I did not think that I could

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<v Speaker 1>write it by myself because there's a lot of complicated

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<v Speaker 1>medical stuff in Aaron. Actually, it turns out I think

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<v Speaker 1>what you brought to the table is very different than

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<v Speaker 1>what I thought you would bring to the table, which

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<v Speaker 1>I can say more about, but it's very But you're right.

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<v Speaker 1>I am not a group project kind of girl, you know.

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<v Speaker 1>I'm more of a like tell everyone a job that's

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<v Speaker 1>not important, and then they do it, and then you

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<v Speaker 1>do the whole thing and put the small numbers of

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<v Speaker 1>things that they did. You know, like, do you work

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<v Speaker 1>on group projects in middle school?

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<v Speaker 2>That was like my moo, yeah, I've been in that predicament.

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<v Speaker 2>I've gotten I have improved over my lifetime in group projects,

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<v Speaker 2>because medicine is a lot of group projects, like in

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<v Speaker 2>a good way, but when I was in middle school

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<v Speaker 2>it's the same way. I was like, can you just

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<v Speaker 2>all get out of my way and let me do

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<v Speaker 2>my thing and we'll do fine.

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<v Speaker 1>So that's my own I feel that I've improved over time,

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<v Speaker 1>but I'm not sure that other people would necessarily say that.

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<v Speaker 1>But you were the first person I thought of to

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<v Speaker 1>write this book with because we've written together before. We've

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<v Speaker 1>written a paper together, and I think you're great and

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<v Speaker 1>you're actually you turned out to be like far easier

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<v Speaker 1>to work with than I thought you would be. And

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<v Speaker 1>the main thing is that you're very fast. Ah, you're

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<v Speaker 1>like you do always do the things. You're not a

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<v Speaker 1>like a malingerer.

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<v Speaker 2>I'm not a doctor. What you're saying, No, listen, I agree.

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<v Speaker 2>I think that we had a very good working rapport

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<v Speaker 2>because a lot of things about us are similar. We

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<v Speaker 2>both answer our emails too quickly. Like before, is.

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<v Speaker 1>We're like in our email we're like living in our computers.

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<v Speaker 2>Yes, yeah, so we answer emails quickly and we do

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<v Speaker 2>things well before the deadline, and we're both like that.

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<v Speaker 2>But it's it is interesting. I will say, just from

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<v Speaker 2>my perspective, I loved writing the book with you. First

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<v Speaker 2>of all, you're you're a professional. You're really good at this.

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<v Speaker 2>I'm not blowing smoke up here, but everyone knows you're

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<v Speaker 2>awesome at this. And so it's a little intimidating to

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<v Speaker 2>work with someone who's so good at this because I'm

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<v Speaker 2>I'm not down on myself. I'm a lovely person. I

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<v Speaker 2>think I'm a bright guy. I'm a good doctor, but

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<v Speaker 2>I'm not a writer. Like it's not what I do,

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<v Speaker 2>and so it's a little intimidating to go into a

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<v Speaker 2>process with someone. I'm like, oh my god, I'm gonna

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<v Speaker 2>be terrible, I'm gonna suck. I'm on to like colder

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<v Speaker 2>back and this or that. But whether I did or didn't,

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<v Speaker 2>you were very gracious and you're always very encouraging and

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<v Speaker 2>did not make me feel that way. Either because I

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<v Speaker 2>didn't deserve to feel that way, or because you were

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<v Speaker 2>kind enough not to make me feel the way, I

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<v Speaker 2>don't really care. Either one is fine. But it was

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<v Speaker 2>really a delight, And I could say that I've actually

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<v Speaker 2>always toyed around with writing a book. Years ago, I

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<v Speaker 2>said I want to write a book, but you know,

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<v Speaker 2>I mean, well, I'm not gonna write a book, right,

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<v Speaker 2>So I thought I would, and I was one of

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<v Speaker 2>the things I really really wanted to talk about in

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<v Speaker 2>a book was not so much like nuts and bolts

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<v Speaker 2>medical type books. I've written medical chapters before for textbooks,

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<v Speaker 2>but not that that's not writing that's like that's horrifying,

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<v Speaker 2>but writing to people who see doctors to try to

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<v Speaker 2>give them an insight as to like how do you

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<v Speaker 2>know what to do? Like what to ask? How do

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<v Speaker 2>you know if your doctor is any good? Right, how

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<v Speaker 2>do you know if like this is productive or not,

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<v Speaker 2>Because I mean, you know if your doctor's nice, and

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<v Speaker 2>you know if their office is clean, and you know

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<v Speaker 2>if they run on time, and you know if they're

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<v Speaker 2>building departments annoying like you know those things, but you

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<v Speaker 2>have no idea if your doctors any good. You could

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<v Speaker 2>see a diploma on the wall, but the correlation between

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<v Speaker 2>that and a good doctor is very minimal, right, And

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<v Speaker 2>it's hard legitimately, Listen, I'm I'm also a patient, rite

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<v Speaker 2>and my wife's a patient, my kids are patients. I

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<v Speaker 2>don't know if are doctors are good. It's very, very hard.

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<v Speaker 2>And so that was something I always wanted to do,

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<v Speaker 2>and when this project came along, it actually worked out

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<v Speaker 2>perfectly because it's what we both wanted to do from

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<v Speaker 2>different angles, and so I think one of the reasons

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<v Speaker 2>it was really fun in that sense for me.

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<v Speaker 1>So let me give people a little bit of a

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<v Speaker 1>sense of what the book is. What the book is like.

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<v Speaker 2>The book is awesome.

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<v Speaker 1>Well, first of all, it's great, So I mean, so

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<v Speaker 1>this is a book about navigating pregnancy after complications, and

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<v Speaker 1>I think we really have written it with the idea

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<v Speaker 1>that you know, people have had a complication in one

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<v Speaker 1>pregnancy and thinking about how to navigate another one. And

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<v Speaker 1>we say this in the book, but about fifty percent

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<v Speaker 1>of pregnancies either ended or include one of the complications

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<v Speaker 1>that we talk about here, so it's a pretty large

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<v Speaker 1>share of pregnancies. And what the book does is there's

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<v Speaker 1>some sort of general material at the top to try

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<v Speaker 1>to help people think about what kinds of information they

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<v Speaker 1>should have out of their medical records and how to

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<v Speaker 1>kind of navigate their way into that. And then there

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<v Speaker 1>are a series of chapters which in which first sort

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<v Speaker 1>of there's the there's Emily talking about the answers to

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<v Speaker 1>many of the questions I get, which are like, will

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<v Speaker 1>this happen again, what's the risk of recurrence? What kind

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<v Speaker 1>of treatments are there? Can you help me just understand

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<v Speaker 1>what this complication is? And then there's your part of

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<v Speaker 1>the chapter, which is about how do I have a

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<v Speaker 1>conversation about this with my doctor? In the case of

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<v Speaker 1>many of these complications, probably all of them, there's not

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<v Speaker 1>like one answer. It's not like if this happened, like

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<v Speaker 1>for sure, this is what we'll do next time, and

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<v Speaker 1>everything will be fine, and you know, thanks for the data.

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<v Speaker 1>A lot of it is about the nuances of a

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<v Speaker 1>particular case and the just the details of how to

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<v Speaker 1>move through it. And so this the thing that I

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<v Speaker 1>think we get out of your parts of the book

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<v Speaker 1>are just how to navigate those conversations. And I will

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<v Speaker 1>say I had a conversation the other day with someone

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<v Speaker 1>who who sort of works in birth trauma and who

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<v Speaker 1>was very influential for me and thinking about writing this book.

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<v Speaker 1>She said, I started reading this book and I thought,

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<v Speaker 1>you know, this is going to be kind of like

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<v Speaker 1>expecting better but for complications, and this is going to

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<v Speaker 1>be a great resource. And I'm you know, I'm glad

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<v Speaker 1>that this is going to be available. And then she said,

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<v Speaker 1>but actually the book is so much better than that,

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<v Speaker 1>because Nate's parts are so great, and like your parts

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<v Speaker 1>are fine, I expected them to be like they are.

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<v Speaker 1>But this additional piece is the most important thing in

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<v Speaker 1>the book. So for me, that's it's part of what

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<v Speaker 1>I didn't expect you to bring to the table. And

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<v Speaker 1>I do think it's probably among the strongest pieces of

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<v Speaker 1>the book.

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<v Speaker 2>Oh that's very touching, you know. I think that in

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<v Speaker 2>terms of the book itself, it seems like it's written

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<v Speaker 2>for people who had a pregnancy that didn't go well

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<v Speaker 2>or had a bump in the road and they're trying

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<v Speaker 2>to figure out what to do next time around. That's

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<v Speaker 2>sort of like I would say, the surface level, and

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<v Speaker 2>that's probably the bulk of people who are going to

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<v Speaker 2>get this book. It's for that reason, but I would

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<v Speaker 2>argue that, in fact, it's much more than that. And

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<v Speaker 2>number one, if someone is fortunate enough to never have

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<v Speaker 2>had a pregnancy with a complication, which is actually unusual,

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<v Speaker 2>but let's say that's the case, everyone knows someone who

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<v Speaker 2>had a pregnancy with a complication. Everybody knows someone it

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<v Speaker 2>may be their sister or their friend, whatever. And I

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<v Speaker 2>think that this book is also written in a way

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<v Speaker 2>to help people understand what their circle of people have

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<v Speaker 2>gone through and to just give an appreciation for that

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<v Speaker 2>and what they're thinking and what their fears are and

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<v Speaker 2>what their concerns are. And I think also just in general,

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<v Speaker 2>since the complications are so ubiquitous, we're talking about. This

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<v Speaker 2>is not crazy things that no one's ever heard of,

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<v Speaker 2>or talking about miscarriage, pre term birth, like bleeding. I

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<v Speaker 2>mean things that so many people have in pregnancy, and

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<v Speaker 2>people talk about this really gives people an understanding of

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<v Speaker 2>them or of pregnancy at a much higher level. So

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<v Speaker 2>even someone has never been pregnant or is never going

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<v Speaker 2>to be pregnant, it's sort of interesting in that sense

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<v Speaker 2>to understand it. And I think on the deepest level,

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<v Speaker 2>what I was trying to bring to the table is

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<v Speaker 2>also even for someone who's not literally never going to

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<v Speaker 2>be pregnant. Right, you're talking about the single guide, right,

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<v Speaker 2>whatever it is. It really I try to get into

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<v Speaker 2>that concept of what's happening when you're with your doctor

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<v Speaker 2>and why it's so complicated and why it's so rich,

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<v Speaker 2>Like it's a relationship. It's not like chat GBT when

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<v Speaker 2>you plug something in and you get back a response.

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<v Speaker 2>It involves personalities, it involves emotions, it involves nuance. And

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<v Speaker 2>although this is related to pregnancy obviously, and that's sort

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<v Speaker 2>of the framework we use, the principles are very broad

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<v Speaker 2>and that's sort of when I was thinking, it's not

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<v Speaker 2>just you know, nuts and bolts, it's sort of high

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<v Speaker 2>level what's happening in these meetings, And this would be

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<v Speaker 2>I would think relevant for anybody about to see a

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<v Speaker 2>doctor for a question, how do I think about it,

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<v Speaker 2>How do I talk about it? What am I looking for?

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<v Speaker 2>How do I know if they're answering my questions? Because

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<v Speaker 2>that's that's like the golden question out there.

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<v Speaker 1>I mean, I think there's a sense in which patients

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<v Speaker 1>bring one kind of expertise and doctors bring in other

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<v Speaker 1>kinds of expertise, and some of these conversations are about

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<v Speaker 1>kind of how do we bring those together, And it's

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<v Speaker 1>hard to bring those together if patients don't know about

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<v Speaker 1>what's going on, and it's hard to bring those together.

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<v Speaker 1>On the other side of doctors are kind of not

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<v Speaker 1>prepared to have nuanced conversations that involve patient preferences. And

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<v Speaker 1>so I think the book is the book is a

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<v Speaker 1>little bit about scaffolding those conversations, as you say, like

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<v Speaker 1>in any setting, all though you know the particular examples

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<v Speaker 1>are in this complicated pregnancy space. I don't know. I

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<v Speaker 1>feel like it's kind of interesting for the two of

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<v Speaker 1>us to write that, because that is effectively what we

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<v Speaker 1>try to do working together, is like recognize that, like

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<v Speaker 1>you have a set of expertise that I don't have

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<v Speaker 1>it I have a set of expertise that you don't have,

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<v Speaker 1>and like we're trying to bring them together to kind

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<v Speaker 1>of work as a team.

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<v Speaker 2>Yeah, I mean it's part of the you know, this

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<v Speaker 2>very loaded and confusing term that people use, which is

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<v Speaker 2>shared decision making, right, And in medicine, that's like a

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<v Speaker 2>that's a big thing now, right, I hear it, you know,

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<v Speaker 2>with the residents and the med students, the shared decision making.

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<v Speaker 2>And I always say, like, what do you mean by that,

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<v Speaker 2>Like that's a very sounds great, right, We're sharing, sharing

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<v Speaker 2>is caring, right, it sounds delightful, But how does that

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<v Speaker 2>work in practice? Because in practice, you know, the patient

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<v Speaker 2>is the person who knows herself the best, her personality,

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<v Speaker 2>her wants, her wishes, her fears, her experiences. I don't

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<v Speaker 2>know anything about that, right. I may have an insight

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<v Speaker 2>just by talking to her and knowing her, but she

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<v Speaker 2>knows herself way better than I know her, and I

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<v Speaker 2>know the medical side, right. I don't expect her to

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<v Speaker 2>know the medicine like she may have been a great Googler,

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<v Speaker 2>but you know, I went to medical school at the

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<v Speaker 2>training I do this for a living. And so the

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<v Speaker 2>best part of shared decision making is she brings to

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<v Speaker 2>the table her expertise, about herself, and I bring to

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<v Speaker 2>the table my expertise about the medical side, and we

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<v Speaker 2>try to use both of those expertise together to come

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<v Speaker 2>up for the right answer for what to do for her,

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<v Speaker 2>to individualize it. That's how it should be. But what

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<v Speaker 2>ends up happening is people say share decision making, and

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<v Speaker 2>then what ends up happening is the doctor says, well,

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<v Speaker 2>you can do AB or C and it's your choice,

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<v Speaker 2>and some people are like, great, I get to choose,

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<v Speaker 2>and other people are like, what the hell I don't know?

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<v Speaker 2>Like how am I supposed to know? Like if my

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<v Speaker 2>plumber sets, you can't you go to a business caol

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<v Speaker 2>Like I mean literally, if my plumber set to me, well,

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<v Speaker 2>you know, we could use copper pipes or we can

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<v Speaker 2>use plastic pipes, what do you want? I'd be like,

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<v Speaker 2>what do I look like a plumber? Like, I have

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<v Speaker 2>no idea. You tell me what's better. Now, if the

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<v Speaker 2>plumber set to me for my expertise, the copper pipes

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<v Speaker 2>and maybe false, but the copper pipes are more expensive,

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<v Speaker 2>but they're gonna last ten years, whereas the plastic pipes

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<v Speaker 2>are less expensive in the last three years. And I

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<v Speaker 2>know how much money I have whether I'm leaving house

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<v Speaker 2>in three years, how much it bothers me to have

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<v Speaker 2>a plumber come back. And so that's shared decision making.

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<v Speaker 2>We've just said, here are your choices, let me know

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<v Speaker 2>what you want. That's not shared decision making, and that's

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<v Speaker 2>what ends up happening a lot, and it's very frustrating

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<v Speaker 2>both for doctors and for patients when it's not done

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<v Speaker 2>in the ideal setting or an ideal way.

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<v Speaker 1>I would say, yeah, I think one of the nuances

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<v Speaker 1>of those conversations is that who's whose expertise should get

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<v Speaker 1>more weight depends quite a lot on what is the

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<v Speaker 1>decision that you are making. So you know, if I'm

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<v Speaker 1>in the this experience, you know eight months ago where

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<v Speaker 1>I was in the er, like I had a bike accident,

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<v Speaker 1>like an accident with a bike. I was running, they

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<v Speaker 1>were biking, and I ended up in.

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<v Speaker 2>The hospital with liked by a bike.

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<v Speaker 1>That makes it sound like it was the bike's faut,

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<v Speaker 1>whereas it was really more of a joint fault. But anyway,

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<v Speaker 1>I ended up in the hospital with an elaceration in

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<v Speaker 1>my head, and in that moment, like I don't my

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<v Speaker 1>expertise in my own feelings about like my head and

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<v Speaker 1>so on, it's really not relevant. Like the question is

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<v Speaker 1>like somebody used to figure out if you have a

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<v Speaker 1>skull fracture or not, and that's the that's the doctor's expertise,

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<v Speaker 1>and you kind of have to defer. And then there

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<v Speaker 1>are settings in which it's almost entirely about patient preferences.

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<v Speaker 1>One of the ones we've talked about various places is

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<v Speaker 1>like what kind of genetic testing people want? So, if

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<v Speaker 1>you're pregnant, you want some genetic testing, that's really a

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<v Speaker 1>lot about what would you do with that information? What

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<v Speaker 1>are the you know, what are your feelings about the

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<v Speaker 1>results out of that? And the doctor can provide information

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<v Speaker 1>about what you learn from the test, but ultimately the

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<v Speaker 1>patient preferences really win. And then there are many things

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<v Speaker 1>in the middle where there's a combination of kind of

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<v Speaker 1>expertise about your medical situation and what's possible with you know,

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<v Speaker 1>what does patient preference look like?

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<v Speaker 2>Yeah, one hundred percent. And I think that again, it

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<v Speaker 2>always depends on the context. When I'm teaching the residents

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<v Speaker 2>and they have a patient who's coming in AND's got

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<v Speaker 2>some problem, and I always say to them, what do

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<v Speaker 2>you want to do? Right? Because they'll present the patient

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<v Speaker 2>and the goal of it is not for them presented

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<v Speaker 2>to me to tell them what to do. It's like teaching,

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<v Speaker 2>says he what would you like to do? And frequently

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<v Speaker 2>what I get back as well, we could do this,

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<v Speaker 2>we could do this, or we could do this, And

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<v Speaker 2>I would say, okay, I'm aware of the choices, tell

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<v Speaker 2>me what do you want to do? And they get

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<v Speaker 2>very uncomfortable, right, because what happens is earlier medical training,

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<v Speaker 2>you know, many many years ago, it was very paternalistic, right,

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<v Speaker 2>and doctors were basically trained you're the doctor, you're the professional.

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<v Speaker 2>You're going to tell your patient what to do, and

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<v Speaker 2>he or she's going to listen to you or they're

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<v Speaker 2>horrible people, right, And that's sort of how the it

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<v Speaker 2>went in medicine, and there has been a pushback against that,

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<v Speaker 2>I think in a good way. But now I think

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<v Speaker 2>it's the pendulum is sort of gone the other way

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<v Speaker 2>where people are being trained in medicine patient autonomy. He

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<v Speaker 2>should make the choice, she should make the choice. You know,

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<v Speaker 2>present them with options and they'll choose. But neither is

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<v Speaker 2>really correct. It depends on the circumstances, right, And so

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00:19:49.680 --> 00:19:53.080
<v Speaker 2>if the patient's hemorrhaging. I'm not going to say, you know,

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<v Speaker 2>which medication would you like for me to help you

387
00:19:55.680 --> 00:19:59.119
<v Speaker 2>stop hemorrhaging? Like then I'm an idiot, right and like

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<v Speaker 2>I'm a terrible doct But for things like genetic testing,

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<v Speaker 2>if I tell her you're going to do a B

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<v Speaker 2>and C, that's also really not good. And so you

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00:20:07.320 --> 00:20:10.720
<v Speaker 2>have to sort of know the situation. You got to

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<v Speaker 2>read the room in a sense like you have to

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<v Speaker 2>read the room is what does he or she want

394
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<v Speaker 2>do they want you to be a little bit more

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<v Speaker 2>tell me what to do versus give me choices, and

396
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<v Speaker 2>what is the decision that we're making call for?

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<v Speaker 1>So there's a sort of class example of shared decision

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<v Speaker 1>making I want to talk about here, which is sort

399
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<v Speaker 1>of how should people think about a vback about a

400
00:20:28.240 --> 00:20:31.399
<v Speaker 1>vaginal birth after cesarean And so this is a case

401
00:20:31.440 --> 00:20:34.360
<v Speaker 1>in which someone has had at least one let's say

402
00:20:34.359 --> 00:20:37.880
<v Speaker 1>they've had one cesarean section with their first birth. They're

403
00:20:37.920 --> 00:20:42.840
<v Speaker 1>thinking about the what to do birth wise for the

404
00:20:42.880 --> 00:20:45.880
<v Speaker 1>second birth. So there's an option which is to try

405
00:20:45.920 --> 00:20:47.760
<v Speaker 1>for a vaginal birth. There's another option to have a

406
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<v Speaker 1>REPEATZ section, And this is something we talk a lot

407
00:20:49.800 --> 00:20:51.760
<v Speaker 1>about in the book to a little bit different than

408
00:20:51.760 --> 00:20:53.840
<v Speaker 1>some of the other complications in the book because it's

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<v Speaker 1>not a cesarean section, is not sort of properly a

410
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<v Speaker 1>pregnancy complication the way preterm birth or preclampsia is. But

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<v Speaker 1>it is something we wanted to include because many people

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<v Speaker 1>wonder about this in a subsequent pregnancy when they've had

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<v Speaker 1>a C section the first time. So let's just let's

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<v Speaker 1>do a little doctor. Let's do a little doctrine eight.

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<v Speaker 1>So I come in, I say, you know, I've had

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<v Speaker 1>I had a C section in my first berth. I'm

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<v Speaker 1>trying to decide about this next berth. What are you

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<v Speaker 1>asking me?

419
00:21:20.720 --> 00:21:24.199
<v Speaker 2>Right? So? I mean, essentially this is the paradigm of

420
00:21:24.240 --> 00:21:29.439
<v Speaker 2>the shared decision making, because there is something medical that

421
00:21:29.600 --> 00:21:31.520
<v Speaker 2>I need to know and I need to weigh in on. So,

422
00:21:31.560 --> 00:21:35.160
<v Speaker 2>for example, what kind of sea section did you have? Right?

423
00:21:35.280 --> 00:21:38.400
<v Speaker 2>Meaning what kind of incision on the uterus? Ninety nine

424
00:21:38.440 --> 00:21:40.280
<v Speaker 2>percent of people have a sea section have what we

425
00:21:40.359 --> 00:21:43.440
<v Speaker 2>call a low transverse incision, which means it was low

426
00:21:43.480 --> 00:21:45.240
<v Speaker 2>down on the uterus, I meaning towards the bottom of

427
00:21:45.359 --> 00:21:48.440
<v Speaker 2>uterus versus towards the top, and transverse means the incision

428
00:21:48.480 --> 00:21:51.159
<v Speaker 2>goes side to side versus up and down. If you

429
00:21:51.240 --> 00:21:55.159
<v Speaker 2>had that type of incision, then in the next pregnancy,

430
00:21:55.200 --> 00:21:57.359
<v Speaker 2>if you try to labor, your risk of a uterine

431
00:21:57.440 --> 00:22:00.960
<v Speaker 2>rupture is bullpark one percent slightly less, but let's just

432
00:22:00.960 --> 00:22:03.560
<v Speaker 2>say one percent because it's an easy number. Versus if

433
00:22:03.560 --> 00:22:05.960
<v Speaker 2>you had the other type, it's much higher. So I

434
00:22:06.000 --> 00:22:08.359
<v Speaker 2>need to know that right from a medical side to

435
00:22:08.400 --> 00:22:11.040
<v Speaker 2>tell you whether it's even on the table to try

436
00:22:11.080 --> 00:22:14.600
<v Speaker 2>to deliver vaginally, because whether it's possibly safe or unsafe.

437
00:22:15.359 --> 00:22:17.879
<v Speaker 2>Next is what were the circumstances of your sea section?

438
00:22:18.000 --> 00:22:20.280
<v Speaker 2>Why did you have the C section? Was it because

439
00:22:20.760 --> 00:22:22.680
<v Speaker 2>you had a six pound baby and pushed for eight

440
00:22:22.680 --> 00:22:24.760
<v Speaker 2>hours and the baby didn't come out right? That's a

441
00:22:24.800 --> 00:22:28.479
<v Speaker 2>little bit like sort of doesn't sound as good for

442
00:22:28.520 --> 00:22:32.280
<v Speaker 2>your future prospects, although it's not definitive versus I had

443
00:22:32.359 --> 00:22:35.679
<v Speaker 2>totally healthy pregnancy, but since it was twins and they

444
00:22:35.680 --> 00:22:37.639
<v Speaker 2>were both breached, they said to do a sea section.

445
00:22:37.800 --> 00:22:40.920
<v Speaker 2>And no, that's not so much related to the risk

446
00:22:41.080 --> 00:22:44.199
<v Speaker 2>in the next pregnancy, but the likelihood of success in

447
00:22:44.200 --> 00:22:47.000
<v Speaker 2>the next pregnancy, meaning with success being defined as a

448
00:22:47.080 --> 00:22:50.520
<v Speaker 2>vaginal delivery, although obviously success is healthy mother, healthy baby,

449
00:22:50.520 --> 00:22:54.840
<v Speaker 2>but we're talking specifically about this. So for me, based

450
00:22:54.840 --> 00:22:57.880
<v Speaker 2>on her history, based on maybe reviewing her records, maybe

451
00:22:57.920 --> 00:23:01.120
<v Speaker 2>an examination her, maybe an ultra whatever, some tests I'm

452
00:23:01.119 --> 00:23:03.480
<v Speaker 2>going to what I bring to the table is, all right,

453
00:23:03.600 --> 00:23:07.959
<v Speaker 2>here's the likelihood that if you tried, you would be successful.

454
00:23:08.000 --> 00:23:10.879
<v Speaker 2>Is it fifty percent, seventy percent, ninety percent, whatever it is.

455
00:23:11.640 --> 00:23:14.920
<v Speaker 2>And what is the risk to you if you tried?

456
00:23:15.040 --> 00:23:17.040
<v Speaker 2>Is it in that one percent rangers and much higher?

457
00:23:17.080 --> 00:23:19.879
<v Speaker 2>That's what I bring to the table. But what she

458
00:23:19.920 --> 00:23:21.680
<v Speaker 2>brings to the tables what does she want?

459
00:23:22.240 --> 00:23:22.440
<v Speaker 3>Right?

460
00:23:22.520 --> 00:23:24.199
<v Speaker 2>And so I always ask her at the beginning of

461
00:23:24.200 --> 00:23:26.119
<v Speaker 2>this an addition to those questions, I say, what are

462
00:23:26.160 --> 00:23:28.439
<v Speaker 2>you looking for? Like, what is it you're trying to

463
00:23:28.480 --> 00:23:30.320
<v Speaker 2>get here? Are you looking to try to have a

464
00:23:30.400 --> 00:23:34.280
<v Speaker 2>vagual delivery? Are you looking for a repeat C section?

465
00:23:34.359 --> 00:23:36.000
<v Speaker 2>Do you have no idea? And you want to sort

466
00:23:36.000 --> 00:23:37.760
<v Speaker 2>of learn about each of those. And I need to

467
00:23:37.760 --> 00:23:39.960
<v Speaker 2>see what she wants and what are her fears, and

468
00:23:40.280 --> 00:23:44.160
<v Speaker 2>I'll have the same sort of clinical circumstances. Let's say,

469
00:23:44.200 --> 00:23:47.240
<v Speaker 2>and one person says, I really really want to try

470
00:23:47.359 --> 00:23:50.080
<v Speaker 2>v back and I'm willing to accept certain risks and

471
00:23:50.160 --> 00:23:53.080
<v Speaker 2>certain you know, likely to success. And son Elsa's like,

472
00:23:53.119 --> 00:23:54.560
<v Speaker 2>I want no part of that. I want to repeat

473
00:23:54.560 --> 00:23:57.439
<v Speaker 2>C section. And those are both good decisions right in

474
00:23:57.480 --> 00:24:00.320
<v Speaker 2>my opinion. So you have the same facts on the

475
00:24:00.320 --> 00:24:03.360
<v Speaker 2>table from my end, but they lead to different decisions

476
00:24:03.359 --> 00:24:06.000
<v Speaker 2>because the facts on the table from her end are

477
00:24:06.040 --> 00:24:09.000
<v Speaker 2>different what she wants and vice versa. I could have

478
00:24:09.040 --> 00:24:13.040
<v Speaker 2>two women who want the same thing, but they're going

479
00:24:13.080 --> 00:24:14.720
<v Speaker 2>to have different numbers on my end, and one of them,

480
00:24:14.760 --> 00:24:16.920
<v Speaker 2>I'll say, you have a fifty percent chance of success,

481
00:24:16.960 --> 00:24:18.840
<v Speaker 2>and the other one you have a ninety plus chance

482
00:24:19.200 --> 00:24:21.520
<v Speaker 2>of success, and so then they may decide differently. And

483
00:24:21.560 --> 00:24:26.280
<v Speaker 2>so that's really how shared decision making is supposed to work,

484
00:24:26.880 --> 00:24:32.440
<v Speaker 2>and unfortunately it doesn't either because the doctor's not doing

485
00:24:32.480 --> 00:24:36.000
<v Speaker 2>their job by getting the right information or inquiring what

486
00:24:36.040 --> 00:24:39.680
<v Speaker 2>does she wanted and getting her opinion, or because potentially

487
00:24:40.320 --> 00:24:43.160
<v Speaker 2>it's trying to be done. But let's say the hospital

488
00:24:43.200 --> 00:24:45.800
<v Speaker 2>doesn't have an option for vback, so it's it's irrelevant

489
00:24:45.840 --> 00:24:47.920
<v Speaker 2>almost in a sense. And there's a lot of stuff

490
00:24:47.960 --> 00:24:50.560
<v Speaker 2>that goes into that. But that's what we're trying to

491
00:24:50.600 --> 00:24:53.880
<v Speaker 2>get at this book, to help people create those kinds

492
00:24:53.920 --> 00:24:57.760
<v Speaker 2>of conversations or find someone who can have that conversation

493
00:24:58.000 --> 00:25:00.200
<v Speaker 2>with you so you can come to a good desis.

494
00:25:00.640 --> 00:25:02.600
<v Speaker 1>So how long do you think that conversation should take?

495
00:25:04.000 --> 00:25:07.159
<v Speaker 2>Should it? Literally? It could take It could be as

496
00:25:07.200 --> 00:25:09.280
<v Speaker 2>short as five to ten minutes. It does not have

497
00:25:09.359 --> 00:25:12.840
<v Speaker 2>to be very long. If someone doesn't want to labor

498
00:25:12.880 --> 00:25:14.760
<v Speaker 2>and just wants to repeat sea section, it could be

499
00:25:15.160 --> 00:25:16.600
<v Speaker 2>two minutes, just because I have to make sure she

500
00:25:16.680 --> 00:25:18.560
<v Speaker 2>understands that there's risks to a sea section, that it's

501
00:25:18.560 --> 00:25:22.080
<v Speaker 2>not you know, you know, unicorns and rainbows like sea sections.

502
00:25:22.160 --> 00:25:23.800
<v Speaker 2>She should know she had a prior sea section, but

503
00:25:23.920 --> 00:25:28.000
<v Speaker 2>just you know, for example, I'll say how many kids

504
00:25:28.040 --> 00:25:30.120
<v Speaker 2>do you want to have? If she says nine, right,

505
00:25:30.320 --> 00:25:33.240
<v Speaker 2>then the second delivery, whether it's a vaginal or sea section,

506
00:25:33.359 --> 00:25:35.080
<v Speaker 2>is going to have a lot more implication for her

507
00:25:35.119 --> 00:25:37.919
<v Speaker 2>future health because if she has her second, she'll end

508
00:25:38.000 --> 00:25:40.280
<v Speaker 2>up with nine sea sections, where if she delivers vaginally,

509
00:25:40.640 --> 00:25:43.160
<v Speaker 2>it might be one sea section followed by eight vaginal birds.

510
00:25:43.200 --> 00:25:46.160
<v Speaker 2>So but short of that, it could be very very short.

511
00:25:46.240 --> 00:25:49.359
<v Speaker 2>Sometimes it's very very long. Sometimes we're working through what

512
00:25:49.440 --> 00:25:51.680
<v Speaker 2>does she wants, what are the risks, what does this mean,

513
00:25:51.680 --> 00:25:53.280
<v Speaker 2>what does that mean? What would happen if what would

514
00:25:53.280 --> 00:25:56.479
<v Speaker 2>happen if and that's fine, and it's rarely not that long.

515
00:25:57.240 --> 00:26:00.800
<v Speaker 2>If everyone comes to the table with sort of a

516
00:26:00.840 --> 00:26:02.520
<v Speaker 2>mutual understanding and what we're trying to do.

517
00:26:03.160 --> 00:26:04.960
<v Speaker 1>And I think for me, that is a lot of

518
00:26:04.960 --> 00:26:09.119
<v Speaker 1>what I'm trying to deliver with this book, because it

519
00:26:09.400 --> 00:26:14.160
<v Speaker 1>feels often as a patient that once time is quite limited.

520
00:26:13.880 --> 00:26:14.119
<v Speaker 3>You know.

521
00:26:14.240 --> 00:26:16.879
<v Speaker 1>I think if there are circumstances in which you can

522
00:26:16.920 --> 00:26:18.320
<v Speaker 1>get much more time with your doctor, but a lot

523
00:26:18.359 --> 00:26:21.440
<v Speaker 1>of us we're looking at, you know, fifteen minutes at

524
00:26:21.560 --> 00:26:23.640
<v Speaker 1>a visit, and that's not very much time. And if

525
00:26:23.640 --> 00:26:27.280
<v Speaker 1>you come in better informed, with a sense of your

526
00:26:27.359 --> 00:26:29.480
<v Speaker 1>questions and a sense of what you are trying to

527
00:26:29.480 --> 00:26:33.080
<v Speaker 1>get out of the visit or what the choices even

528
00:26:33.200 --> 00:26:37.880
<v Speaker 1>might be, it can make those conversations, yeah, more productive.

529
00:26:37.920 --> 00:26:38.840
<v Speaker 2>And I think this book is.

530
00:26:38.800 --> 00:26:41.320
<v Speaker 1>Really about kind of okay, let's get enough background knowledge

531
00:26:41.359 --> 00:26:43.920
<v Speaker 1>and kind of come into that conversation in the right way.

532
00:26:44.480 --> 00:26:48.160
<v Speaker 2>You and I are both lovers of efficiency, and so

533
00:26:48.320 --> 00:26:50.400
<v Speaker 2>it definitely makes it more efficient. One of the nice

534
00:26:50.440 --> 00:26:55.159
<v Speaker 2>things about vback is it's rarely something that has to

535
00:26:55.160 --> 00:26:57.280
<v Speaker 2>be made on the spot, meaning you can have that

536
00:26:57.359 --> 00:27:00.720
<v Speaker 2>conversation early and see how it evolves also part of

537
00:27:00.760 --> 00:27:05.080
<v Speaker 2>the ongoing data. Right. Someone might normally be someone who

538
00:27:05.080 --> 00:27:06.840
<v Speaker 2>wants to have a feedback, but then they find out

539
00:27:06.920 --> 00:27:09.679
<v Speaker 2>later and pregnancy the estimated weighs ten pounds, and they

540
00:27:09.680 --> 00:27:12.359
<v Speaker 2>may feel differently about that, or vice versa. They may

541
00:27:12.400 --> 00:27:14.200
<v Speaker 2>be someone who said, you know what, I really don't

542
00:27:14.240 --> 00:27:16.359
<v Speaker 2>want to take that risk or that and I really

543
00:27:16.400 --> 00:27:18.679
<v Speaker 2>prefer a sea section. But then a week before her

544
00:27:18.680 --> 00:27:20.800
<v Speaker 2>schedule see section, she comes in labor and she's eight

545
00:27:20.800 --> 00:27:23.159
<v Speaker 2>centimeters dilated and the head's like low on the pelvist.

546
00:27:23.160 --> 00:27:25.520
<v Speaker 2>So like, wait, like now the data has changed, we

547
00:27:25.560 --> 00:27:28.879
<v Speaker 2>can maybe revisit this. There are other conversations at a

548
00:27:28.880 --> 00:27:32.560
<v Speaker 2>little more time specific, like genetic testing. And I'll tell

549
00:27:32.560 --> 00:27:35.520
<v Speaker 2>you that when I lecture a lot about genetic testing,

550
00:27:35.560 --> 00:27:37.040
<v Speaker 2>and it's like one of the things I talk about,

551
00:27:37.080 --> 00:27:40.800
<v Speaker 2>and so many people they say, and it's true, this

552
00:27:40.960 --> 00:27:43.960
<v Speaker 2>is so hard, like this is such complex stuff. No

553
00:27:43.960 --> 00:27:47.680
<v Speaker 2>one understands this. How could you possibly have a conversation

554
00:27:47.760 --> 00:27:50.560
<v Speaker 2>with your doctor or doctor of a conversation with patient

555
00:27:50.960 --> 00:27:52.680
<v Speaker 2>and put them in a level that they can understand

556
00:27:52.680 --> 00:27:55.000
<v Speaker 2>this And the answer is they can't. That's true. You

557
00:27:55.480 --> 00:27:58.600
<v Speaker 2>know you need an hour, let's say, But if someone

558
00:27:58.640 --> 00:28:02.760
<v Speaker 2>has a basic understanding what we're talking about, and the

559
00:28:02.840 --> 00:28:05.640
<v Speaker 2>person who's doing the counseling, the doctor, the genet counselor

560
00:28:05.960 --> 00:28:10.439
<v Speaker 2>really is focusing on what we're trying to answer, it

561
00:28:10.480 --> 00:28:12.720
<v Speaker 2>doesn't take that long because you can sort of hone

562
00:28:12.760 --> 00:28:15.240
<v Speaker 2>in on the question, you know, like if your risk

563
00:28:15.280 --> 00:28:18.320
<v Speaker 2>were one percent, does that number seem scary to you

564
00:28:18.480 --> 00:28:21.160
<v Speaker 2>or reassuring to you? Like it's a very simple question

565
00:28:21.240 --> 00:28:23.000
<v Speaker 2>that people can answer, and I'll tell them, like, you know,

566
00:28:23.000 --> 00:28:25.440
<v Speaker 2>if all your testing is normal, you're non evasive testing,

567
00:28:25.480 --> 00:28:27.840
<v Speaker 2>you're ultrasound this your risk of a baby with Down

568
00:28:27.840 --> 00:28:29.919
<v Speaker 2>syndrome is very very low, one in ten thousand, but

569
00:28:29.960 --> 00:28:33.159
<v Speaker 2>your risk of any genetic conditions one percent? Does that

570
00:28:33.240 --> 00:28:37.000
<v Speaker 2>number reassure you or scare you? And if it reassures you,

571
00:28:37.040 --> 00:28:39.560
<v Speaker 2>get up and leave like you're done, have a good day.

572
00:28:39.640 --> 00:28:41.920
<v Speaker 2>Whereas if that terrifies you, you should be thinking about

573
00:28:41.920 --> 00:28:45.000
<v Speaker 2>a CBS or an amnio. And that's a very straightforward

574
00:28:45.040 --> 00:28:47.800
<v Speaker 2>question that most people can answer. Not everybody. Some people

575
00:28:47.840 --> 00:28:49.400
<v Speaker 2>like I don't know how I feel about one percent, Fine,

576
00:28:49.480 --> 00:28:53.080
<v Speaker 2>think about it, get back to me. But it requires

577
00:28:53.120 --> 00:28:56.720
<v Speaker 2>a lot to get to that question. And so again

578
00:28:56.760 --> 00:28:58.240
<v Speaker 2>it's on the doctor, it's on the patient, it's on

579
00:28:58.280 --> 00:29:01.280
<v Speaker 2>everybody to try to make these more productive. And I

580
00:29:01.320 --> 00:29:03.400
<v Speaker 2>hope that this book is very helpful with that.

581
00:29:03.640 --> 00:29:05.320
<v Speaker 1>No, but I think you're right that sort of we

582
00:29:05.360 --> 00:29:07.240
<v Speaker 1>have this idea that like, to do that, you would

583
00:29:07.240 --> 00:29:09.920
<v Speaker 1>need to have somebody understand like all of the incredible

584
00:29:10.280 --> 00:29:12.600
<v Speaker 1>you know, details about how exactly we're running these tests

585
00:29:12.600 --> 00:29:15.360
<v Speaker 1>and what exactly all of these just genetic things mean

586
00:29:15.400 --> 00:29:17.400
<v Speaker 1>and so on. But that's not really if you can

587
00:29:17.440 --> 00:29:20.840
<v Speaker 1>get to the question, yeah, that is relevant for decision making,

588
00:29:20.920 --> 00:29:24.080
<v Speaker 1>it may actually be that that is much simpler than

589
00:29:25.320 --> 00:29:27.360
<v Speaker 1>and you know, college level course in genetics.

590
00:29:27.640 --> 00:29:30.080
<v Speaker 2>Yeah, Like for vback, I often tell people, you know,

591
00:29:30.160 --> 00:29:33.239
<v Speaker 2>there's really there's three ways this can go, right. You

592
00:29:33.240 --> 00:29:35.200
<v Speaker 2>can try for a V back and have a successful

593
00:29:35.280 --> 00:29:38.160
<v Speaker 2>v back. That's sort of the best option. You can

594
00:29:38.280 --> 00:29:41.000
<v Speaker 2>try for a V back and not have a successful

595
00:29:41.040 --> 00:29:43.560
<v Speaker 2>v back, which might be the worst option unless someone

596
00:29:43.560 --> 00:29:45.680
<v Speaker 2>feels like I'd rather try and fail than not try.

597
00:29:46.000 --> 00:29:47.680
<v Speaker 2>And then there's the middle option, which is sort of

598
00:29:47.720 --> 00:29:49.080
<v Speaker 2>like I don't do eat, I don't try to just

599
00:29:49.080 --> 00:29:50.760
<v Speaker 2>have a C section. And I would say to them,

600
00:29:50.840 --> 00:29:52.880
<v Speaker 2>when you go for a V back, you're going to

601
00:29:52.960 --> 00:29:54.560
<v Speaker 2>get the best or the worst. You're not going to

602
00:29:54.600 --> 00:29:56.240
<v Speaker 2>go to the middle. So you the type of person

603
00:29:56.600 --> 00:29:58.920
<v Speaker 2>who would roll the dice a little bit, so to speak,

604
00:29:58.960 --> 00:30:01.160
<v Speaker 2>to try to get the best op, knowing you may

605
00:30:01.640 --> 00:30:04.320
<v Speaker 2>backfire again, not backfire like die, but like you know

606
00:30:04.440 --> 00:30:07.560
<v Speaker 2>whatever in terms of maybe overall outcome. Or you're the

607
00:30:07.600 --> 00:30:09.160
<v Speaker 2>type of person who really I'd rather just do the

608
00:30:09.200 --> 00:30:11.400
<v Speaker 2>middle of the road. And people can wrap their heads

609
00:30:11.440 --> 00:30:13.640
<v Speaker 2>around that they know who they are, and so that's

610
00:30:14.080 --> 00:30:17.760
<v Speaker 2>we try to help people make these decisions by framing

611
00:30:17.760 --> 00:30:21.600
<v Speaker 2>the questions in a way that if you're this type

612
00:30:21.600 --> 00:30:24.280
<v Speaker 2>of person, you're likely to go this direction, whereas if

613
00:30:24.320 --> 00:30:27.120
<v Speaker 2>you're this type of person, you're like this type of direction.

614
00:30:27.240 --> 00:30:29.720
<v Speaker 2>And that I found to be helpful over the years

615
00:30:29.760 --> 00:30:33.160
<v Speaker 2>to try to let people give them that context to

616
00:30:33.200 --> 00:30:34.600
<v Speaker 2>make complicated decisions.

617
00:30:41.080 --> 00:31:01.120
<v Speaker 1>More parent data after the break. All right, so let's

618
00:31:01.160 --> 00:31:03.040
<v Speaker 1>test this out for a minute. We're going to see

619
00:31:03.080 --> 00:31:06.920
<v Speaker 1>where the rubber meets the road. I've invited Tamar, my producer,

620
00:31:07.040 --> 00:31:09.160
<v Speaker 1>in to ask Nate Nice some questions.

621
00:31:09.720 --> 00:31:12.560
<v Speaker 2>Hello, Hi Tamorrow. All right, so we were not given

622
00:31:12.560 --> 00:31:14.520
<v Speaker 2>the questions in advance. This is not like quish.

623
00:31:15.200 --> 00:31:15.920
<v Speaker 1>Let's do it.

624
00:31:15.880 --> 00:31:20.960
<v Speaker 4>Okay, so I have tested positive as a cystic fibrosis carrier.

625
00:31:21.960 --> 00:31:24.480
<v Speaker 4>My husband still needs to be tested. We have the

626
00:31:24.480 --> 00:31:27.720
<v Speaker 4>appointment in another week. How much should I be freaking out?

627
00:31:28.200 --> 00:31:31.040
<v Speaker 2>Uh? Minimally is the answer. How much you should be

628
00:31:31.040 --> 00:31:36.600
<v Speaker 2>freaking out? Essentially, with carrier screening, which is what we're

629
00:31:36.600 --> 00:31:41.200
<v Speaker 2>talking about, we're checking to see if the couple has

630
00:31:41.440 --> 00:31:44.480
<v Speaker 2>usually autosomal recessive conditions, which are the kind that you

631
00:31:44.480 --> 00:31:47.080
<v Speaker 2>can carry and out of a condition, and to see

632
00:31:47.080 --> 00:31:48.680
<v Speaker 2>if they both have the same one. So when we

633
00:31:48.720 --> 00:31:51.360
<v Speaker 2>do a full panel, it's hundreds and hundreds of conditions.

634
00:31:51.840 --> 00:31:56.920
<v Speaker 2>And you tested positive for cystic fibrosis. Okay, you yourself

635
00:31:56.960 --> 00:31:59.920
<v Speaker 2>have no cystic fibrosis, no medical issues, You would never

636
00:32:00.120 --> 00:32:02.520
<v Speaker 2>know you had this in your entire life. It's only

637
00:32:02.560 --> 00:32:06.440
<v Speaker 2>relevant if the person with whom you are approcreating also

638
00:32:06.920 --> 00:32:09.440
<v Speaker 2>has a mutation for cystic fibrosis. So the question is

639
00:32:09.440 --> 00:32:13.600
<v Speaker 2>what is the chance of that. I believe the population

640
00:32:13.760 --> 00:32:17.720
<v Speaker 2>frequency depends on is ancestry, but let's say it's one

641
00:32:17.760 --> 00:32:20.719
<v Speaker 2>in fifty two percent, So the chance that you're a

642
00:32:20.760 --> 00:32:25.400
<v Speaker 2>couple that both carry cystic fibrosis is two percent. And

643
00:32:25.640 --> 00:32:29.480
<v Speaker 2>if he carries systic fibrosis, then each of your kids

644
00:32:29.480 --> 00:32:31.960
<v Speaker 2>has a twenty five percent chance of having it, which

645
00:32:32.000 --> 00:32:34.640
<v Speaker 2>you could either get pregnant and test and find out,

646
00:32:34.880 --> 00:32:38.360
<v Speaker 2>or do IVF and test the embryos and only put

647
00:32:38.400 --> 00:32:41.040
<v Speaker 2>in embryos who don't have cystic fibrosis. So all that's

648
00:32:41.080 --> 00:32:43.480
<v Speaker 2>available to you. But I'm glad you're doing the testing.

649
00:32:43.520 --> 00:32:45.920
<v Speaker 2>It's good to know. But minimally is what I would

650
00:32:45.920 --> 00:32:48.080
<v Speaker 2>say in terms of how much to freak out. And

651
00:32:49.000 --> 00:32:54.960
<v Speaker 2>when you undergo advanced and comprehensive genetic screening, more than

652
00:32:55.040 --> 00:32:58.960
<v Speaker 2>fifty percent of people will get back a positive, quote

653
00:32:59.000 --> 00:33:01.880
<v Speaker 2>unquote abnormal result, meaning you have a mutation that's very,

654
00:33:01.960 --> 00:33:04.600
<v Speaker 2>very common. It's not unexpected, it's not a problem, it's

655
00:33:04.600 --> 00:33:08.040
<v Speaker 2>not a health issue. It's not any issue whatsoever, unless

656
00:33:08.040 --> 00:33:11.040
<v Speaker 2>you happen to be prograding with someone who has the

657
00:33:11.120 --> 00:33:13.720
<v Speaker 2>same mutation, which is unlikely.

658
00:33:14.720 --> 00:33:19.320
<v Speaker 4>Okay, this one's for Emily. Are kick counts just torture

659
00:33:19.360 --> 00:33:20.680
<v Speaker 4>devices for Type A.

660
00:33:20.760 --> 00:33:25.440
<v Speaker 1>Personalities, So data on ky counts a little mixed. So

661
00:33:25.800 --> 00:33:28.320
<v Speaker 1>the idea behind KIT counting is that it is a

662
00:33:28.360 --> 00:33:31.200
<v Speaker 1>method to prevent stillbirth, which is one of the complications

663
00:33:31.240 --> 00:33:34.719
<v Speaker 1>we talked through in the book. The idea is that

664
00:33:35.080 --> 00:33:37.560
<v Speaker 1>you would count for some period of time every day,

665
00:33:37.640 --> 00:33:40.600
<v Speaker 1>particularly towards the end of pregnancy. You would look for

666
00:33:41.360 --> 00:33:44.320
<v Speaker 1>some number of movements in an hour or count until

667
00:33:44.360 --> 00:33:46.880
<v Speaker 1>you get to some number. There's a few different methods

668
00:33:46.880 --> 00:33:51.400
<v Speaker 1>for this, and it's a structured way to detect abnormal

669
00:33:51.480 --> 00:33:57.760
<v Speaker 1>changes in movement which could indicate a problem with the baby.

670
00:33:57.840 --> 00:34:03.360
<v Speaker 1>The evidence Theoretta it seems like this could help do

671
00:34:03.800 --> 00:34:08.200
<v Speaker 1>that kind of detection. In practice, the evidence to support

672
00:34:08.719 --> 00:34:13.720
<v Speaker 1>this as an important method for preventing stillbirth is quite weak,

673
00:34:13.840 --> 00:34:18.080
<v Speaker 1>and part of the issue is that stillbirth will more

674
00:34:18.120 --> 00:34:21.000
<v Speaker 1>common than many people think, is still very rare, and

675
00:34:21.080 --> 00:34:25.160
<v Speaker 1>so it's very difficult to run a large trial that

676
00:34:25.239 --> 00:34:29.880
<v Speaker 1>would actually detect changes in stillbirth, just because the overall

677
00:34:29.960 --> 00:34:32.759
<v Speaker 1>prevalence is low, and so any changes you need a

678
00:34:32.800 --> 00:34:37.319
<v Speaker 1>lot of data to detect them statistically. So I think

679
00:34:37.360 --> 00:34:40.360
<v Speaker 1>this is one of the cases where it actually depends

680
00:34:40.400 --> 00:34:42.440
<v Speaker 1>a little bit on how someone's going to kind of

681
00:34:42.480 --> 00:34:45.080
<v Speaker 1>come to it emotionally. So for some people this is

682
00:34:45.160 --> 00:34:47.400
<v Speaker 1>very reassuring, and it's like I'm going to do this,

683
00:34:47.440 --> 00:34:48.799
<v Speaker 1>I'm going to put it on my calendar, I'm going

684
00:34:48.840 --> 00:34:51.759
<v Speaker 1>to do it every day. You know, that'll sort of

685
00:34:51.800 --> 00:34:54.360
<v Speaker 1>be a positive experience, and for some people it's super

686
00:34:54.360 --> 00:34:55.440
<v Speaker 1>anxiety provoking.

687
00:34:56.200 --> 00:34:57.880
<v Speaker 2>We do get more visits.

688
00:34:57.520 --> 00:35:01.279
<v Speaker 1>To doctors as a result of this becauseeople want reassurance.

689
00:35:01.320 --> 00:35:05.120
<v Speaker 1>So I'm not sure there's one hundred percent answer to

690
00:35:05.200 --> 00:35:07.880
<v Speaker 1>whether this is the right thing for everybody.

691
00:35:08.160 --> 00:35:10.120
<v Speaker 2>No, I mean, I listen, I agree. I think the

692
00:35:10.160 --> 00:35:15.640
<v Speaker 2>issue is, yes, if a baby is moving or appears

693
00:35:15.680 --> 00:35:20.440
<v Speaker 2>to be moving less than expected, that usually means nothing,

694
00:35:21.000 --> 00:35:22.759
<v Speaker 2>but it's something we want to know about, and so

695
00:35:22.840 --> 00:35:26.200
<v Speaker 2>we have people come and check it out. Fine, every

696
00:35:26.200 --> 00:35:28.840
<v Speaker 2>now and again, we do see something that's real and

697
00:35:28.880 --> 00:35:32.480
<v Speaker 2>we intervene and we think, you know, it improved the outcome.

698
00:35:32.600 --> 00:35:35.640
<v Speaker 2>The question is whether it's valuable to tell everyone who's

699
00:35:35.680 --> 00:35:38.680
<v Speaker 2>pregnant do some sort of formal test at home to

700
00:35:38.680 --> 00:35:40.880
<v Speaker 2>make sure your baby's moving. Okay, are you going to

701
00:35:40.960 --> 00:35:44.560
<v Speaker 2>quote unquote save any babies compared to the many, many,

702
00:35:44.560 --> 00:35:45.920
<v Speaker 2>many people You're going to freak out?

703
00:35:46.239 --> 00:35:46.439
<v Speaker 3>Right?

704
00:35:46.760 --> 00:35:49.960
<v Speaker 2>And so it's that is the question that's quite unclear.

705
00:35:50.120 --> 00:35:54.160
<v Speaker 2>So I don't typically recommend kick counting as a routine,

706
00:35:54.760 --> 00:35:57.600
<v Speaker 2>but I tell people if they feel their babies moving

707
00:35:58.160 --> 00:36:01.960
<v Speaker 2>abnormally one day, right, because most people know they're babies. Right,

708
00:36:02.080 --> 00:36:04.160
<v Speaker 2>is some babies are very active. Somebodies are less. Somebody's

709
00:36:04.200 --> 00:36:06.200
<v Speaker 2>moving night, somebody's move in the morning. Right, there's you know,

710
00:36:06.239 --> 00:36:09.640
<v Speaker 2>babies have personalities just like adults do. And so if

711
00:36:09.680 --> 00:36:12.719
<v Speaker 2>you think there's a change and something's unusual and you're concerned,

712
00:36:13.400 --> 00:36:15.600
<v Speaker 2>then I will say, all right, lie down, close your eyes,

713
00:36:15.640 --> 00:36:18.239
<v Speaker 2>focus on the baby. Wait thirty minutes. If you feel

714
00:36:18.280 --> 00:36:20.279
<v Speaker 2>three movements of it's okay. And if you don't, let

715
00:36:20.400 --> 00:36:23.400
<v Speaker 2>us know. But as a routine, I don't anyone who's

716
00:36:23.440 --> 00:36:25.680
<v Speaker 2>high risk enough for still birth. I haven't come to

717
00:36:25.719 --> 00:36:28.240
<v Speaker 2>the office once or twice a week for like formal testing,

718
00:36:28.920 --> 00:36:31.200
<v Speaker 2>whether it's a biophysical profile or a non stress test,

719
00:36:31.280 --> 00:36:33.879
<v Speaker 2>so we can really get, you know, something with data

720
00:36:33.920 --> 00:36:36.719
<v Speaker 2>on it and something really can see whereas someone is

721
00:36:36.719 --> 00:36:39.279
<v Speaker 2>at lowers for stillbirth, I generally just say just keep

722
00:36:39.320 --> 00:36:40.960
<v Speaker 2>an eye on your baby and if everything seems normal,

723
00:36:41.000 --> 00:36:41.520
<v Speaker 2>you're good to go.

724
00:36:44.160 --> 00:36:49.759
<v Speaker 4>As a migraine sufferer during pregnancy, I was really like,

725
00:36:49.800 --> 00:36:51.880
<v Speaker 4>I always had my tile and all at the ready,

726
00:36:52.800 --> 00:36:56.120
<v Speaker 4>but I was googling and I noticed that it actually

727
00:36:56.239 --> 00:37:00.880
<v Speaker 4>depends at least shaking your head at my googling, that

728
00:37:01.960 --> 00:37:06.560
<v Speaker 4>taking ibuprofen or an end said during pregnancy is actually like,

729
00:37:06.600 --> 00:37:09.320
<v Speaker 4>it's different when in the pregnancy you take it. Is

730
00:37:09.360 --> 00:37:11.200
<v Speaker 4>it the kind of thing that has just blanket never

731
00:37:11.239 --> 00:37:14.040
<v Speaker 4>take ibuprofen during your pregnancy, or does it actually matter

732
00:37:14.239 --> 00:37:16.040
<v Speaker 4>when it matters?

733
00:37:16.080 --> 00:37:19.759
<v Speaker 2>So thilanol and ibuprofen are different, just to be clear,

734
00:37:19.760 --> 00:37:22.040
<v Speaker 2>because you first said tylanol and then you said ibuprofen,

735
00:37:22.120 --> 00:37:26.120
<v Speaker 2>so thailanol. You can also google some bad things about tileanol,

736
00:37:26.200 --> 00:37:30.440
<v Speaker 2>but basically the overwhelming evidence evidence is that tylanol is safe.

737
00:37:31.120 --> 00:37:34.200
<v Speaker 2>And the studies that seem to scare people about tilanol

738
00:37:35.080 --> 00:37:38.080
<v Speaker 2>are very complicated because it could be the reason somewhat

739
00:37:38.120 --> 00:37:41.000
<v Speaker 2>took talanol like which is usually fever, illness, this or that.

740
00:37:41.320 --> 00:37:46.080
<v Speaker 2>So tilanol is separate ibuprofen, which is like motrin, which

741
00:37:46.120 --> 00:37:49.920
<v Speaker 2>is like an advil, or another end said like neproxin

742
00:37:50.040 --> 00:37:53.000
<v Speaker 2>or a leive there. It's not a concern as far

743
00:37:53.040 --> 00:37:55.160
<v Speaker 2>as you know in terms of birth defects like early

744
00:37:55.200 --> 00:37:58.520
<v Speaker 2>in pregnancy, later in pregnancy, and sort of the mid

745
00:37:58.560 --> 00:38:00.920
<v Speaker 2>to late third trimester, there is a risk of it

746
00:38:00.960 --> 00:38:03.160
<v Speaker 2>affecting one of the blood vessels in the baby's heart,

747
00:38:03.280 --> 00:38:05.759
<v Speaker 2>so we tell people not to take it in the

748
00:38:05.760 --> 00:38:09.359
<v Speaker 2>third trimester. The reason we tell people not to take

749
00:38:09.400 --> 00:38:12.120
<v Speaker 2>it in the first and second trimester is prenominantly because

750
00:38:12.440 --> 00:38:15.279
<v Speaker 2>we don't want people to sort of get confused, which

751
00:38:15.320 --> 00:38:18.000
<v Speaker 2>one because people always confuse, like you know, just we

752
00:38:18.120 --> 00:38:20.239
<v Speaker 2>just heard Talento motor and advil, and so we tell

753
00:38:20.280 --> 00:38:23.400
<v Speaker 2>them not to take that sort of ever, so they

754
00:38:23.440 --> 00:38:26.200
<v Speaker 2>don't end up taking the third trimester. But if someone

755
00:38:26.239 --> 00:38:29.040
<v Speaker 2>needed it at eighteen weeks, they could take it and

756
00:38:29.080 --> 00:38:31.080
<v Speaker 2>we tell them, you know this, and so we sort

757
00:38:31.120 --> 00:38:35.279
<v Speaker 2>of do give it to people for certain circumstances. But yes,

758
00:38:35.440 --> 00:38:39.239
<v Speaker 2>later in pregnancy becomes definitely don't take it later in pregnancy.

759
00:38:39.440 --> 00:38:42.520
<v Speaker 2>But that's that's exactly when exactly how much it's a

760
00:38:42.520 --> 00:38:44.680
<v Speaker 2>little bit complicated, which is why there's more of a

761
00:38:44.719 --> 00:38:48.759
<v Speaker 2>blanket statement not to take ibuprofen because it will become dangerous.

762
00:38:49.800 --> 00:38:51.640
<v Speaker 2>But there are a lot of nuances to that.

763
00:38:53.600 --> 00:38:55.920
<v Speaker 4>Yeah, I will say like as a as a chronic

764
00:38:55.960 --> 00:38:59.080
<v Speaker 4>pain sufferer, that made pregnancy really scar like it was

765
00:38:59.120 --> 00:39:01.640
<v Speaker 4>the ultimate like me or my baby. You know, it's

766
00:39:01.680 --> 00:39:02.720
<v Speaker 4>like how can I get.

767
00:39:02.600 --> 00:39:03.120
<v Speaker 3>Through the day.

768
00:39:03.360 --> 00:39:07.200
<v Speaker 2>Each medication requires a conversation and you know, a discussion.

769
00:39:07.280 --> 00:39:10.200
<v Speaker 2>But there are options for people with pain, and there

770
00:39:10.200 --> 00:39:13.080
<v Speaker 2>are options with people with migraine pain. And I think

771
00:39:13.120 --> 00:39:15.839
<v Speaker 2>that sometimes people feel like they can't take anything because,

772
00:39:15.880 --> 00:39:18.480
<v Speaker 2>like you said, it's me versus the baby, which is

773
00:39:18.560 --> 00:39:21.440
<v Speaker 2>actually the exception. It's very unusual that there's a me

774
00:39:21.560 --> 00:39:25.520
<v Speaker 2>versus the baby conversation. It happens so rarely. It's almost

775
00:39:25.560 --> 00:39:27.520
<v Speaker 2>always what's good for the mother is good for the baby.

776
00:39:27.680 --> 00:39:30.160
<v Speaker 2>Or there's three options that are good for the mother,

777
00:39:30.239 --> 00:39:31.920
<v Speaker 2>and we'll pick the one that save us for the baby.

778
00:39:32.040 --> 00:39:38.960
<v Speaker 3>Okay, okay, last one, do doctors suggest ce sections, you know,

779
00:39:39.360 --> 00:39:42.480
<v Speaker 3>to make their tea times? Is that a really like

780
00:39:42.880 --> 00:39:47.959
<v Speaker 3>outdated worry that doctors kind of jump to suggest ce

781
00:39:47.960 --> 00:39:50.319
<v Speaker 3>sections in order to make it faster for them.

782
00:39:53.080 --> 00:39:57.840
<v Speaker 2>Loaded I will so for the record, I do not golf,

783
00:39:58.560 --> 00:40:02.240
<v Speaker 2>so I would never do it for tea time. Listen,

784
00:40:02.760 --> 00:40:06.960
<v Speaker 2>are there doctors who make recommendations because it's easier for

785
00:40:07.040 --> 00:40:10.000
<v Speaker 2>them than the patient. I'm sure, I'm sure they exist, right,

786
00:40:10.239 --> 00:40:11.960
<v Speaker 2>I mean, there's there's I don't know how many doctors

787
00:40:11.960 --> 00:40:13.759
<v Speaker 2>there are in the United States, a million, I don't

788
00:40:13.760 --> 00:40:15.560
<v Speaker 2>know what the number is. Many, many, many doctors, right,

789
00:40:15.560 --> 00:40:18.200
<v Speaker 2>And I'm sure there are ones that make recommendations that

790
00:40:18.280 --> 00:40:20.160
<v Speaker 2>are not in the best interest of their patients. I

791
00:40:20.200 --> 00:40:24.200
<v Speaker 2>would say, in my experience of knowing doctors, talking to doctors,

792
00:40:24.239 --> 00:40:27.920
<v Speaker 2>meeting doctors, and working with doctors, very rare. It's just

793
00:40:28.560 --> 00:40:31.400
<v Speaker 2>it doesn't work like that typically. And I would say

794
00:40:31.440 --> 00:40:35.680
<v Speaker 2>that especially in the field of obstetrics, the way things

795
00:40:35.800 --> 00:40:41.400
<v Speaker 2>have evolved, you rarely have that solo practitioner who's deciding

796
00:40:41.400 --> 00:40:43.560
<v Speaker 2>between a tea time and a birth right. So, like,

797
00:40:43.680 --> 00:40:46.440
<v Speaker 2>take my schedule, for example, if I'm covering the labor floor,

798
00:40:47.160 --> 00:40:49.680
<v Speaker 2>I'm on the labor floor from seventy am to seven pm.

799
00:40:50.200 --> 00:40:52.320
<v Speaker 2>It makes no difference to me whether someone has a

800
00:40:52.400 --> 00:40:55.759
<v Speaker 2>vaginal birth or a C section from my convenience, like

801
00:40:55.760 --> 00:40:59.120
<v Speaker 2>whatever's best for hers, best for her. And similarly, I'm

802
00:40:59.120 --> 00:41:02.600
<v Speaker 2>being relieved by someone at seven pm who is fresh

803
00:41:02.880 --> 00:41:05.319
<v Speaker 2>and you know, slept and capable and had dinner and

804
00:41:05.360 --> 00:41:08.040
<v Speaker 2>as someone I trust. And so whether someone has a

805
00:41:08.040 --> 00:41:09.920
<v Speaker 2>C section at six pm, or we wait and they

806
00:41:09.920 --> 00:41:11.640
<v Speaker 2>have it at nine pm, or they deliver vaginal lever

807
00:41:11.680 --> 00:41:14.279
<v Speaker 2>and it doesn't matter to me, there's no upside or

808
00:41:14.280 --> 00:41:18.240
<v Speaker 2>downside to me. So I think nowadays that type of behavior,

809
00:41:18.320 --> 00:41:22.759
<v Speaker 2>if it existed, or to what degree existed, must be

810
00:41:23.080 --> 00:41:26.520
<v Speaker 2>much less because there's there aren't the same time pressures

811
00:41:26.840 --> 00:41:30.120
<v Speaker 2>on obstetricians that there may have used to be.

812
00:41:30.960 --> 00:41:34.040
<v Speaker 1>I think can I make one Can I say one

813
00:41:35.120 --> 00:41:35.560
<v Speaker 1>one thing?

814
00:41:35.960 --> 00:41:38.160
<v Speaker 2>No, No, you cannot.

815
00:41:38.239 --> 00:41:41.279
<v Speaker 1>Because you have a tea time to get to. So

816
00:41:41.400 --> 00:41:46.000
<v Speaker 1>I think one piece related to this is about inductions,

817
00:41:46.120 --> 00:41:47.719
<v Speaker 1>which comes up a lot, and you and I have

818
00:41:47.760 --> 00:41:51.080
<v Speaker 1>talked about this that basically labor induction can be very

819
00:41:51.120 --> 00:41:52.160
<v Speaker 1>slow and.

820
00:41:52.120 --> 00:41:53.879
<v Speaker 2>So right, but the doctor doesn't have to be there.

821
00:41:54.080 --> 00:41:56.640
<v Speaker 1>Is that the doctor, yes, but just for people a

822
00:41:56.760 --> 00:41:59.319
<v Speaker 1>kind of point related to like you're getting from an

823
00:41:59.320 --> 00:42:02.319
<v Speaker 1>induction to to a C section like something I think

824
00:42:02.320 --> 00:42:04.440
<v Speaker 1>it's really important for people to understand is that labor

825
00:42:04.440 --> 00:42:07.080
<v Speaker 1>induction itself can be extremely slow. And so if you

826
00:42:07.160 --> 00:42:10.000
<v Speaker 1>are going to have an induced labor and you're planning

827
00:42:10.040 --> 00:42:12.080
<v Speaker 1>for a vaginal barth at the end of that, which

828
00:42:12.120 --> 00:42:16.880
<v Speaker 1>would be typical you and your doctor they will be

829
00:42:16.920 --> 00:42:19.120
<v Speaker 1>prepared because doctors know this, but you should be prepared

830
00:42:19.120 --> 00:42:21.480
<v Speaker 1>that it will be very that it will be very slow.

831
00:42:22.040 --> 00:42:26.400
<v Speaker 2>Yeah. I would say that the one thing that sadly

832
00:42:27.040 --> 00:42:32.160
<v Speaker 2>does drive a lot of decisions regarding mode of delivery,

833
00:42:32.239 --> 00:42:37.279
<v Speaker 2>right cea section versu. The vaginal is the either the

834
00:42:37.320 --> 00:42:42.239
<v Speaker 2>actual fear of getting sued of litigation, or even if

835
00:42:42.280 --> 00:42:45.600
<v Speaker 2>it's not actual, it's sort of built into the system.

836
00:42:45.840 --> 00:42:51.359
<v Speaker 2>There are so many safeguards built into the system that

837
00:42:51.600 --> 00:42:54.399
<v Speaker 2>end up increasing the risk of ce sections that we're

838
00:42:54.400 --> 00:42:57.000
<v Speaker 2>not even aware of in a certain sense, and they're

839
00:42:57.000 --> 00:43:00.359
<v Speaker 2>built in there because of fear of lawsuits. It's not

840
00:43:00.360 --> 00:43:03.000
<v Speaker 2>just the doctor that's afraid of getting sued. The nurses

841
00:43:03.000 --> 00:43:05.680
<v Speaker 2>are afraid of getting sued, the hospital is afraid of

842
00:43:05.719 --> 00:43:09.640
<v Speaker 2>getting sued, the hospital's insurance carrier is afraid of getting sued,

843
00:43:09.680 --> 00:43:13.319
<v Speaker 2>and so sadly that is sort of cooked into the

844
00:43:13.400 --> 00:43:18.279
<v Speaker 2>numbers sometimes and it's unfortunate, it just is, but it's

845
00:43:18.280 --> 00:43:20.400
<v Speaker 2>a reality. And I'm not saying that from like a

846
00:43:20.440 --> 00:43:22.759
<v Speaker 2>political reason about what to do about it, because there

847
00:43:22.800 --> 00:43:26.320
<v Speaker 2>isn't a great solution. But I think that definitely doctors

848
00:43:26.400 --> 00:43:32.400
<v Speaker 2>sometimes consciously or subconsciously worry about well, the chance of

849
00:43:32.440 --> 00:43:35.920
<v Speaker 2>something going wrong is very low, and medically it's probably

850
00:43:35.960 --> 00:43:38.640
<v Speaker 2>okay to continue if she wants to. But if something

851
00:43:38.680 --> 00:43:40.759
<v Speaker 2>were to go wrong, it's not going to look good

852
00:43:40.800 --> 00:43:43.680
<v Speaker 2>on paper, and I'm going to be in big trouble

853
00:43:44.400 --> 00:43:46.520
<v Speaker 2>and either that means I'll get sued or the hospital's

854
00:43:46.560 --> 00:43:48.200
<v Speaker 2>gonna come down on me because they're gonna get sued

855
00:43:48.280 --> 00:43:50.759
<v Speaker 2>or they're going to strict my privileges. And again I'm

856
00:43:50.800 --> 00:43:53.640
<v Speaker 2>not saying that to complain. It's a reality of the system,

857
00:43:53.920 --> 00:43:56.480
<v Speaker 2>and it's just it's it's hard. I don't know what

858
00:43:56.520 --> 00:43:59.480
<v Speaker 2>the solution is, but it's that is probably a more

859
00:43:59.560 --> 00:44:04.080
<v Speaker 2>prevalent and factor than the doctor's tea times or show

860
00:44:04.120 --> 00:44:07.440
<v Speaker 2>tickets or dinner reservations or whatever, you know, whatever the

861
00:44:07.480 --> 00:44:13.440
<v Speaker 2>doctors are supposedly doing in high society that the regular

862
00:44:13.440 --> 00:44:16.839
<v Speaker 2>people aren't. So yeah, we're probably going home to our

863
00:44:16.840 --> 00:44:18.000
<v Speaker 2>second job, is what we're doing.

864
00:44:20.560 --> 00:44:23.200
<v Speaker 3>Okay, Well, thank you both. I will see myself.

865
00:44:22.960 --> 00:44:27.279
<v Speaker 1>Up, thank you tomorrow. So I had I had a

866
00:44:27.360 --> 00:44:29.000
<v Speaker 1>last top I want to talk about because I think

867
00:44:29.000 --> 00:44:34.960
<v Speaker 1>it is something that that we don't agree on, and

868
00:44:35.000 --> 00:44:37.799
<v Speaker 1>there are very few things like this, well me and you. Yeah,

869
00:44:38.239 --> 00:44:42.520
<v Speaker 1>And it is about how people how much detailed people

870
00:44:42.560 --> 00:44:45.200
<v Speaker 1>want on risks. So one of the things I spend

871
00:44:45.239 --> 00:44:47.960
<v Speaker 1>a lot of time on in like in my in

872
00:44:48.000 --> 00:44:49.560
<v Speaker 1>my work, in my book and so on, is trying

873
00:44:49.600 --> 00:44:52.360
<v Speaker 1>to be like super precise about you know, is the

874
00:44:52.480 --> 00:44:56.280
<v Speaker 1>risk of recurrence of this condition? You know, sixteen percent

875
00:44:56.400 --> 00:44:59.799
<v Speaker 1>or twenty percent or twenty five percent, And I in

876
00:45:00.000 --> 00:45:02.160
<v Speaker 1>even writing this book, I spend a huge amount of

877
00:45:02.239 --> 00:45:06.080
<v Speaker 1>time in that space of like, let's be you know, really,

878
00:45:06.200 --> 00:45:07.920
<v Speaker 1>let me try to like get as close as I

879
00:45:07.920 --> 00:45:11.000
<v Speaker 1>can to some you know, precise number and understand how

880
00:45:11.080 --> 00:45:14.799
<v Speaker 1>much variation there is and so on. And you came

881
00:45:14.840 --> 00:45:18.600
<v Speaker 1>into this, I think, with an idea that there are

882
00:45:18.680 --> 00:45:21.400
<v Speaker 1>kind of three categories of risk that you like to

883
00:45:21.440 --> 00:45:24.959
<v Speaker 1>explain to people. There's like, probably this won't happen again.

884
00:45:25.040 --> 00:45:26.800
<v Speaker 1>You know, most of the time this is kind of

885
00:45:26.840 --> 00:45:29.640
<v Speaker 1>pretty aosyncratic, so it's probably not gonna happen again. It

886
00:45:30.680 --> 00:45:33.880
<v Speaker 1>might happen again, but you don't really know, or it's

887
00:45:33.960 --> 00:45:35.640
<v Speaker 1>you should assume it's going to happen again, and if

888
00:45:35.680 --> 00:45:38.000
<v Speaker 1>it doesn't, you're lucky, I think, is how you put it.

889
00:45:38.200 --> 00:45:43.560
<v Speaker 1>So you're kind of like pooh pooed my precision around risk.

890
00:45:43.880 --> 00:45:45.399
<v Speaker 1>And I think part of that is I think part

891
00:45:45.400 --> 00:45:47.360
<v Speaker 1>of it comes from the clinical maybe this sort of

892
00:45:47.440 --> 00:45:49.680
<v Speaker 1>expertise of talking to people and saying like people don't

893
00:45:49.719 --> 00:45:53.080
<v Speaker 1>really like fundamentally, the difference between sixty five and seventy

894
00:45:53.120 --> 00:45:57.239
<v Speaker 1>percent isn't actually very meaningful when people make decisions, So

895
00:45:57.320 --> 00:45:59.040
<v Speaker 1>I don't think we disagree.

896
00:46:00.120 --> 00:46:03.200
<v Speaker 2>I think that it's more so the practicality of it,

897
00:46:03.280 --> 00:46:06.600
<v Speaker 2>meaning I'm also I'm a data person. I love data.

898
00:46:06.800 --> 00:46:09.600
<v Speaker 2>I think that there's two issues with trying to get

899
00:46:09.600 --> 00:46:15.160
<v Speaker 2>that precise number. One, the research we have in almost

900
00:46:15.239 --> 00:46:18.880
<v Speaker 2>all of these aspects is so limited that the difference

901
00:46:18.880 --> 00:46:21.840
<v Speaker 2>between sixteen percent and twenty one percent is usually nothing

902
00:46:22.000 --> 00:46:24.759
<v Speaker 2>because the brackets around them are wide enough that it

903
00:46:24.840 --> 00:46:27.680
<v Speaker 2>really doesn't There is no actual difference between those numbers,

904
00:46:27.719 --> 00:46:30.080
<v Speaker 2>which you understand better than I do, but sort of statistically.

905
00:46:30.480 --> 00:46:34.480
<v Speaker 2>So that's one issue. The second is, I don't think

906
00:46:34.800 --> 00:46:38.560
<v Speaker 2>most people think like you think, right, So I think

907
00:46:38.600 --> 00:46:41.359
<v Speaker 2>there are people, and I certainly take care of them,

908
00:46:41.360 --> 00:46:43.600
<v Speaker 2>come across them, have some in my family this who

909
00:46:43.760 --> 00:46:45.760
<v Speaker 2>they're like? No, I want to know is it closer

910
00:46:45.800 --> 00:46:48.080
<v Speaker 2>to sixteen or closer twenty one? And fine, I'll tell you,

911
00:46:48.120 --> 00:46:50.680
<v Speaker 2>like God bless, we'll go to the decimal point whichever,

912
00:46:50.719 --> 00:46:53.160
<v Speaker 2>however many sing figs you want, we'll go there, right,

913
00:46:53.320 --> 00:46:56.719
<v Speaker 2>no problem. But most people don't think like that, right.

914
00:46:56.760 --> 00:47:00.440
<v Speaker 2>Most people, when they're thinking about risk, they categorize in

915
00:47:00.480 --> 00:47:03.839
<v Speaker 2>their brain like high risk, low risk, medium risk. Right

916
00:47:03.840 --> 00:47:06.880
<v Speaker 2>where am I? And so I sort of usually break

917
00:47:06.880 --> 00:47:09.600
<v Speaker 2>it down again based on the risk into something like

918
00:47:09.760 --> 00:47:14.000
<v Speaker 2>less than ten, ten to fifty or more than fifty. Again,

919
00:47:14.040 --> 00:47:16.560
<v Speaker 2>it depends on Sometimes all of them are under ten,

920
00:47:16.640 --> 00:47:18.399
<v Speaker 2>and it's like, all right, less than one, one to five,

921
00:47:18.440 --> 00:47:20.719
<v Speaker 2>five to ten, like it depends on the But try

922
00:47:20.760 --> 00:47:23.680
<v Speaker 2>to give them a sense so they can wrap their

923
00:47:23.719 --> 00:47:27.520
<v Speaker 2>head around the statistics because most people, the average person

924
00:47:27.560 --> 00:47:30.040
<v Speaker 2>is functioning at you know, I don't know, a middle

925
00:47:30.040 --> 00:47:33.120
<v Speaker 2>school level when it comes to toss. That's not an insult.

926
00:47:33.360 --> 00:47:36.359
<v Speaker 2>That's like high functioning people who are very bright and

927
00:47:36.400 --> 00:47:38.960
<v Speaker 2>working in the world. That's the level of statistics they're

928
00:47:39.000 --> 00:47:42.160
<v Speaker 2>usually working at. The exception are the people who are

929
00:47:42.719 --> 00:47:45.240
<v Speaker 2>very very into data on one and know the exact decimals,

930
00:47:45.239 --> 00:47:48.960
<v Speaker 2>and God bless them, but they're the exception. They're the outliers,

931
00:47:49.000 --> 00:47:52.440
<v Speaker 2>I would say. And so for me, if you get

932
00:47:52.440 --> 00:47:56.840
<v Speaker 2>into very very precise numbers on people with people, you

933
00:47:56.920 --> 00:48:00.399
<v Speaker 2>lose them in counseling. Now with reading, it might be

934
00:48:00.400 --> 00:48:05.400
<v Speaker 2>because it's a reference versus a conversation. They hear seventeen percent,

935
00:48:05.440 --> 00:48:08.680
<v Speaker 2>what does that mean to them? And also the other

936
00:48:08.719 --> 00:48:11.840
<v Speaker 2>thing is people think about math differently, So I always

937
00:48:11.880 --> 00:48:14.919
<v Speaker 2>have to say those numbers twice, I'll say your risk

938
00:48:15.120 --> 00:48:19.040
<v Speaker 2>is thirty percent, your risk is about three out of ten,

939
00:48:19.239 --> 00:48:21.080
<v Speaker 2>about one out of three. Like, you have to say

940
00:48:21.080 --> 00:48:23.920
<v Speaker 2>it in so many different ways because people hear things differently.

941
00:48:23.960 --> 00:48:26.560
<v Speaker 2>Some people don't get percentages. When I tell people one

942
00:48:26.600 --> 00:48:28.560
<v Speaker 2>in ten thousands, some people don't get what that means.

943
00:48:28.560 --> 00:48:30.400
<v Speaker 2>And again not that they don't understand it, it's just

944
00:48:30.480 --> 00:48:33.360
<v Speaker 2>they're hearing it, and they may be more of a

945
00:48:33.440 --> 00:48:35.840
<v Speaker 2>verbal learner. And you have to write something down or

946
00:48:36.360 --> 00:48:39.440
<v Speaker 2>it's it's it's fascinating. The human brain is fascinating, and

947
00:48:39.480 --> 00:48:43.000
<v Speaker 2>so we see all comers. And that's sort of what

948
00:48:43.080 --> 00:48:45.400
<v Speaker 2>I was getting at, not so much that it doesn't matter,

949
00:48:45.840 --> 00:48:47.480
<v Speaker 2>but that it's usually not practical.

950
00:48:48.040 --> 00:48:50.239
<v Speaker 1>Yeah, no, I think that's fair. The question of how

951
00:48:50.239 --> 00:48:55.239
<v Speaker 1>people understand probabilities, particularly small probabilities, is like incredibly interesting one,

952
00:48:55.440 --> 00:48:57.360
<v Speaker 1>Like how do you how do you help somebody understand

953
00:48:57.360 --> 00:48:59.480
<v Speaker 1>one in ten thousands, since like most of the time

954
00:48:59.480 --> 00:49:02.200
<v Speaker 1>you won't expl experience something, And how is one in

955
00:49:02.280 --> 00:49:04.239
<v Speaker 1>ten thousand different from one in one hundred thousand, Like

956
00:49:04.239 --> 00:49:06.600
<v Speaker 1>those booth You're never going to see either of those

957
00:49:06.800 --> 00:49:07.520
<v Speaker 1>right in your life.

958
00:49:07.560 --> 00:49:10.160
<v Speaker 2>I tell people that, you know, when we talk about

959
00:49:10.280 --> 00:49:13.439
<v Speaker 2>I'll go back to the genetic screening thing where I'll

960
00:49:13.440 --> 00:49:16.440
<v Speaker 2>tell people their risk is one percent, right, and if

961
00:49:16.440 --> 00:49:19.160
<v Speaker 2>they do an amnuur CVS, their risk of a miscarriage

962
00:49:19.160 --> 00:49:21.080
<v Speaker 2>is let's say, one in five hundred, little less than

963
00:49:21.160 --> 00:49:23.680
<v Speaker 2>one percent. And I'll tell them, all right, you have

964
00:49:23.719 --> 00:49:26.080
<v Speaker 2>two options here. You're going to do a procedure, you're

965
00:49:26.080 --> 00:49:29.279
<v Speaker 2>not gonna do a procedure. And I said, think about it.

966
00:49:29.600 --> 00:49:32.680
<v Speaker 2>You can close your eyes and flip a coin and

967
00:49:32.719 --> 00:49:36.040
<v Speaker 2>make this decision, and whether the coin leads heads or tails,

968
00:49:36.640 --> 00:49:40.000
<v Speaker 2>ninety nine plus percent of the time, you're not gonna miscarry,

969
00:49:40.120 --> 00:49:42.560
<v Speaker 2>and you're gonna have a healthy baby. I said, no

970
00:49:42.560 --> 00:49:44.799
<v Speaker 2>matter what, right, if you do a CVS ninety nine

971
00:49:44.800 --> 00:49:46.480
<v Speaker 2>plus percent of the time, you're not gonna miscarry. You're

972
00:49:46.480 --> 00:49:48.560
<v Speaker 2>gonna have a healthy baby. And if you don't do a

973
00:49:48.560 --> 00:49:50.719
<v Speaker 2>CVS ninety nine plus percent of the time, you're not

974
00:49:50.760 --> 00:49:53.080
<v Speaker 2>gonna misscarre. You're gonna have a healthy baby. How often in

975
00:49:53.080 --> 00:49:55.359
<v Speaker 2>your life do you get to make a decision that's

976
00:49:55.400 --> 00:49:58.160
<v Speaker 2>important to you or ninety nine plus percent of time

977
00:49:58.239 --> 00:49:59.480
<v Speaker 2>is going to work out no matter what you do.

978
00:50:00.200 --> 00:50:02.000
<v Speaker 2>So don't lose too much sleep over this. As I

979
00:50:02.040 --> 00:50:05.120
<v Speaker 2>go with your gut. If it's one percent versus eight percent,

980
00:50:05.840 --> 00:50:07.320
<v Speaker 2>then I'll you know, then it's different.

981
00:50:07.520 --> 00:50:07.680
<v Speaker 3>Right.

982
00:50:07.719 --> 00:50:11.560
<v Speaker 2>But when it's really really small numbers, it doesn't matter

983
00:50:11.600 --> 00:50:14.080
<v Speaker 2>to the individual, matters to the population. And so I

984
00:50:14.160 --> 00:50:16.719
<v Speaker 2>try to help them not worry too much about the

985
00:50:16.800 --> 00:50:19.719
<v Speaker 2>decision because it won't matter for almost everybody, and they

986
00:50:19.719 --> 00:50:22.200
<v Speaker 2>have to do, like, say, you have to sleep at night, right,

987
00:50:22.200 --> 00:50:24.200
<v Speaker 2>So whatever's going to make you sleep a night, that's

988
00:50:24.239 --> 00:50:26.120
<v Speaker 2>what you should do because you have to live with

989
00:50:26.120 --> 00:50:28.400
<v Speaker 2>yourself the rest of the pregnancy, So pick that one.

990
00:50:29.000 --> 00:50:30.640
<v Speaker 2>So again you have to break it down in a

991
00:50:30.680 --> 00:50:33.120
<v Speaker 2>way that's sort of manageable for people.

992
00:50:34.880 --> 00:50:36.680
<v Speaker 1>All right, Well, I just want to end Nate by

993
00:50:36.719 --> 00:50:40.200
<v Speaker 1>saying thank you. I don't, as I said at the top,

994
00:50:40.239 --> 00:50:44.160
<v Speaker 1>I don't like group projects, and doing this group project

995
00:50:44.160 --> 00:50:47.960
<v Speaker 1>with you was just a treat and I'm really grateful

996
00:50:48.360 --> 00:50:50.080
<v Speaker 1>for I'm really grateful we did together.

997
00:50:50.560 --> 00:50:55.480
<v Speaker 2>Well, now it's my turn. I have to say I

998
00:50:55.600 --> 00:50:59.840
<v Speaker 2>got turned on Emily from reading your book Right Expecting,

999
00:51:00.280 --> 00:51:04.280
<v Speaker 2>which is recommended by a patient. I never read pregnancy

1000
00:51:04.320 --> 00:51:06.600
<v Speaker 2>books ever, Right, why would ever read them? I'm like,

1001
00:51:06.600 --> 00:51:10.440
<v Speaker 2>this is ridiculous. I read yours, loved it. Loved it.

1002
00:51:10.800 --> 00:51:13.399
<v Speaker 2>Cold called you said, I'm a guy in New York.

1003
00:51:13.960 --> 00:51:18.560
<v Speaker 2>We have to meet. Yeah, And you've been just in

1004
00:51:18.640 --> 00:51:21.680
<v Speaker 2>general before we did this book, you've been so like

1005
00:51:21.880 --> 00:51:24.719
<v Speaker 2>friendly and gracious and we've had a great relationship. And

1006
00:51:24.760 --> 00:51:29.400
<v Speaker 2>as your fame has grown, you never sort of like

1007
00:51:29.840 --> 00:51:32.520
<v Speaker 2>ditched me or dumped me like we always maintained that relationship,

1008
00:51:32.520 --> 00:51:35.759
<v Speaker 2>which is I appreciate that. But then also when we

1009
00:51:35.840 --> 00:51:38.440
<v Speaker 2>decided to write this book, like I said, you're you're

1010
00:51:38.440 --> 00:51:41.120
<v Speaker 2>a well known author. You do this, You're very very

1011
00:51:41.120 --> 00:51:42.840
<v Speaker 2>good at it, You're very successful. A lot of people

1012
00:51:42.840 --> 00:51:45.359
<v Speaker 2>listen to you. And you could not have been more

1013
00:51:45.400 --> 00:51:47.600
<v Speaker 2>gracious in doing this in a way that made me

1014
00:51:47.600 --> 00:51:51.680
<v Speaker 2>feel like a partner. You know that you know, even

1015
00:51:51.719 --> 00:51:53.160
<v Speaker 2>partners whatever you want to say, It is like that

1016
00:51:53.160 --> 00:51:56.600
<v Speaker 2>we worked together on this and I really really enjoyed it.

1017
00:51:56.680 --> 00:51:59.760
<v Speaker 2>I learned a tremendous amount from you and from the process.

1018
00:51:59.760 --> 00:52:03.239
<v Speaker 2>I'm very proud of the book, really like I'm proud

1019
00:52:03.280 --> 00:52:04.759
<v Speaker 2>of it. I think what we did was great. I

1020
00:52:04.800 --> 00:52:07.440
<v Speaker 2>think is gonna hopefully help a lot a lot of people.

1021
00:52:08.640 --> 00:52:13.000
<v Speaker 2>I'm going to again display it proudly, and it's really

1022
00:52:13.000 --> 00:52:15.960
<v Speaker 2>something I'm gonna cherish that we did for a long time.

1023
00:52:16.040 --> 00:52:16.719
<v Speaker 2>That's great meat.

1024
00:52:18.040 --> 00:52:30.040
<v Speaker 1>Thanks Nate, Thank you. The Unexpected Navigating Pregnancy During and

1025
00:52:30.080 --> 00:52:34.719
<v Speaker 1>After Complications is out April thirtieth, twenty twenty four. You

1026
00:52:34.760 --> 00:52:38.279
<v Speaker 1>can get it anywhere that you buy books. Parent Data

1027
00:52:38.320 --> 00:52:41.319
<v Speaker 1>is produced by Tamar Avishai with support from the parent

1028
00:52:41.400 --> 00:52:44.360
<v Speaker 1>Data team and PI Rex. If you have thoughts on

1029
00:52:44.400 --> 00:52:47.480
<v Speaker 1>this episode, please join the conversation on my Instagram at

1030
00:52:47.560 --> 00:52:51.000
<v Speaker 1>prof Emily Ostar, and if you want to support the show,

1031
00:52:51.280 --> 00:52:54.680
<v Speaker 1>become a subscriber to the parent Data newsletter at parentdata

1032
00:52:54.719 --> 00:52:57.680
<v Speaker 1>dot org, where I write weekly posts on everything to

1033
00:52:57.719 --> 00:53:00.479
<v Speaker 1>do with parents and data to help you make better,

1034
00:53:00.600 --> 00:53:04.359
<v Speaker 1>more informed parenting decisions. There are a lot of ways

1035
00:53:04.360 --> 00:53:06.480
<v Speaker 1>that you can help people find out about us. Leave

1036
00:53:06.520 --> 00:53:09.680
<v Speaker 1>a rating or review on Apple Podcasts, Text your friend

1037
00:53:09.719 --> 00:53:12.759
<v Speaker 1>about something you learned from this episode. Debate your mother

1038
00:53:12.800 --> 00:53:15.600
<v Speaker 1>in law about the merits of something parents do now

1039
00:53:15.640 --> 00:53:19.040
<v Speaker 1>that is totally different from what she did. Host a

1040
00:53:19.080 --> 00:53:21.759
<v Speaker 1>story to your Instagram debunking a panic headline of your own.

1041
00:53:22.560 --> 00:53:26.600
<v Speaker 1>Just remember to mention the podcast too. Write Penelope right, mam.

1042
00:53:27.280 --> 00:53:28.080
<v Speaker 1>We'll see you next time.