WEBVTT 1 00:00:00.920 --> 00:00:01.800 I'm Emily Ost. 2 00:00:02.520 --> 00:00:08.920 This is parent Data and today, well, today is a 3 00:00:08.960 --> 00:00:09.559 special day. 4 00:00:10.680 --> 00:00:16.680 Today is our potiversary pod Anniversary Podiversary, let's go with that. 5 00:00:17.400 --> 00:00:20.000 We relaunched the new and improved parent Data podcast a 6 00:00:20.040 --> 00:00:20.520 year ago. 7 00:00:20.800 --> 00:00:23.000 Hey, Emily, Emily, Emily, Emily. 8 00:00:23.440 --> 00:00:28.120 I'm Emily Oster and today parent Data the podcast. I'll 9 00:00:28.120 --> 00:00:31.800 be interviewing experts to parse out fact from anecdote, causality 10 00:00:31.840 --> 00:00:32.640 from correlation. 11 00:00:32.760 --> 00:00:34.400 And it has been a great year. 12 00:00:35.120 --> 00:00:39.080 We have had some incredibly smart educational guests. 13 00:00:39.280 --> 00:00:43.240 Once you realize that we have to have unpaid labor 14 00:00:43.920 --> 00:00:46.400 done by women for society to function, you start to 15 00:00:46.440 --> 00:00:48.000 understand everything that surrounds it. 16 00:00:48.159 --> 00:00:50.720 Talking about sex is not correlated with a bad sex life. 17 00:00:50.720 --> 00:00:55.440 Talking about sex is correlated with a spectacular, magnificent, optimal 18 00:00:55.480 --> 00:00:56.520 sexual experience. 19 00:00:56.880 --> 00:00:59.560 One of the criticisms of this developmental story that we're 20 00:00:59.560 --> 00:01:01.640 talking about here is, oh, so you're blaming the boys. 21 00:01:01.840 --> 00:01:06.160 Actually the opposite, that the education system has inadvertently kind 22 00:01:06.160 --> 00:01:08.280 of defaulted to more of the kind of female standard. 23 00:01:08.440 --> 00:01:12.040 Could you please tell me how to solve my baby? 24 00:01:12.440 --> 00:01:16.520 Well, salting and swaddling were part of an idea that 25 00:01:16.680 --> 00:01:19.920 helpsway for quite a while that a baby would not 26 00:01:20.080 --> 00:01:23.959 acquire human form unless it was imposed on that baby. 27 00:01:25.240 --> 00:01:29.759 We've had fun late night panic Googles. Hello, Mandy Moore, 28 00:01:29.840 --> 00:01:32.840 Hello has Reclined, Hello Abby, Philip, Jackie Ashray. 29 00:01:32.480 --> 00:01:36.679 Thank you for joining me. Hello Emily as And here's 30 00:01:36.720 --> 00:01:37.440 what I've learned. 31 00:01:38.440 --> 00:01:42.199 It's hard to interview other people, but it's also really fun, 32 00:01:42.720 --> 00:01:47.360 and it's a really interesting way to get more intimate 33 00:01:47.560 --> 00:01:52.160 and to really connect with people who are going through 34 00:01:52.240 --> 00:01:54.520 the same things that I'm going through or different things, 35 00:01:54.760 --> 00:01:59.960 and where our shared experiences come out more than I 36 00:02:00.000 --> 00:02:06.160 I would sometimes expect. So today we're going to see 37 00:02:06.200 --> 00:02:09.800 how much I actually learned and how much I already know. 38 00:02:11.320 --> 00:02:13.959 If you follow my Instagram at Pratt Family ask, you're 39 00:02:13.960 --> 00:02:16.920 familiar with my Wednesday q and as. On those I 40 00:02:16.960 --> 00:02:19.679 post a question box. People ask their questions and I 41 00:02:19.760 --> 00:02:22.840 choose which one to answer. People sometimes ask me how 42 00:02:22.840 --> 00:02:25.800 do I choose? And I try to choose things that 43 00:02:25.880 --> 00:02:30.240 are entertaining or interesting or if everyone is already asking them. 44 00:02:30.400 --> 00:02:32.440 So in the last couple of weeks we asked you 45 00:02:32.520 --> 00:02:37.080 for your questions, and today I've got some answers and 46 00:02:37.200 --> 00:02:37.640 some help. 47 00:02:38.600 --> 00:02:40.720 I've invited my producer tomorrow to give me a hand. 48 00:02:41.240 --> 00:02:45.320 Hi tomorrow, Hi Emily, So how are we doing this? 49 00:02:45.840 --> 00:02:49.960 Okay, So, as you said, we solicited questions from all 50 00:02:50.000 --> 00:02:53.640 over the place from your readers, your listeners, your Instagram followers. 51 00:02:54.200 --> 00:02:58.160 Not unexpectedly, they really delivered. So I have taken the 52 00:02:58.240 --> 00:03:01.320 questions that I think I've to borrow your model and 53 00:03:01.560 --> 00:03:06.120 pick the ones that are interesting and different and actually 54 00:03:06.240 --> 00:03:06.800 very common. 55 00:03:07.080 --> 00:03:09.160 Follow the part of the model where I pick the 56 00:03:09.200 --> 00:03:10.360 ones I know the answers to. 57 00:03:11.240 --> 00:03:14.560 Well, that's the thing about somebody else picking them for you, 58 00:03:15.040 --> 00:03:17.800 So put a pin in that for a second. Okay, 59 00:03:18.360 --> 00:03:20.919 I've organized them by theme and I'm going to play 60 00:03:20.919 --> 00:03:23.119 them for you, and you are going to answer them 61 00:03:23.120 --> 00:03:26.160 in real time. So I can't stress this enough. You 62 00:03:26.240 --> 00:03:29.360 have not heard these questions before. This is not going 63 00:03:29.440 --> 00:03:32.000 to be like the magic of audio editing. This is 64 00:03:32.120 --> 00:03:35.680 real life. This is what you do. Help is available, though, 65 00:03:36.400 --> 00:03:39.240 so in true who wants to be a millionaire fashion? 66 00:03:39.240 --> 00:03:42.560 We have a couple different options for any help that 67 00:03:42.640 --> 00:03:45.920 you may need. We have searched the Internet and of 68 00:03:45.960 --> 00:03:50.520 course not Google, but actually like you know, diving in yeah, 69 00:03:50.680 --> 00:03:55.560 parent data Dewey, diving into those you know, Ivy League 70 00:03:55.600 --> 00:03:58.200 economist research papers, that will help give you the answer. 71 00:03:59.520 --> 00:04:00.680 That's not where I'm looking for help. 72 00:04:00.720 --> 00:04:04.680 But okay, you can phone a friend and you can 73 00:04:04.960 --> 00:04:07.880 pull the audience, so that will be some members of 74 00:04:07.920 --> 00:04:10.800 your parent data team who might be able to help 75 00:04:10.840 --> 00:04:14.360 out with answers that might be a little bit maybe 76 00:04:14.400 --> 00:04:17.440 more anecdotal, but enough, you know, enough anecdotes become data. 77 00:04:17.880 --> 00:04:20.240 It's not how it works, but okay, I like the idea. 78 00:04:20.279 --> 00:04:21.320 I like the concept. 79 00:04:22.520 --> 00:04:25.159 You can only pick each one once, so you have 80 00:04:25.200 --> 00:04:25.919 to be strategic. 81 00:04:25.920 --> 00:04:32.080 Okay, this seems hard. Okay, I'm ready, You're ready. Okay, 82 00:04:32.240 --> 00:04:32.760 I'm ready. 83 00:04:32.880 --> 00:04:36.359 Ish, all right, let's get started. Let's do it after 84 00:04:36.400 --> 00:04:50.760 the break. So the first category is pregnancy and birth. 85 00:04:51.600 --> 00:04:52.880 So let's start with the first question. 86 00:04:53.839 --> 00:04:57.080 Hi, Emily, I am currently twenty one weeks pregnant and 87 00:04:57.400 --> 00:04:59.440 I live in Canada. 88 00:04:59.120 --> 00:05:01.320 Access to great health care, very lucky for that. 89 00:05:01.600 --> 00:05:02.559 I live in a big city. 90 00:05:03.360 --> 00:05:05.599 One thing that I'm just really noticing and have a 91 00:05:05.640 --> 00:05:09.320 question about, is how far the pendulum really has swung, 92 00:05:09.560 --> 00:05:13.400 you know, toward non intervention you know, quote unquote natural 93 00:05:13.440 --> 00:05:18.360 birth or just non intervention birth. And look, it really 94 00:05:18.400 --> 00:05:21.240 just to seem that the system has built in assumptions 95 00:05:21.279 --> 00:05:25.040 now that nobody that everyone is trying to avoid interventions, 96 00:05:25.040 --> 00:05:27.960 be it avoiding pain meds, be it avoiding induction, avoiding 97 00:05:28.040 --> 00:05:31.280 sea section, all of the above. I'm wondering where it 98 00:05:31.320 --> 00:05:34.120 comes from that like this assumption is so strong, and 99 00:05:34.160 --> 00:05:34.800 if there is like. 100 00:05:34.800 --> 00:05:40.000 A data basis. I know that there are obviously like risks. 101 00:05:39.680 --> 00:05:43.080 Inherent and sy sections specifically, but just a bit of 102 00:05:43.560 --> 00:05:46.120 h I'm trying to understand why my care providers seem 103 00:05:46.839 --> 00:05:52.400 to just really assume at every turn that, like everything 104 00:05:52.400 --> 00:05:56.320 that I'm going to prefer is to avoid interventions at 105 00:05:56.320 --> 00:05:58.680 all costs. Frankly, I just want to have my baby 106 00:05:58.680 --> 00:06:03.240 out safely, So I don't have any opinion about not 107 00:06:03.279 --> 00:06:04.880 having a c section or having one if it's the 108 00:06:04.960 --> 00:06:06.200 right thing being induced. 109 00:06:06.240 --> 00:06:07.960 And I certainly would like payments. 110 00:06:08.120 --> 00:06:11.080 So trying to understand this system that we're in a 111 00:06:11.080 --> 00:06:12.200 little bit better, thank you. 112 00:06:13.440 --> 00:06:16.800 So I think this question I would really separate in 113 00:06:16.839 --> 00:06:17.920 a couple of different parts. 114 00:06:18.000 --> 00:06:21.320 So one kind of intervention we would talk about. 115 00:06:21.120 --> 00:06:26.200 Is a C section, and there are of course very 116 00:06:26.240 --> 00:06:28.640 good reasons for a c section, and it can be 117 00:06:28.800 --> 00:06:32.080 very life saving, but it's also true that that is 118 00:06:32.360 --> 00:06:37.640 not the default method of birth. That most providers are 119 00:06:38.240 --> 00:06:42.560 hoping for because the recovery is more significant, because that 120 00:06:42.720 --> 00:06:49.119 is a major abnominal surgery and for most people it 121 00:06:49.160 --> 00:06:51.640 is more likely to lead to complications if you want 122 00:06:51.680 --> 00:06:54.800 a later child, you know again, sort of super safe, 123 00:06:55.279 --> 00:06:58.279 not something to worry about, but also something we're not 124 00:06:58.360 --> 00:07:02.479 hoping will be the default, which is why most providers 125 00:07:02.520 --> 00:07:05.800 will not offer an electacy section unless there is a 126 00:07:05.880 --> 00:07:09.520 reason to do that. I would pull out that as 127 00:07:09.560 --> 00:07:13.000 sort of separate from the question of pain medication and 128 00:07:14.040 --> 00:07:17.480 to some extent induction, where I do feel like we 129 00:07:17.560 --> 00:07:21.200 have sometimes gotten into this idea of late that you know, 130 00:07:21.280 --> 00:07:24.520 less is better that we would all be ideal if 131 00:07:24.520 --> 00:07:27.760 we were like giving birth you know, alone under a tree, 132 00:07:29.320 --> 00:07:30.160 like with no. 133 00:07:30.240 --> 00:07:32.880 Help and pulling the baby out yourself. 134 00:07:33.280 --> 00:07:35.920 Yeah, certainly that's not what we'd recommend. 135 00:07:35.960 --> 00:07:38.240 But if you look at something like an epidaural and 136 00:07:38.280 --> 00:07:40.800 you ask, you know, are there any doubts significant downsides 137 00:07:40.800 --> 00:07:45.760 to pain relief, like absolutely those are. That is a 138 00:07:45.920 --> 00:07:50.320 very safe and effective method of pain relief with tremendous benefits, 139 00:07:51.280 --> 00:07:53.600 namely that it's quite painful to have a baby. 140 00:07:53.720 --> 00:07:58.440 So I think this is you know again, like if you. 141 00:07:58.480 --> 00:08:01.480 Asked why are people well, why do people talk about 142 00:08:01.520 --> 00:08:03.600 this like it would be better to not do anything. 143 00:08:04.080 --> 00:08:04.960 I'm not really sure. 144 00:08:05.040 --> 00:08:07.520 I think it's part of this general culture of like 145 00:08:07.960 --> 00:08:11.880 the more suffering we have as parents, the better. And 146 00:08:11.920 --> 00:08:13.960 it's again one of the things I would say, you 147 00:08:14.200 --> 00:08:16.440 have to decide what we should have. We should be 148 00:08:16.480 --> 00:08:19.920 open to people deciding whatever space they want. You want 149 00:08:20.120 --> 00:08:22.680 an induction, do you want a an epidural? 150 00:08:22.800 --> 00:08:24.080 Do not want those things? 151 00:08:24.320 --> 00:08:27.480 I think very reasonable people could choose both, and but 152 00:08:27.600 --> 00:08:30.240 I do I would separate that from the C section question. 153 00:08:31.120 --> 00:08:34.480 Yeah, I think too. I found going through my own 154 00:08:34.520 --> 00:08:38.960 pregnancies that it's something that feels like it should be 155 00:08:39.040 --> 00:08:42.679 very natural, and right off the bat feels like it's 156 00:08:42.720 --> 00:08:46.160 it becomes medicalized. You know, as soon as you as 157 00:08:46.200 --> 00:08:47.800 soon as you find out you're pregnant, you book a 158 00:08:47.800 --> 00:08:51.280 doctor's appointment, and it's like one thing after another where 159 00:08:51.320 --> 00:08:55.280 you're continually putting, your putting something that you know, your 160 00:08:55.360 --> 00:08:57.240 quote unquote your body is built to do in the 161 00:08:57.240 --> 00:09:01.319 hands of doctors. And I think that there is this 162 00:09:01.840 --> 00:09:07.480 trend now to kind of take the medicalization out, but 163 00:09:07.679 --> 00:09:09.120 it does seem like a trend. 164 00:09:10.400 --> 00:09:13.400 It's interesting, is part of what I like about midwif 165 00:09:13.440 --> 00:09:17.079 frey care, which has grown in the US. And when 166 00:09:17.080 --> 00:09:18.800 you talk about that in the context for the US, 167 00:09:18.840 --> 00:09:22.080 people think about home birds, but actually most midwift berths. 168 00:09:21.760 --> 00:09:24.080 Are are in hospitals. 169 00:09:24.520 --> 00:09:27.880 But there is a model associated with with midwif. 170 00:09:27.559 --> 00:09:30.439 Frey care different from from you know, care with. 171 00:09:30.400 --> 00:09:35.120 An ob where it is a little bit more kind 172 00:09:35.160 --> 00:09:38.160 of coming at it from the default idea of like, 173 00:09:38.240 --> 00:09:42.480 this is something that you know, where it like is 174 00:09:42.559 --> 00:09:47.120 expected that that is a normal part of a thing 175 00:09:47.160 --> 00:09:50.520 that happens in life, and and that of course there 176 00:09:50.520 --> 00:09:53.400 are reasons why we might need medical intervention at a 177 00:09:53.440 --> 00:09:56.120 more serious level, but that the default is kind of 178 00:09:56.160 --> 00:09:58.200 you are going to your body is sort of going 179 00:09:58.280 --> 00:10:02.480 to do this, and that talking to midwives about this, 180 00:10:02.559 --> 00:10:07.040 it's it. You will get a picture that's somewhere in 181 00:10:07.080 --> 00:10:09.440 the middle, I would say, which I kind of like. 182 00:10:10.120 --> 00:10:13.920 Okay, So speaking of c sections, Hi, my name is 183 00:10:13.960 --> 00:10:17.319 Kristen and my question is related to trying to conceive 184 00:10:17.440 --> 00:10:21.360 over forty This would be a fifth scheduled C section, 185 00:10:21.960 --> 00:10:24.640 and I've been told I have a thin uterus already 186 00:10:24.720 --> 00:10:26.360 due to the priority sections. 187 00:10:26.840 --> 00:10:28.800 So I was wondering the concern. 188 00:10:29.960 --> 00:10:32.719 Once you go beyond four s sections obviously, this being 189 00:10:32.760 --> 00:10:36.120 the fifth and the thin uterus combined, and the age 190 00:10:36.160 --> 00:10:37.760 of forty four as well. 191 00:10:38.480 --> 00:10:40.199 Thank you for any advice. Bye. 192 00:10:40.840 --> 00:10:42.480 Mar think we're gonna I think we're gonna phone a 193 00:10:42.480 --> 00:10:45.120 friend on this. Yeah, let's call Nate. 194 00:10:45.600 --> 00:10:48.480 Okay, So this is doctor Nate Fox obg y n 195 00:10:48.720 --> 00:10:51.920 friend of the podcast and your co author for the Unexpected, 196 00:10:52.280 --> 00:10:53.439 and we've got them queued up. 197 00:10:57.040 --> 00:10:57.199 Hi. 198 00:10:57.240 --> 00:11:00.360 Hello, Emily, how you doing, Nate? 199 00:11:00.440 --> 00:11:01.240 I'm calling you. 200 00:11:01.400 --> 00:11:04.480 I'm phoning a friend on this because you're a doctor 201 00:11:05.040 --> 00:11:06.040 and I. 202 00:11:05.960 --> 00:11:07.880 Trust you and I think you're the best doctor. 203 00:11:08.440 --> 00:11:10.440 Oh God, that's so nice. 204 00:11:10.920 --> 00:11:12.800 Can you help answer this person's question? 205 00:11:13.760 --> 00:11:15.600 I'm sure, anything for a friend. 206 00:11:17.120 --> 00:11:18.040 So what's the answer? 207 00:11:19.000 --> 00:11:27.280 So, yeah, great question. It's a long answer for her specifically, 208 00:11:27.559 --> 00:11:31.000 and this is something I usually see people and talk 209 00:11:31.080 --> 00:11:33.760 to them for at least an hour about. But in 210 00:11:33.840 --> 00:11:36.880 terms of the high points of the question, it seems 211 00:11:36.920 --> 00:11:41.200 to be there's three. Number one is getting pregnant over 212 00:11:41.200 --> 00:11:44.960 the age of forty Number two is getting pregnant with 213 00:11:45.040 --> 00:11:50.680 having four prior caesareans, and number three getting pregnant with 214 00:11:50.840 --> 00:11:55.200 having a thin lower uterine segments or a thin wall. 215 00:11:55.280 --> 00:11:58.600 The uterus and so high level in terms of getting 216 00:11:58.600 --> 00:12:02.800 pregnant after forty. You know, I definitely do not discourage 217 00:12:02.800 --> 00:12:05.960 people from getting pregnant after forty. I encourage it. But 218 00:12:06.000 --> 00:12:10.080 there are some things that can sometimes be challenging for people. 219 00:12:10.240 --> 00:12:13.560 The likeli of infertility goes up, the likely of miscarriage 220 00:12:13.600 --> 00:12:16.920 goes up. But assuming that doesn't happen, either you get 221 00:12:16.920 --> 00:12:19.200 pregnant on your own, or you do IVF and you 222 00:12:19.240 --> 00:12:22.800 get pregnant and there's no miscarriage, the pregnancy itself tends 223 00:12:22.840 --> 00:12:26.559 to go well. There's an increased risk of some complications 224 00:12:26.600 --> 00:12:29.800 at the end of pregnancy, like preclamsy or justestational diabetes, 225 00:12:30.400 --> 00:12:33.400 and that's something where I typically would watch someone closer 226 00:12:33.440 --> 00:12:36.760 for those things, but again, most of the complications tend 227 00:12:36.800 --> 00:12:40.760 to be on the front end of pregnancy. One of 228 00:12:40.800 --> 00:12:44.320 the complications that not complications, but one of the things 229 00:12:44.320 --> 00:12:46.600 that's more likely as you get older is the risk 230 00:12:46.679 --> 00:12:50.400 of caesarean, which is true for anyone who's getting pregnant 231 00:12:50.440 --> 00:12:55.520 over forty, but certainly for your follower specifically who's already 232 00:12:55.559 --> 00:12:59.679 had four C sections. So that's number two. So getting 233 00:12:59.679 --> 00:13:02.600 pregnate after four sea sections does not tend to be 234 00:13:02.640 --> 00:13:06.600 an issue again with getting pregnant or the pregnancy itself. 235 00:13:06.640 --> 00:13:10.959 That's really just related to delivery because you're going to 236 00:13:11.040 --> 00:13:13.240 need a sea section for your fifth delivery. As far 237 00:13:13.280 --> 00:13:15.840 as we know, it's not safe to labor after four 238 00:13:15.880 --> 00:13:18.240 prior sea sections, and so you're going to have to 239 00:13:18.280 --> 00:13:20.600 be scheduled for a sea section, and then there's some 240 00:13:21.679 --> 00:13:24.280 questions about the timing of it, when should that be done, 241 00:13:24.800 --> 00:13:26.959 sort of is it going to be complicated is it not? 242 00:13:27.280 --> 00:13:30.040 And one of the biggest variables on that is whether 243 00:13:30.120 --> 00:13:33.680 you end up having a placenta previa or not, where 244 00:13:33.679 --> 00:13:36.880 the placenta covers the cervix, which seems to be pure luck. 245 00:13:37.600 --> 00:13:40.199 It's about a five percent chance. And if you are 246 00:13:40.440 --> 00:13:44.040 someone who has four prior sea sections and you also 247 00:13:44.160 --> 00:13:48.000 coincidentally have a percenta previa, then there's a very high 248 00:13:48.120 --> 00:13:52.160 chance of something called percenta a creta where the placenta 249 00:13:52.200 --> 00:13:55.880 gets stuck to the uterus and likely you would need 250 00:13:55.920 --> 00:13:59.160 a hysterectomy at the time of delivery. So that's a 251 00:13:59.280 --> 00:14:02.680 conversation that needs to be had for anyone who's getting 252 00:14:02.720 --> 00:14:06.080 pregnant with several prior sea sections, that this is a 253 00:14:06.120 --> 00:14:09.080 possibility for you. Doesn't mean it'll happen, obviously, but that 254 00:14:09.160 --> 00:14:13.040 is a possibility. The third thing, which is more unique, 255 00:14:13.040 --> 00:14:15.760 and this is something we're seeing more and more of nowadays, 256 00:14:16.280 --> 00:14:19.160 is this idea of a thin lower part of the uterus. 257 00:14:19.160 --> 00:14:21.640 So what is that. Basically, when we do a sea section, 258 00:14:21.760 --> 00:14:24.600 we open the uterus and then we close it obviously, 259 00:14:24.880 --> 00:14:27.840 and that scar and the uterus has to heal and 260 00:14:27.880 --> 00:14:30.640 then if you look at it an ultrasound or you 261 00:14:30.680 --> 00:14:32.800 look at it maybe the time of the next sea section, 262 00:14:33.680 --> 00:14:36.360 that scar could heal and the muscle can be very thick, 263 00:14:36.440 --> 00:14:38.840 like it healed perfectly. It looks like a normal muscle, 264 00:14:39.120 --> 00:14:43.320 or sometimes it heals, but it's very very thin, and 265 00:14:43.360 --> 00:14:46.000 there isn't a lot of sort of muscle attached to 266 00:14:47.760 --> 00:14:49.400 the other part of the muscle anymore. So it's not 267 00:14:49.440 --> 00:14:51.480 that it's open, it's not that it's ruptured, but it 268 00:14:51.560 --> 00:14:53.920 just seems to be thin. And there's two concerns with that. 269 00:14:54.080 --> 00:14:57.560 One concern is that if you have that and you're 270 00:14:57.600 --> 00:15:00.600 pregnant and you go into labor, you have a higher 271 00:15:00.680 --> 00:15:05.280 risk potentially of that thin lower segment rupturing as opposed 272 00:15:05.280 --> 00:15:07.040 to if it were nice and thick, which just makes 273 00:15:07.080 --> 00:15:10.280 sense to people for the physics of it. So that's 274 00:15:10.360 --> 00:15:12.640 one problem. And so when people do have a history 275 00:15:12.680 --> 00:15:15.520 of a thin lower uterine segment, we tend to deliver 276 00:15:15.560 --> 00:15:18.840 them earlier because we don't want them to go into labor. 277 00:15:18.920 --> 00:15:21.680 So instead of delivering them let's say thirty nine weeks 278 00:15:21.720 --> 00:15:23.720 or thirty eight, sometimes we do it at thirty seven 279 00:15:23.840 --> 00:15:27.840 or thirty six, prior to them going into labor. The 280 00:15:27.920 --> 00:15:32.200 second issue potentially with a thin lower uterine segment is 281 00:15:32.400 --> 00:15:38.240 if the pregnancy early on implants in that scar where 282 00:15:38.280 --> 00:15:41.560 the where it's supposed to be a nice thick muscle, 283 00:15:41.600 --> 00:15:43.520 but instead it's thin in this sort of like an 284 00:15:43.520 --> 00:15:46.600 area that's chewed out. We sometimes call that a niche 285 00:15:46.640 --> 00:15:50.680 and icche. If the pregnancy happens to implant in there, 286 00:15:50.720 --> 00:15:54.960 that could be a very very dangerous pregnancy. So ultimately, 287 00:15:55.320 --> 00:15:57.200 to go back to the original question, if I were 288 00:15:57.240 --> 00:15:59.600 to meet with someone who's over forty and has four 289 00:15:59.640 --> 00:16:03.640 prior sections and has a thin lower segment, it does 290 00:16:03.680 --> 00:16:05.800 not mean I would tell the person not to get pregnant. 291 00:16:05.840 --> 00:16:08.080 There are some who would. There's definitely doctors who say, 292 00:16:08.080 --> 00:16:10.040 you know, enough is enough, no more babies. Don't get 293 00:16:10.080 --> 00:16:13.160 pregnant too high risk. That's not how I typically address these. 294 00:16:13.280 --> 00:16:16.320 As you go over each of these individually, try to 295 00:16:16.360 --> 00:16:19.640 personalize it and individualize and just explain what are the risks, 296 00:16:19.680 --> 00:16:21.720 what are the things we're looking for, and how might 297 00:16:21.760 --> 00:16:22.800 we follow for those? 298 00:16:23.560 --> 00:16:26.400 Best of luck. That's a good. 299 00:16:26.320 --> 00:16:28.720 Answer, Nate, Wow, great answer. 300 00:16:29.320 --> 00:16:33.040 Okay, So with that we say goodbye to doctor Nate 301 00:16:33.160 --> 00:16:34.920 and hello to the next question. 302 00:16:35.760 --> 00:16:39.520 Hey, Emily Oster, I've got a question for you. Is 303 00:16:39.520 --> 00:16:42.560 it okay to take melatonin? What pregnant to combat that 304 00:16:42.680 --> 00:16:47.080 pesky pregnancy insomnia? The internet is a posed because of 305 00:16:47.080 --> 00:16:50.320 the lack of data, but my pregnancy app says I 306 00:16:50.440 --> 00:16:53.480 can and I have horrible insomnia. 307 00:16:54.160 --> 00:16:54.560 Let me know. 308 00:16:55.880 --> 00:17:00.280 So this falls in the category of things during pregnancy 309 00:17:00.360 --> 00:17:02.200 where I wish we had better data and we don't, 310 00:17:02.480 --> 00:17:06.359 because it absolutely is the case that many people have 311 00:17:06.760 --> 00:17:11.400 insomnia during pregnancy, and melatonin is a naturally occurring hormone, 312 00:17:11.480 --> 00:17:14.800 so it's not it would not be crazy to imagine 313 00:17:15.040 --> 00:17:20.640 that this was safe, and indeed we have a reasonable 314 00:17:20.680 --> 00:17:27.840 amount of reassuring evidence, and in fact, there are actually 315 00:17:27.920 --> 00:17:33.679 some complications in pregnancy which are associated with problematic melatonin. 316 00:17:33.760 --> 00:17:36.639 So actually some people have suggested that supplementation with melatonin 317 00:17:36.840 --> 00:17:40.720 might actually improve some things like preterm birth or preclamsya. 318 00:17:40.800 --> 00:17:43.600 That's not something that has shown up in the trials yet, 319 00:17:43.720 --> 00:17:48.840 but that could be true in theory. But we also 320 00:17:48.920 --> 00:17:54.639 know that melatonin is transmitted to the fetus melatonin from supplements, melatonin. 321 00:17:54.080 --> 00:17:55.120 Then occurs naturally. 322 00:17:55.840 --> 00:17:59.040 And it's like you land in this complicated space, which 323 00:17:59.119 --> 00:18:02.120 is basically like, there's no absolutely no reason to think 324 00:18:02.119 --> 00:18:05.760 that we would be concerned, but also nothing where you 325 00:18:05.760 --> 00:18:08.480 can say, here's a large randomized trial that is like 326 00:18:08.960 --> 00:18:12.320 going to prove to you that there's no possible issue. 327 00:18:13.200 --> 00:18:16.200 Many people do take low doses of melatone and during 328 00:18:16.200 --> 00:18:19.520 pregnancy if there were significant risks, we would obviously know 329 00:18:19.600 --> 00:18:22.720 about that. And so that is that for me, I 330 00:18:22.720 --> 00:18:27.280 think is pretty reassuring. And you know, sleep is sleep is. 331 00:18:26.960 --> 00:18:28.520 Important for your health. 332 00:18:29.000 --> 00:18:30.840 But I mean, I guess my more general point here 333 00:18:30.960 --> 00:18:34.840 is like, sometimes the reason for conflicting advice is that 334 00:18:34.880 --> 00:18:37.560 the answer is like, we don't have perfect evidence, and 335 00:18:37.640 --> 00:18:41.240 so the conflict is how do you read the limited 336 00:18:41.240 --> 00:18:44.360 evidence that we have, not that people have different evidence, 337 00:18:44.359 --> 00:18:46.280 And that's probably useful to keep in mind when you 338 00:18:46.320 --> 00:18:48.080 read these conflicting recommendations. 339 00:18:48.760 --> 00:18:51.160 Yeah, I read a thing that said that your baby 340 00:18:51.160 --> 00:18:54.080 will sleep better if you've taken melotone and during pregnancy. 341 00:18:54.200 --> 00:18:55.679 So that's that's reason enough for me. 342 00:18:56.119 --> 00:18:58.359 Definitely no evidence of that too, you know. 343 00:18:59.240 --> 00:19:02.200 Oh well, oh well, you got to cling to what. 344 00:19:02.119 --> 00:19:02.679 You can give. 345 00:19:02.720 --> 00:19:05.560 It's a bourbon too, you know that that's a no, 346 00:19:05.760 --> 00:19:07.640 don't do that. 347 00:19:07.640 --> 00:19:13.080 A little bourbon sp Okay, well, you just mentioned preclamsia, 348 00:19:13.280 --> 00:19:15.080 so let's click on the next question. 349 00:19:16.080 --> 00:19:17.040 Hi, my name is Abby. 350 00:19:17.200 --> 00:19:19.800 I'm thirty years old, and I had my first baby 351 00:19:20.240 --> 00:19:23.639 in June, and it was a little bit eventful. I 352 00:19:23.680 --> 00:19:27.399 lost about twelve hundred secies of blood after delivery, and 353 00:19:27.440 --> 00:19:31.800 then I also developed postpartum preclampsia about four days after 354 00:19:31.840 --> 00:19:32.400 getting home. 355 00:19:32.680 --> 00:19:34.120 And I have two sisters. 356 00:19:34.240 --> 00:19:39.000 One of them experienced postpartum hemorrhage and another one experienced 357 00:19:39.119 --> 00:19:41.439 pre clamsia and pre term birth. 358 00:19:42.200 --> 00:19:44.679 And so my question is, what. 359 00:19:44.880 --> 00:19:48.640 Is the likelihood of either or both of these events 360 00:19:48.680 --> 00:19:51.720 happening again in a future pregnancy and a future birth. 361 00:19:53.000 --> 00:19:55.160 Should I be worried about getting pregnant again? 362 00:19:55.720 --> 00:19:58.360 My doctors think it's fine if I just wait a year, 363 00:19:58.440 --> 00:20:00.480 but I'd love to know what the day that says, 364 00:20:00.680 --> 00:20:01.400 thank you so much. 365 00:20:02.320 --> 00:20:07.919 So for preclamcy in particular, we can we have a 366 00:20:07.960 --> 00:20:10.720 fair amount of very good data on recurrence risk because 367 00:20:10.760 --> 00:20:14.800 it's actually a fairly common complication and it's not that 368 00:20:15.000 --> 00:20:17.280 hard in the data to learn about the risk of 369 00:20:17.320 --> 00:20:20.080 recurrence of something like that, because you can use these 370 00:20:20.080 --> 00:20:22.160 like very large data sets from Europe. 371 00:20:21.840 --> 00:20:25.160 Where you can see link people over over time. 372 00:20:25.720 --> 00:20:27.399 So what we see out of that is that the 373 00:20:27.760 --> 00:20:31.840 recurrence risk varies quite a lot based on when the 374 00:20:31.960 --> 00:20:37.080 preclamsia appeared, and so if your preclamsia appeared early in pregnancy, 375 00:20:37.400 --> 00:20:40.320 which is often associated with pre term birth, the recurrence 376 00:20:40.400 --> 00:20:43.320 risk is very high. As it gets later in pregnancy, 377 00:20:43.359 --> 00:20:45.560 we get to lower recurrence risks. So people who develop 378 00:20:45.840 --> 00:20:48.280 preclamsia at term or in this case after term, the 379 00:20:48.359 --> 00:20:51.000 recurrence risk is only in the range of ten percent, 380 00:20:51.359 --> 00:20:54.280 so higher than the chance that you would have it 381 00:20:54.400 --> 00:20:58.160 kind of at baseline, but not certainly not one hundred percent, 382 00:20:58.200 --> 00:20:59.960 and still actually fairly low. 383 00:21:00.680 --> 00:21:02.560 Preclamsia is also something. 384 00:21:02.200 --> 00:21:06.359 Where we have some treatment options. In particular, dosing with 385 00:21:06.440 --> 00:21:11.040 baby aspirin is actually quite effective at reducing the risk 386 00:21:11.080 --> 00:21:14.080 of pre eclamsia, So surely that is an intervention your 387 00:21:14.080 --> 00:21:18.240 doctor would encourage in a second pregnancy. And because you 388 00:21:18.440 --> 00:21:21.760 know about this risk, and because it was post birth, 389 00:21:22.160 --> 00:21:25.960 it's something where the monitoring would likely be much better 390 00:21:25.960 --> 00:21:28.160 in a later pregnancy. So there's a lot of reasons 391 00:21:28.200 --> 00:21:31.920 to think that the experience of this might be both 392 00:21:31.960 --> 00:21:34.960 there's a lower risk than you would have had before 393 00:21:35.160 --> 00:21:37.199 and that the experience would be different because you know 394 00:21:37.280 --> 00:21:42.679 it's a risk for postpartum hemorrhage. Again, some of the 395 00:21:42.720 --> 00:21:45.640 reasons for that are things which could recur, but it's 396 00:21:45.680 --> 00:21:50.119 also true that it's not anywhere near like one hundred percent, 397 00:21:50.240 --> 00:21:54.320 And in fact, because there are again are treatments higher 398 00:21:54.359 --> 00:21:59.280 doses of potocin after a birth that can lock up 399 00:21:59.320 --> 00:22:02.920 the uterus that's not a technical term, but can can 400 00:22:03.080 --> 00:22:06.639 sort of reduce the risk of bleeding. That's something that 401 00:22:06.680 --> 00:22:08.520