WEBVTT - Ep 171 Pregnancy: Act 4

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<v Speaker 1>We want to start with a disclaimer that throughout this

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<v Speaker 1>series we feature explanations and stories that include some heavy material,

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<v Speaker 1>including early pregnancy, loss, still birth, and other traumatic experiences

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<v Speaker 1>of pregnancy, childbirth, and the postpartum period.

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<v Speaker 2>There's a lot I could say about the physical difficulty

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<v Speaker 2>of carrying a baby, that I'm going to focus on

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<v Speaker 2>the postpartum because that was what was most surprising and

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<v Speaker 2>unsettling to me throughout my pregnancy. I always expected that

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<v Speaker 2>I would start kind of falling in love with the baby,

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<v Speaker 2>like I always heard people saying, I'm already so in

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<v Speaker 2>love with you, all those you know, social media posts

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<v Speaker 2>and what people are talking about, and I never really

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<v Speaker 2>felt an attachment. But I was especially promised that when

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<v Speaker 2>you give birth, it's the happiest day of your life.

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<v Speaker 2>You look down at the baby and you love them

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<v Speaker 2>instantly more than it's a different love than you've ever

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<v Speaker 2>experienced before. And so after, you know, three days of

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<v Speaker 2>pre labor and then fifteen hours of labor, I gave

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<v Speaker 2>birth and the baby was put on my chest and

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<v Speaker 2>I just felt this kind of heartbreaking missed step feeling

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<v Speaker 2>because it felt the same as it always had. There

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<v Speaker 2>was no immediate love. There was a baby on my

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<v Speaker 2>chest and that was it. And then in the hospital

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<v Speaker 2>I kind of was feeling like I had no idea

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<v Speaker 2>how to take care of this baby. There was kind

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<v Speaker 2>of this helplessness. I couldn't feed it, he wasn't latching.

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<v Speaker 2>I could hardly stand myself, like I needed help getting

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<v Speaker 2>to the bathroom. I couldn't sit up, I didn't change

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<v Speaker 2>into clothes. I just felt like very sick. And when

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<v Speaker 2>the nurse came with the wheelchair and was going to

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<v Speaker 2>wheel us out, I was like, how the heck am

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<v Speaker 2>I going to go home and take care of this baby.

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<v Speaker 2>I have no idea and I don't even love it.

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<v Speaker 2>Does anyone know around me that I don't love this

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<v Speaker 2>baby and that I don't know how to take care

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<v Speaker 2>of it? And my husband drove us home and I

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<v Speaker 2>walked into the house and it was even Actually, when

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<v Speaker 2>we pulled into the garage, there was this immediate sense

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<v Speaker 2>of everything around me looks different than it did, nothing

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<v Speaker 2>looks familiar. It's like we drove into this kind of

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<v Speaker 2>parallel universe that I'd never lived in before, and it

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<v Speaker 2>was very unsettling. And my parents were there and everyone

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<v Speaker 2>was so happy, and I was like, something feels so

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<v Speaker 2>off to me. And then my husband went to take

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<v Speaker 2>the dog for a walk because we'd been gone for

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<v Speaker 2>three days, and I felt a panic inside me, and

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<v Speaker 2>I left the baby with my parents and I went

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<v Speaker 2>into my bedroom and I cried because I didn't want

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<v Speaker 2>to be without my husband. He was the only person

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<v Speaker 2>who knew what I'd been through the last three days.

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<v Speaker 2>So then I had this kind of like vague feeling

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<v Speaker 2>of desolation for a long time, and I would cry

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<v Speaker 2>for hours at a time at night, and I just

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<v Speaker 2>kind of I'd never really felt happy. I was always

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<v Speaker 2>just kind of leaning towards depression, I guess, and I'd

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<v Speaker 2>never experienced depression before, so I didn't recognize it. It

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<v Speaker 2>just felt like homesickness, like this nagging sense of homesickness

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<v Speaker 2>that intensified or dulled but never went away. And the

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<v Speaker 2>scariest part was when my in laws visited and my

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<v Speaker 2>parents also visited, and they were taking turns carrying the

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<v Speaker 2>babe all day and when they finally when they gave

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<v Speaker 2>him back to me after maybe an hour, I looked

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<v Speaker 2>down and I didn't recognize my baby, and it could

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<v Speaker 2>have been any baby I had. I had had him

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<v Speaker 2>for two weeks. He was two weeks old, and I

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<v Speaker 2>didn't know who he was. It could have been they

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<v Speaker 2>could have swapped him out and I would have had

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<v Speaker 2>no idea, and I started sobbing. I told my husband

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<v Speaker 2>right away, and he googled mother can't recognize baby. And

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<v Speaker 2>I watched him google that, and it was so heartbreaking.

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<v Speaker 2>And I came up with this kind of soothing exercise

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<v Speaker 2>where because my son's face didn't look familiar to me,

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<v Speaker 2>I kind of broke it down into pieces and I

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<v Speaker 2>would say, like, there's his mouth, there's his eyes, there's

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<v Speaker 2>his nose, there's his ears, and I would memorize them

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<v Speaker 2>in pieces, and from then on, whenever I held him,

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<v Speaker 2>I would go over and recognize each of those small

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<v Speaker 2>pieces until they looked familiar to me. To this day,

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<v Speaker 2>I don't know if it was like mild psychosis or depression.

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<v Speaker 2>By the time I went to the doctor six weeks later,

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<v Speaker 2>it had I mean, I was still sad and should

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<v Speaker 2>have been treated with depression, but it wasn't so startling

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<v Speaker 2>that the doctors picked up on it. And I didn't

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<v Speaker 2>know how to report it myself because I didn't know

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<v Speaker 2>what to recognize. I wish that I had seen a

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<v Speaker 2>doctor a way earlier. It wasn't required and I didn't

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<v Speaker 2>know to ask for it, and I wish that I

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<v Speaker 2>had been treated because that dull sadness probably stuck around

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<v Speaker 2>for six months, and if there had been earlier intervention,

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<v Speaker 2>I think I would have had a much more enjoyable

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<v Speaker 2>early motherhood experience. I also told my husband that I

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<v Speaker 2>didn't love the baby as much as I loved him,

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<v Speaker 2>and that that seemed wrong to me, and he assured

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<v Speaker 2>me that I'd known my husband for ten years, so

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<v Speaker 2>it kind of made sense that I would love him

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<v Speaker 2>more than somebody that i'd only known for two weeks.

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<v Speaker 2>It probably took a year for me until I had

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<v Speaker 2>the solid bond that I was expecting to have right away,

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<v Speaker 2>and I wish that other women knew that sometimes it's

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<v Speaker 2>just a bond that has to build as you get

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<v Speaker 2>to know people. And now my son is six, and

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<v Speaker 2>I couldn't possibly love him more.

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<v Speaker 1>It has been so incredible to hear everyone's stories, and

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<v Speaker 1>we really can't thank everyone enough for sharing your stories

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<v Speaker 1>with us. We read hundreds of first hand accounts and

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<v Speaker 1>it truly is such an honor and it feels so

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<v Speaker 1>I can't. It feels surreal. Yeah, it's amazing. So thank

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<v Speaker 1>you to each and every one of you who wrote

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<v Speaker 1>in and who shared your stories.

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<v Speaker 3>Yeah.

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<v Speaker 4>We tried so hard to include as many different stories

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<v Speaker 4>from as many different perspectives and experiences of pregnancy and

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<v Speaker 4>childbirth and the postpartum period as we could, and we

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<v Speaker 4>know that as many as we included, there's so many

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<v Speaker 4>that we didn't and we just want to thank you

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<v Speaker 4>all again from the bottom of our hearts.

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<v Speaker 5>We really really appreciate it.

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<v Speaker 4>It means it means the world to us, and this

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<v Speaker 4>podcast would not be the same without all of you.

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<v Speaker 1>Absolutely not. Yeah, it has really been. It's such an

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<v Speaker 1>integral part. It's it's amazing.

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<v Speaker 6>It is.

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<v Speaker 3>Yeah.

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<v Speaker 1>Hi, I'm Aaron Welsh.

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<v Speaker 3>And I'm Erin Allman.

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<v Speaker 1>Update and this is this podcast will kill you.

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<v Speaker 4>We are coming to you with the fourth and final

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<v Speaker 4>for now episode in our series Pregnancy Now.

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<v Speaker 1>I mean to be continued to continue.

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<v Speaker 5>But this is our season finale.

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<v Speaker 1>That was lovely. Thank you.

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<v Speaker 4>I did a drum even though it was more like

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<v Speaker 4>a trumpet.

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<v Speaker 1>Yeah, No, I liked it. I think it's it was.

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<v Speaker 1>It was a really nice touch.

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<v Speaker 4>It's also our last episode recording in the exactly right studios.

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<v Speaker 4>So thank you guys for having us here. Yes, we're

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<v Speaker 4>having too much fun. We are having too much fun,

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<v Speaker 4>too much fun, No such thing. We're just relaxing. That's

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<v Speaker 4>been the joke all morning. If you listen to the

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<v Speaker 4>first couple episodes, you get it.

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<v Speaker 1>Oh my god. Okay, okay, we still have an intro

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<v Speaker 1>to get there. We do, we do. We have some.

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<v Speaker 4>Things to discuss. If you've listened to the other episodes,

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<v Speaker 4>you've heard these.

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<v Speaker 1>Before, heard this before. Yeah, we want to just sort

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<v Speaker 1>of briefly go through again what we've already covered in

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<v Speaker 1>the first three episodes, what we're going to be covering

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<v Speaker 1>in this episode, talk about some of the language that

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<v Speaker 1>we'll be using, and our goals overall with creating the series.

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<v Speaker 1>And so we decided, like we have said early on,

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<v Speaker 1>to dedicate four episodes to pregnancy for each trimester. Clearly

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<v Speaker 1>not enough to actually cover this huge experience that is pregnancy, childbirth,

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<v Speaker 1>and the postpartum period. Yeah, and so if you are like, hey,

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<v Speaker 1>I really want to hear more about this, I want

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<v Speaker 1>to learn about this aspect, what about this? Send in

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<v Speaker 1>your questions, Send in your topic ideas. We are happy

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<v Speaker 1>to have them. This will not be the last episode

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<v Speaker 1>on anything related to pregnancy now, So, yeah, we've got

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<v Speaker 1>more to go, so much more.

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<v Speaker 4>We know that we haven't answered all of your questions.

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<v Speaker 4>We still have this episode to try, but we definitely

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<v Speaker 4>have not covered every possible experience that a person could

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<v Speaker 4>have during pregnancy, childbirth, and beyond, because pregnancy is such

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<v Speaker 4>an individual experience. So each episode that we have done

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<v Speaker 4>thus far has covered roughly a trimester of pregnancy. So

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<v Speaker 4>in our very first episode we talked about how you

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<v Speaker 4>even know whether or not you're pregnant and what happens

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<v Speaker 4>during early development.

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<v Speaker 1>The second episode, we talked a lot about the placenta,

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<v Speaker 1>what an incredible organ that is, and we also talked

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<v Speaker 1>about the physiological changes and antempal changes that someone experiences

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<v Speaker 1>throughout pregnancy, and we touched on some of the complications

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<v Speaker 1>that can arise.

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<v Speaker 4>Last episode last week, we talked all about the process

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<v Speaker 4>of childbirth itself, Yeah, all the different ways that you

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<v Speaker 4>can do it. Yeah, a little bit about labor and

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<v Speaker 4>modes of delivery, and then the history of the cesareans

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<v Speaker 4>actually about C section, wasn't Julius Caesar y'all no yeah.

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<v Speaker 1>Tune into episode three to find out more. And finally, today,

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<v Speaker 1>our fourth episode, our final episode of the Pregnancy Series

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<v Speaker 1>and our final episode of season seven, will be about

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<v Speaker 1>the concept of the fourth trimester, talking about what changes

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<v Speaker 1>are going on in your body after pregnancy, and we're

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<v Speaker 1>also going to be talking about this big picture of

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<v Speaker 1>how the medicalization of pregnancy and childbirth changed that experience

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<v Speaker 1>and how we moved from home to hospital and some

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<v Speaker 1>of the consequences of that.

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<v Speaker 3>Yes, I'm excited for this episode arin me too.

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<v Speaker 4>We have intended for this Pregnancy Series, as with all

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<v Speaker 4>of our episodes, honestly, to be inclusive of all families,

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<v Speaker 4>and we recognize that not everybody who experiences pregnancy identifies

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<v Speaker 4>as a woman, so we try wherever we can to

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<v Speaker 4>use gender neutral language and discuss pregnant people. At the

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<v Speaker 4>same time, we know that a lot of what we discuss,

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<v Speaker 4>especially when it comes to medical bias during pregnancy and childbirth,

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<v Speaker 4>historically and today, is a result of gender discrimination and racism,

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<v Speaker 4>and so in those context we use the term woman

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<v Speaker 4>or women, and throughout these episodes we also use the

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<v Speaker 4>term mother or maternal and paternal since these are the

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<v Speaker 4>terms that are often used in the scientific and medical literature.

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<v Speaker 1>Yes, and we also want to just you know, recognize

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<v Speaker 1>that there is no such thing as a normal pregnancy.

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<v Speaker 1>There's no This is what is going to happen, and

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<v Speaker 1>this is normal, and that's.

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<v Speaker 5>The only way that it can be, the only way

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<v Speaker 5>there's Differently, you.

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<v Speaker 3>Go gone over that a lot in these episodes.

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<v Speaker 1>But it is really important in discussing, you know, a

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<v Speaker 1>baseline of what is expected to happen, so that we

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<v Speaker 1>can understand what happens when things happen outside of those

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<v Speaker 1>expectations and some of the complications that can happen as

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<v Speaker 1>a result, even defining what a complication is.

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<v Speaker 4>Exactly exactly, And we're going to do that today for

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<v Speaker 4>the postpartum period.

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<v Speaker 1>We are.

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<v Speaker 2>We are.

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<v Speaker 1>But first, if I remembered it, this time, it's quarantine time, Aaron,

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<v Speaker 1>what are we drinking again this week?

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<v Speaker 5>We're drinking yet again, Great expectations.

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<v Speaker 1>Great expectation.

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<v Speaker 5>Which is a plasy burrita that is a non alcoholic bev.

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<v Speaker 1>It's really good. It's got ginger ale, it's got muddled

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<v Speaker 1>blackberries and mint, it's got lemon juice.

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<v Speaker 5>Is shockingly delicious, very refreshing.

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<v Speaker 1>Yeah, super refreshing. I love it. I'm thinking of it

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<v Speaker 1>right now.

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<v Speaker 3>Too, which I actually had one, but alas.

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<v Speaker 1>Later today.

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<v Speaker 4>Yes, if you want to see us make it. We

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<v Speaker 4>made a really fun quarantine video that you can find

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<v Speaker 4>on the YouTube tube tube. We also were very honored

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<v Speaker 4>to be joined by Georgia Hartstark who made us a

0:12:13.400 --> 0:12:17.160
<v Speaker 4>quarantin ye and alcoholic version to go along with these episodes.

0:12:17.200 --> 0:12:18.920
<v Speaker 4>She called it the on teeny.

0:12:18.960 --> 0:12:20.719
<v Speaker 1>The Tenius and it's delicious.

0:12:20.840 --> 0:12:23.960
<v Speaker 5>Yes, and you can find that video on YouTube as well.

0:12:24.080 --> 0:12:27.600
<v Speaker 1>YouTube you can also find I don't know if we

0:12:27.640 --> 0:12:30.239
<v Speaker 1>have said this enough, but you can find these episodes

0:12:30.360 --> 0:12:33.960
<v Speaker 1>on YouTube, these pregnancy episodes, pregnancy episodes with video with

0:12:34.080 --> 0:12:35.000
<v Speaker 1>video and props.

0:12:35.080 --> 0:12:37.079
<v Speaker 5>Well props.

0:12:37.440 --> 0:12:40.800
<v Speaker 1>We're doing great today. And if you would like the

0:12:40.840 --> 0:12:44.920
<v Speaker 1>recipes for these quarantine and place rita for this series,

0:12:45.440 --> 0:12:48.080
<v Speaker 1>check out also our social media make sure you're following

0:12:48.160 --> 0:12:49.800
<v Speaker 1>us or now in Blue Sky. I don't know if

0:12:49.800 --> 0:12:54.120
<v Speaker 1>we've said that sure, And also our website Yes podcast

0:12:54.160 --> 0:12:56.280
<v Speaker 1>will kill You dot com which features do you want

0:12:56.320 --> 0:12:57.040
<v Speaker 1>me to this listen?

0:12:57.160 --> 0:12:58.120
<v Speaker 5>Let's skip it today?

0:12:58.440 --> 0:13:01.440
<v Speaker 1>Okay? Check out our website transcer rips. I just have

0:13:01.520 --> 0:13:07.280
<v Speaker 1>to throw that in Okay, I think more business.

0:13:07.080 --> 0:13:09.240
<v Speaker 4>Rate review and subscribe. We love you, thanks for listening.

0:13:09.320 --> 0:13:11.320
<v Speaker 1>We'll be back soon with a new season. Yeah, and

0:13:11.360 --> 0:13:13.800
<v Speaker 1>we have so like send us your ideas along the way.

0:13:13.840 --> 0:13:17.000
<v Speaker 1>We are so excited to dig more into the world

0:13:17.000 --> 0:13:21.640
<v Speaker 1>of health, medicine, disease biology, evolution, ecology.

0:13:21.800 --> 0:13:24.240
<v Speaker 5>Literally like after we start misology, we.

0:13:24.200 --> 0:13:25.920
<v Speaker 4>Already have a list of things that were like, Okay,

0:13:25.920 --> 0:13:27.640
<v Speaker 4>so next season booo so like.

0:13:27.640 --> 0:13:32.880
<v Speaker 1>Air quality index, yes, thank you, yeah, thank you Kenton. Okay,

0:13:33.720 --> 0:13:34.240
<v Speaker 1>let's begin.

0:13:34.400 --> 0:13:36.000
<v Speaker 5>Let us after a break.

0:13:52.280 --> 0:13:54.040
<v Speaker 7>I found out I was pregnant on New Year's Day

0:13:54.040 --> 0:13:56.240
<v Speaker 7>twenty twenty four. I was thirty three, and this would

0:13:56.280 --> 0:13:59.360
<v Speaker 7>be my second baby. My pregnancy was relatively uneventful and

0:13:59.400 --> 0:14:01.559
<v Speaker 7>actually a little easier than my first, but both were

0:14:01.600 --> 0:14:04.520
<v Speaker 7>low risk. I went into labor naturally at thirty nine

0:14:04.520 --> 0:14:07.000
<v Speaker 7>weeks and went to the hospital to help things along.

0:14:07.040 --> 0:14:09.880
<v Speaker 7>My midwife broke my water manually. I felt a huge

0:14:09.880 --> 0:14:12.600
<v Speaker 7>gush and things really intensified from there. At this point,

0:14:12.600 --> 0:14:14.520
<v Speaker 7>my memory is a little blurry, but I do remember

0:14:14.520 --> 0:14:17.520
<v Speaker 7>feeling more big gushes when I had contractions. I pushed

0:14:17.559 --> 0:14:19.320
<v Speaker 7>her about an hour and then my daughter was born.

0:14:19.720 --> 0:14:21.960
<v Speaker 7>When the midwives went to place around my chest. They

0:14:22.000 --> 0:14:24.560
<v Speaker 7>discovered that the cord was very short. They could only

0:14:24.600 --> 0:14:27.200
<v Speaker 7>set her on my belly under my belly button. I

0:14:27.240 --> 0:14:29.440
<v Speaker 7>asked them to go ahead and cut the cord so

0:14:29.480 --> 0:14:31.880
<v Speaker 7>that I could hold her on my chest instead. I

0:14:31.920 --> 0:14:33.600
<v Speaker 7>got to hold her for maybe a minute and take

0:14:33.640 --> 0:14:36.400
<v Speaker 7>some pictures before things started to go downhill. I was

0:14:36.440 --> 0:14:38.400
<v Speaker 7>trying to nurse her, and then I started to feel

0:14:38.520 --> 0:14:40.760
<v Speaker 7>very weak. I yelled out for someone to take the

0:14:40.800 --> 0:14:43.160
<v Speaker 7>baby because I thought I would drop her. I had

0:14:43.160 --> 0:14:45.640
<v Speaker 7>been distracted, but then I realized I still hadn't delivered

0:14:45.640 --> 0:14:49.040
<v Speaker 7>the placenta. My midwives sprang to action and told me

0:14:49.080 --> 0:14:51.480
<v Speaker 7>we needed to deliver it immediately. As soon as I

0:14:51.520 --> 0:14:54.160
<v Speaker 7>pushed it out, I felt a huge gush. My first

0:14:54.160 --> 0:14:56.320
<v Speaker 7>thought was that it was amniotic fluid, because it felt

0:14:56.320 --> 0:14:58.840
<v Speaker 7>like when my water was broken. But then I realized

0:14:58.840 --> 0:15:00.840
<v Speaker 7>all that fluid had already been do livered with baby,

0:15:00.920 --> 0:15:03.440
<v Speaker 7>and I said, was that blood. I looked at the

0:15:03.440 --> 0:15:05.480
<v Speaker 7>midwife who had been standing between my legs, and she

0:15:05.520 --> 0:15:07.720
<v Speaker 7>was splattered with blood head to toe, like she'd been

0:15:07.760 --> 0:15:11.480
<v Speaker 7>sprayed with a hose. From there, everything was chaos. All

0:15:11.520 --> 0:15:12.920
<v Speaker 7>of a sudden, there were a lot of people in

0:15:12.960 --> 0:15:15.760
<v Speaker 7>the room. The midwives were vigorously massaging my belly, but

0:15:15.800 --> 0:15:18.800
<v Speaker 7>my uterus wasn't contracting and I was bleeding out. I

0:15:18.880 --> 0:15:21.440
<v Speaker 7>was given multiple drugs via different routes at the same time.

0:15:21.880 --> 0:15:24.400
<v Speaker 7>One of these was cide attack, also known as misiposal.

0:15:24.920 --> 0:15:26.600
<v Speaker 7>This drug is talked about a lot as it is

0:15:26.640 --> 0:15:29.000
<v Speaker 7>the second step in a medication abortion, but it is

0:15:29.000 --> 0:15:31.760
<v Speaker 7>also used to help stop postpartum hemorrhage in labor and delivery.

0:15:32.520 --> 0:15:35.120
<v Speaker 7>The hospital ob and my midwives were working frantically on

0:15:35.200 --> 0:15:37.480
<v Speaker 7>me for about an hour to try to stop the bleeding.

0:15:38.120 --> 0:15:40.160
<v Speaker 7>Oh my husband was doing skinned to skin with the baby.

0:15:40.720 --> 0:15:42.840
<v Speaker 7>I remember thinking that my great grandmother had died from

0:15:42.840 --> 0:15:45.720
<v Speaker 7>a postpartum hemorrhage. I asked one of the nurses if

0:15:45.760 --> 0:15:48.040
<v Speaker 7>I was going to be okay, and all she said was,

0:15:48.160 --> 0:15:50.840
<v Speaker 7>we are doing everything we can. They tried using an

0:15:50.840 --> 0:15:54.920
<v Speaker 7>intrauterine balloon device to apply pressure from within. Unfortunately it

0:15:54.960 --> 0:15:57.840
<v Speaker 7>got clogged with clots and didn't work for me. Staff

0:15:57.880 --> 0:15:59.720
<v Speaker 7>was scooping up blood and clots off of the bed

0:15:59.760 --> 0:16:03.280
<v Speaker 7>and and weighing it to see how much I lost. Ultimately,

0:16:03.280 --> 0:16:05.240
<v Speaker 7>they said I lost about two to three leaders and

0:16:05.280 --> 0:16:08.680
<v Speaker 7>I was given two leaders via transfusion. Eventually, my uterists

0:16:08.680 --> 0:16:10.880
<v Speaker 7>did contract and they were able to stitch me up.

0:16:11.440 --> 0:16:13.240
<v Speaker 7>The other day, I was looking back at those photos

0:16:13.280 --> 0:16:15.280
<v Speaker 7>when I was holding my baby, and I can see

0:16:15.320 --> 0:16:17.160
<v Speaker 7>that my face has a weird gray cast to it.

0:16:17.560 --> 0:16:19.480
<v Speaker 7>I'm so glad that I delivered in a hospital that

0:16:19.520 --> 0:16:22.440
<v Speaker 7>had all of the best medications and resources available to

0:16:22.440 --> 0:16:24.720
<v Speaker 7>stop the hemorrhage. If I hadn't, the outcome could have

0:16:24.760 --> 0:16:25.440
<v Speaker 7>been very different.

0:16:27.000 --> 0:16:29.920
<v Speaker 6>My name is Dawn and I live in Texas. In

0:16:29.960 --> 0:16:32.840
<v Speaker 6>my mid thirties, I became pregnant with my second child.

0:16:33.160 --> 0:16:35.720
<v Speaker 6>My then husband and I were thrilled after having such

0:16:35.800 --> 0:16:39.280
<v Speaker 6>joy from our first one. At my first prenatal appointment,

0:16:39.400 --> 0:16:42.240
<v Speaker 6>everything seemed fine, my bottles were good, and we were

0:16:42.240 --> 0:16:46.280
<v Speaker 6>able to detect a heartbeat. Since my first pregnancy was uneventful,

0:16:46.440 --> 0:16:49.400
<v Speaker 6>I assumed this one would be similar. One thing that

0:16:49.520 --> 0:16:52.720
<v Speaker 6>was very different about this pregnancy was a nausea. Although

0:16:52.760 --> 0:16:55.600
<v Speaker 6>I had had nausea with my first pregnancy, this one

0:16:55.720 --> 0:16:58.720
<v Speaker 6>was much more intense. I felt awful most of the

0:16:58.760 --> 0:17:02.120
<v Speaker 6>time and struggle to do normal things. Nothing seemed to help.

0:17:03.000 --> 0:17:06.439
<v Speaker 6>At my second prenatal appointment, the midwife was unable to

0:17:06.520 --> 0:17:10.119
<v Speaker 6>detect a heartbeat. She did an in office ultrasound and

0:17:10.200 --> 0:17:13.719
<v Speaker 6>confirmed the fetus was no longer alive. I don't believe

0:17:13.840 --> 0:17:17.760
<v Speaker 6>any other information was gleaned from the ultrasound. My midwife

0:17:17.840 --> 0:17:20.840
<v Speaker 6>suggested that I have a DNC soon. We were, of

0:17:20.880 --> 0:17:25.200
<v Speaker 6>course devastated to have lost a baby. Shortly after the DNC,

0:17:25.440 --> 0:17:27.800
<v Speaker 6>the midwife contacted me and asked me to come back

0:17:27.800 --> 0:17:30.639
<v Speaker 6>into the office. In the appointment, she told me that

0:17:30.720 --> 0:17:34.320
<v Speaker 6>pathology done on the placenta or fetal tissue had come

0:17:34.400 --> 0:17:37.480
<v Speaker 6>back with some concerning results, which was that I had

0:17:37.520 --> 0:17:42.000
<v Speaker 6>had a molar pregnancy. I had never heard of this diagnosis.

0:17:42.440 --> 0:17:44.080
<v Speaker 6>She told me that I would need to come in

0:17:44.119 --> 0:17:47.520
<v Speaker 6>for regular blood testing to be sure pregnancy hormone levels

0:17:47.600 --> 0:17:52.399
<v Speaker 6>in my blood were steadily decreasing. After the appointment, I

0:17:52.440 --> 0:17:55.040
<v Speaker 6>talked to my aunt, who was an OBGI in nurse.

0:17:55.600 --> 0:17:57.919
<v Speaker 6>She gave me the highlights of a molar pregnancy, and

0:17:58.040 --> 0:18:00.280
<v Speaker 6>of course I googled on my own. After time talking

0:18:00.320 --> 0:18:04.320
<v Speaker 6>to my aunt, my basic understanding was that amolar pregnancy

0:18:04.560 --> 0:18:08.600
<v Speaker 6>is an unusual, non viable pregnancy that can sometimes develop

0:18:08.640 --> 0:18:12.240
<v Speaker 6>into cancer if all the abnormal cells are not removed.

0:18:12.960 --> 0:18:15.880
<v Speaker 6>Years afterwards, my aunt told me she was very concerned

0:18:15.880 --> 0:18:19.639
<v Speaker 6>for me. While the intense nausea remained for a few weeks.

0:18:19.640 --> 0:18:24.040
<v Speaker 6>After the DNC, my pregnancy hormone levels did steadily decline,

0:18:24.119 --> 0:18:27.159
<v Speaker 6>and after some time I was fortunate to have a

0:18:27.200 --> 0:18:30.760
<v Speaker 6>third pregnancy that resulted in a healthy baby boy. Since

0:18:30.800 --> 0:18:33.040
<v Speaker 6>I live in Texas, I do want to mention that

0:18:33.240 --> 0:18:36.640
<v Speaker 6>I'm not sure if the DNC my midwife recommended would

0:18:36.640 --> 0:19:04.320
<v Speaker 6>be possible now with the unprecedented removal of women's reproductive rights.

0:19:08.240 --> 0:19:11.560
<v Speaker 1>Last week, I took us through the history of cesarean sections,

0:19:11.640 --> 0:19:14.800
<v Speaker 1>a procedure that has been used in some capacity since

0:19:14.840 --> 0:19:18.440
<v Speaker 1>at least ancient times, but one that physicians weren't able

0:19:18.480 --> 0:19:23.160
<v Speaker 1>to widely utilize until the twentieth century, when antibiotics, antisepsis, transfusions,

0:19:23.200 --> 0:19:26.280
<v Speaker 1>and surgical technique transformed it from an almost certain death

0:19:26.320 --> 0:19:30.000
<v Speaker 1>sentence to a life saving tool, and we discussed how

0:19:30.040 --> 0:19:32.960
<v Speaker 1>the high rates of sea sections have led people to

0:19:33.040 --> 0:19:36.080
<v Speaker 1>question whether the surgery, life saving though it may be,

0:19:36.840 --> 0:19:42.080
<v Speaker 1>is overused and what possible consequences might arise as a results. So,

0:19:42.200 --> 0:19:46.040
<v Speaker 1>for many, high rates of sea sections represent sort of

0:19:46.040 --> 0:19:49.520
<v Speaker 1>this dark side of the medicalization of pregnancy. And childbirth

0:19:49.600 --> 0:19:54.080
<v Speaker 1>where medical intervention is seen as always necessary and women

0:19:54.119 --> 0:19:59.879
<v Speaker 1>aren't trusted to give birth. This, of course, is no

0:20:00.320 --> 0:20:04.720
<v Speaker 1>the complete picture, because ultimately, as childbirth moved from the

0:20:04.760 --> 0:20:09.720
<v Speaker 1>home to hospitals, rates of maternal and perinatal mortality declined

0:20:09.880 --> 0:20:13.399
<v Speaker 1>as medicine developed methods to manage the complications that in

0:20:13.480 --> 0:20:18.199
<v Speaker 1>previous centuries may have resulted in tragedy. But this rosy

0:20:18.280 --> 0:20:22.240
<v Speaker 1>picture of modern medicine marching onwards with doctors saving the

0:20:22.320 --> 0:20:26.119
<v Speaker 1>day that really fails to capture the inevitable and often

0:20:26.240 --> 0:20:30.640
<v Speaker 1>overlooked cost of progress. What did we leave behind when

0:20:30.680 --> 0:20:33.959
<v Speaker 1>we moved from the home to the hospital. So today

0:20:34.400 --> 0:20:36.720
<v Speaker 1>I want to take this big picture view of how

0:20:36.840 --> 0:20:40.480
<v Speaker 1>childbirth has changed over the centuries, exploring some of the

0:20:40.480 --> 0:20:44.920
<v Speaker 1>factors that have underlaid those changes, and ultimately I want

0:20:44.960 --> 0:20:48.119
<v Speaker 1>to kind of just think about this question of how

0:20:48.200 --> 0:20:51.680
<v Speaker 1>can we use the past to ensure a better future.

0:20:52.800 --> 0:20:54.560
<v Speaker 1>Before I dig in, I want to shout out a

0:20:54.560 --> 0:20:56.280
<v Speaker 1>few of the major sources that I used to put

0:20:56.280 --> 0:20:58.639
<v Speaker 1>this together. There was a book called Brought to Bed

0:20:58.760 --> 0:21:02.280
<v Speaker 1>by Judith Walser Levitt about childbirth in America from seventeen

0:21:02.359 --> 0:21:05.760
<v Speaker 1>fifty to nineteen fifty. The title sounds somewhat dry. It

0:21:05.800 --> 0:21:08.600
<v Speaker 1>is one of the most fascinating books I have ever read,

0:21:08.920 --> 0:21:13.280
<v Speaker 1>very enlightening. The book A Midwife's Tale by Laurel Thatcher Ulrich,

0:21:13.359 --> 0:21:15.919
<v Speaker 1>which is so good. Oh my gosh, this is the

0:21:15.960 --> 0:21:20.400
<v Speaker 1>excellent history book about the life of midwife Martha Ballard snippets.

0:21:20.440 --> 0:21:23.520
<v Speaker 1>It's such I love this book. I could talk about

0:21:23.520 --> 0:21:26.560
<v Speaker 1>this forever. But the way that it approaches history is

0:21:26.720 --> 0:21:29.399
<v Speaker 1>fascinating because it takes like, here's a segment, here's a

0:21:29.440 --> 0:21:32.680
<v Speaker 1>month in her life. Now let's think about marriage laws

0:21:32.680 --> 0:21:36.000
<v Speaker 1>in Massachusetts or not in Massachusetts, in Maine the late

0:21:36.000 --> 0:21:37.400
<v Speaker 1>seventeen hundred, so like all the.

0:21:37.320 --> 0:21:39.119
<v Speaker 5>Context of what was happenings.

0:21:39.200 --> 0:21:40.280
<v Speaker 3>Oh, how interesting.

0:21:40.520 --> 0:21:42.560
<v Speaker 1>It's so good not to mention like the aspects of

0:21:42.840 --> 0:21:46.719
<v Speaker 1>midwiffery and childbirth and so on. Okay, another book is

0:21:47.160 --> 0:21:49.280
<v Speaker 1>I use snippets of a book called The Midwife Said

0:21:49.320 --> 0:21:51.600
<v Speaker 1>fear Not just about the history of midwiffery in the

0:21:51.720 --> 0:21:55.400
<v Speaker 1>US up through today. That one is by Helen Varney

0:21:55.440 --> 0:21:58.919
<v Speaker 1>and Joyce bb Thompson. And then finally there's a book

0:21:59.080 --> 0:22:02.280
<v Speaker 1>Blue by Rachel Moran. Not our not our friend friend

0:22:02.359 --> 0:22:05.439
<v Speaker 1>Rachel Moriann, but a different Rachel Moran about the history

0:22:05.480 --> 0:22:08.600
<v Speaker 1>of postpartum depression in the US. So you can probably

0:22:08.600 --> 0:22:10.720
<v Speaker 1>tell based on these titles that this history section is

0:22:11.000 --> 0:22:13.320
<v Speaker 1>mostly going to be primarily focused on the US.

0:22:13.680 --> 0:22:13.760
<v Speaker 8>It.

0:22:14.040 --> 0:22:18.520
<v Speaker 1>Yeah, there is no origin story for midwives. Their existence

0:22:18.600 --> 0:22:23.080
<v Speaker 1>probably predates written history, and assistance during childbirth may even

0:22:23.119 --> 0:22:25.240
<v Speaker 1>be a key part of human evolution. As we kind

0:22:25.240 --> 0:22:30.159
<v Speaker 1>of talked about, the word midwife means with women, and

0:22:30.320 --> 0:22:33.440
<v Speaker 1>over the centuries and across the globe, midwives have taken

0:22:33.480 --> 0:22:38.040
<v Speaker 1>on various roles that have held different meanings wise women

0:22:38.480 --> 0:22:42.399
<v Speaker 1>all around, healer, which to the haters, and so on,

0:22:42.960 --> 0:22:45.280
<v Speaker 1>but there have been a few constants that have persisted.

0:22:46.000 --> 0:22:50.879
<v Speaker 1>Midwife care often focuses specifically on women, that training often

0:22:51.000 --> 0:22:56.560
<v Speaker 1>involves models of apprenticeship, that scientific knowledge is incorporated into practice,

0:22:57.080 --> 0:23:01.240
<v Speaker 1>and that pregnancy and birth are considered normal life events.

0:23:02.040 --> 0:23:04.520
<v Speaker 1>This is not a history of midwives. I won't be

0:23:04.560 --> 0:23:07.879
<v Speaker 1>talking about like the profession today, but it is a

0:23:07.960 --> 0:23:12.520
<v Speaker 1>history of childbirth, and the two are of course inextricably linked.

0:23:12.880 --> 0:23:15.600
<v Speaker 1>In the early years of the US, childbirth was at home,

0:23:15.760 --> 0:23:20.639
<v Speaker 1>most commonly attended by midwives, then by midwives with occasional

0:23:20.720 --> 0:23:24.480
<v Speaker 1>visits from physicians, then by physicians with a woman's friends

0:23:24.480 --> 0:23:28.000
<v Speaker 1>and family in attendance, and then in hospitals with no

0:23:28.119 --> 0:23:32.360
<v Speaker 1>familiar faces. Husbands weren't even allowed in the hospital room

0:23:32.720 --> 0:23:35.760
<v Speaker 1>until the nineteen sixties like the late nineteen sixties and

0:23:35.840 --> 0:23:37.560
<v Speaker 1>non spouses way later.

0:23:37.920 --> 0:23:39.920
<v Speaker 3>Wow. Very interesting.

0:23:40.359 --> 0:23:43.879
<v Speaker 1>Yeah, the transition from home to hospital and from midwife

0:23:43.920 --> 0:23:47.520
<v Speaker 1>to physician was not uniform across the US. Immigrants, the

0:23:47.600 --> 0:23:50.240
<v Speaker 1>less wealthy, non white women, and those living in rural

0:23:50.280 --> 0:23:54.040
<v Speaker 1>areas gave birth at home for much longer than wealthier individuals.

0:23:54.520 --> 0:23:57.040
<v Speaker 1>And so, to give you some idea of this timeline,

0:23:57.119 --> 0:24:00.720
<v Speaker 1>in nineteen ten, about fifty percent of all babies were

0:24:00.720 --> 0:24:05.080
<v Speaker 1>delivered by midwivesteen ten nineteen ten. By nineteen thirty that

0:24:05.160 --> 0:24:07.159
<v Speaker 1>number had gone down to fifteen percent.

0:24:07.400 --> 0:24:07.840
<v Speaker 3>Wow.

0:24:07.920 --> 0:24:11.240
<v Speaker 1>And by nineteen seventy three about one percent of births

0:24:11.240 --> 0:24:14.399
<v Speaker 1>were attended by a midwife. Wow. And compare that to

0:24:14.440 --> 0:24:16.639
<v Speaker 1>twenty twenty one, which is the most recent one that

0:24:16.720 --> 0:24:18.960
<v Speaker 1>I found. I'm sure there are more recent ones out there.

0:24:19.400 --> 0:24:21.480
<v Speaker 1>Twelve percent. Okay, we're attended.

0:24:21.119 --> 0:24:22.439
<v Speaker 4>By So we went all the way down and then

0:24:22.440 --> 0:24:24.640
<v Speaker 4>a little bit back and back up. I will say

0:24:24.640 --> 0:24:26.359
<v Speaker 4>that I know this is US centric but that is

0:24:26.480 --> 0:24:29.600
<v Speaker 4>very different than the data today for most other high

0:24:29.640 --> 0:24:30.560
<v Speaker 4>income countries even.

0:24:30.800 --> 0:24:33.199
<v Speaker 1>Yes, yes, and that is part that is wrapped up

0:24:33.200 --> 0:24:40.080
<v Speaker 1>in the history of how the US treated midwives, specifically laws. Yeah, yeah,

0:24:40.119 --> 0:24:43.320
<v Speaker 1>the transition from home to hospital. This did not happen overnight,

0:24:43.800 --> 0:24:47.879
<v Speaker 1>nor was it simply a hostel takeover by physicians, as

0:24:48.000 --> 0:24:51.159
<v Speaker 1>Levitt puts it in brought to bed. The process by

0:24:51.200 --> 0:24:54.919
<v Speaker 1>which this occurred reflected the needs women felt to upgrade

0:24:55.000 --> 0:24:58.239
<v Speaker 1>and to control their birthing experiences, as well as the

0:24:58.280 --> 0:25:03.000
<v Speaker 1>increasing medical management of birth. What I really really appreciate

0:25:03.080 --> 0:25:05.040
<v Speaker 1>about this quote is what I feel like so many

0:25:05.080 --> 0:25:09.040
<v Speaker 1>histories of childbirth leave out that birthing women were and

0:25:09.320 --> 0:25:13.120
<v Speaker 1>are agents of change. They were not just passive bystanders

0:25:13.160 --> 0:25:16.720
<v Speaker 1>of the medical and legal attacks on midwifery. They held

0:25:16.760 --> 0:25:19.800
<v Speaker 1>the power to say what they wanted their childbirth to

0:25:19.840 --> 0:25:24.120
<v Speaker 1>be like. Until hospitals became the default place to give birth,

0:25:24.200 --> 0:25:27.840
<v Speaker 1>women often chose who would be there to help, to support,

0:25:27.880 --> 0:25:30.600
<v Speaker 1>to make decisions when she could not, and the people

0:25:30.680 --> 0:25:34.120
<v Speaker 1>she chose were often midwives and her female friends and family.

0:25:34.920 --> 0:25:37.919
<v Speaker 1>It was like a birthing network rather than just like

0:25:38.000 --> 0:25:42.240
<v Speaker 1>here's the hospital staff and as obstetrics became a more

0:25:42.240 --> 0:25:45.000
<v Speaker 1>common part of medical training. Many women opted to bring

0:25:45.080 --> 0:25:49.840
<v Speaker 1>a physician into that network, believing that his professionalism, his tools,

0:25:49.880 --> 0:25:53.240
<v Speaker 1>and his expertise would ensure the safety of mother and baby.

0:25:53.640 --> 0:25:57.840
<v Speaker 1>And I say his because that was almost universally the case. Yep, yep.

0:25:58.040 --> 0:26:01.760
<v Speaker 1>In nineteen hundred, only six of doctors in the US

0:26:01.840 --> 0:26:02.280
<v Speaker 1>were women.

0:26:02.440 --> 0:26:04.399
<v Speaker 3>I'm actually surprised it was that high.

0:26:04.480 --> 0:26:06.960
<v Speaker 1>I know, I know. I mean. The other thing, the

0:26:07.000 --> 0:26:09.399
<v Speaker 1>other caveat to that is that, yes, there were six percent,

0:26:09.480 --> 0:26:12.400
<v Speaker 1>but they had very few patients because most people didn't

0:26:12.400 --> 0:26:15.320
<v Speaker 1>want to see them, but they were elected like a

0:26:15.320 --> 0:26:19.240
<v Speaker 1>lot of women who were giving birth wanted a female doctor.

0:26:19.320 --> 0:26:20.560
<v Speaker 3>Okay, interesting then back then.

0:26:20.640 --> 0:26:24.360
<v Speaker 1>Yeah, And of course most medical schools banned women and

0:26:24.600 --> 0:26:29.480
<v Speaker 1>non white men from applying. What led to women choosing

0:26:29.560 --> 0:26:33.119
<v Speaker 1>physicians and hospitals for childbirth is wrapped up in the

0:26:33.160 --> 0:26:39.480
<v Speaker 1>professionalization of medicine and active campaigns against midwiffery. Midwives were

0:26:39.480 --> 0:26:42.919
<v Speaker 1>portrayed as lacking the training in medical expertise to safely

0:26:42.960 --> 0:26:47.159
<v Speaker 1>deliver babies, while also being explicitly forbidden to seek that

0:26:47.280 --> 0:26:49.000
<v Speaker 1>training and medical expertise.

0:26:49.119 --> 0:26:50.960
<v Speaker 3>Wow, yeah, okay, and.

0:26:50.960 --> 0:26:53.800
<v Speaker 1>Women wanting to make the safest decision for themselves and

0:26:53.840 --> 0:26:57.159
<v Speaker 1>their baby broaden male physicians believing that they would provide

0:26:57.200 --> 0:27:00.879
<v Speaker 1>protection from the dangers of childbirth, which there were many. Yeah,

0:27:01.160 --> 0:27:03.080
<v Speaker 1>all right, so now that we've got the big picture

0:27:03.119 --> 0:27:05.200
<v Speaker 1>of view, let's dig a bit deeper to see how

0:27:05.240 --> 0:27:09.439
<v Speaker 1>this all went down. We as a society have a

0:27:09.480 --> 0:27:13.280
<v Speaker 1>tendency to romanticize certain aspects of the past, like how

0:27:13.359 --> 0:27:16.159
<v Speaker 1>much better food must have tasted it didn't.

0:27:17.000 --> 0:27:18.320
<v Speaker 3>I feel like I've never thought of that.

0:27:18.560 --> 0:27:22.880
<v Speaker 1>Oh yeah, absolutely. And they also though see our book

0:27:22.960 --> 0:27:25.040
<v Speaker 1>Club episode on the poison Squad, like there is a

0:27:25.080 --> 0:27:28.480
<v Speaker 1>reason that pasteurization is hailed as one of the most

0:27:28.520 --> 0:27:33.560
<v Speaker 1>life saving inventions. Yes, and I think that this romanticization

0:27:33.880 --> 0:27:37.679
<v Speaker 1>happens to a certain degree also with pregnancy and childbirth.

0:27:38.320 --> 0:27:42.520
<v Speaker 1>A call for less medical intervention is understandable, especially when

0:27:42.560 --> 0:27:46.800
<v Speaker 1>you consider how early medical interventions during childbirth often caused

0:27:46.840 --> 0:27:50.600
<v Speaker 1>more harm than good. But it also fails to acknowledge

0:27:50.840 --> 0:27:54.760
<v Speaker 1>that childbirth can be dangerous. And no, it is not

0:27:54.800 --> 0:27:57.320
<v Speaker 1>a disease, and it's not an unnatural state of being,

0:27:57.359 --> 0:28:00.080
<v Speaker 1>as early twentieth century physicians believed, but it is a

0:28:00.080 --> 0:28:04.280
<v Speaker 1>physically demanding experience with potential impact on both mother and

0:28:04.359 --> 0:28:08.680
<v Speaker 1>babies life and health. Although I really I did find

0:28:08.680 --> 0:28:12.680
<v Speaker 1>it interesting that in that Diary of a Midwife Life,

0:28:12.800 --> 0:28:16.159
<v Speaker 1>the Martha Ballard, she called like when a woman was

0:28:16.160 --> 0:28:19.480
<v Speaker 1>starting labor, she called it her illness is beginning, which

0:28:19.520 --> 0:28:21.440
<v Speaker 1>I think is very fascinating.

0:28:21.440 --> 0:28:23.199
<v Speaker 4>It was like the pregnancy was not the illness, but

0:28:23.240 --> 0:28:25.480
<v Speaker 4>the delivery.

0:28:24.600 --> 0:28:27.159
<v Speaker 1>The laborers you're at, which maybe just shows how she

0:28:27.280 --> 0:28:29.399
<v Speaker 1>saw it as like this is a potential where like

0:28:29.560 --> 0:28:33.199
<v Speaker 1>there is a lot of attention thats needed here, right right? Yeah.

0:28:33.400 --> 0:28:36.359
<v Speaker 1>Imagining the women of the seventeen hundreds giving birth with

0:28:36.520 --> 0:28:40.040
<v Speaker 1>no fear, as relaxed as could be, is erasing the

0:28:40.120 --> 0:28:43.400
<v Speaker 1>experience of so many who approached their labors with dread

0:28:43.400 --> 0:28:47.080
<v Speaker 1>and apprehension. In the early eighteen hundreds, women in the

0:28:47.200 --> 0:28:50.480
<v Speaker 1>US had an average of seven children. That the number

0:28:50.520 --> 0:28:56.160
<v Speaker 1>of pregnancies was probably higher, yes, because that doesn't include miscarriage, stir.

0:28:57.360 --> 0:29:01.840
<v Speaker 1>Many women spent the majority of their adult lives pregnant, breastfading,

0:29:02.040 --> 0:29:06.280
<v Speaker 1>recovering from childbirth, and taking care of small children. A

0:29:06.320 --> 0:29:09.400
<v Speaker 1>baby every two or three years was kind of expected,

0:29:09.480 --> 0:29:12.440
<v Speaker 1>a routine part of life, but that didn't mean that

0:29:12.480 --> 0:29:17.760
<v Speaker 1>women necessarily looked towards childbirth without anxiety. It wasn't just

0:29:17.800 --> 0:29:20.080
<v Speaker 1>the loss of a child, the potential loss of a

0:29:20.160 --> 0:29:22.760
<v Speaker 1>child that weighed on them. It was the physical act

0:29:22.840 --> 0:29:25.680
<v Speaker 1>of childbirth that carried with it the threat of death.

0:29:26.680 --> 0:29:29.520
<v Speaker 1>Diary entries and letters written in the eighteen hundreds give

0:29:29.600 --> 0:29:33.240
<v Speaker 1>us a glimpse into these worries, as women wrote wills

0:29:33.440 --> 0:29:36.120
<v Speaker 1>or gave instructions on who should care for the baby

0:29:36.200 --> 0:29:37.080
<v Speaker 1>if she died.

0:29:37.920 --> 0:29:38.680
<v Speaker 3>This hurts my heart.

0:29:39.000 --> 0:29:41.120
<v Speaker 1>I know, I know, I'm sorry, but I feel like

0:29:41.200 --> 0:29:43.920
<v Speaker 1>it's such a part that we don't think that much about,

0:29:44.000 --> 0:29:45.760
<v Speaker 1>or at least I don't. Maybe that's just putting my

0:29:45.800 --> 0:29:47.280
<v Speaker 1>own No, I.

0:29:47.200 --> 0:29:49.400
<v Speaker 4>Do think, especially because I think a lot of what

0:29:49.400 --> 0:29:51.920
<v Speaker 4>you're talking about already is like we see and we

0:29:51.960 --> 0:29:53.800
<v Speaker 4>see this in a lot of aspects of medicine. We

0:29:53.840 --> 0:29:57.040
<v Speaker 4>see these pendulum swings, yes, right, and we see things

0:29:57.080 --> 0:29:59.640
<v Speaker 4>going from like absolutely no intervention, too far, too m

0:30:00.440 --> 0:30:03.120
<v Speaker 4>or like. And it's not just in obstetrics, right, It's

0:30:03.160 --> 0:30:06.480
<v Speaker 4>in so many aspects of medicine. And so I think

0:30:06.520 --> 0:30:08.920
<v Speaker 4>that that we see that playing out a lot of

0:30:09.080 --> 0:30:11.760
<v Speaker 4>especially in like social media right now, where it's like

0:30:12.160 --> 0:30:16.160
<v Speaker 4>there's all the intervention or there's natural childbirth, which we

0:30:16.200 --> 0:30:18.680
<v Speaker 4>talked about last episode of like that that mean that

0:30:18.760 --> 0:30:23.360
<v Speaker 4>word does not have meaning, right, And yeah, I just

0:30:23.400 --> 0:30:25.640
<v Speaker 4>I think that that is such an important part that

0:30:25.840 --> 0:30:28.400
<v Speaker 4>isn't ever discussed when we're talking about like a low

0:30:28.440 --> 0:30:30.320
<v Speaker 4>intervention birth or something like that.

0:30:30.800 --> 0:30:31.800
<v Speaker 3>Yeah that like it.

0:30:31.800 --> 0:30:35.200
<v Speaker 5>Wasn't all roses back in the day.

0:30:35.800 --> 0:30:39.560
<v Speaker 1>Yeah, yeah, So I want to I've pulled a lot

0:30:39.560 --> 0:30:43.000
<v Speaker 1>of these quotes from Brought to Bed because I think

0:30:43.040 --> 0:30:46.000
<v Speaker 1>that there they just illustrate this, like this idea that

0:30:46.080 --> 0:30:49.280
<v Speaker 1>it's not There are many there's a lot of nuance

0:30:49.320 --> 0:30:52.400
<v Speaker 1>to how people felt about their impending you know, pregnancy,

0:30:52.480 --> 0:30:56.120
<v Speaker 1>childbirth and so on. So Lizzie Cabot wrote to her

0:30:56.200 --> 0:30:59.000
<v Speaker 1>sister in the mid eighteen hundreds, I have made my

0:30:59.080 --> 0:31:02.040
<v Speaker 1>will and divided off all my little things and don't

0:31:02.040 --> 0:31:04.040
<v Speaker 1>mean to leave undone what I ought to do if

0:31:04.040 --> 0:31:07.720
<v Speaker 1>I can help it. Sarah Ripley Sterns wrote in her

0:31:07.720 --> 0:31:11.160
<v Speaker 1>diary late in her pregnancy, perhaps this is the last

0:31:11.160 --> 0:31:14.200
<v Speaker 1>time I shall be permitted to join with my earthly friends.

0:31:15.480 --> 0:31:18.680
<v Speaker 1>A woman described her third birth in eighteen eighty five

0:31:19.160 --> 0:31:23.240
<v Speaker 1>between oceans of pain, their stretch, continence of fear, fear,

0:31:23.280 --> 0:31:27.560
<v Speaker 1>of death and dread of suffering beyond bearing. Those who

0:31:27.640 --> 0:31:31.880
<v Speaker 1>attended births, midwives and physicians felt similar apprehension. Like there

0:31:31.920 --> 0:31:34.560
<v Speaker 1>was a physician writing in eighteen seventy who described his

0:31:34.640 --> 0:31:38.480
<v Speaker 1>feelings of alarm and gloomy forebodings after seeing a patient

0:31:38.520 --> 0:31:42.080
<v Speaker 1>die unexpectedly during childbirth. He goes on to write about

0:31:42.120 --> 0:31:45.960
<v Speaker 1>how those feelings stayed with him, making it impossible quote

0:31:46.040 --> 0:31:48.960
<v Speaker 1>while attending a case of confinement to banish the feeling

0:31:49.000 --> 0:31:51.840
<v Speaker 1>of uncertainty and dread as to the results of cases

0:31:51.840 --> 0:31:58.160
<v Speaker 1>which seemingly are terminating unfavorably. Sometimes the dread wasn't isolated

0:31:58.200 --> 0:32:00.600
<v Speaker 1>to the act of childbirth itself, but extended to the

0:32:00.640 --> 0:32:04.560
<v Speaker 1>long period of recovery. Like Agnes Read's letter about her

0:32:04.600 --> 0:32:08.400
<v Speaker 1>second pregnancy, I confess I had dreaded it with a

0:32:08.480 --> 0:32:11.560
<v Speaker 1>dread that every mother must feel in repeating the experience

0:32:11.600 --> 0:32:14.520
<v Speaker 1>of child bearing. I could only think that another birth

0:32:14.560 --> 0:32:18.240
<v Speaker 1>would mean another pitiful struggle of days duration followed by

0:32:18.400 --> 0:32:23.840
<v Speaker 1>months of weakness as it had been before. Yeah. Yeah,

0:32:23.920 --> 0:32:27.920
<v Speaker 1>And when comparing historical and modern experiences of childbirth, we

0:32:28.520 --> 0:32:31.640
<v Speaker 1>use data, right, Like we're talking about what about the data?

0:32:32.120 --> 0:32:34.920
<v Speaker 1>And our data are limited to things like maternal mortality

0:32:35.040 --> 0:32:38.640
<v Speaker 1>or complicated births. They're not that great anyway, and we

0:32:38.720 --> 0:32:41.200
<v Speaker 1>can look at I think it's interesting to look at

0:32:41.280 --> 0:32:45.640
<v Speaker 1>Martha Ballard's eight hundred and fourteen deliveries from seventeen eighty

0:32:45.680 --> 0:32:50.400
<v Speaker 1>five to eighteen twelve, so five maternal deaths, none during delivery,

0:32:50.440 --> 0:32:53.760
<v Speaker 1>all during two weeks after birth. And that's today compared

0:32:53.800 --> 0:32:56.840
<v Speaker 1>to zero point two two per every one thousand, so

0:32:56.960 --> 0:33:00.320
<v Speaker 1>five per one thousand, two point two two. Okay, yeah,

0:33:00.600 --> 0:33:04.400
<v Speaker 1>Martha recorded twenty neonatal deaths. That's two point five for

0:33:04.480 --> 0:33:07.800
<v Speaker 1>every one hundred live births, compared today two point five

0:33:07.840 --> 0:33:08.240
<v Speaker 1>to six.

0:33:09.320 --> 0:33:11.960
<v Speaker 4>So that I think also is very often left out

0:33:11.960 --> 0:33:15.720
<v Speaker 4>of the discussion, even when we're talking about interventions that

0:33:15.760 --> 0:33:18.920
<v Speaker 4>have reduced maternal mortality. I think that it's easy to

0:33:18.960 --> 0:33:23.000
<v Speaker 4>gloss over how much we have improved infant survival and

0:33:23.040 --> 0:33:26.880
<v Speaker 4>reduced still birth and neonatal mortality like drastically, not even

0:33:26.880 --> 0:33:29.760
<v Speaker 4>to mention like vaccines and saving life's postpartum and all that.

0:33:29.880 --> 0:33:34.960
<v Speaker 1>Right, right, but during childbirth experience itself, yes exactly, yeah, yeah,

0:33:35.240 --> 0:33:38.680
<v Speaker 1>you still birth she recorded fourteen. That's one point eight

0:33:38.760 --> 0:33:41.800
<v Speaker 1>for every one hundred today, that's point six every one hundred,

0:33:41.920 --> 0:33:44.040
<v Speaker 1>So yeah, there's a lot of I mean, we can

0:33:44.160 --> 0:33:46.480
<v Speaker 1>use those data to a certain degree, but I think

0:33:46.520 --> 0:33:50.720
<v Speaker 1>also like hearing those experiences from the women who you

0:33:50.720 --> 0:33:54.000
<v Speaker 1>know went through this is a really fascinating part of it.

0:33:55.280 --> 0:33:59.040
<v Speaker 1>And these data also don't show us what women dealt

0:33:59.080 --> 0:34:01.920
<v Speaker 1>with in other outcomes of pregnancy, Like we talked about

0:34:01.920 --> 0:34:06.440
<v Speaker 1>prolapsed uterus ficials, extensive tearing, perinatal mortality, and the emotional

0:34:06.520 --> 0:34:10.200
<v Speaker 1>experience of that late pregnancy loss, the range of emotions

0:34:10.239 --> 0:34:16.160
<v Speaker 1>that could accompany having limited control over your reproduction. Mary

0:34:16.200 --> 0:34:19.600
<v Speaker 1>Foote described it in the eighteen hundreds as a sort

0:34:19.640 --> 0:34:24.040
<v Speaker 1>of pendulum between joy and dread. For Hannah Whittall Smith,

0:34:24.200 --> 0:34:29.000
<v Speaker 1>writing in eighteen fifty two, that pendulum swung more towards dread.

0:34:29.880 --> 0:34:33.000
<v Speaker 1>I am very unhappy now that trial of my womanhood,

0:34:33.000 --> 0:34:35.479
<v Speaker 1>which to me is so very bitter, has come upon

0:34:35.520 --> 0:34:38.440
<v Speaker 1>me again. When my little Ellie is two years old,

0:34:38.800 --> 0:34:41.120
<v Speaker 1>she will have a little brother or sister. And this

0:34:41.320 --> 0:34:44.440
<v Speaker 1>is the end of all my hopes, my pleasing anticipations,

0:34:44.840 --> 0:34:48.719
<v Speaker 1>my returning youthful joyousness. Well, it is a woman's lot,

0:34:48.719 --> 0:34:50.759
<v Speaker 1>and I must try to become resigned and bear it.

0:34:50.840 --> 0:34:53.840
<v Speaker 1>In patience and silence and not make my home unhappy

0:34:53.880 --> 0:34:56.560
<v Speaker 1>because I am so but oh how hard it is.

0:34:57.640 --> 0:35:04.080
<v Speaker 4>Wow, that's a really heartbreaking are Yeah, it's it's.

0:35:05.239 --> 0:35:08.520
<v Speaker 1>Yeah, yeah, we have gained so much and then now

0:35:08.840 --> 0:35:10.040
<v Speaker 1>we're losing so much again.

0:35:10.160 --> 0:35:12.719
<v Speaker 4>But yeah, I know, yeah, to not because like like

0:35:12.760 --> 0:35:14.560
<v Speaker 4>she said, to not have any control over do not

0:35:14.600 --> 0:35:16.279
<v Speaker 4>have any control, any control over it?

0:35:16.360 --> 0:35:18.440
<v Speaker 1>Right, And it's just like here, it is, it is

0:35:18.480 --> 0:35:23.480
<v Speaker 1>my it is not added life. Yeah. So yeah. Even

0:35:23.560 --> 0:35:26.319
<v Speaker 1>though pregnancy and childbirth were much more common historically, that

0:35:26.360 --> 0:35:29.480
<v Speaker 1>didn't necessarily make them more welcome or more looked forward to.

0:35:30.360 --> 0:35:34.160
<v Speaker 1>Just as with today, women's experiences were incredibly varied and complex,

0:35:34.400 --> 0:35:37.640
<v Speaker 1>and they created ways to manage their fears, whether that

0:35:37.760 --> 0:35:41.720
<v Speaker 1>was surrounding themselves with familiar faces or seeking the latest

0:35:41.719 --> 0:35:47.640
<v Speaker 1>medical advancements or both. The choices available to women depended

0:35:47.680 --> 0:35:50.680
<v Speaker 1>on when she lived, where she lived, and how much

0:35:50.719 --> 0:35:54.160
<v Speaker 1>money she had. Early in US history, most births were

0:35:54.160 --> 0:35:58.479
<v Speaker 1>attended by midwives, who played a largely non interventionist, supportive role.

0:35:59.000 --> 0:36:02.040
<v Speaker 1>According to Levitt, as much as possible, they let nature

0:36:02.080 --> 0:36:05.480
<v Speaker 1>take its course. They examined the cervix or encouraged women

0:36:05.520 --> 0:36:09.120
<v Speaker 1>to walk around they lubricated the perenial tissues to aid stretching.

0:36:09.600 --> 0:36:12.400
<v Speaker 1>They delivered the child and tied the umbilical cord, and

0:36:12.480 --> 0:36:16.680
<v Speaker 1>sometimes they manually expressed the placenta. Historically, at least from

0:36:16.680 --> 0:36:20.240
<v Speaker 1>my understanding, there wasn't a ton of post natal care

0:36:20.440 --> 0:36:22.719
<v Speaker 1>for like mom and baby. She would be there for

0:36:22.760 --> 0:36:25.560
<v Speaker 1>a bit and maybe make another visit, but usually the

0:36:25.600 --> 0:36:28.239
<v Speaker 1>woman had other friends who would come and help with

0:36:28.280 --> 0:36:32.760
<v Speaker 1>like other women in her life and that it's exactly yeah,

0:36:32.920 --> 0:36:36.120
<v Speaker 1>And the midwife was typically not alone in the like

0:36:36.480 --> 0:36:38.920
<v Speaker 1>in attendance. Often they were like friends and family right

0:36:39.320 --> 0:36:42.880
<v Speaker 1>as well, usually formal friends and family. But as the

0:36:42.880 --> 0:36:46.600
<v Speaker 1>practice of medicine became a formal profession, meaning like you

0:36:46.680 --> 0:36:48.520
<v Speaker 1>had to have a certificate, you had to go to

0:36:48.600 --> 0:36:49.839
<v Speaker 1>show your training here at.

0:36:49.760 --> 0:36:53.080
<v Speaker 4>School yep, then they developed residency. That's the whole episode

0:36:53.120 --> 0:36:54.920
<v Speaker 4>something episode yep.

0:36:55.800 --> 0:36:59.920
<v Speaker 1>So this active professionalization started in the late seventeen hundred

0:37:00.080 --> 0:37:02.000
<v Speaker 1>early eighteen hundreds, maybe even a little bit earlier in

0:37:02.000 --> 0:37:05.280
<v Speaker 1>the seventeen hundreds. Towns. That meant that towns and cities

0:37:05.560 --> 0:37:08.480
<v Speaker 1>had more physicians that could be called in during birth,

0:37:08.880 --> 0:37:11.880
<v Speaker 1>and sometimes that call came from the midwife who wanted

0:37:11.920 --> 0:37:15.000
<v Speaker 1>a bit of extra assistance during a particularly difficult berth.

0:37:15.320 --> 0:37:17.200
<v Speaker 3>It's been a long time since I've watched Call the Midwife.

0:37:17.280 --> 0:37:20.839
<v Speaker 1>I know, I love love that show. I really love that.

0:37:20.880 --> 0:37:24.360
<v Speaker 1>There are probably seasons I haven't seen it, definitely, so yeah, yeah,

0:37:24.440 --> 0:37:28.800
<v Speaker 1>I should watch it. And physicians and midwives weren't always

0:37:28.800 --> 0:37:32.200
<v Speaker 1>in direct opposition during this time, and many physicians saw

0:37:32.200 --> 0:37:36.600
<v Speaker 1>the potential for partnership, with midwives primarily being the ones

0:37:36.640 --> 0:37:39.920
<v Speaker 1>attending the births and only calling in doctors in cases

0:37:39.920 --> 0:37:43.160
<v Speaker 1>of emergency, and these occasions could also lead to tension,

0:37:43.200 --> 0:37:46.879
<v Speaker 1>though if the midwife and doctor disagreed, some physicians might

0:37:46.960 --> 0:37:50.120
<v Speaker 1>defer to a midwife with hundreds of berths under her belt,

0:37:50.640 --> 0:37:54.120
<v Speaker 1>but gender and class dynamics ultimately put the authority in

0:37:54.160 --> 0:37:57.040
<v Speaker 1>the hands of the doctor, no matter how little experience

0:37:57.080 --> 0:37:59.560
<v Speaker 1>he had. So I want to read you a quote

0:37:59.560 --> 0:38:03.280
<v Speaker 1>from Martha Ballard's diary. She records a few of these clashes,

0:38:03.320 --> 0:38:06.600
<v Speaker 1>and here's one of them. They meaning the parents, They

0:38:06.600 --> 0:38:09.800
<v Speaker 1>were intimidated and called doctor Page, who gave my patient

0:38:09.840 --> 0:38:12.319
<v Speaker 1>twenty drops of laudanum, which put her into such a

0:38:12.360 --> 0:38:16.040
<v Speaker 1>stupor that her pains, which were regular and promising in

0:38:16.080 --> 0:38:19.160
<v Speaker 1>a matter stopped till near night when she puked, and

0:38:19.200 --> 0:38:21.960
<v Speaker 1>they returned and she delivered at seven hour evening of

0:38:22.000 --> 0:38:23.239
<v Speaker 1>a son, her firstborn.

0:38:23.480 --> 0:38:25.960
<v Speaker 4>Okay, Aaron, so I told you that I read that

0:38:26.239 --> 0:38:29.520
<v Speaker 4>like fictional Okay, that that story is in there, but

0:38:29.600 --> 0:38:32.600
<v Speaker 4>in like way more detail because it's obviously like fictionalized

0:38:32.760 --> 0:38:33.560
<v Speaker 4>version of history.

0:38:33.800 --> 0:38:36.480
<v Speaker 5>It is fascinating to hear.

0:38:36.680 --> 0:38:38.600
<v Speaker 1>The actual like diary entry.

0:38:38.719 --> 0:38:41.960
<v Speaker 4>Yes, and then like the like the description because this

0:38:42.160 --> 0:38:45.000
<v Speaker 4>story it's called frozen for the book, and it's like

0:38:45.280 --> 0:38:47.120
<v Speaker 4>they go she goes so much into like what she

0:38:47.239 --> 0:38:49.560
<v Speaker 4>assumes that Martha Ballard was thinking during the time and

0:38:49.560 --> 0:38:52.399
<v Speaker 4>stuff like that, which is just so like fun and fascinating.

0:38:52.640 --> 0:38:53.200
<v Speaker 1>Yeah.

0:38:53.320 --> 0:38:55.319
<v Speaker 3>Yeah, but that story isn't in there, so I knew

0:38:55.360 --> 0:38:55.560
<v Speaker 3>that one.

0:38:55.640 --> 0:38:57.760
<v Speaker 1>I want to read that book. I'm very curious because

0:38:57.840 --> 0:39:00.720
<v Speaker 1>like there is her diary entries are so so sparse

0:39:00.760 --> 0:39:04.000
<v Speaker 1>in terms of like rightail, that's what she said, very

0:39:04.000 --> 0:39:06.000
<v Speaker 1>few emotions. There have been like a couple times well

0:39:06.040 --> 0:39:09.400
<v Speaker 1>she'll say like poor poor mother because she lost a

0:39:09.440 --> 0:39:12.080
<v Speaker 1>baby or kind of thing. But but yeah, this and

0:39:12.120 --> 0:39:14.000
<v Speaker 1>then I think there's another time she calls out doctor

0:39:14.040 --> 0:39:16.520
<v Speaker 1>Page and she's like, what an unfortunate man or something

0:39:16.640 --> 0:39:18.799
<v Speaker 1>like that. But it's hard to know if she's like

0:39:19.120 --> 0:39:21.719
<v Speaker 1>and who knows is she irritated at him or does

0:39:21.760 --> 0:39:25.440
<v Speaker 1>she actually feel bad because he is chosen a profession

0:39:25.480 --> 0:39:27.960
<v Speaker 1>that clearly is not to his skill set.

0:39:28.080 --> 0:39:29.640
<v Speaker 3>Yeah, yeah, so interesting.

0:39:30.000 --> 0:39:33.200
<v Speaker 5>Yeah, check out this those books to check out those books.

0:39:34.040 --> 0:39:37.120
<v Speaker 1>As doctors became a more regular presence during childbirth, so

0:39:37.480 --> 0:39:43.160
<v Speaker 1>did the doctor's toolkit, which probably helped bolster appearance of expertise.

0:39:43.280 --> 0:39:43.400
<v Speaker 9>Right.

0:39:44.000 --> 0:39:47.960
<v Speaker 1>If midwives took a largely non interventionist approach, nineteenth century

0:39:48.000 --> 0:39:51.640
<v Speaker 1>doctors did the opposite. There was laudanum or opium, as

0:39:51.640 --> 0:39:55.480
<v Speaker 1>Martha mentioned, blood letting even in the case of hemorrhage.

0:39:56.160 --> 0:39:58.839
<v Speaker 4>Oh, I still can't get I'm sorry. Yeah, but yes,

0:39:59.160 --> 0:40:01.120
<v Speaker 4>we haven't talked about he are blood letting these all

0:40:01.160 --> 0:40:01.960
<v Speaker 4>these episodes, So.

0:40:02.120 --> 0:40:04.480
<v Speaker 1>I know the humors I didn't. That's the only thing

0:40:04.480 --> 0:40:07.200
<v Speaker 1>that I haven't mentioned is the humors. At some point,

0:40:07.400 --> 0:40:11.400
<v Speaker 1>there was something called tobacco infusions I don't know, doesn't

0:40:11.440 --> 0:40:16.200
<v Speaker 1>sound great, surgical separation of pelvic bones, which was often

0:40:16.280 --> 0:40:21.600
<v Speaker 1>led to like permanent disability yea, And of course forceps.

0:40:22.200 --> 0:40:25.400
<v Speaker 1>By the mid nineteenth century, forceps came in all shapes

0:40:25.440 --> 0:40:28.960
<v Speaker 1>and sizes, and were restricted by law to medical professionals,

0:40:29.000 --> 0:40:31.800
<v Speaker 1>like you could not own a pair of forceps unless

0:40:31.840 --> 0:40:33.080
<v Speaker 1>you could prove you were a doctor.

0:40:33.160 --> 0:40:33.760
<v Speaker 3>Wow. Okay.

0:40:34.920 --> 0:40:38.480
<v Speaker 1>One doctor bragged in jama in the mid eighteen eighties

0:40:38.600 --> 0:40:42.680
<v Speaker 1>that I hate this quote. Okay quote. I take pride

0:40:42.719 --> 0:40:45.920
<v Speaker 1>in stating that, as far as my recollection goes, in

0:40:46.000 --> 0:40:48.560
<v Speaker 1>no case of my own was a woman ever allowed

0:40:48.560 --> 0:40:51.400
<v Speaker 1>to lie in suffering and danger till the cervix was

0:40:51.440 --> 0:40:58.200
<v Speaker 1>completely dilated. Oh no, I'm sorry. Oh no, yeah, yeah,

0:40:58.239 --> 0:41:01.239
<v Speaker 1>they would like prophylactically use forceps.

0:41:01.000 --> 0:41:02.960
<v Speaker 5>But like before the survices all the way dilated.

0:41:03.080 --> 0:41:06.080
<v Speaker 1>Yes, no, like before the baby had even fully entered

0:41:06.080 --> 0:41:08.320
<v Speaker 1>the berth, that they had the long long forceps.

0:41:08.320 --> 0:41:10.359
<v Speaker 3>No, nope, nope, nope, nope, nope, nope, nope.

0:41:10.400 --> 0:41:12.080
<v Speaker 1>Yeah, nope, nope, nope, nope, nope.

0:41:12.280 --> 0:41:14.320
<v Speaker 4>Okay, that's not how forceps are used today. I just

0:41:14.360 --> 0:41:15.239
<v Speaker 4>want to put that out there.

0:41:15.320 --> 0:41:17.760
<v Speaker 1>No, no, no, put that over there. We have corrected,

0:41:17.960 --> 0:41:18.400
<v Speaker 1>of course.

0:41:18.600 --> 0:41:21.600
<v Speaker 5>Yeah, are not used in that way today. No, Wow,

0:41:21.800 --> 0:41:22.560
<v Speaker 5>they used to be used.

0:41:22.640 --> 0:41:27.160
<v Speaker 1>Yeah okay. So, unsurprisingly, the site of forceps was not

0:41:27.280 --> 0:41:30.319
<v Speaker 1>always a welcome one, and so the doctor would just

0:41:30.400 --> 0:41:33.520
<v Speaker 1>be instructed to like he instructed his students to hide them.

0:41:33.960 --> 0:41:37.080
<v Speaker 1>Just wear big gowns so that you can hide your tools,

0:41:37.400 --> 0:41:42.239
<v Speaker 1>because it'll, you know, make make the woman nervous. If

0:41:42.239 --> 0:41:46.000
<v Speaker 1>a medical school included training specifically on obstetrics, and few

0:41:46.160 --> 0:41:49.920
<v Speaker 1>actually did and the late eighteen hundreds, it mostly centered

0:41:49.960 --> 0:41:53.000
<v Speaker 1>on how to use these tools and rarely included hands

0:41:53.000 --> 0:41:57.000
<v Speaker 1>on supervised experience. Awesome, Okay, there, So there's one example

0:41:57.000 --> 0:41:58.000
<v Speaker 1>that I want to share with you.

0:41:58.160 --> 0:41:58.840
<v Speaker 3>I don't want to hear it.

0:41:58.920 --> 0:42:01.399
<v Speaker 1>I hope it's an urban led, but I don't know.

0:42:01.920 --> 0:42:04.760
<v Speaker 1>I would actually believe that it's not necessarily that. Okay.

0:42:04.840 --> 0:42:08.800
<v Speaker 1>Tells the story of a newly graduated doctor, official doctor

0:42:09.280 --> 0:42:13.040
<v Speaker 1>in the late eighteen hundreds, who examined his first laboring patient,

0:42:13.160 --> 0:42:16.000
<v Speaker 1>only to be horrified at what he thought was a

0:42:16.040 --> 0:42:20.120
<v Speaker 1>tumor blocking the birth canal. He figured, Okay, no, she's

0:42:20.160 --> 0:42:23.240
<v Speaker 1>a goner. I just have to wait for her to pass,

0:42:23.760 --> 0:42:26.399
<v Speaker 1>only to realize a few minutes later after she gave

0:42:26.480 --> 0:42:28.440
<v Speaker 1>birth that what he thought was a tumor was the

0:42:28.480 --> 0:42:29.200
<v Speaker 1>baby's head.

0:42:30.040 --> 0:42:32.520
<v Speaker 4>Okay, I thought it was going to go a different way,

0:42:32.560 --> 0:42:34.040
<v Speaker 4>and I was getting very nervous.

0:42:34.160 --> 0:42:35.759
<v Speaker 1>Oh no, what did you think I was. I'm not

0:42:35.760 --> 0:42:38.400
<v Speaker 1>going to say, okay, we can we can discuss off camera.

0:42:40.760 --> 0:42:41.120
<v Speaker 3>Okay.

0:42:41.200 --> 0:42:45.200
<v Speaker 1>Yeah. So someone who is a medical doctor and didn't

0:42:45.280 --> 0:42:46.880
<v Speaker 1>know how babies were born.

0:42:46.760 --> 0:42:49.239
<v Speaker 5>Well, I mean, I'm that doesn't surprise me.

0:42:49.480 --> 0:42:54.080
<v Speaker 1>No, I know. Back in the day, yeah, yeah, but sorry,

0:42:54.120 --> 0:42:56.600
<v Speaker 1>wouldn't you have at least seen a diagram somewhere?

0:42:57.480 --> 0:42:59.920
<v Speaker 5>I don't know, I wasn't in med school in the age.

0:43:01.560 --> 0:43:05.080
<v Speaker 1>They did have like theaters where someone the students could

0:43:05.120 --> 0:43:07.239
<v Speaker 1>watch someone. Can you just imagine the horror of that?

0:43:07.640 --> 0:43:07.719
<v Speaker 3>No.

0:43:08.600 --> 0:43:14.160
<v Speaker 1>Yeah, But aside from forceps, the other major tool that

0:43:14.239 --> 0:43:19.000
<v Speaker 1>was employed by nineteenth century physicians was anesthesia. First ether

0:43:19.200 --> 0:43:22.240
<v Speaker 1>and then chloroform were introduced in the mid eighteen hundreds,

0:43:22.280 --> 0:43:25.240
<v Speaker 1>and pretty quickly they exploded in popularity. And it wasn't

0:43:25.280 --> 0:43:28.680
<v Speaker 1>just like popular with doctors. Everyone wanted them, especially after

0:43:28.760 --> 0:43:31.879
<v Speaker 1>Queen Victoria had one of her kids with I don't

0:43:31.920 --> 0:43:34.200
<v Speaker 1>know if it was ether or chloroform, but it was

0:43:34.200 --> 0:43:37.400
<v Speaker 1>like made the news. You know who administered it, John

0:43:37.440 --> 0:43:41.840
<v Speaker 1>Snow as John John Snow of Color Effe color not

0:43:43.040 --> 0:43:47.680
<v Speaker 1>disgraced Game of Thrones. Yeah yeah, wow yeah, And so

0:43:47.719 --> 0:43:49.920
<v Speaker 1>that that really I think allowed people to go, oh,

0:43:49.960 --> 0:43:52.160
<v Speaker 1>I want that, And she was like, this was great.

0:43:52.400 --> 0:43:55.840
<v Speaker 5>Yeah, it again, I would highly recommend.

0:43:55.920 --> 0:43:58.799
<v Speaker 1>Yes, okay, yeah, and it's I think it's pretty easy

0:43:58.800 --> 0:44:00.839
<v Speaker 1>to see the appeal if you if you look at

0:44:00.840 --> 0:44:03.080
<v Speaker 1>some of them, I mean, even not based on today,

0:44:03.160 --> 0:44:05.799
<v Speaker 1>but like and like people you know you have experienced

0:44:05.840 --> 0:44:09.600
<v Speaker 1>child grouth, but the at the time, you know, in

0:44:09.640 --> 0:44:12.560
<v Speaker 1>these diary entries. In these letters, women described their labor

0:44:12.600 --> 0:44:17.280
<v Speaker 1>pains as travail suffering, screams of agony, anguish tortures, pains

0:44:17.280 --> 0:44:21.600
<v Speaker 1>from hell, and from the doctor's perspective, popular there too, right.

0:44:21.640 --> 0:44:24.080
<v Speaker 1>It made for a much more compliant patient whose arms

0:44:24.080 --> 0:44:26.239
<v Speaker 1>and legs would usually be strapped down to the bed.

0:44:27.200 --> 0:44:31.279
<v Speaker 1>And yeah, this is when the bed often became the

0:44:31.400 --> 0:44:34.640
<v Speaker 1>place instead of like a birthing stool, instead of leaning

0:44:34.680 --> 0:44:38.200
<v Speaker 1>on somebody else, instead of doing what feels like you

0:44:38.239 --> 0:44:42.000
<v Speaker 1>want to do, you were physically, in some cases strapped

0:44:42.040 --> 0:44:45.359
<v Speaker 1>down to a bed. I'm not going to get into

0:44:45.360 --> 0:44:48.800
<v Speaker 1>twilight sleep here, because I had a long section that

0:44:48.880 --> 0:44:50.880
<v Speaker 1>I was like, this deserves its own thing when we

0:44:50.920 --> 0:44:55.520
<v Speaker 1>talk about, you know, anthesia, but twilight birth was this

0:44:55.600 --> 0:44:59.120
<v Speaker 1>thing where you would be given like scopolamine and something

0:44:59.200 --> 0:45:02.040
<v Speaker 1>else and often the effect was not or the goal

0:45:02.160 --> 0:45:04.520
<v Speaker 1>was not necessarily to believe pain, but it was to

0:45:04.800 --> 0:45:08.680
<v Speaker 1>make you forget and it could induce a lot of

0:45:09.040 --> 0:45:13.759
<v Speaker 1>anxiety and delusions, and so they would be physically strapped down.

0:45:13.920 --> 0:45:15.920
<v Speaker 1>And then this idea was that you would wake up

0:45:16.360 --> 0:45:17.640
<v Speaker 1>with a baby in your arms.

0:45:17.840 --> 0:45:19.200
<v Speaker 3>Alah Madmen Allah.

0:45:18.960 --> 0:45:24.000
<v Speaker 1>Madmen and Betty Yeah yep. By nineteen hundred, ether or

0:45:24.080 --> 0:45:27.640
<v Speaker 1>chloroform was used in fifty percent of births attended by

0:45:27.640 --> 0:45:32.359
<v Speaker 1>a physician. Wow, ether or chloroform. And we got better

0:45:32.440 --> 0:45:34.640
<v Speaker 1>lead around in terms of like the safety because a

0:45:34.640 --> 0:45:36.600
<v Speaker 1>lot of doctors did have concerns about the safety of

0:45:36.680 --> 0:45:40.920
<v Speaker 1>like general anesthesia and these in particular, and the demand

0:45:41.080 --> 0:45:44.160
<v Speaker 1>for anesthesia during childbirth actually helped to speed up the

0:45:44.239 --> 0:45:48.520
<v Speaker 1>move from home birth to hospital because the equipment necessary

0:45:48.560 --> 0:45:51.440
<v Speaker 1>to administer these drugs would be hard to haul around

0:45:51.440 --> 0:45:55.640
<v Speaker 1>from like house to house. The introduction of both anesthesia

0:45:55.640 --> 0:46:00.120
<v Speaker 1>and other medical tools changed expectations for childbirth in the

0:46:00.200 --> 0:46:04.320
<v Speaker 1>late nineteenth century. It can be done quickly, safely.

0:46:03.920 --> 0:46:04.640
<v Speaker 3>And with no pain.

0:46:04.960 --> 0:46:07.520
<v Speaker 1>That was what childbirth had become, right like, this is

0:46:07.560 --> 0:46:10.479
<v Speaker 1>what medicine promised. This is an option, and of course

0:46:10.480 --> 0:46:13.120
<v Speaker 1>that was not always the reality, Nor was it the

0:46:13.160 --> 0:46:16.320
<v Speaker 1>reality for those who couldn't afford to pay for a physician,

0:46:16.840 --> 0:46:18.680
<v Speaker 1>or who felt it was taboo to have a man

0:46:18.719 --> 0:46:23.400
<v Speaker 1>present during labor and delivery. Doctors charged more for midwives, so,

0:46:23.440 --> 0:46:27.239
<v Speaker 1>for instance, Martha Ballard charged two dollars for her assistance

0:46:27.320 --> 0:46:31.000
<v Speaker 1>during labor and delivery and her contemporary doctor Page charged

0:46:31.080 --> 0:46:35.480
<v Speaker 1>six dollars. Yeah, this could be a lucrative job for physicians,

0:46:35.520 --> 0:46:38.920
<v Speaker 1>and as more doctors incorporated childbirth into their practice, they

0:46:39.000 --> 0:46:44.200
<v Speaker 1>increasingly saw midwives as competition for patients rather than collaborators.

0:46:45.040 --> 0:46:49.040
<v Speaker 1>And instead of this high price discouraging people from hiring doctors,

0:46:49.120 --> 0:46:53.040
<v Speaker 1>it played into the psychological phenomenon familiar to many of us.

0:46:53.080 --> 0:46:57.399
<v Speaker 1>All of us were higher price is equated with higher quality. Yeah, yeah,

0:46:57.440 --> 0:47:01.600
<v Speaker 1>and that is completely understandable, right. Who wouldn't pay whatever

0:47:01.640 --> 0:47:04.440
<v Speaker 1>they could if it meant the best care possible for

0:47:04.560 --> 0:47:08.440
<v Speaker 1>mom and baby? The issue was whether it was actually

0:47:08.480 --> 0:47:11.440
<v Speaker 1>the best care. In the last few decades of the

0:47:11.480 --> 0:47:17.280
<v Speaker 1>eighteen hundreds, childbirth became increasingly medicalized. Physicians now attended nearly

0:47:17.400 --> 0:47:21.040
<v Speaker 1>half of all births and tried their hands at various interventions,

0:47:21.280 --> 0:47:25.279
<v Speaker 1>none of which had been adequately examined. For safety or efficacy,

0:47:26.000 --> 0:47:29.319
<v Speaker 1>and while women still held the power in home childbirth,

0:47:29.600 --> 0:47:34.239
<v Speaker 1>doctors were growing more resentful of that conversation should be prohibited.

0:47:34.520 --> 0:47:36.880
<v Speaker 1>Nothing is more common than for the patient's friends to

0:47:36.920 --> 0:47:39.520
<v Speaker 1>object to blood letting urging as a reason that she

0:47:39.640 --> 0:47:42.040
<v Speaker 1>has lost blood enough of this, They are in no

0:47:42.160 --> 0:47:46.560
<v Speaker 1>respect suitable judges. Oh gosh right, Her friends are probably

0:47:46.600 --> 0:47:51.480
<v Speaker 1>like she is, like, she has been drained, stoppedop. And

0:47:51.520 --> 0:47:53.560
<v Speaker 1>he's like, oh, come on, you don't know anything.

0:47:54.520 --> 0:47:55.760
<v Speaker 3>Yeah, you didn't go to Harvard.

0:47:55.840 --> 0:48:02.320
<v Speaker 1>Medical schools were also blamed for high rates of pupil

0:48:02.360 --> 0:48:06.000
<v Speaker 1>fever and sepsis, despite adence that it was in fact

0:48:06.120 --> 0:48:09.719
<v Speaker 1>doctors who were more much more responsible for the infections

0:48:10.200 --> 0:48:13.960
<v Speaker 1>due to their proclivity to just go from cadaver dissection

0:48:14.120 --> 0:48:17.680
<v Speaker 1>to the labor and delivery room in hospitals. Listened to

0:48:17.680 --> 0:48:20.200
<v Speaker 1>our pupil fever episode. There's so much more on that,

0:48:21.560 --> 0:48:25.040
<v Speaker 1>And in fact, maternal mortality in the US was on

0:48:25.120 --> 0:48:27.759
<v Speaker 1>the decline by the end of the nineteenth century, but

0:48:27.800 --> 0:48:31.040
<v Speaker 1>it plateaued for a while until the late nineteen thirties,

0:48:31.560 --> 0:48:36.600
<v Speaker 1>which was after most births were happening in hospitals. Interesting, okay,

0:48:36.680 --> 0:48:40.560
<v Speaker 1>and that's probably because of all of the adjustment we'll

0:48:40.600 --> 0:48:44.160
<v Speaker 1>call charitably call it adjustment for transition to the hospital

0:48:44.200 --> 0:48:46.400
<v Speaker 1>where people were still trying to figure things out.

0:48:46.320 --> 0:48:48.560
<v Speaker 4>Well and still studying and learning things because they hadn't

0:48:48.800 --> 0:48:49.720
<v Speaker 4>done that, right.

0:48:49.680 --> 0:48:54.120
<v Speaker 1>Yep, it's all yeah, yeah, the field of gynecology being

0:48:54.160 --> 0:48:58.040
<v Speaker 1>built on the backs of people who probably did not

0:48:58.080 --> 0:49:01.680
<v Speaker 1>consent in a way that was meaningful. Oh yeah, yeah,

0:49:02.440 --> 0:49:05.760
<v Speaker 1>Medical Bondage. For more on that, Medical Bondage. Yes, yeah,

0:49:05.760 --> 0:49:09.040
<v Speaker 1>that's such a great book. The US seemed an especially

0:49:09.160 --> 0:49:12.279
<v Speaker 1>deadly place to have a baby. In nineteen ten, one

0:49:12.400 --> 0:49:15.520
<v Speaker 1>mother died for every one hundred and fifty four live births.

0:49:16.320 --> 0:49:16.640
<v Speaker 3>Wow.

0:49:16.800 --> 0:49:19.239
<v Speaker 1>Compare that to Sweden at the same time, where the

0:49:19.320 --> 0:49:21.720
<v Speaker 1>number was one in every four hundred and thirty.

0:49:21.920 --> 0:49:22.960
<v Speaker 3>Okay, yeah wow.

0:49:23.640 --> 0:49:27.920
<v Speaker 1>In the early nineteen hundreds, US states introduced laws banning midwiffery,

0:49:28.200 --> 0:49:31.640
<v Speaker 1>and all midwiffrey became illegal in nineteen fifty nine under

0:49:31.680 --> 0:49:34.840
<v Speaker 1>a law that redefined midwiffery as the practice of medicine.

0:49:36.520 --> 0:49:38.759
<v Speaker 4>Interesting, eron, I did not know that.

0:49:39.080 --> 0:49:41.759
<v Speaker 1>Yeah, And I'm not saying that we should have like

0:49:41.960 --> 0:49:45.359
<v Speaker 1>there's like, I'm not advocating for a blanket defense of midwiffery.

0:49:45.400 --> 0:49:50.279
<v Speaker 1>At the time, because undoubtedly they were unnecessary injuries or

0:49:50.480 --> 0:49:53.560
<v Speaker 1>infections and deaths at the hands of midwives, just as

0:49:53.600 --> 0:49:56.960
<v Speaker 1>there were for doctors. But those early bands did not

0:49:57.080 --> 0:50:01.600
<v Speaker 1>provide any pathways for training or certification for midwives, and

0:50:01.680 --> 0:50:05.360
<v Speaker 1>so then that disproportionately impacted poor women who couldn't afford

0:50:05.360 --> 0:50:07.400
<v Speaker 1>a doctor or who were then forced to go to

0:50:07.400 --> 0:50:11.719
<v Speaker 1>a hospital, which were deadly at the time.

0:50:12.239 --> 0:50:16.080
<v Speaker 4>And this is like at the time when becoming a physician,

0:50:16.080 --> 0:50:19.319
<v Speaker 4>and like the process of that is becoming very well regulated.

0:50:19.440 --> 0:50:22.400
<v Speaker 4>Oh even before then, yes, and then there's no pathway

0:50:22.480 --> 0:50:25.200
<v Speaker 4>to become a like certified licensed midwife the way that

0:50:25.239 --> 0:50:27.799
<v Speaker 4>we have today with like a registered nurse midwife kind

0:50:27.800 --> 0:50:28.160
<v Speaker 4>of thing.

0:50:28.320 --> 0:50:31.440
<v Speaker 1>And so other countries did have that pathway for midwise

0:50:31.960 --> 0:50:33.759
<v Speaker 1>in the US we did not get it, okay, And

0:50:33.800 --> 0:50:37.359
<v Speaker 1>so then this eliminated an entire career path that women had.

0:50:37.440 --> 0:50:39.160
<v Speaker 1>So then what what do you do?

0:50:39.280 --> 0:50:39.760
<v Speaker 3>Interesting?

0:50:40.239 --> 0:50:47.799
<v Speaker 1>Okay, this process devalued the contribution of midwives and the

0:50:47.840 --> 0:50:51.319
<v Speaker 1>importance of human presence as an essential part of care,

0:50:52.280 --> 0:50:56.680
<v Speaker 1>like familiar human presence, not just like a nurse or

0:50:56.719 --> 0:51:00.799
<v Speaker 1>a doctor popping in every hour thirty minutes something like that.

0:51:01.480 --> 0:51:06.560
<v Speaker 1>This also furthered the notion of pregnancy and childbirth as pathologies.

0:51:07.560 --> 0:51:10.960
<v Speaker 1>The father of modern obstetrics, Joseph D. Lee. Does his

0:51:11.040 --> 0:51:12.920
<v Speaker 1>name sound familiar to at all? I don't think I've

0:51:12.920 --> 0:51:14.880
<v Speaker 1>ever talked about him, Yeah, okay, I didn't know if

0:51:14.960 --> 0:51:18.120
<v Speaker 1>like in med school or something. Okay, he wrote in

0:51:18.200 --> 0:51:23.399
<v Speaker 1>nineteen twenty. So frequent are these bad effects that I

0:51:23.440 --> 0:51:27.239
<v Speaker 1>often wonder whether nature did not deliberately intend women to

0:51:27.320 --> 0:51:30.160
<v Speaker 1>be used up in the process of reproduction in a

0:51:30.200 --> 0:51:33.799
<v Speaker 1>manner analogous to that of salmon, which dies after spawning.

0:51:34.560 --> 0:51:41.439
<v Speaker 1>Oh my god, we're just fish. That's also also male

0:51:41.560 --> 0:51:44.080
<v Speaker 1>salmon die too. Come on.

0:51:44.360 --> 0:51:47.360
<v Speaker 4>But also that's like doesn't make evolution, Like clearly you

0:51:47.360 --> 0:51:49.920
<v Speaker 4>don't understand evolution for that to make so, because salmon

0:51:50.160 --> 0:51:54.000
<v Speaker 4>spawned like bajillions of fish. Listen, and we're reproducing one

0:51:54.040 --> 0:51:57.000
<v Speaker 4>offspring at a time, who's going to require intensive care thereafter?

0:51:57.160 --> 0:51:57.239
<v Speaker 8>Like?

0:51:57.280 --> 0:51:57.520
<v Speaker 3>Come on.

0:51:57.800 --> 0:52:00.840
<v Speaker 1>He's the father of modern obstetric case and not the

0:52:01.320 --> 0:52:08.279
<v Speaker 1>modern synthesis and evolutionary Okay, I'm for his part because

0:52:08.280 --> 0:52:11.719
<v Speaker 1>there's nuance to every most people. He was aware of

0:52:11.760 --> 0:52:14.640
<v Speaker 1>the dangers that hospitals posed in terms of infections, and

0:52:14.680 --> 0:52:16.840
<v Speaker 1>he was a big advocate for home birth or like

0:52:16.920 --> 0:52:21.040
<v Speaker 1>birthing centers and keeping and like creating new different types

0:52:21.080 --> 0:52:23.719
<v Speaker 1>of maternity wards where it would be separate from the

0:52:23.719 --> 0:52:28.279
<v Speaker 1>rest of the hospital and you had different kind of care. Interesting, Okay, okay, right, still,

0:52:28.280 --> 0:52:33.680
<v Speaker 1>thanks for Salmon. But pathologizing childbirth was a way to

0:52:33.800 --> 0:52:37.200
<v Speaker 1>send home the message that midwives were not qualified. Right,

0:52:37.400 --> 0:52:40.439
<v Speaker 1>this is a dangerous state, and you need someone who

0:52:40.680 --> 0:52:43.399
<v Speaker 1>is has been trained in this way and has this

0:52:43.880 --> 0:52:50.040
<v Speaker 1>you know, diploma from this university, right, yea. And the

0:52:50.080 --> 0:52:54.560
<v Speaker 1>way that society saw women during this time, especially middle

0:52:54.640 --> 0:52:58.319
<v Speaker 1>and upper class white women, as fragile and over civilized

0:52:58.920 --> 0:53:05.120
<v Speaker 1>in need of protection this birth exactly, exactly, And so

0:53:05.239 --> 0:53:08.279
<v Speaker 1>all of these factors drove childbirth from the home to

0:53:08.360 --> 0:53:13.279
<v Speaker 1>the hospital. Midwiffrey discredited and banned the pathologization of childbirth,

0:53:13.520 --> 0:53:18.120
<v Speaker 1>the growth of hospitals, women themselves choosing hospitals and physicians.

0:53:18.800 --> 0:53:22.840
<v Speaker 1>As Levitt writes, women who opted for hospital childbirth quote

0:53:23.360 --> 0:53:27.360
<v Speaker 1>gave up some kinds of control for others because, on balance,

0:53:27.440 --> 0:53:31.399
<v Speaker 1>the new benefits seemed more important. Okay, yeah, yeah, that's

0:53:31.640 --> 0:53:32.759
<v Speaker 1>completely understandable.

0:53:32.840 --> 0:53:33.320
<v Speaker 3>Yeah.

0:53:33.440 --> 0:53:36.400
<v Speaker 1>One woman wrote to her mother in nineteen eighteen, I

0:53:36.440 --> 0:53:39.480
<v Speaker 1>have placed myself in the hands of a specialist in obstetrics.

0:53:39.640 --> 0:53:42.120
<v Speaker 1>I have every confidence in him, and it is a

0:53:42.160 --> 0:53:47.120
<v Speaker 1>great relief. Another described her hospital stay as a quote

0:53:47.200 --> 0:53:52.960
<v Speaker 1>unquote lovely vacation, but some women felt the loss of

0:53:53.080 --> 0:53:58.040
<v Speaker 1>familiar faces keenly quote. The cruelest part of hospital childbirth

0:53:58.120 --> 0:54:02.240
<v Speaker 1>is being alone among strangers. Another called it a nightmare

0:54:02.280 --> 0:54:08.080
<v Speaker 1>of impersonality. Another quote months later, I would scream out

0:54:08.120 --> 0:54:11.319
<v Speaker 1>loud and wake up remembering that lonely labor room and

0:54:11.480 --> 0:54:14.120
<v Speaker 1>just feeling no one cared what happened to me. No

0:54:14.320 --> 0:54:18.040
<v Speaker 1>one kind reassuring word was spoken by nurse or doctor.

0:54:18.560 --> 0:54:21.040
<v Speaker 1>I was treated as if I was an inanimate object.

0:54:21.320 --> 0:54:24.000
<v Speaker 3>Oh my god, Yeah, awful.

0:54:24.000 --> 0:54:27.799
<v Speaker 1>Awful, truly like dehumanizing. You are just a machine to

0:54:27.960 --> 0:54:30.319
<v Speaker 1>make babies, so no one cares about your mental well being.

0:54:31.440 --> 0:54:35.200
<v Speaker 1>We know best. This period from the nineteen thirties to

0:54:35.239 --> 0:54:38.520
<v Speaker 1>the nineteen sixties is marked by tremendous gains and our

0:54:38.640 --> 0:54:42.120
<v Speaker 1>understanding of the physiology of childbirth, which is clear from

0:54:42.160 --> 0:54:46.080
<v Speaker 1>the drastic drop in maternal and neonatal mortality during this time.

0:54:47.080 --> 0:54:50.759
<v Speaker 1>But along with those gains came losses, the loss of

0:54:50.840 --> 0:54:54.719
<v Speaker 1>control and choice that women had in previous centuries, the

0:54:54.840 --> 0:54:58.080
<v Speaker 1>loss of friends and family in the birthing room and

0:54:58.160 --> 0:55:01.080
<v Speaker 1>the loss of a voice. This was just how it was.

0:55:01.360 --> 0:55:05.319
<v Speaker 1>Deal with it. This is what you get. And it

0:55:05.400 --> 0:55:09.680
<v Speaker 1>took women years to reckon with those losses and to

0:55:09.760 --> 0:55:12.840
<v Speaker 1>put words to them. And of course not everyone felt

0:55:12.880 --> 0:55:15.359
<v Speaker 1>those losses to the same degree. Right, Some women didn't

0:55:15.360 --> 0:55:18.280
<v Speaker 1>think twice about their hospital experience. It was a lovely vacation.

0:55:18.960 --> 0:55:21.560
<v Speaker 1>Others maybe didn't love it, but didn't mind it overall,

0:55:21.600 --> 0:55:23.719
<v Speaker 1>and it was like, yeah, okay, that was.

0:55:24.040 --> 0:55:26.520
<v Speaker 3>Sure, was what it was, and now it's done right exactly.

0:55:26.600 --> 0:55:30.319
<v Speaker 1>And then some were completely traumatized and everything in between. Yeah,

0:55:30.719 --> 0:55:34.360
<v Speaker 1>as we've said a million times, there is no universal childbirth, pregnancy,

0:55:34.560 --> 0:55:38.800
<v Speaker 1>postpartum experience. In the nineteen sixties and the nineteen seventies,

0:55:38.840 --> 0:55:42.120
<v Speaker 1>those who did feel the losses began to fight against them.

0:55:42.280 --> 0:55:45.600
<v Speaker 1>To reclaim a voice in the birthing room. They demanded

0:55:45.600 --> 0:55:48.440
<v Speaker 1>that their partners be allowed in that they could breastfeed

0:55:48.480 --> 0:55:51.919
<v Speaker 1>on their own schedule rather than the hospital mandated one.

0:55:52.040 --> 0:55:55.959
<v Speaker 1>Oh that is really really interesting. Yeah, and they would

0:55:56.000 --> 0:55:58.680
<v Speaker 1>be like, oh no, not here two hours.

0:55:58.719 --> 0:56:00.360
<v Speaker 4>And they also that was at the time when it

0:56:00.400 --> 0:56:02.400
<v Speaker 4>was like nurseries, and so your baby was taken away

0:56:02.400 --> 0:56:04.160
<v Speaker 4>and put in a nursery, which is like the opposite

0:56:04.200 --> 0:56:06.440
<v Speaker 4>of what we do now, which also people have opinions

0:56:06.480 --> 0:56:08.200
<v Speaker 4>about because then it means a mother doesn't get any rest.

0:56:08.239 --> 0:56:09.800
<v Speaker 3>Oh my god, there's so much I don't.

0:56:09.640 --> 0:56:12.880
<v Speaker 1>Know, right, I mean, we have this is like jumping

0:56:12.880 --> 0:56:16.880
<v Speaker 1>ahead a little bit. But the history of this, this

0:56:16.960 --> 0:56:20.239
<v Speaker 1>whole series, yeah, just shows us that, like we don't

0:56:20.280 --> 0:56:22.640
<v Speaker 1>have everything figured out. And that's I mean, that's okay.

0:56:22.719 --> 0:56:26.879
<v Speaker 1>It is things are really overall good, yeah, and which

0:56:27.320 --> 0:56:30.040
<v Speaker 1>people are talking about them, are researching them, are writing

0:56:30.080 --> 0:56:32.960
<v Speaker 1>about them, are sharing their experiences. I think it just

0:56:34.000 --> 0:56:38.360
<v Speaker 1>gives such hope that things will continue to improve. But

0:56:38.440 --> 0:56:41.160
<v Speaker 1>it is really also that is not to erase the

0:56:41.200 --> 0:56:44.480
<v Speaker 1>experience of people who are like I did not have

0:56:44.560 --> 0:56:45.000
<v Speaker 1>a good.

0:56:44.880 --> 0:56:47.279
<v Speaker 4>Time, right, yeah, right, And I think I think it

0:56:47.320 --> 0:56:50.040
<v Speaker 4>is just so interesting to do what you're doing right now, Aaron,

0:56:50.080 --> 0:56:52.560
<v Speaker 4>which is like look back at like how did it

0:56:52.680 --> 0:56:54.960
<v Speaker 4>used to be, How did people feel about that at

0:56:54.960 --> 0:56:57.279
<v Speaker 4>the time, How did we get from there to here?

0:56:57.600 --> 0:57:00.040
<v Speaker 4>Why did the pendulum swing this way? Where are we

0:57:00.120 --> 0:57:04.759
<v Speaker 4>in this pendulum arc right now? It's so interesting to

0:57:05.040 --> 0:57:07.200
<v Speaker 4>go back and try and kind of piece it together

0:57:07.360 --> 0:57:09.680
<v Speaker 4>on like, because it gives you so much context that

0:57:09.719 --> 0:57:13.439
<v Speaker 4>sometimes might make something that feels horrible today make more

0:57:13.520 --> 0:57:17.360
<v Speaker 4>sense and then make it more like you you can, Okay,

0:57:17.400 --> 0:57:20.480
<v Speaker 4>I understand why this thing happened, right, I think that's

0:57:20.520 --> 0:57:21.120
<v Speaker 4>so important.

0:57:21.240 --> 0:57:23.280
<v Speaker 1>Why why are we here today?

0:57:23.320 --> 0:57:24.200
<v Speaker 3>Why are we here today?

0:57:24.280 --> 0:57:30.640
<v Speaker 1>Yeah? Did not mean to get that existential, although I'm surprised,

0:57:30.640 --> 0:57:32.600
<v Speaker 1>given that this is a series on pregnancy that we

0:57:32.640 --> 0:57:37.840
<v Speaker 1>haven't gotten that existential for that. Yeah, putting it all

0:57:37.840 --> 0:57:40.480
<v Speaker 1>on the table, all on the table. But yeah, all

0:57:40.520 --> 0:57:44.040
<v Speaker 1>of these, all of these new choices or choices that

0:57:44.160 --> 0:57:46.840
<v Speaker 1>previously had not been available, things like having your your

0:57:46.920 --> 0:57:49.720
<v Speaker 1>partner in the room, right, breastfeeding whenever you want, do

0:57:49.760 --> 0:57:52.240
<v Speaker 1>I want an epidural or not? And so many other

0:57:52.360 --> 0:57:56.000
<v Speaker 1>choices that simply probably were not available. Right, And we

0:57:56.040 --> 0:57:59.320
<v Speaker 1>are now, I think, coming to terms with some of these,

0:57:59.400 --> 0:58:03.520
<v Speaker 1>like the voices and the range of choices. And I

0:58:03.560 --> 0:58:05.760
<v Speaker 1>will say too that that is a double edged sword.

0:58:05.920 --> 0:58:06.120
<v Speaker 9>Right.

0:58:06.480 --> 0:58:12.720
<v Speaker 1>Since the nineteen seventies, women, along with researchers, doctors, nurses, midwives, dulas, partners, parents,

0:58:13.160 --> 0:58:17.920
<v Speaker 1>have examined the childbirth experience from every angle, asking what

0:58:18.080 --> 0:58:21.520
<v Speaker 1>do I want what's best for me, what's safest for baby?

0:58:22.120 --> 0:58:26.600
<v Speaker 1>How do we balance everyone's needs? And today there are

0:58:26.720 --> 0:58:29.920
<v Speaker 1>so many choices, there are so many options, and there

0:58:29.920 --> 0:58:33.439
<v Speaker 1>are so much information out there that it can feel overwhelming.

0:58:33.920 --> 0:58:35.920
<v Speaker 1>How do you make the right choice, especially when the

0:58:35.920 --> 0:58:41.320
<v Speaker 1>internet has very strong opinions about everything. What happens when

0:58:41.640 --> 0:58:45.000
<v Speaker 1>you are not able to choose or if the choice

0:58:45.080 --> 0:58:50.200
<v Speaker 1>is made for you. Navigating pregnancy, childbirth, and the fourth

0:58:50.240 --> 0:58:54.240
<v Speaker 1>trimester is a huge challenge, which is the understatement of

0:58:54.320 --> 0:58:55.160
<v Speaker 1>this series.

0:58:55.400 --> 0:58:58.440
<v Speaker 5>I'm getting like so many flashbacks right now.

0:58:58.480 --> 0:58:59.920
<v Speaker 1>It's a lot from you.

0:59:00.440 --> 0:59:04.080
<v Speaker 5>Yeah, yeah, yeah, yeah, yeah, keep going home?

0:59:04.720 --> 0:59:06.880
<v Speaker 1>Is this the right strugg the right choice?

0:59:07.240 --> 0:59:08.000
<v Speaker 3>Is that the right choice?

0:59:08.000 --> 0:59:09.600
<v Speaker 5>If I don't make a choice, what does that mean?

0:59:09.600 --> 0:59:10.720
<v Speaker 5>And when if this happens?

0:59:10.960 --> 0:59:13.480
<v Speaker 1>Yes? And what if there's a choice that like, did

0:59:13.480 --> 0:59:17.320
<v Speaker 1>I have a choice? I'm not sure? Yeah that yeah?

0:59:17.360 --> 0:59:21.520
<v Speaker 1>And there are a million voices telling you yes, no,

0:59:22.160 --> 0:59:24.760
<v Speaker 1>maybe in conflict, maybe not in conflict? Do this do

0:59:24.880 --> 0:59:28.600
<v Speaker 1>that that we have more choices and more knowledge today

0:59:28.640 --> 0:59:31.160
<v Speaker 1>than we did sixty or one hundred years ago is

0:59:31.240 --> 0:59:35.440
<v Speaker 1>a powerful testament to the work of countless women and

0:59:35.600 --> 0:59:39.680
<v Speaker 1>modern medicine striving to make this a safer and better experience,

0:59:40.400 --> 0:59:43.120
<v Speaker 1>and of course there's still room for improvement. There will

0:59:43.160 --> 0:59:48.040
<v Speaker 1>always be room for improvement. But understanding our past, understanding

0:59:48.360 --> 0:59:51.200
<v Speaker 1>what we lost during the medicalization of pregnancy, as well

0:59:51.240 --> 0:59:54.520
<v Speaker 1>as just how much we've gained, is crucial for creating

0:59:54.560 --> 0:59:59.240
<v Speaker 1>a better future. Recognizing those gains is especially important because

0:59:59.280 --> 1:00:01.800
<v Speaker 1>I think sometimes we take them for granted, yes, or

1:00:01.840 --> 1:00:04.320
<v Speaker 1>we lose sight of them. Next to the negative impacts

1:00:04.320 --> 1:00:07.560
<v Speaker 1>of medicalization, that is what stands out the most to us.

1:00:07.640 --> 1:00:08.280
<v Speaker 3>Yeah.

1:00:08.600 --> 1:00:12.640
<v Speaker 1>For instance, take postpartum depression and other postpartum perinatal mood

1:00:12.640 --> 1:00:16.800
<v Speaker 1>disorders from pupil insanity in the late nineteenth century, which

1:00:16.840 --> 1:00:18.840
<v Speaker 1>is what it was called, well, which is what it

1:00:18.960 --> 1:00:22.360
<v Speaker 1>was a diagnosis, so it's not necessarily there's more. There's

1:00:22.360 --> 1:00:26.480
<v Speaker 1>more nuance to pupil insanity, yes, yea, to what was

1:00:26.520 --> 1:00:30.520
<v Speaker 1>called baby blues post World War two, to postpartum depression

1:00:30.760 --> 1:00:34.560
<v Speaker 1>finally making it into the DSM four in nineteen ninety four.

1:00:34.960 --> 1:00:38.280
<v Speaker 1>Nineteen ninety four, I told my mom that she was like,

1:00:38.600 --> 1:00:41.680
<v Speaker 1>really wait, oh, and it's not even I know. And

1:00:41.720 --> 1:00:44.160
<v Speaker 1>then in there there's like a whole journey about how

1:00:44.160 --> 1:00:46.240
<v Speaker 1>it got in there, and it was it actually put

1:00:46.400 --> 1:00:48.320
<v Speaker 1>place in there in an appropriate way.

1:00:48.200 --> 1:00:50.200
<v Speaker 3>And what we don't have in there today.

1:00:49.960 --> 1:00:53.520
<v Speaker 1>They don't have in there today. And then also like

1:00:53.560 --> 1:00:56.400
<v Speaker 1>there's the book Blue is really fascinating too because it

1:00:56.440 --> 1:01:01.560
<v Speaker 1>talks about how postpartum depression became like aiined more awareness

1:01:01.640 --> 1:01:03.600
<v Speaker 1>and it was through the work of a lot of

1:01:03.640 --> 1:01:06.960
<v Speaker 1>people advocates who worked really strongly to make people more

1:01:06.960 --> 1:01:11.400
<v Speaker 1>aware of this potential outcome. But the way that popular

1:01:11.440 --> 1:01:15.680
<v Speaker 1>media often seized on postpartum depression was through the most

1:01:15.680 --> 1:01:19.600
<v Speaker 1>sensationalist news stories possible. And so then that was like

1:01:20.120 --> 1:01:23.760
<v Speaker 1>I think in some ways had this effect of oh,

1:01:23.800 --> 1:01:26.120
<v Speaker 1>well I didn't I don't think I had postprime depression

1:01:26.160 --> 1:01:29.480
<v Speaker 1>because it was you know, exactly, wasn't that bad? So

1:01:29.600 --> 1:01:32.280
<v Speaker 1>the extreme scenarios right, right, And I think that we

1:01:32.360 --> 1:01:36.440
<v Speaker 1>have now like there's been such incredible representation in the media,

1:01:36.480 --> 1:01:42.240
<v Speaker 1>and it's still again room for improvement. But yeah, I mean,

1:01:42.280 --> 1:01:44.919
<v Speaker 1>I think it's safe to say that since the late

1:01:44.960 --> 1:01:49.000
<v Speaker 1>eighteen hundred's postpartum depression post part of mental health has

1:01:49.080 --> 1:01:53.040
<v Speaker 1>really been on a journey and ultimately creating a clinical

1:01:53.040 --> 1:01:56.400
<v Speaker 1>definition for PPD imperfect, though it may be, it opened

1:01:56.440 --> 1:02:00.560
<v Speaker 1>up research areas for treatment. It raised awareness and established

1:02:00.600 --> 1:02:04.360
<v Speaker 1>ways to treat people or reach people who might need help,

1:02:04.760 --> 1:02:07.360
<v Speaker 1>and it removed some of the blame that had been

1:02:07.480 --> 1:02:11.520
<v Speaker 1>so central to postparti mental health for decades. Oh, she's

1:02:11.520 --> 1:02:14.080
<v Speaker 1>depressed because she hasn't accepted her role as a mother,

1:02:14.560 --> 1:02:18.200
<v Speaker 1>thanks Freud. She's got PPD because she had a C section.

1:02:19.360 --> 1:02:26.160
<v Speaker 1>Working moms bring on PPD themselves because they're just not equipped. Yeah. Yeah,

1:02:26.480 --> 1:02:31.040
<v Speaker 1>blame certainly remains. It is not gone by any means.

1:02:32.120 --> 1:02:36.480
<v Speaker 1>But turning this into a more having a more biological

1:02:36.520 --> 1:02:40.160
<v Speaker 1>framework for understanding this has helped to remove some of

1:02:40.200 --> 1:02:44.600
<v Speaker 1>that to some degree. And there is, of course downside

1:02:44.600 --> 1:02:48.280
<v Speaker 1>to this medicalization, right it has discouraged to some degree

1:02:48.360 --> 1:02:52.760
<v Speaker 1>consideration of systemic and societal drivers that might underlie PPD

1:02:52.840 --> 1:02:55.080
<v Speaker 1>that I know you're going to talk about, sure, am By,

1:02:55.160 --> 1:02:57.320
<v Speaker 1>because if you're treating it just as a hormonal or

1:02:57.360 --> 1:03:00.520
<v Speaker 1>chemical imbalance, and it's like so, but it's not happening

1:03:00.520 --> 1:03:01.240
<v Speaker 1>in a vacuum.

1:03:01.360 --> 1:03:03.720
<v Speaker 4>Oh my god, Aaron, I literally can't believe how well

1:03:03.760 --> 1:03:05.040
<v Speaker 4>this is like segueing in.

1:03:05.040 --> 1:03:08.080
<v Speaker 5>To what I'm going to talk about, Like we do this,

1:03:08.520 --> 1:03:09.600
<v Speaker 5>it's like it's our job.

1:03:11.920 --> 1:03:18.479
<v Speaker 1>But yes, yes, And it creates boundaries around what is normal, right,

1:03:18.560 --> 1:03:21.560
<v Speaker 1>And those boundaries might be different for different people, But

1:03:21.600 --> 1:03:26.560
<v Speaker 1>it's really hard to incorporate that into a medical definition, right.

1:03:26.880 --> 1:03:29.840
<v Speaker 1>And I will say also those boundaries are a necessary

1:03:29.880 --> 1:03:34.560
<v Speaker 1>part of any medical definition. But having that lack of

1:03:34.680 --> 1:03:37.600
<v Speaker 1>nuance in understanding the individual can also be really have

1:03:37.680 --> 1:03:42.480
<v Speaker 1>consequences associated with it. Yeah, personalization of care is a

1:03:42.480 --> 1:03:46.360
<v Speaker 1>crucial aspect, not just for PPD, but also for childbirth

1:03:46.440 --> 1:03:49.520
<v Speaker 1>and pregnancy more broadly. And I want to end with

1:03:49.720 --> 1:03:52.560
<v Speaker 1>yet another quote by Judith Walser Levitt. I really loved

1:03:52.560 --> 1:03:56.560
<v Speaker 1>this book. As you can tell quote, throughout American history,

1:03:56.720 --> 1:03:59.680
<v Speaker 1>women have wanted and have worked to achieve their own

1:04:00.080 --> 1:04:04.000
<v Speaker 1>deals of childbirth, ideals that have developed and been nurtured

1:04:04.040 --> 1:04:06.880
<v Speaker 1>within their own communities in conjunction with the rest of

1:04:06.920 --> 1:04:11.360
<v Speaker 1>their life experiences. Childbirth remains as it has always been

1:04:11.640 --> 1:04:15.720
<v Speaker 1>a cultural event as much as a biological one. Problems

1:04:15.720 --> 1:04:18.200
<v Speaker 1>emerged during the middle of the twentieth century because the

1:04:18.280 --> 1:04:21.880
<v Speaker 1>hospital acted to homogenize the birth experience and make it

1:04:21.920 --> 1:04:26.440
<v Speaker 1>similar for all women. But childbirth cannot successfully be reduced

1:04:26.480 --> 1:04:29.080
<v Speaker 1>to one kind of experience, and at the same time,

1:04:29.320 --> 1:04:32.600
<v Speaker 1>satisfy the wide range of expectations women bring to it.

1:04:33.440 --> 1:04:36.480
<v Speaker 1>The diversity that women seek will continue to reflect the

1:04:36.480 --> 1:04:43.640
<v Speaker 1>differences of the women themselves. End quote and chills and

1:04:43.720 --> 1:04:47.120
<v Speaker 1>with that, err and oh turn it over me right there.

1:04:47.840 --> 1:04:49.160
<v Speaker 1>Tell me about the fourth trimester.

1:04:49.600 --> 1:04:52.920
<v Speaker 5>Okay, you might need a little breather after that.

1:04:53.280 --> 1:04:54.440
<v Speaker 1>Okay, we can do that.

1:04:54.440 --> 1:04:56.240
<v Speaker 5>I'll take a break and then get into it.

1:04:56.360 --> 1:04:57.520
<v Speaker 1>Sho, let's do it.

1:05:11.400 --> 1:05:13.640
<v Speaker 9>At thirty two years old, I got pregnant for the

1:05:13.680 --> 1:05:16.360
<v Speaker 9>first time. I had what you'd call a textbook pregnancy,

1:05:16.640 --> 1:05:18.960
<v Speaker 9>healthy baby, low risk, and a noticeabook low.

1:05:19.040 --> 1:05:20.000
<v Speaker 3>But there was a lot of.

1:05:19.960 --> 1:05:22.440
<v Speaker 9>Things that I wasn't warned about, and things that just

1:05:22.520 --> 1:05:25.360
<v Speaker 9>weren't talked about unless I brought them up harmy and

1:05:25.400 --> 1:05:27.800
<v Speaker 9>I started trying for a baby in September, and luckily enough,

1:05:27.800 --> 1:05:30.840
<v Speaker 9>by November, I was pregnant. My first symptom wasn't warning

1:05:30.880 --> 1:05:34.320
<v Speaker 9>sickness or anything like that. In fact, it was excruciating

1:05:34.360 --> 1:05:36.920
<v Speaker 9>period pain. I genuinely thought I was about to have

1:05:36.920 --> 1:05:39.120
<v Speaker 9>the worst period ever, as some kind of cruel joke.

1:05:39.840 --> 1:05:42.720
<v Speaker 9>Turns out, it was implantation. The next time I felt

1:05:42.720 --> 1:05:45.640
<v Speaker 9>that level of pain was actually an active labor within

1:05:45.680 --> 1:05:48.760
<v Speaker 9>two weeks of conception, my body already started changing. My

1:05:48.800 --> 1:05:51.280
<v Speaker 9>boobs went from an age with seacup almost a night overnight,

1:05:51.320 --> 1:05:53.880
<v Speaker 9>and they continued to grow throughout my pregnancy and got

1:05:53.880 --> 1:05:58.120
<v Speaker 9>pretty big during breastfeeding. My stomach also grew quickly. I

1:05:58.280 --> 1:06:01.400
<v Speaker 9>was mostly water because the baby boy was measuring perfect

1:06:01.440 --> 1:06:04.240
<v Speaker 9>the entire time. I was very lucky when it came

1:06:04.240 --> 1:06:06.080
<v Speaker 9>to nausea. I only experienced it for about a week

1:06:06.120 --> 1:06:09.280
<v Speaker 9>and cardamin tea helped a lot. I only vomited twice,

1:06:09.480 --> 1:06:11.320
<v Speaker 9>once from a bad meal which my husband also got

1:06:11.320 --> 1:06:13.960
<v Speaker 9>sick from, and once when I accidentally ate bacon. Because

1:06:14.000 --> 1:06:16.400
<v Speaker 9>pork was a major food version for me, which is

1:06:16.480 --> 1:06:20.720
<v Speaker 9>kind of surprising giving my Italian Australian background. Thankfully, since

1:06:20.760 --> 1:06:22.480
<v Speaker 9>my husband is Muslim, pork wasn't something I had to

1:06:22.480 --> 1:06:25.240
<v Speaker 9>deal with in the house. The cravings did start really

1:06:25.280 --> 1:06:27.919
<v Speaker 9>early at first, to as salt, venigo, chips, and anything sour,

1:06:28.040 --> 1:06:31.080
<v Speaker 9>especially lemon ice cream. In a second trimester, I craved

1:06:31.080 --> 1:06:34.120
<v Speaker 9>corn and coffee. Of course, I only ate drank decaf,

1:06:34.160 --> 1:06:36.680
<v Speaker 9>but I never drank coffee before pregnancy. Funnily enough, I'm

1:06:36.680 --> 1:06:40.040
<v Speaker 9>still drinking it now after giving birth. By the third trimester,

1:06:40.120 --> 1:06:42.160
<v Speaker 9>my cravings had evolved to steak with an egg on top.

1:06:42.800 --> 1:06:45.120
<v Speaker 9>On the flip side, I couldn't stand chicken or pork.

1:06:45.400 --> 1:06:48.120
<v Speaker 9>Even the smell of chicken maybe nauseous, to the point

1:06:48.160 --> 1:06:49.800
<v Speaker 9>that if my husband ate it, he had to brush

1:06:49.840 --> 1:06:53.240
<v Speaker 9>his teeth before coming miming. Pregnancy also came with a

1:06:53.280 --> 1:06:56.720
<v Speaker 9>long list of symptoms. I just wasn't prepared for. Blood noses,

1:06:56.840 --> 1:07:00.760
<v Speaker 9>gray hairs, loose ligaments, ligament pain triggered by sneezing, dry skin,

1:07:00.960 --> 1:07:03.280
<v Speaker 9>exhaustion that left me sleeping for ten hours at night

1:07:03.320 --> 1:07:05.280
<v Speaker 9>and then still napping for four hours during the day,

1:07:05.840 --> 1:07:09.520
<v Speaker 9>acid reflux, and reoccurring thrush, which I had never experienced

1:07:09.560 --> 1:07:13.840
<v Speaker 9>before pregnancy. The physical strain was pretty intense. At times,

1:07:13.840 --> 1:07:16.000
<v Speaker 9>it felt like I'd done a hardcore leg day at

1:07:16.000 --> 1:07:18.720
<v Speaker 9>the gym, or I'd been riding a horse bearback for hours.

1:07:19.280 --> 1:07:21.120
<v Speaker 9>I had to give up weightlifting and running because I

1:07:21.160 --> 1:07:23.560
<v Speaker 9>was just too exhausted. But I did manage to do

1:07:23.560 --> 1:07:25.200
<v Speaker 9>a little bit of yoga a couple of times a week,

1:07:25.320 --> 1:07:27.000
<v Speaker 9>and maybe that's why I could still time my own

1:07:27.000 --> 1:07:28.040
<v Speaker 9>shoes at nine months pregnant.

1:07:28.080 --> 1:07:28.560
<v Speaker 3>Who knows.

1:07:29.360 --> 1:07:31.960
<v Speaker 9>In my third trimester, I needed an iron infusion. My

1:07:32.040 --> 1:07:34.800
<v Speaker 9>iron levels were actually fine, but my hemoglobins were slightly load,

1:07:34.920 --> 1:07:37.600
<v Speaker 9>so it was recommended that I do it. Around this time,

1:07:37.600 --> 1:07:39.800
<v Speaker 9>baby boy started moving into position and I could feel

1:07:40.000 --> 1:07:43.439
<v Speaker 9>every shift. There was a moment when I genuinely thought

1:07:43.440 --> 1:07:45.240
<v Speaker 9>that he might just fall out because of how low

1:07:45.320 --> 1:07:49.080
<v Speaker 9>he moved. Despite all the unexpected symptoms, I got the

1:07:49.080 --> 1:07:51.520
<v Speaker 9>birth experience that I wanted. I had a pain relief

1:07:51.560 --> 1:07:53.760
<v Speaker 9>water berth, and in the final moments, I reached down

1:07:53.800 --> 1:07:55.920
<v Speaker 9>and pulled my baby at myself. It was an intense

1:07:55.960 --> 1:07:59.640
<v Speaker 9>and transformative experience and one that I'm really grateful for.

1:08:00.400 --> 1:08:02.280
<v Speaker 9>Looking back, I know I was lucky to have such

1:08:02.280 --> 1:08:05.400
<v Speaker 9>a smooth pregnancy, but that doesn't mean it was easy.

1:08:06.000 --> 1:08:07.960
<v Speaker 9>There were a lot of challenges, surprises, and lots of

1:08:08.040 --> 1:08:11.400
<v Speaker 9>moments of discomfort. Through it all, my body did exactly

1:08:11.400 --> 1:08:15.000
<v Speaker 9>what I needed to do, and I'm so grateful for

1:08:15.080 --> 1:08:17.400
<v Speaker 9>my body for doing that and for giving me my beautiful,

1:08:17.400 --> 1:08:20.040
<v Speaker 9>healthy baby boy.

1:08:20.240 --> 1:08:23.439
<v Speaker 10>Hi, Aaron's. My name is Miranda, and I want to

1:08:23.479 --> 1:08:26.080
<v Speaker 10>thank you for allowing me to share my pregnancy and

1:08:26.120 --> 1:08:29.320
<v Speaker 10>birth journey. I have to say that overall, my pregnancy

1:08:29.400 --> 1:08:33.640
<v Speaker 10>journey was relatively uneventful and I'm very thankful for that

1:08:33.960 --> 1:08:36.599
<v Speaker 10>for the health of myself and of my baby boy,

1:08:36.760 --> 1:08:40.639
<v Speaker 10>who is now eighteen months old. I will say the

1:08:40.760 --> 1:08:47.120
<v Speaker 10>most annoying and most prominent pregnancy symptom I had was

1:08:47.160 --> 1:08:51.160
<v Speaker 10>actually carpal tunnel syndrome, which going into pregnancy I had

1:08:51.240 --> 1:08:54.519
<v Speaker 10>no idea that that was a common symptom. I spent

1:08:54.600 --> 1:08:58.080
<v Speaker 10>probably the second half of my pregnancy with my hands

1:08:58.240 --> 1:09:03.320
<v Speaker 10>being numb or tingling, or painful, almost twenty four to seven,

1:09:03.560 --> 1:09:06.760
<v Speaker 10>so that was definitely frustrating. Other than that, towards the

1:09:06.800 --> 1:09:11.160
<v Speaker 10>end of my pregnancy, I started to have some gestational hypertension,

1:09:11.680 --> 1:09:15.160
<v Speaker 10>so we did a few non stress tests in biophysical

1:09:15.160 --> 1:09:18.120
<v Speaker 10>profiles to make sure that I was safe and that

1:09:18.200 --> 1:09:20.800
<v Speaker 10>my little guy was safe. On the fourth of July,

1:09:21.280 --> 1:09:22.920
<v Speaker 10>maybe I had a little too much fun on the

1:09:23.000 --> 1:09:26.840
<v Speaker 10>lake and enjoyed some salty snacks, but my blood pressure

1:09:26.880 --> 1:09:29.160
<v Speaker 10>did go pretty high, so they ended up deciding to

1:09:29.280 --> 1:09:31.600
<v Speaker 10>induce me when I was due in mid July, so

1:09:31.800 --> 1:09:34.720
<v Speaker 10>it was not too early. I really didn't need much

1:09:34.720 --> 1:09:39.120
<v Speaker 10>of a kickstart for labor. Thankfully, I started labor pretty

1:09:39.200 --> 1:09:45.000
<v Speaker 10>darn quickly without even having any potocin. Unfortunately, I did

1:09:45.040 --> 1:09:48.559
<v Speaker 10>not progress in labor as we'd hoped. I was in

1:09:48.640 --> 1:09:51.559
<v Speaker 10>labor for eighteen hours and I was dilated to nine

1:09:51.600 --> 1:09:55.120
<v Speaker 10>and a half centimeters and I was stalled out. So

1:09:55.400 --> 1:09:58.639
<v Speaker 10>after about six hours stalled out, my son's heart rate

1:09:58.680 --> 1:10:03.760
<v Speaker 10>started dropping, and my doctor advised us that we could

1:10:03.800 --> 1:10:06.640
<v Speaker 10>wait a little bit longer and potentially have to have

1:10:06.680 --> 1:10:10.120
<v Speaker 10>an emergency sea section, or we could just do a

1:10:10.160 --> 1:10:13.559
<v Speaker 10>sea section now, And after eighteen hours of labor, I

1:10:13.600 --> 1:10:16.640
<v Speaker 10>was on board with that. We had a beautiful and

1:10:16.680 --> 1:10:19.840
<v Speaker 10>wonderful sea section experience, and I'm so thankful for all

1:10:19.880 --> 1:10:22.040
<v Speaker 10>of the staff and my husband and my mom for

1:10:22.160 --> 1:10:26.519
<v Speaker 10>being there to support me. I was very surprised by

1:10:26.520 --> 1:10:29.639
<v Speaker 10>the swelling after the sea section. I couldn't wear shoes

1:10:29.720 --> 1:10:33.600
<v Speaker 10>for two to three days, But other than that, my

1:10:33.960 --> 1:10:37.920
<v Speaker 10>little guy was happy and healthy and I had an

1:10:37.960 --> 1:10:40.080
<v Speaker 10>overall great experience. Thank you.

1:11:05.960 --> 1:11:09.120
<v Speaker 4>So last week, at the end of episode three, I

1:11:09.600 --> 1:11:15.799
<v Speaker 4>ended where most conversations regarding pregnancy end, and that is once.

1:11:15.560 --> 1:11:18.880
<v Speaker 1>The baby's delivered, right, everything's over. Yeah, But that's not

1:11:18.920 --> 1:11:20.080
<v Speaker 1>where pregnancy ends.

1:11:21.479 --> 1:11:21.840
<v Speaker 3>At all.

1:11:23.120 --> 1:11:25.840
<v Speaker 4>So Aarin, you just walked us through a lot of

1:11:25.880 --> 1:11:32.080
<v Speaker 4>the kind of social and institutional, high level factors that

1:11:32.280 --> 1:11:38.200
<v Speaker 4>have caused this shift in where delivery happens, and how

1:11:38.280 --> 1:11:40.400
<v Speaker 4>these things have kind of contributed to a lot of

1:11:40.400 --> 1:11:44.920
<v Speaker 4>the big picture postpartum outcomes. Those big picture things are

1:11:44.960 --> 1:11:49.280
<v Speaker 4>like maternal mortality rates, even like postpartum depression rates, which

1:11:49.280 --> 1:11:52.200
<v Speaker 4>we'll get into. And so that is where I'm I'm

1:11:52.240 --> 1:11:55.160
<v Speaker 4>kind of picking up your threads right there, perfect, but

1:11:55.200 --> 1:11:58.040
<v Speaker 4>then I'm gonna unravel them a little bit more to

1:11:58.240 --> 1:12:03.920
<v Speaker 4>also remind us of what is going on biologically in

1:12:03.960 --> 1:12:08.719
<v Speaker 4>this so called fourth trimester, why it might be rocky

1:12:09.040 --> 1:12:13.519
<v Speaker 4>for some of us. And my favorite, what do we

1:12:13.600 --> 1:12:18.120
<v Speaker 4>know about evidence based ways to improve outcomes?

1:12:19.000 --> 1:12:22.760
<v Speaker 1>Evidence based? What a beautiful phrase. Oh, I just love it.

1:12:22.840 --> 1:12:25.400
<v Speaker 3>You want a spoiler alert on what it is we

1:12:25.479 --> 1:12:26.679
<v Speaker 3>don't know public health?

1:12:26.720 --> 1:12:29.920
<v Speaker 1>Oh, okay, don't worry. We know we don't know.

1:12:30.160 --> 1:12:31.200
<v Speaker 5>No, we do know health.

1:12:31.240 --> 1:12:34.280
<v Speaker 1>But then, yeah, do we invest in public health?

1:12:34.560 --> 1:12:35.320
<v Speaker 5>Maybe we will.

1:12:35.640 --> 1:12:38.200
<v Speaker 4>Someone will listen to this episode and be like, aha,

1:12:38.880 --> 1:12:40.840
<v Speaker 4>I didn't want to read the Lancet Global Health article,

1:12:40.880 --> 1:12:42.519
<v Speaker 4>but I listened to this podcast will kill you, and.

1:12:42.479 --> 1:12:43.360
<v Speaker 3>Now I have all the answers.

1:12:43.400 --> 1:12:46.600
<v Speaker 4>Okay, I do also want to quickly acknowledge what I

1:12:46.640 --> 1:12:49.400
<v Speaker 4>Am not going to talk about in this episode, even

1:12:49.400 --> 1:12:53.080
<v Speaker 4>though it's so cool, And that is the physiology of

1:12:53.160 --> 1:12:57.120
<v Speaker 4>the newborn. Just like I kind of breezed through early

1:12:57.160 --> 1:13:00.160
<v Speaker 4>embryonic development and I didn't talk at all about the

1:13:00.160 --> 1:13:02.240
<v Speaker 4>rest of fetal development. I am not going to talk

1:13:02.280 --> 1:13:04.920
<v Speaker 4>about the physiology of the newborn, but it is really

1:13:04.920 --> 1:13:05.920
<v Speaker 4>cool and fascinating.

1:13:05.960 --> 1:13:08.799
<v Speaker 1>We'll do it someday. Second fourth trimester exactly.

1:13:08.880 --> 1:13:12.280
<v Speaker 4>Yeah, yeah, but this is pregnancy, and so this is

1:13:12.320 --> 1:13:17.680
<v Speaker 4>the fourth trimester of pregnancy. Yeah, pregnant person, Yes, Okay. Physiologically,

1:13:17.960 --> 1:13:20.599
<v Speaker 4>there is still a lot of changes to take place

1:13:20.840 --> 1:13:25.280
<v Speaker 4>after the baby and placenta have been delivered. Now, the placenta,

1:13:26.000 --> 1:13:30.160
<v Speaker 4>our favorite, is the primary organ that was making all

1:13:30.200 --> 1:13:33.840
<v Speaker 4>of the hormones that kept the pregnancy going. So once

1:13:33.880 --> 1:13:37.600
<v Speaker 4>that placenta has been delivered, you have a rapid withdrawal

1:13:37.640 --> 1:13:42.040
<v Speaker 4>of placental hormones, and that results in significant decreases because

1:13:42.040 --> 1:13:44.400
<v Speaker 4>the placental hormones are like there's a whole bunch of

1:13:44.400 --> 1:13:47.280
<v Speaker 4>different things, and a lot of them. It's not necessarily

1:13:47.479 --> 1:13:50.320
<v Speaker 4>just like estrogen and progesterone alone, but it's like hormones

1:13:50.320 --> 1:13:53.000
<v Speaker 4>that are telling us to make more estrogen and progesterone

1:13:53.040 --> 1:13:53.439
<v Speaker 4>and stuff.

1:13:53.479 --> 1:13:56.600
<v Speaker 1>It's it's like both a radio tower. It's not just

1:13:56.680 --> 1:14:00.479
<v Speaker 1>like a trans Okay, here's what I was thinking. Love

1:14:00.520 --> 1:14:06.240
<v Speaker 1>is blind. It's not just the window between the two, right,

1:14:06.360 --> 1:14:09.160
<v Speaker 1>It's like if the window we're also saying now go

1:14:09.400 --> 1:14:18.439
<v Speaker 1>get flat. Also the producers, Yes, the producers. Analogy does

1:14:18.479 --> 1:14:20.920
<v Speaker 1>not need to exist, but I like it. Love a

1:14:20.960 --> 1:14:26.559
<v Speaker 1>bad analogy. Yes, Okay, it's that. Okay, it is the producer,

1:14:26.640 --> 1:14:27.960
<v Speaker 1>the director, whatever.

1:14:29.240 --> 1:14:30.280
<v Speaker 5>But so once this.

1:14:30.240 --> 1:14:34.439
<v Speaker 4>Placenta is gone, you have a significant and pretty rapid,

1:14:34.640 --> 1:14:37.679
<v Speaker 4>like in a number of days weeks decline in estrogen

1:14:37.720 --> 1:14:43.200
<v Speaker 4>and progesterone especially, And this cascade is what results in

1:14:43.600 --> 1:14:46.880
<v Speaker 4>a lot of the physiologic changes that we see. So

1:14:47.160 --> 1:14:48.840
<v Speaker 4>I'm going to kind of walk through again a little

1:14:48.880 --> 1:14:51.559
<v Speaker 4>bit system by system about what some of these changes are.

1:14:52.439 --> 1:14:56.880
<v Speaker 4>Most of these changes kind of get you back to

1:14:57.400 --> 1:15:00.000
<v Speaker 4>and I hate to say back to because it's.

1:14:59.840 --> 1:15:00.920
<v Speaker 3>Really a new normal.

1:15:01.240 --> 1:15:03.519
<v Speaker 4>Okay, But in terms of your physiology, a lot of

1:15:03.520 --> 1:15:07.439
<v Speaker 4>it is closer to pre pregnancy levels of the stuff

1:15:07.479 --> 1:15:10.040
<v Speaker 4>that we're going to talk about by about six weeks.

1:15:10.560 --> 1:15:12.120
<v Speaker 4>Some of it takes about twelve weeks.

1:15:12.560 --> 1:15:15.400
<v Speaker 1>So can I ask a question about, like, what how

1:15:16.200 --> 1:15:18.760
<v Speaker 1>different are those changes? Like is there just a way,

1:15:18.800 --> 1:15:22.840
<v Speaker 1>so I can in my head quantify what that looks like.

1:15:22.920 --> 1:15:25.040
<v Speaker 1>And I guess it's hard to know, like how much

1:15:25.200 --> 1:15:26.840
<v Speaker 1>estrogen is actually.

1:15:26.680 --> 1:15:29.840
<v Speaker 4>Yeah, those numbers, Yeah, I don't know. I think one

1:15:29.880 --> 1:15:33.040
<v Speaker 4>of the graphs that I had in last episode showed

1:15:33.080 --> 1:15:35.960
<v Speaker 4>like hormone concentrations and stuff like that, But there's also

1:15:36.120 --> 1:15:40.799
<v Speaker 4>such ranges. And especially like anyone who is menstruating, your

1:15:41.080 --> 1:15:44.240
<v Speaker 4>levels fluctuate so much with your menstrual cycle. I will

1:15:44.280 --> 1:15:48.320
<v Speaker 4>say that after like in postpardum, you have a withdrawal

1:15:48.400 --> 1:15:50.799
<v Speaker 4>of these hormones, so they go down to very low levels,

1:15:51.120 --> 1:15:56.600
<v Speaker 4>and if you are breastfeeding, they remain suppressed because of prolactin.

1:15:56.840 --> 1:16:00.000
<v Speaker 4>That's being so like the withdrawal of progesterone, skipping around

1:16:00.040 --> 1:16:03.160
<v Speaker 4>to my notes, the withdrawal of progesterone causes an increase

1:16:03.200 --> 1:16:06.240
<v Speaker 4>in prolactin, which is the hormone that stimulates milk production.

1:16:07.040 --> 1:16:10.519
<v Speaker 4>So if you are then breastfeeding, you continue to have

1:16:10.680 --> 1:16:15.080
<v Speaker 4>high levels of prolactin, and that suppresses the release of

1:16:15.640 --> 1:16:18.839
<v Speaker 4>LH which is lutinizing hormone, and FSH which is follicle

1:16:18.840 --> 1:16:22.280
<v Speaker 4>stimulating hormone, and those are what would induce a normal

1:16:22.439 --> 1:16:26.280
<v Speaker 4>ovulatory and menstrual cycle, and that is why you see

1:16:26.280 --> 1:16:30.479
<v Speaker 4>suppression of mensis during breastfeeding, and why that is for

1:16:30.560 --> 1:16:33.240
<v Speaker 4>a lot of people a good form of contraception.

1:16:33.040 --> 1:16:36.000
<v Speaker 1>But doesn't always it doesn't.

1:16:35.800 --> 1:16:37.400
<v Speaker 5>But okay, in no way. But I mean it is

1:16:37.600 --> 1:16:39.200
<v Speaker 5>like it's more effective than condoms.

1:16:39.600 --> 1:16:40.599
<v Speaker 1>Okay, that's interesting.

1:16:40.640 --> 1:16:42.640
<v Speaker 4>It does not get I had a whole paragraph on

1:16:42.640 --> 1:16:44.080
<v Speaker 4>this somewhere, but I can't even find it, so I'm

1:16:44.080 --> 1:16:46.519
<v Speaker 4>gonna just talk to you from my brain. Yeah, it is,

1:16:46.840 --> 1:16:49.440
<v Speaker 4>I forget the exact number, but it is actually quite effective.

1:16:49.479 --> 1:16:52.840
<v Speaker 4>But it's only for the first six months postpartum that

1:16:52.880 --> 1:16:54.439
<v Speaker 4>we have good data on it, and it's only when

1:16:54.479 --> 1:16:58.400
<v Speaker 4>people are exclusively breastfeeding, which does not include pumping, because

1:16:58.400 --> 1:17:01.320
<v Speaker 4>it is also breastfeeding on demand, which means that you

1:17:01.360 --> 1:17:05.120
<v Speaker 4>are breastfeeding based on your newborn's cues and not necessarily

1:17:05.160 --> 1:17:06.920
<v Speaker 4>on an hourly schedule, which is what you end up

1:17:06.960 --> 1:17:10.360
<v Speaker 4>having to do if you're exclusively pumping. Not everybody is

1:17:10.400 --> 1:17:12.559
<v Speaker 4>going to remain a menner reec which means they're not

1:17:12.600 --> 1:17:15.800
<v Speaker 4>having mensis. But it is it as actually, as per

1:17:15.880 --> 1:17:18.800
<v Speaker 4>the World Health Organization guidelines, it is an effective and

1:17:18.880 --> 1:17:20.759
<v Speaker 4>recommended form of birth control for a lot of people.

1:17:20.800 --> 1:17:23.000
<v Speaker 1>Oh my god, Okay, I didn't know that there's more

1:17:23.080 --> 1:17:25.640
<v Speaker 1>nuance because I know a number of people who have

1:17:25.720 --> 1:17:28.400
<v Speaker 1>gotten pregnant. Absolutely absolutely, and.

1:17:28.439 --> 1:17:30.360
<v Speaker 4>So there's more nuance too because if you are sort

1:17:30.400 --> 1:17:32.640
<v Speaker 4>of supplementing with formula, or if you're having to be

1:17:32.680 --> 1:17:34.680
<v Speaker 4>away and then you're pumping and things like that, then

1:17:34.800 --> 1:17:37.960
<v Speaker 4>absolutely your mensies can come back earlier than that six months.

1:17:38.280 --> 1:17:40.400
<v Speaker 4>They can come back in a matter of weeks. Again,

1:17:40.439 --> 1:17:42.160
<v Speaker 4>it's going to be different person to person. That's why

1:17:42.200 --> 1:17:45.960
<v Speaker 4>it's not one hundred percent effective what it means, but yeah,

1:17:45.960 --> 1:17:46.240
<v Speaker 4>it is.

1:17:46.280 --> 1:17:51.320
<v Speaker 3>This is really interesting. Yeah, how about that tangent for

1:17:51.439 --> 1:17:51.840
<v Speaker 3>us there?

1:17:52.000 --> 1:17:53.320
<v Speaker 1>I love a tangent me too.

1:17:53.640 --> 1:17:56.720
<v Speaker 4>So, yes, we see this big hormonal change, and then

1:17:56.800 --> 1:17:59.960
<v Speaker 4>a lot of those physiologic changes that happened to sustain

1:18:00.240 --> 1:18:03.280
<v Speaker 4>the pregnancy are going to kind of unravel themselves.

1:18:03.600 --> 1:18:05.559
<v Speaker 5>So your blood volume, which.

1:18:05.400 --> 1:18:09.600
<v Speaker 4>Again had increased by about fifty percent during pregnancy, is

1:18:09.640 --> 1:18:13.320
<v Speaker 4>going to return to pre pregnancy baseline within a matter

1:18:13.400 --> 1:18:17.960
<v Speaker 4>of weeks. And what that means is that you immediately

1:18:18.040 --> 1:18:21.639
<v Speaker 4>after birth have way more fluid on your body than

1:18:21.680 --> 1:18:23.360
<v Speaker 4>your body thinks that it needs. Now that there's no

1:18:23.360 --> 1:18:26.160
<v Speaker 4>placenta there secreting hormones to say, keep up this blood volume,

1:18:26.680 --> 1:18:29.720
<v Speaker 4>so your kidneys have to take over the work of

1:18:29.840 --> 1:18:33.120
<v Speaker 4>excreting all that extra fluid, and so your kidneys have

1:18:33.200 --> 1:18:36.479
<v Speaker 4>to further increase their diuresis, and so you have this

1:18:36.520 --> 1:18:39.640
<v Speaker 4>physiologic diuresis. So a lot of times you'll you'll be

1:18:39.800 --> 1:18:43.559
<v Speaker 4>very kind of puffy immediately postpartum, and that's because of

1:18:43.600 --> 1:18:46.240
<v Speaker 4>all this excess fluid that your kidneys are now just

1:18:46.280 --> 1:18:48.080
<v Speaker 4>trying to like shunt out, and then you're peeing all

1:18:48.080 --> 1:18:48.920
<v Speaker 4>the time because of that.

1:18:49.000 --> 1:18:50.400
<v Speaker 1>And how long does that last?

1:18:50.640 --> 1:18:53.920
<v Speaker 4>A few days usually for like the physiologic diuresis, I

1:18:53.920 --> 1:18:56.160
<v Speaker 4>think it. I don't remember the exact days that it peaks,

1:18:56.160 --> 1:18:57.559
<v Speaker 4>but it's like a few days and then you kind

1:18:57.600 --> 1:19:01.040
<v Speaker 4>of go back to your pre pregnancy baseline. Ish your

1:19:01.080 --> 1:19:04.440
<v Speaker 4>GI tract, which remembers slowed down a lot during pregnancy

1:19:04.479 --> 1:19:09.479
<v Speaker 4>because of progesterone, It actually slows down even further during labor,

1:19:10.120 --> 1:19:13.240
<v Speaker 4>and it will start to return to a pre pregnancy

1:19:13.400 --> 1:19:15.840
<v Speaker 4>type of functioning, like mobility will come back within a

1:19:15.880 --> 1:19:19.480
<v Speaker 4>few days. But in those first few days immediately postpartum,

1:19:20.080 --> 1:19:22.639
<v Speaker 4>you can have that continue like it's a little bit

1:19:22.640 --> 1:19:25.920
<v Speaker 4>more slow, and that can result in constipation. This is

1:19:26.000 --> 1:19:30.520
<v Speaker 4>exacerbated by c sections because those are again abdominal surgeries

1:19:30.680 --> 1:19:33.000
<v Speaker 4>where it can cause the bowels to kind of like

1:19:33.040 --> 1:19:35.880
<v Speaker 4>go to sleep a little bit, and so that can

1:19:35.920 --> 1:19:37.960
<v Speaker 4>mean that you can end up a little bit constipated. Plus,

1:19:38.000 --> 1:19:41.360
<v Speaker 4>opioids are often used, and so those slow down the

1:19:41.400 --> 1:19:44.760
<v Speaker 4>bowels even more. So that can make people either very

1:19:44.800 --> 1:19:48.439
<v Speaker 4>nervous about their first bowel movement postpartum because if whether

1:19:48.520 --> 1:19:50.560
<v Speaker 4>you had a vaginal delivery or a C section, you

1:19:50.640 --> 1:19:52.840
<v Speaker 4>might be worried about a hard stool that might be

1:19:52.880 --> 1:19:56.000
<v Speaker 4>harder to pass. So, yes, that's the thing that can happens.

1:19:56.040 --> 1:20:00.360
<v Speaker 4>Constipation postpartum usually gets better within a few days unless

1:20:00.360 --> 1:20:04.920
<v Speaker 4>you're on opioids continuously. Okay, Yeah, Your uterus, which of

1:20:04.960 --> 1:20:08.040
<v Speaker 4>course had to grow so large that it displaced all

1:20:08.080 --> 1:20:10.760
<v Speaker 4>of the rest of your organs, like we talked about

1:20:10.800 --> 1:20:13.200
<v Speaker 4>last episode, has to shrink back down, and it does

1:20:13.240 --> 1:20:16.559
<v Speaker 4>this very quickly, except that it doesn't go all the

1:20:16.560 --> 1:20:20.880
<v Speaker 4>way back to pre pregnancy baseline until a number of

1:20:20.920 --> 1:20:23.880
<v Speaker 4>weeks later, closer to like six weeks later, because it

1:20:23.960 --> 1:20:27.040
<v Speaker 4>just has to like continue to shrink. Part of that

1:20:27.120 --> 1:20:30.919
<v Speaker 4>process also means a couple things are happening to encourage

1:20:30.920 --> 1:20:35.639
<v Speaker 4>that process. One is that the release of oxytocin, which

1:20:35.680 --> 1:20:38.600
<v Speaker 4>is triggered by breastfeeding. So for people who are breastfeeding,

1:20:38.640 --> 1:20:41.120
<v Speaker 4>they're going to have an increase in the release of oxytocin.

1:20:41.520 --> 1:20:45.720
<v Speaker 4>That oxytocin is the hormone that stimulates uterine contraction, so

1:20:45.800 --> 1:20:49.080
<v Speaker 4>that's going to cause further uterine shrinkage back down to

1:20:49.240 --> 1:20:50.960
<v Speaker 4>like the size of a fist, which is what it

1:20:51.000 --> 1:20:52.920
<v Speaker 4>is pre pregnancy.

1:20:52.760 --> 1:20:55.920
<v Speaker 1>And is that pumping or.

1:20:56.280 --> 1:20:58.800
<v Speaker 4>Pumping or breastfeeding either one. And then even if you

1:20:59.000 --> 1:21:01.679
<v Speaker 4>are not breastfeeding, it's still going to shrink on its own.

1:21:02.040 --> 1:21:04.120
<v Speaker 4>It just might maybe take a little bit longer or

1:21:04.160 --> 1:21:06.800
<v Speaker 4>things like that. But yeah, so that it's going to

1:21:06.880 --> 1:21:08.880
<v Speaker 4>take a few weeks before it really goes back down.

1:21:08.920 --> 1:21:11.559
<v Speaker 4>It's not like a automatic It clamps way down, but

1:21:11.600 --> 1:21:13.679
<v Speaker 4>it doesn't like go back takes time.

1:21:13.800 --> 1:21:15.120
<v Speaker 1>Yeahs sense.

1:21:15.800 --> 1:21:18.120
<v Speaker 4>And as part of all of this, as this uterus

1:21:18.160 --> 1:21:20.960
<v Speaker 4>is continuing to shrink and contract, it also means that

1:21:21.000 --> 1:21:24.080
<v Speaker 4>you are going to be shedding all of the remnants

1:21:24.200 --> 1:21:28.559
<v Speaker 4>of your endometrium. Regardless of your mode of delivery, you

1:21:28.600 --> 1:21:31.439
<v Speaker 4>are going to be shedding this lining of your uterus,

1:21:31.479 --> 1:21:34.640
<v Speaker 4>and your uterus is remodeling its whole inner lining. So

1:21:34.680 --> 1:21:37.839
<v Speaker 4>you have a lot of vaginal bleeding. This is called lokia.

1:21:38.000 --> 1:21:42.120
<v Speaker 4>That's like just what we call the postpartum heating l

1:21:42.200 --> 1:21:43.600
<v Speaker 4>o chia.

1:21:44.080 --> 1:21:46.960
<v Speaker 1>Huh lokia. And how how long does that last? How

1:21:47.040 --> 1:21:47.639
<v Speaker 1>much blood?

1:21:48.240 --> 1:21:52.080
<v Speaker 4>Like, yeah, so how much blood can vary? Of course,

1:21:52.160 --> 1:21:54.559
<v Speaker 4>it usually can last anywhere from like a couple of

1:21:54.600 --> 1:21:58.400
<v Speaker 4>weeks to a month or more, totally person dependent, okay, Yeah, and.

1:21:58.360 --> 1:22:01.599
<v Speaker 1>The amount of like relative to a regular like if

1:22:01.600 --> 1:22:05.000
<v Speaker 1>you have more regular periods.

1:22:04.320 --> 1:22:06.439
<v Speaker 5>What is a regular period.

1:22:06.439 --> 1:22:09.479
<v Speaker 1>For an individual that doesn't even that?

1:22:10.600 --> 1:22:12.559
<v Speaker 5>No, yeah, it totally varies.

1:22:12.600 --> 1:22:15.280
<v Speaker 4>What I will say is what we Okay, we talked

1:22:15.280 --> 1:22:18.800
<v Speaker 4>a lot about postpartum hemorrhage last episode. Yeah, delayed postpartum

1:22:18.840 --> 1:22:22.160
<v Speaker 4>hemorrhage is also a thing where you can have a

1:22:22.200 --> 1:22:25.920
<v Speaker 4>hemorrhage that occurs later on after delivery, in the days

1:22:25.960 --> 1:22:26.640
<v Speaker 4>or weeks.

1:22:26.360 --> 1:22:27.439
<v Speaker 1>Posts or weeks okay.

1:22:27.560 --> 1:22:29.439
<v Speaker 4>And so what I will say is like the general

1:22:29.520 --> 1:22:32.240
<v Speaker 4>advice in terms of how much is too much bleeding?

1:22:33.320 --> 1:22:35.640
<v Speaker 4>I don't actually like to give medical advice on this podcast.

1:22:35.840 --> 1:22:39.519
<v Speaker 4>This is not medical advice. We are not your doctors.

1:22:39.840 --> 1:22:42.840
<v Speaker 4>We can hould your doctor. But usually if somebody is

1:22:42.880 --> 1:22:46.479
<v Speaker 4>bleeding so much they're that they're like completely saturating pads

1:22:46.560 --> 1:22:49.040
<v Speaker 4>for like hours in a row, or they're passing very

1:22:49.200 --> 1:22:53.000
<v Speaker 4>large blood clots, that is usually considered too much bleeding. Okay,

1:22:53.439 --> 1:22:55.719
<v Speaker 4>so it's kind of it should be like a moderate amount,

1:22:55.840 --> 1:22:58.920
<v Speaker 4>but not like heavy heavy bleeding, right, But again can

1:22:58.960 --> 1:23:02.919
<v Speaker 4>farely vary. Some people have very little bleeding, okay. Yeah,

1:23:02.960 --> 1:23:05.160
<v Speaker 4>And then we of course have milk production, which we

1:23:05.240 --> 1:23:07.400
<v Speaker 4>kind of already talked about, so I can skip it

1:23:07.800 --> 1:23:09.280
<v Speaker 4>unless you have any other questions about that.

1:23:10.360 --> 1:23:14.360
<v Speaker 1>When does it really like, of course I have questions

1:23:14.360 --> 1:23:15.640
<v Speaker 1>about that? Kidding me.

1:23:15.880 --> 1:23:20.840
<v Speaker 4>So the first milk quote unquote that you produce. All

1:23:20.840 --> 1:23:23.320
<v Speaker 4>of this is stimulated by again this withdrawal of hormones

1:23:23.320 --> 1:23:26.280
<v Speaker 4>and then the increase of prolactin. But even as that process,

1:23:26.320 --> 1:23:28.439
<v Speaker 4>before that process is really kind of kicked in, in

1:23:28.479 --> 1:23:31.720
<v Speaker 4>those first couple of days, your body is producing this

1:23:31.800 --> 1:23:35.640
<v Speaker 4>substance called colostrum, and that's that kind of yellowy like

1:23:35.680 --> 1:23:39.839
<v Speaker 4>it's a different texture, it looks different substance. We actually

1:23:39.840 --> 1:23:42.959
<v Speaker 4>start making that most people during about the second trimester.

1:23:43.160 --> 1:23:46.880
<v Speaker 4>Some people might notice it, some people might not and

1:23:46.960 --> 1:23:50.240
<v Speaker 4>then it takes usually two or three days on average

1:23:50.240 --> 1:23:53.439
<v Speaker 4>for your breast milk to come in okay. In people

1:23:53.479 --> 1:23:56.760
<v Speaker 4>who aren't going to be breastfeeding, there are a lot

1:23:56.800 --> 1:24:00.559
<v Speaker 4>of situations that can cause challenges to that, whether it's

1:24:00.600 --> 1:24:04.240
<v Speaker 4>delayed milk production. One of the risk factors for delayed

1:24:04.240 --> 1:24:07.679
<v Speaker 4>milk production might be a sea section. The mechanism there

1:24:08.040 --> 1:24:10.479
<v Speaker 4>not fully known right, we don't know, but it is

1:24:10.600 --> 1:24:13.280
<v Speaker 4>the case that sea section is associated with an increased

1:24:13.320 --> 1:24:17.040
<v Speaker 4>risk of delayed milk production. Also early delivery, whether that's

1:24:17.080 --> 1:24:20.920
<v Speaker 4>early term which would be before thirty seven weeks, or

1:24:20.960 --> 1:24:23.360
<v Speaker 4>like late pre term it's like thirty four to thirty

1:24:23.400 --> 1:24:26.040
<v Speaker 4>six weeks or so in there, or even just that

1:24:26.080 --> 1:24:28.479
<v Speaker 4>like early term thirty seven thirty eight weeks. Sometimes people

1:24:28.479 --> 1:24:30.840
<v Speaker 4>have a little bit of a delay or have like

1:24:31.120 --> 1:24:32.840
<v Speaker 4>a little bit of a delayed start in their breast

1:24:32.840 --> 1:24:35.799
<v Speaker 4>milk production. And then there is so many individual factors

1:24:35.840 --> 1:24:38.120
<v Speaker 4>as well that play in have you ever breastfed before?

1:24:38.600 --> 1:24:42.400
<v Speaker 4>Like so many different things. There's also infant factors that

1:24:42.439 --> 1:24:46.240
<v Speaker 4>can really contribute to the successful breastfeeding relationship. Babies who

1:24:46.280 --> 1:24:49.439
<v Speaker 4>are born early, either that early term or preterm, might

1:24:49.520 --> 1:24:52.799
<v Speaker 4>have difficulty latching. They might not have really good muscle

1:24:52.840 --> 1:24:55.519
<v Speaker 4>tone yet because they weren't fully developed in utero, and

1:24:55.560 --> 1:24:57.160
<v Speaker 4>so they don't have a great suck.

1:24:57.280 --> 1:24:57.360
<v Speaker 9>Like.

1:24:57.360 --> 1:25:02.320
<v Speaker 4>There's literally so many things, And I feel very strongly

1:25:03.320 --> 1:25:07.760
<v Speaker 4>about the rhetoric around breastfeeding today. Yeah, I do feel

1:25:07.760 --> 1:25:09.760
<v Speaker 4>that it deserves its whole own episode.

1:25:09.840 --> 1:25:13.160
<v Speaker 1>We will do one, absolutely, because there is a lot

1:25:13.200 --> 1:25:17.120
<v Speaker 1>to unpack there. Yeah, And the short answer is, in

1:25:17.120 --> 1:25:20.200
<v Speaker 1>my opinion and per medical establishment, regardless of whether they

1:25:20.240 --> 1:25:20.639
<v Speaker 1>admit it.

1:25:20.640 --> 1:25:21.599
<v Speaker 3>Or not, fed is best.

1:25:21.840 --> 1:25:25.280
<v Speaker 4>Okay, long story short, two to three days for breast

1:25:25.320 --> 1:25:26.520
<v Speaker 4>milk production postpartum.

1:25:26.560 --> 1:25:26.880
<v Speaker 3>Usually.

1:25:27.640 --> 1:25:31.639
<v Speaker 4>Now, during all of these physiologic changes that we've gone through,

1:25:31.760 --> 1:25:33.519
<v Speaker 4>whether you notice them or not, Like you might not

1:25:33.520 --> 1:25:35.800
<v Speaker 4>notice your blood volume changing, but you might notice that

1:25:35.840 --> 1:25:36.439
<v Speaker 4>you're peeing a.

1:25:36.360 --> 1:25:37.280
<v Speaker 3>Lot sort of a thing.

1:25:37.720 --> 1:25:41.680
<v Speaker 4>You also have just given birth, either vaginally or through

1:25:41.680 --> 1:25:45.720
<v Speaker 4>a C section, so you might have stitches either in

1:25:45.760 --> 1:25:49.400
<v Speaker 4>your abdomen or in your paraneum or maybe not. In

1:25:49.439 --> 1:25:52.599
<v Speaker 4>either case, you're probably going to be sore. There's going

1:25:52.640 --> 1:25:55.840
<v Speaker 4>to be pain that is there because of the whole

1:25:55.880 --> 1:26:00.080
<v Speaker 4>process that literally just happened. And then on top of that,

1:26:00.160 --> 1:26:06.800
<v Speaker 4>you have an infant or multiple who needs literal constant.

1:26:06.520 --> 1:26:10.120
<v Speaker 1>Care, constant around the clock, cannot be.

1:26:10.160 --> 1:26:14.280
<v Speaker 4>Left alone for like a minute. Who sucks at sleeping?

1:26:15.439 --> 1:26:16.240
<v Speaker 4>They suck at it?

1:26:16.280 --> 1:26:17.599
<v Speaker 1>Why are they so bad at sleeping?

1:26:17.600 --> 1:26:21.040
<v Speaker 4>Why are they so bad at sleeping? They suck at pooping.

1:26:21.160 --> 1:26:24.240
<v Speaker 4>They're not even good at there. They suck at eating.

1:26:24.840 --> 1:26:28.160
<v Speaker 4>They cannot figure it out, and you are now entirely

1:26:28.240 --> 1:26:32.599
<v Speaker 4>responsible for them. This is a very difficult time period.

1:26:33.360 --> 1:26:35.320
<v Speaker 4>Even if you are good at it, or you've done

1:26:35.360 --> 1:26:38.519
<v Speaker 4>it before or something like that, it's very hard. And

1:26:38.560 --> 1:26:41.840
<v Speaker 4>we talked in these last few episodes a lot about

1:26:41.880 --> 1:26:46.360
<v Speaker 4>the risky parts of pregnancy, the postpart and period. Really often,

1:26:46.520 --> 1:26:50.160
<v Speaker 4>especially in the US, gets dismissed. Oh right, Yeah, but

1:26:50.320 --> 1:26:53.360
<v Speaker 4>all of these physiologic changes that we've gone through, they

1:26:54.240 --> 1:26:59.559
<v Speaker 4>don't reverse themselves automatically, and they are still kind of

1:26:59.760 --> 1:27:03.400
<v Speaker 4>change and finding a brand new baseline in this postpartum period,

1:27:03.439 --> 1:27:06.200
<v Speaker 4>which means that we are still at increased risk of

1:27:06.280 --> 1:27:11.200
<v Speaker 4>things like postpartum pre acclampsia yeah okay, of delayed postpartum

1:27:11.240 --> 1:27:14.080
<v Speaker 4>hemorrhage like I talked about. There's also the risk of

1:27:14.120 --> 1:27:18.320
<v Speaker 4>infections like endometritis, which can happen post delivery. So there

1:27:18.400 --> 1:27:22.040
<v Speaker 4>is a lot of different topics that I could go into,

1:27:22.080 --> 1:27:24.559
<v Speaker 4>but what I'm going to now shift to focusing on

1:27:25.080 --> 1:27:29.120
<v Speaker 4>is one of the biggest contributors to postpartum morbidity, and

1:27:29.200 --> 1:27:33.080
<v Speaker 4>that is postpartum depression and postpartum anxiety and other postpartum

1:27:33.080 --> 1:27:38.120
<v Speaker 4>mood disorders. So postpartum depression, which is the one that

1:27:38.320 --> 1:27:40.960
<v Speaker 4>gets probably the most pressed these days and is the

1:27:40.960 --> 1:27:43.640
<v Speaker 4>most well defined because it does exist kind of in

1:27:43.680 --> 1:27:48.439
<v Speaker 4>the DSM five. It is generally recognized as more than

1:27:48.560 --> 1:27:51.439
<v Speaker 4>two weeks, and sometimes it's like has to be developed

1:27:51.479 --> 1:27:56.400
<v Speaker 4>in the first four weeks of a depressed mood in

1:27:56.479 --> 1:27:59.960
<v Speaker 4>the postpartum period, and we use a number of different

1:28:00.080 --> 1:28:03.760
<v Speaker 4>screening tools that are very well validated, like this questionnaire

1:28:03.880 --> 1:28:07.040
<v Speaker 4>which is called the Edinburgh Depression Scale or Edinburgh Postpartum

1:28:07.080 --> 1:28:11.639
<v Speaker 4>Depression Scale to decide if somebody meets criteria or needs

1:28:11.680 --> 1:28:15.600
<v Speaker 4>additional evaluation for postpartum depression. So it's a series of

1:28:15.680 --> 1:28:19.200
<v Speaker 4>questions and there are things like how like in the

1:28:19.280 --> 1:28:23.559
<v Speaker 4>last two weeks, how often have you felt like I'm

1:28:23.560 --> 1:28:27.320
<v Speaker 4>not looking forward to enjoyment with things, or how often

1:28:27.479 --> 1:28:29.840
<v Speaker 4>Some of the ones that I really hate are like

1:28:30.320 --> 1:28:33.040
<v Speaker 4>do you feel like you are worried for no good reason.

1:28:34.880 --> 1:28:36.479
<v Speaker 4>This is when I told you I feel like I

1:28:36.560 --> 1:28:38.320
<v Speaker 4>lie on these because I'm like, sorry, I am very

1:28:38.320 --> 1:28:38.800
<v Speaker 4>worried for.

1:28:38.760 --> 1:28:40.160
<v Speaker 1>A very good reason.

1:28:41.000 --> 1:28:43.760
<v Speaker 4>I am been anxious for no good reason at all. Right,

1:28:43.880 --> 1:28:45.400
<v Speaker 4>I've been crying for no reason.

1:28:45.479 --> 1:28:49.479
<v Speaker 1>Right to ask someone to say, are your anxieties justified?

1:28:49.479 --> 1:28:51.240
<v Speaker 1>Are your worries justified? Like that's not.

1:28:51.439 --> 1:28:53.639
<v Speaker 4>Yeah, but that's just my personal feelings. These are very

1:28:53.640 --> 1:28:58.600
<v Speaker 4>well validated tools for screening, and so this is the

1:28:58.680 --> 1:29:02.000
<v Speaker 4>kind of first thing that's recommend that everybody during pregnancy

1:29:02.040 --> 1:29:05.200
<v Speaker 4>and postpartum is supposed to be offered questionnaires like this

1:29:05.560 --> 1:29:09.640
<v Speaker 4>to try and identify people who are perhaps experiencing postpartum

1:29:09.680 --> 1:29:12.559
<v Speaker 4>mood disorders or who are at risk of developing postpartum

1:29:12.560 --> 1:29:18.519
<v Speaker 4>mood disorders. Globally, postpartum depression has an estimated prevalence of

1:29:18.680 --> 1:29:22.400
<v Speaker 4>seventeen percent. That is so much higher than any of

1:29:22.439 --> 1:29:25.519
<v Speaker 4>the other complications that we have talked about, like, so

1:29:25.720 --> 1:29:29.880
<v Speaker 4>much higher. That global number, though is not you can't

1:29:29.920 --> 1:29:34.080
<v Speaker 4>just leave it there, okay, because the variation geographically is huge.

1:29:34.360 --> 1:29:34.920
<v Speaker 1>Okay.

1:29:35.120 --> 1:29:39.759
<v Speaker 4>Now, low and middle income countries prevalence is significantly higher,

1:29:40.280 --> 1:29:43.880
<v Speaker 4>significantly higher than in high income countries. The average if

1:29:43.920 --> 1:29:46.400
<v Speaker 4>you just lump all low in middle income countries, which

1:29:46.439 --> 1:29:47.760
<v Speaker 4>is not a fair thing to do, but if you

1:29:47.840 --> 1:29:51.120
<v Speaker 4>do that, then the prevalence is estimated at around twenty percent.

1:29:52.439 --> 1:29:55.439
<v Speaker 4>High income countries, the average is like fifteen and a

1:29:55.479 --> 1:29:58.559
<v Speaker 4>half percent. But as you can see, there's a graph

1:29:58.640 --> 1:30:02.639
<v Speaker 4>that's in a paper that I cite that shows this

1:30:02.920 --> 1:30:06.400
<v Speaker 4>huge range in distribution. Some countries are as high as

1:30:06.520 --> 1:30:10.840
<v Speaker 4>thirty in the thirty percentile. So yeah, so the range

1:30:10.880 --> 1:30:13.000
<v Speaker 4>is really really huge, and a lot of high income

1:30:13.040 --> 1:30:17.120
<v Speaker 4>countries the prevalence of postpartum depression is in the single digits,

1:30:17.479 --> 1:30:20.960
<v Speaker 4>like eight nine percent. The US and the UK are

1:30:21.000 --> 1:30:24.200
<v Speaker 4>a little bit of outliers in the high income country bracket,

1:30:24.600 --> 1:30:30.920
<v Speaker 4>where the prevalence is estimated at eighteen and twenty percent respectively. Okay, okay,

1:30:31.360 --> 1:30:34.160
<v Speaker 4>now pause for a second because we're gonna err and

1:30:34.240 --> 1:30:38.240
<v Speaker 4>math this a little bit. Because that is, in the US,

1:30:38.600 --> 1:30:41.240
<v Speaker 4>we have an estimated around three and a half million

1:30:41.280 --> 1:30:45.000
<v Speaker 4>live berths every year if eighteen percent of those, and

1:30:45.320 --> 1:30:48.280
<v Speaker 4>postpartum depression is not limited to live births. This also

1:30:48.400 --> 1:30:52.840
<v Speaker 4>encompasses depression post miscarriage and still birth, which those rates

1:30:52.840 --> 1:30:56.040
<v Speaker 4>are even higher. But even if we just look at

1:30:56.040 --> 1:30:59.519
<v Speaker 4>those numbers, three and a half million live berths, eighteen

1:30:59.560 --> 1:31:03.599
<v Speaker 4>percent of those people having postpartum depression is over six

1:31:03.720 --> 1:31:07.240
<v Speaker 4>hundred and thirty thousand people in just the US every year.

1:31:07.280 --> 1:31:11.240
<v Speaker 4>That's not a small number of individuals or families that

1:31:11.280 --> 1:31:17.160
<v Speaker 4>are being affected. So that's postpartum depression, which is just

1:31:17.360 --> 1:31:22.320
<v Speaker 4>one of the postpartum mood disorders post part of anxiety.

1:31:22.800 --> 1:31:25.400
<v Speaker 1>I have a question. Okay, sorry, I know you're like,

1:31:25.840 --> 1:31:29.000
<v Speaker 1>I just want to I know, I know, I know. Okay,

1:31:29.479 --> 1:31:33.320
<v Speaker 1>this map that shows the rate of postpartum depression or

1:31:33.320 --> 1:31:38.559
<v Speaker 1>the prevalence, prevalence or prevalence. Okay, what is postpartum depression?

1:31:38.640 --> 1:31:39.920
<v Speaker 1>Is this all being defined?

1:31:40.520 --> 1:31:42.879
<v Speaker 4>It's all being defined as DSM five definitions.

1:31:42.960 --> 1:31:44.160
<v Speaker 1>Yes, depressions.

1:31:45.080 --> 1:31:47.920
<v Speaker 4>Post Partum anxiety another one of the post partum mood disorders,

1:31:48.320 --> 1:31:51.480
<v Speaker 4>estimated to effect eight to twelve percent of people postpartum.

1:31:51.680 --> 1:31:56.840
<v Speaker 4>Here's the big problem here, Okay, we don't have diagnostic criteria.

1:31:56.880 --> 1:32:01.240
<v Speaker 4>There is no such disorder. There is no disorder that

1:32:01.439 --> 1:32:05.599
<v Speaker 4>is called postpartum anxiety. We also do not have a

1:32:05.640 --> 1:32:09.920
<v Speaker 4>screening test. In theory, the EDS should be capturing people

1:32:09.920 --> 1:32:13.920
<v Speaker 4>who are at risk for postpartum anxiety type mood disorders, yeah,

1:32:14.080 --> 1:32:18.599
<v Speaker 4>and depressive disorders, but it doesn't like there's no screening

1:32:18.680 --> 1:32:22.559
<v Speaker 4>test for anxiety that is universally administered in the postpartum period,

1:32:22.600 --> 1:32:26.880
<v Speaker 4>and there is also not a specific like disorder that

1:32:26.960 --> 1:32:29.479
<v Speaker 4>is recognized as a post part of anxiety disorder. So

1:32:29.520 --> 1:32:32.800
<v Speaker 4>then people have to like to get a diagnosis quote

1:32:32.840 --> 1:32:35.160
<v Speaker 4>unquote whether that's important or not is a different discussion.

1:32:35.160 --> 1:32:38.360
<v Speaker 4>But it would then be a different type of anxiety disorder,

1:32:38.400 --> 1:32:41.800
<v Speaker 4>like a generalized anxiety disorder, obsessive compulsive disorder, right, like

1:32:41.920 --> 1:32:45.680
<v Speaker 4>all these other type of anxiety disorders, because anxiety is

1:32:45.760 --> 1:32:48.240
<v Speaker 4>a symptom and not a diagnosis.

1:32:48.320 --> 1:32:53.520
<v Speaker 1>Okay, good questions here, So a person could have postpartum

1:32:53.560 --> 1:32:59.000
<v Speaker 1>depression and postpartum anxiety absolutely, Okay. Secondly, then do postprium

1:32:59.000 --> 1:33:02.200
<v Speaker 1>depression post partum ascis because I know that in reading

1:33:02.200 --> 1:33:05.839
<v Speaker 1>about the history the postpartum like there was a huge

1:33:06.080 --> 1:33:10.080
<v Speaker 1>fight or struggle to get postpartum to be a specific thing,

1:33:10.120 --> 1:33:12.920
<v Speaker 1>and part of that was related to insurance and stuff,

1:33:12.960 --> 1:33:14.920
<v Speaker 1>so that it's like, oh, if this was pre existing,

1:33:14.960 --> 1:33:15.800
<v Speaker 1>we're not going to cover it.

1:33:15.880 --> 1:33:16.240
<v Speaker 5>Correct.

1:33:16.439 --> 1:33:20.519
<v Speaker 1>But but and so then that postpartum period was shown

1:33:20.560 --> 1:33:23.679
<v Speaker 1>as a risk factor, and that is how we got

1:33:23.680 --> 1:33:25.840
<v Speaker 1>postpartum depression as a diagnosis.

1:33:25.880 --> 1:33:31.479
<v Speaker 8>But then what was so I think it's usually it

1:33:31.560 --> 1:33:34.840
<v Speaker 8>has to last longer than two weeks, okay, because the

1:33:34.880 --> 1:33:38.800
<v Speaker 8>first two weeks postpartum people can have a depressed mood

1:33:38.800 --> 1:33:40.519
<v Speaker 8>that is still called the baby blues.

1:33:40.920 --> 1:33:42.480
<v Speaker 3>Yeah, the postpartum blues.

1:33:42.200 --> 1:33:46.559
<v Speaker 1>Which is people have described it as infantilizing, but.

1:33:47.320 --> 1:33:49.360
<v Speaker 3>I'd agree with that. Yeah.

1:33:49.360 --> 1:33:51.280
<v Speaker 1>In the sixties, do you want to know what, like

1:33:51.439 --> 1:33:53.280
<v Speaker 1>I think it was doctor Spock or something, you know,

1:33:53.439 --> 1:33:55.320
<v Speaker 1>like the Benjamin S. Bacao was like, this is how

1:33:55.360 --> 1:33:55.960
<v Speaker 1>to care for people.

1:33:55.960 --> 1:33:58.640
<v Speaker 3>I only know this Spock with like the livelong and prosper.

1:33:58.600 --> 1:34:09.639
<v Speaker 1>This is relative Okay, yeah, not really. Oh no, it

1:34:09.720 --> 1:34:12.559
<v Speaker 1>was recommended that to pick to like, oh, if you

1:34:12.600 --> 1:34:14.720
<v Speaker 1>have baby blues, pick yourself up by getting yourself a

1:34:14.760 --> 1:34:17.840
<v Speaker 1>new hat or treat yourself to a new dress, Go

1:34:17.920 --> 1:34:18.879
<v Speaker 1>get your hair done.

1:34:18.800 --> 1:34:19.439
<v Speaker 3>Get your hair DoD.

1:34:19.560 --> 1:34:22.920
<v Speaker 1>That was literally okay, yeah, I love that anyway.

1:34:23.160 --> 1:34:26.080
<v Speaker 4>Yeah, so lasting more than two weeks. And then in

1:34:26.160 --> 1:34:29.519
<v Speaker 4>terms of the onset of development, it's like usually the

1:34:29.600 --> 1:34:33.719
<v Speaker 4>first year postpartum is all still considered within the postpartum period.

1:34:33.840 --> 1:34:37.519
<v Speaker 1>Okay, that's what that was My terribly worded question was trying.

1:34:37.280 --> 1:34:39.280
<v Speaker 5>To get the like overall time frame.

1:34:39.400 --> 1:34:42.040
<v Speaker 1>Yeah, yeah, yeah, yeah yeah.

1:34:42.120 --> 1:34:45.759
<v Speaker 4>And then of course, there is also the most severe

1:34:46.200 --> 1:34:50.200
<v Speaker 4>spectrum of maternal like postpartum mental health disorders, and that

1:34:50.360 --> 1:34:53.760
<v Speaker 4>is postpartum psychosis, which is not called postpartum psychosis. It's

1:34:54.080 --> 1:34:58.240
<v Speaker 4>brief psychotic disorder with postpartum onset is the DSM five title.

1:34:59.040 --> 1:35:00.519
<v Speaker 5>But this is the set.

1:35:00.360 --> 1:35:06.599
<v Speaker 4>Of hallucinations or delusions and like disorganized behavior and things

1:35:06.600 --> 1:35:09.679
<v Speaker 4>like that that usually go along with depression or depressive

1:35:09.720 --> 1:35:14.360
<v Speaker 4>symptoms during this postpartum period. This is thought to be

1:35:14.400 --> 1:35:17.400
<v Speaker 4>relatively rare, though our studies are not as robust on it,

1:35:17.840 --> 1:35:21.080
<v Speaker 4>but estimated between zero point eight six to two point

1:35:21.160 --> 1:35:24.360
<v Speaker 4>six per one thousand berths. So it's commonly cited as

1:35:24.360 --> 1:35:27.080
<v Speaker 4>like one to two per thousand based on a global

1:35:27.120 --> 1:35:30.439
<v Speaker 4>analysis from twenty seventeen. But it is also the most

1:35:30.479 --> 1:35:33.720
<v Speaker 4>acutely dangerous of the maternal mental health disorders because this

1:35:33.800 --> 1:35:37.400
<v Speaker 4>can be it can be very severe and really disturbing

1:35:37.760 --> 1:35:41.000
<v Speaker 4>for the mom and the family, and so often results

1:35:41.000 --> 1:35:41.840
<v Speaker 4>in hospitalization.

1:35:42.040 --> 1:35:44.679
<v Speaker 1>Yeah, I am I think I told you this, Aaron,

1:35:44.720 --> 1:35:48.160
<v Speaker 1>But I listened to a book called a memoir called Inferno,

1:35:48.439 --> 1:35:51.200
<v Speaker 1>a Memoir of Motherhood and Madness by Catherine Choe, and

1:35:51.280 --> 1:35:56.519
<v Speaker 1>it was about this person's experience with postpartum psychosis. And

1:35:56.560 --> 1:36:01.759
<v Speaker 1>it was a really insightful and meaning full and also

1:36:01.960 --> 1:36:04.639
<v Speaker 1>like really, I just it feels like a really important book.

1:36:04.680 --> 1:36:07.320
<v Speaker 1>I really appreciated it. But the other thing that I

1:36:07.320 --> 1:36:11.000
<v Speaker 1>think was really interesting about that was how she talked

1:36:11.000 --> 1:36:14.519
<v Speaker 1>about she was in the US when this, when this

1:36:14.520 --> 1:36:17.640
<v Speaker 1>this happened, and when she was hospitalized, but she was

1:36:17.680 --> 1:36:22.240
<v Speaker 1>actually like traveling from the UK where she lived in

1:36:22.240 --> 1:36:25.719
<v Speaker 1>the UK, and the treatment is very different in terms

1:36:25.720 --> 1:36:30.160
<v Speaker 1>of like the management okay, okay, well keep mom with baby, okay, UK,

1:36:30.360 --> 1:36:32.599
<v Speaker 1>keep mom separate from baby in the US, and just

1:36:32.640 --> 1:36:36.760
<v Speaker 1>like interesting, I just yeah, yeah, all the different all

1:36:36.760 --> 1:36:37.760
<v Speaker 1>the different choices.

1:36:37.960 --> 1:36:41.160
<v Speaker 4>And I will say that our understanding of like the

1:36:41.240 --> 1:36:47.600
<v Speaker 4>neurologic or the biologic basis that underpins postpartum depression anxiety psychosis,

1:36:47.600 --> 1:36:50.360
<v Speaker 4>like it is poor, to say the least. It's like

1:36:50.400 --> 1:36:54.760
<v Speaker 4>an understatement. It is very often blamed, especially in like

1:36:54.880 --> 1:37:01.559
<v Speaker 4>popular media press, about postpartum depression on quote unquote hormones. Yeah,

1:37:02.320 --> 1:37:05.040
<v Speaker 4>maybe there is some data that that might be true

1:37:05.080 --> 1:37:09.519
<v Speaker 4>for this quote unquote baby blues period, where I also

1:37:09.760 --> 1:37:12.320
<v Speaker 4>it's important to say that like forty to seventy percent

1:37:12.360 --> 1:37:15.719
<v Speaker 4>of people can experience this mood lability during those first

1:37:15.720 --> 1:37:18.599
<v Speaker 4>two weeks, and that is when our hormonal shifts are

1:37:18.600 --> 1:37:22.600
<v Speaker 4>the most extreme. So sure, maybe that is responsible for

1:37:22.720 --> 1:37:26.040
<v Speaker 4>that first period, but we actually do not have data

1:37:26.160 --> 1:37:30.280
<v Speaker 4>to suggest that there are hormonal differences in people who

1:37:30.320 --> 1:37:34.040
<v Speaker 4>are experiencing other postpartum mood disorders past that two week

1:37:34.080 --> 1:37:36.880
<v Speaker 4>period and people who do not, So we do not

1:37:37.000 --> 1:37:39.200
<v Speaker 4>understand it the same way that we don't understand the

1:37:39.600 --> 1:37:42.919
<v Speaker 4>biologic causes of depression or anxiety or other mood disorders

1:37:42.920 --> 1:37:49.320
<v Speaker 4>outside of the postpartum period. However, However, what is clear

1:37:49.640 --> 1:37:55.360
<v Speaker 4>from the epidemiological correlates from the facts that, for example,

1:37:55.560 --> 1:37:59.320
<v Speaker 4>as we saw globally, the rates are significantly higher in

1:37:59.439 --> 1:38:04.680
<v Speaker 4>low and middle income countries that lack health infrastructure, that

1:38:04.800 --> 1:38:08.919
<v Speaker 4>lack access to healthcare in the prenatal and post natal period,

1:38:09.920 --> 1:38:13.880
<v Speaker 4>or that rates of postpartum depression are significantly higher in

1:38:14.040 --> 1:38:18.719
<v Speaker 4>lower income households in high income countries that lack access

1:38:18.840 --> 1:38:22.360
<v Speaker 4>to healthcare, that they are higher in people who are

1:38:22.360 --> 1:38:27.480
<v Speaker 4>subjected to additional stressors such as abusive or unsafe relationships,

1:38:27.960 --> 1:38:33.519
<v Speaker 4>or unintended pregnancies. What is clear from these epidemiological studies

1:38:33.640 --> 1:38:37.280
<v Speaker 4>is that a lot of the factors that contribute to

1:38:37.400 --> 1:38:41.200
<v Speaker 4>an increased risk of postpartum depression and other mood disorders

1:38:41.640 --> 1:38:47.360
<v Speaker 4>are potentially modifiable and not on an individual level, so important,

1:38:47.680 --> 1:38:50.880
<v Speaker 4>not on an individual level, and in fact, the single

1:38:50.960 --> 1:38:55.519
<v Speaker 4>greatest risk factor for postpartum depression and postpartum anxiety are

1:38:55.680 --> 1:39:00.519
<v Speaker 4>untreated anxiety and depression outside or during pregnant and see

1:39:00.760 --> 1:39:05.120
<v Speaker 4>so if we can actually recognize and provide treatment of

1:39:05.320 --> 1:39:07.960
<v Speaker 4>mental health disorders outside of the context of pregnancy, we

1:39:08.000 --> 1:39:11.160
<v Speaker 4>can help reduce the burden of postpartum disorders as well.

1:39:11.520 --> 1:39:14.800
<v Speaker 4>So I'm going to now shift this to talk about

1:39:14.840 --> 1:39:19.400
<v Speaker 4>what we know from data about how to improve postpartum

1:39:19.439 --> 1:39:25.960
<v Speaker 4>outcomes overall at ready based. I found a quote from

1:39:26.160 --> 1:39:28.560
<v Speaker 4>an article from twenty sixteen in the American Journal of

1:39:28.560 --> 1:39:29.800
<v Speaker 4>Obstetrics and Kynecology.

1:39:30.920 --> 1:39:32.280
<v Speaker 3>That's it end I quote.

1:39:33.640 --> 1:39:38.639
<v Speaker 4>The intense focus on women's health prenatally is unbalanced by

1:39:38.720 --> 1:39:41.120
<v Speaker 4>infrequent and late postpartum care.

1:39:40.960 --> 1:39:42.360
<v Speaker 3>End quote yep.

1:39:42.680 --> 1:39:46.040
<v Speaker 4>And that in the United States of America is an

1:39:46.240 --> 1:39:51.320
<v Speaker 4>understatement because postpartum care is not just infrequent for most

1:39:51.320 --> 1:39:53.719
<v Speaker 4>people in the US. It is one singular visit which

1:39:53.760 --> 1:39:56.559
<v Speaker 4>forty percent of people, especially those on public insurance, do

1:39:56.640 --> 1:39:59.719
<v Speaker 4>not usually attend. And it occurs at six weeks postpartum,

1:39:59.720 --> 1:40:01.439
<v Speaker 4>which is when I already said that most of those

1:40:01.520 --> 1:40:02.880
<v Speaker 4>changes that are happening are done.

1:40:03.520 --> 1:40:04.120
<v Speaker 3>They're done.

1:40:04.800 --> 1:40:08.200
<v Speaker 4>Contrast this with getting weekly visits for at least the

1:40:08.240 --> 1:40:11.000
<v Speaker 4>first the four weeks prior to delivery, and then every

1:40:11.040 --> 1:40:13.320
<v Speaker 4>two week visits for the several months prior to that.

1:40:13.400 --> 1:40:17.920
<v Speaker 1>Like, yeah, well, okay. Also then, Aaron, and I feel

1:40:17.960 --> 1:40:22.599
<v Speaker 1>like I'm jumping ahead, give it. During pregnancy, who are

1:40:22.640 --> 1:40:26.599
<v Speaker 1>you seeing? And then after pregnancy, who are you seeing? Aaron?

1:40:26.920 --> 1:40:28.600
<v Speaker 4>Let me tell you, as a family medicine physician what

1:40:28.640 --> 1:40:31.519
<v Speaker 4>my feelings about that are. Yes, in the US, our

1:40:31.600 --> 1:40:36.480
<v Speaker 4>system is very fragmented. We are generally seeing obgyn providers

1:40:37.080 --> 1:40:41.880
<v Speaker 4>primarily during prenatal period, during your all your prenatal visits,

1:40:42.240 --> 1:40:45.320
<v Speaker 4>and then afterwards you're seeing a pediatrician and you are

1:40:45.360 --> 1:40:48.400
<v Speaker 4>seeing them pretty frequently, and they are there for baby

1:40:48.520 --> 1:40:51.400
<v Speaker 4>and not for you, And then you see your obgyn one.

1:40:51.280 --> 1:40:54.400
<v Speaker 3>Time at six weeks. Yeah, okay.

1:40:54.880 --> 1:41:03.560
<v Speaker 4>So this concept of a fourth trimester is a recent concept,

1:41:03.720 --> 1:41:07.400
<v Speaker 4>at least in US medicine, and it really is kind of.

1:41:07.720 --> 1:41:10.360
<v Speaker 5>An admission of.

1:41:09.680 --> 1:41:13.519
<v Speaker 4>Our failure thus far to adequately care for people who

1:41:13.520 --> 1:41:17.479
<v Speaker 4>have recently given birth. In the US, an estimated twenty

1:41:17.560 --> 1:41:22.120
<v Speaker 4>three percent of employed women returned to work within ten days.

1:41:21.880 --> 1:41:24.560
<v Speaker 1>Postpartum, sorry ten days.

1:41:24.360 --> 1:41:26.200
<v Speaker 3>Ten days postpartum.

1:41:26.240 --> 1:41:28.560
<v Speaker 4>And if that is not one of the most shocking statistics,

1:41:28.680 --> 1:41:30.280
<v Speaker 4>then I don't know if you've been paying attention to

1:41:30.320 --> 1:41:35.000
<v Speaker 4>these episodes. Now, that is not the case everywhere. So

1:41:35.280 --> 1:41:37.559
<v Speaker 4>I'm going to walk you through a paper that really

1:41:37.920 --> 1:41:40.719
<v Speaker 4>was very interesting. It was a comparative analysis that compared

1:41:40.760 --> 1:41:45.240
<v Speaker 4>and contrasted postpartum care, prenatal and postpartum care in the

1:41:45.360 --> 1:41:49.160
<v Speaker 4>US and five other high income countries, because again, this

1:41:49.200 --> 1:41:50.960
<v Speaker 4>is what we have to compare to, like kind of

1:41:50.960 --> 1:41:56.479
<v Speaker 4>apples to apples, right, And this compared the US to France, Japan, Australia, England,

1:41:56.520 --> 1:42:01.160
<v Speaker 4>and the Netherlands. And we know from things like the

1:42:01.240 --> 1:42:05.360
<v Speaker 4>data on maternal mortality that outcomes are very different in

1:42:05.400 --> 1:42:07.840
<v Speaker 4>the United States compared to all of those other high

1:42:07.880 --> 1:42:11.680
<v Speaker 4>income countries. Our maternal mortality rates are three times as

1:42:11.760 --> 1:42:14.599
<v Speaker 4>high as France and the UK, and nearly ten times

1:42:14.640 --> 1:42:18.479
<v Speaker 4>as high as Australia. Our maternal mortality rates in the

1:42:18.560 --> 1:42:22.040
<v Speaker 4>US have been on a rise faster than any other countries,

1:42:22.080 --> 1:42:23.920
<v Speaker 4>though there has been a rise in the UK, but

1:42:24.000 --> 1:42:27.360
<v Speaker 4>it's been at a less substantial rate compared to the US.

1:42:28.040 --> 1:42:33.360
<v Speaker 4>And maternal mortality is incredibly unequal, with Black American women

1:42:33.439 --> 1:42:37.800
<v Speaker 4>dying at nearly three times the rate. In twenty twenty two,

1:42:38.200 --> 1:42:42.040
<v Speaker 4>maternal mortality for Black women was fifty per one hundred

1:42:42.080 --> 1:42:45.479
<v Speaker 4>thousand live births, compared to nineteen per one hundred thousand

1:42:45.520 --> 1:42:47.920
<v Speaker 4>for white women and sixteen per one hundred thousand for

1:42:48.000 --> 1:42:51.559
<v Speaker 4>Latino women. And I will say the numbers were different

1:42:51.560 --> 1:42:53.120
<v Speaker 4>in twenty twenty one, but we don't know if that

1:42:53.160 --> 1:42:55.960
<v Speaker 4>was because of COVID or what. But this trend has

1:42:56.000 --> 1:42:57.400
<v Speaker 4>been there for decades.

1:42:57.520 --> 1:42:58.240
<v Speaker 3>Yeah, okay.

1:42:59.439 --> 1:43:02.640
<v Speaker 4>And so this comparative analysis was looking at prenatal and

1:43:02.680 --> 1:43:05.360
<v Speaker 4>postnatal care, not just looking at like delivery method or

1:43:05.360 --> 1:43:07.280
<v Speaker 4>like one time point, but like, let's look at these

1:43:07.320 --> 1:43:10.479
<v Speaker 4>overall systems of care to see if there are any

1:43:10.479 --> 1:43:13.559
<v Speaker 4>big themes that come out and boy, how do you

1:43:13.600 --> 1:43:18.640
<v Speaker 4>do they So as a baseline to understand where a

1:43:18.640 --> 1:43:22.479
<v Speaker 4>lot of other countries maybe are getting ideas from the

1:43:22.520 --> 1:43:27.640
<v Speaker 4>World Health Organization recommends immediate postpartum care, so like immediately

1:43:27.640 --> 1:43:30.080
<v Speaker 4>in that postpartum period, like after delivery of placenta for

1:43:30.160 --> 1:43:33.360
<v Speaker 4>the first twenty four hours, and then care in the

1:43:33.400 --> 1:43:38.000
<v Speaker 4>first twenty four hours, and then additional visits at three days,

1:43:38.360 --> 1:43:41.559
<v Speaker 4>seven to fourteen days, and at six weeks postpartum, and

1:43:41.600 --> 1:43:45.800
<v Speaker 4>that should include both maternal and newborn care. And again,

1:43:45.840 --> 1:43:48.800
<v Speaker 4>in the US, our care is divided between specialists in

1:43:48.840 --> 1:43:54.240
<v Speaker 4>obstetrics and kynecology and pediatricians. So in this comparative analysis,

1:43:54.240 --> 1:43:58.559
<v Speaker 4>in every other country that they analyzed aside from the US,

1:43:59.200 --> 1:44:04.439
<v Speaker 4>postnatal care included home visits universal home visit that begin

1:44:04.640 --> 1:44:08.799
<v Speaker 4>immediately post discharge from the hospital and are specifically intended

1:44:08.800 --> 1:44:12.200
<v Speaker 4>to address both maternal and infant health. These programs are

1:44:12.240 --> 1:44:16.320
<v Speaker 4>typically run erin by midwives or nurses who are trained

1:44:16.479 --> 1:44:18.920
<v Speaker 4>in prenatal care and infant care.

1:44:19.080 --> 1:44:19.360
<v Speaker 1>YEP.

1:44:19.560 --> 1:44:23.800
<v Speaker 4>The US has absolutely no such universal system none. We

1:44:24.160 --> 1:44:27.439
<v Speaker 4>have some programs in some parts of the country or

1:44:27.439 --> 1:44:31.040
<v Speaker 4>maybe some specific cities, but they only ever target specific

1:44:31.120 --> 1:44:34.240
<v Speaker 4>populations that are considered high risk, which also means that

1:44:34.280 --> 1:44:36.839
<v Speaker 4>they usually carry with them a lot of shame and stigma.

1:44:37.200 --> 1:44:37.439
<v Speaker 9>YEP.

1:44:37.560 --> 1:44:38.320
<v Speaker 1>Okay, yep.

1:44:38.960 --> 1:44:42.360
<v Speaker 4>Now it's also true that the US, in this comparative analysis,

1:44:42.479 --> 1:44:46.120
<v Speaker 4>was the only country where the majority of our prenatal

1:44:46.160 --> 1:44:52.519
<v Speaker 4>care was conducted by obgins as opposed to midwives. Okay,

1:44:52.920 --> 1:44:56.000
<v Speaker 4>we also in the US, it's not just postnatal care,

1:44:56.000 --> 1:44:59.439
<v Speaker 4>it's not just postpartum care. We have huge inequalities in

1:44:59.479 --> 1:45:02.599
<v Speaker 4>our acts as to care early in pregnancy because of

1:45:02.640 --> 1:45:07.519
<v Speaker 4>our ridiculous insurance system. Those are my editorialization that wasn't

1:45:07.520 --> 1:45:11.200
<v Speaker 4>in the paper. So that like, even though in the

1:45:11.320 --> 1:45:18.000
<v Speaker 4>US pregnant people are guaranteed access to Medicaid services, However, individuals,

1:45:18.040 --> 1:45:21.000
<v Speaker 4>like from data, individuals that are on public insurance such

1:45:21.000 --> 1:45:25.840
<v Speaker 4>as Medicaid, start prenatal care significantly later. They in many

1:45:25.920 --> 1:45:30.400
<v Speaker 4>states lose their insurance at sixty days postpartum. Mm hmm,

1:45:31.000 --> 1:45:34.920
<v Speaker 4>I'm sorry, yeah, what and that What that means is

1:45:34.960 --> 1:45:38.679
<v Speaker 4>that in the US, more people are coming into their

1:45:38.680 --> 1:45:43.880
<v Speaker 4>pregnancy without any access to healthcare to address their underlying

1:45:44.040 --> 1:45:47.760
<v Speaker 4>or chronic health conditions that existed prior to pregnancy.

1:45:48.120 --> 1:45:49.080
<v Speaker 5>Then they have the.

1:45:49.000 --> 1:45:52.360
<v Speaker 4>Bare minimum of prenatal care, and in fact, over six

1:45:52.479 --> 1:45:55.040
<v Speaker 4>percent of pregnant women in the US have no prenatal

1:45:55.080 --> 1:45:57.240
<v Speaker 4>care at all. Or they don't start prenatal care until

1:45:57.240 --> 1:45:59.680
<v Speaker 4>the third trimester, even though again they're supposed to be

1:46:00.000 --> 1:46:04.280
<v Speaker 4>eligible for Medicaid services, and then they attend one postpartum

1:46:04.400 --> 1:46:06.840
<v Speaker 4>visit if they're lucky, and then they lose their insurance. Again,

1:46:07.280 --> 1:46:11.080
<v Speaker 4>it is not like this in other high income countries,

1:46:12.120 --> 1:46:15.320
<v Speaker 4>period period. Now, there is data, and I think you

1:46:15.400 --> 1:46:18.240
<v Speaker 4>mentioned this at one point, I don't remember in which episode,

1:46:18.360 --> 1:46:21.680
<v Speaker 4>that like the prevalence of a lot of conditions that

1:46:21.720 --> 1:46:24.880
<v Speaker 4>we know are associated with an increased risk of adverse

1:46:24.880 --> 1:46:31.000
<v Speaker 4>pregnancy outcomes, right, things like hypertension, diabetes, older maternal aged

1:46:31.479 --> 1:46:33.840
<v Speaker 4>at your first pregnancy. We know that these things are

1:46:33.880 --> 1:46:37.160
<v Speaker 4>associated with riskier pregnancies, and some of these things are

1:46:37.200 --> 1:46:39.759
<v Speaker 4>in fact on the rise in the US and elsewhere,

1:46:40.240 --> 1:46:43.439
<v Speaker 4>and certainly that likely contributes to some of the trends

1:46:43.479 --> 1:46:46.040
<v Speaker 4>that we are seeing. But I think that what ends

1:46:46.120 --> 1:46:51.160
<v Speaker 4>up happening in the rhetoric about this is that politicians especially,

1:46:51.320 --> 1:46:56.760
<v Speaker 4>and organizations and even individuals lay this blame on individuals themselves.

1:46:57.280 --> 1:47:01.320
<v Speaker 5>It's because of your pre existing condition, it's your medic complication,

1:47:02.439 --> 1:47:03.679
<v Speaker 5>is your age, Oh.

1:47:03.640 --> 1:47:07.439
<v Speaker 1>You chose to have a career first, it's your choice.

1:47:07.600 --> 1:47:09.559
<v Speaker 4>Yep, Yeah, and that makes it seem like it was

1:47:09.640 --> 1:47:12.240
<v Speaker 4>unavoidable or it was your it was your lifestyle.

1:47:12.560 --> 1:47:13.200
<v Speaker 1>Lifestyle.

1:47:13.320 --> 1:47:21.120
<v Speaker 4>Yeah, that is a lie period across the globe, not

1:47:21.200 --> 1:47:26.360
<v Speaker 4>just in the US. Millions of maternal deaths each decade

1:47:26.600 --> 1:47:29.760
<v Speaker 4>are due to preventable factors. And this is not just

1:47:29.840 --> 1:47:32.799
<v Speaker 4>coming from me. This is coming from the Lancet Global

1:47:32.800 --> 1:47:36.240
<v Speaker 4>Health twenty twenty four. They said, and I quote these,

1:47:36.520 --> 1:47:42.080
<v Speaker 4>these maternal deaths are quote tangible manifestations of the prevailing

1:47:42.200 --> 1:47:47.479
<v Speaker 4>determinants of maternal health and persistent inequities in global health

1:47:47.479 --> 1:47:49.040
<v Speaker 4>and socioeconomic development.

1:47:49.479 --> 1:47:52.160
<v Speaker 1>Yep, yep. So we know.

1:47:52.360 --> 1:47:55.479
<v Speaker 4>I'm getting like we can sweaty from how angry I

1:47:55.520 --> 1:47:58.960
<v Speaker 4>get about this, because it's like, I feel really passionate about.

1:47:58.760 --> 1:47:59.960
<v Speaker 1>This, justifiably angry.

1:48:00.120 --> 1:48:04.360
<v Speaker 4>We know the things to do to prevent this. We

1:48:04.400 --> 1:48:09.400
<v Speaker 4>can prevent maternal mortality, we can prevent adverse neonatal outcomes

1:48:09.640 --> 1:48:12.000
<v Speaker 4>as well by doing what erin.

1:48:12.880 --> 1:48:13.479
<v Speaker 3>Let me tell you.

1:48:15.080 --> 1:48:20.400
<v Speaker 4>Number one, access to universal health care. Number two, specifically

1:48:20.600 --> 1:48:24.040
<v Speaker 4>access to comprehensive This is again from data. This is

1:48:24.080 --> 1:48:27.320
<v Speaker 4>not just me Aaron Onrman Updike saying this. Okay, I

1:48:27.439 --> 1:48:29.680
<v Speaker 4>say this, but this is literally the data that we

1:48:29.760 --> 1:48:31.640
<v Speaker 4>have on what prevents.

1:48:31.360 --> 1:48:32.720
<v Speaker 1>Adversources we have.

1:48:33.720 --> 1:48:40.479
<v Speaker 4>We need universal access to comprehensive and modern contraception so

1:48:40.520 --> 1:48:42.840
<v Speaker 4>that people can plan if and when they want to

1:48:42.840 --> 1:48:43.479
<v Speaker 4>get pregnant.

1:48:43.600 --> 1:48:43.840
<v Speaker 1>Yep.

1:48:44.240 --> 1:48:50.760
<v Speaker 4>We need universal legal, safe access to abortion services, which

1:48:50.800 --> 1:48:52.160
<v Speaker 4>are life saving.

1:48:51.880 --> 1:48:53.280
<v Speaker 3>Medical care, medical care.

1:48:53.520 --> 1:48:58.280
<v Speaker 4>We need universal access to high quality prenatal, intrapartum and

1:48:58.400 --> 1:49:02.639
<v Speaker 4>postpartum care, which includes wives and obstetrics and gynecology and

1:49:02.680 --> 1:49:05.559
<v Speaker 4>family physicians and pediatricians, all.

1:49:05.360 --> 1:49:07.200
<v Speaker 1>Of it, all of it working together.

1:49:07.400 --> 1:49:12.120
<v Speaker 4>We're together as annical system. And this particular paper does

1:49:12.160 --> 1:49:14.439
<v Speaker 4>not get into this like deep of detail, but I

1:49:14.520 --> 1:49:18.639
<v Speaker 4>have other sources that show that guaranteed paid parental leave,

1:49:18.680 --> 1:49:21.120
<v Speaker 4>which we also do not have in the US, is

1:49:21.160 --> 1:49:25.080
<v Speaker 4>in fact associated with reductions in the risk of postpartum depression,

1:49:25.600 --> 1:49:29.479
<v Speaker 4>depression later in life, lower risk of intimate partner violence,

1:49:29.479 --> 1:49:34.160
<v Speaker 4>which is added is peak during pregnancy and postpartumy. Paid

1:49:34.240 --> 1:49:37.600
<v Speaker 4>parental leave also increases the likelihood and duration of breastfeeding.

1:49:37.680 --> 1:49:40.600
<v Speaker 4>So folks who are all making sure that everyone breastfeeds,

1:49:40.880 --> 1:49:43.120
<v Speaker 4>that's a thing that can help it and it is

1:49:43.400 --> 1:49:49.519
<v Speaker 4>directly associated with decreased infant mortality. Sorry, we have a playbook.

1:49:49.600 --> 1:49:50.559
<v Speaker 1>The answer is here.

1:49:50.680 --> 1:49:53.920
<v Speaker 5>We know the answers, we just have to implement them.

1:49:54.520 --> 1:49:55.160
<v Speaker 5>I'm done.

1:49:57.760 --> 1:50:02.360
<v Speaker 1>No, but it's it is. Oh, it's really hard sometimes

1:50:02.360 --> 1:50:05.800
<v Speaker 1>because it's like, on the one hand, I want to

1:50:05.880 --> 1:50:12.040
<v Speaker 1>find that very inspirational or like hopeful or like here, look,

1:50:12.080 --> 1:50:14.400
<v Speaker 1>we know how to do this. We have answer. We

1:50:14.439 --> 1:50:17.519
<v Speaker 1>have had these answers I know for so long.

1:50:17.640 --> 1:50:20.800
<v Speaker 5>I know, I know it, I know it.

1:50:20.800 --> 1:50:21.280
<v Speaker 1>It's true.

1:50:21.560 --> 1:50:24.479
<v Speaker 3>It's true, it's tru it's true. But we have the answers.

1:50:24.560 --> 1:50:27.400
<v Speaker 4>We know the answers, right, These answers just have to

1:50:27.400 --> 1:50:30.280
<v Speaker 4>be enacted, and they are being done in certain places

1:50:31.040 --> 1:50:34.080
<v Speaker 4>in this I mean, the state by state mortality data

1:50:34.080 --> 1:50:36.280
<v Speaker 4>in the US is like shocking. If you go to

1:50:36.360 --> 1:50:38.000
<v Speaker 4>the CDC website and you look at like what the

1:50:38.080 --> 1:50:40.439
<v Speaker 4>rates are in like one state versus another, it's like

1:50:40.479 --> 1:50:44.759
<v Speaker 4>the disparities are very severe. Systemic racism plays a huge

1:50:44.880 --> 1:50:47.640
<v Speaker 4>role in all of this in the United States, in

1:50:47.640 --> 1:50:50.040
<v Speaker 4>addition to like the quality of care that people get

1:50:50.080 --> 1:50:52.960
<v Speaker 4>depending on what color their skin is. So there is

1:50:53.000 --> 1:50:56.000
<v Speaker 4>a lot of things that are not easy to fix.

1:50:56.560 --> 1:50:58.360
<v Speaker 4>I mean, they could be easy to fix because we

1:50:58.439 --> 1:50:59.120
<v Speaker 4>know how to do them.

1:50:59.160 --> 1:51:02.760
<v Speaker 1>We can fix parts of most everything, right, Yeah.

1:51:02.520 --> 1:51:05.000
<v Speaker 3>But so we've we've done all your work for you.

1:51:05.120 --> 1:51:08.240
<v Speaker 1>It required no investment. It does and that is the

1:51:08.280 --> 1:51:09.559
<v Speaker 1>hardest thing to convince people.

1:51:09.680 --> 1:51:11.760
<v Speaker 5>That's our constant theme and it's my favorite thing on

1:51:11.800 --> 1:51:13.200
<v Speaker 5>this podcast. Will kill You.

1:51:13.280 --> 1:51:16.439
<v Speaker 1>Investment and trade offs and investing now is public health,

1:51:16.520 --> 1:51:19.720
<v Speaker 1>and public health is investing in saving money and it's not.

1:51:20.040 --> 1:51:25.200
<v Speaker 3>Yeah, yeah, I know, so, Aaron, I.

1:51:25.160 --> 1:51:27.559
<v Speaker 1>Can't believe are we done? We're done for now.

1:51:27.960 --> 1:51:30.479
<v Speaker 5>While we're done with this season, we're done with this series.

1:51:30.600 --> 1:51:33.120
<v Speaker 1>I have so many feelings about everything. Me too.

1:51:33.520 --> 1:51:35.320
<v Speaker 4>I also, I just want to say, because I know

1:51:35.400 --> 1:51:37.799
<v Speaker 4>that there was a lot of parts of this series

1:51:37.840 --> 1:51:39.920
<v Speaker 4>where we got very heavy, we got very heavy, and

1:51:39.960 --> 1:51:42.240
<v Speaker 4>where we focused a lot on the kind of complications

1:51:42.280 --> 1:51:43.880
<v Speaker 4>or things that can go wrong.

1:51:44.400 --> 1:51:47.320
<v Speaker 5>I love to.

1:51:47.439 --> 1:51:51.439
<v Speaker 4>Know these things and know at the same time in

1:51:51.479 --> 1:51:54.760
<v Speaker 4>my brain how often everything.

1:51:54.360 --> 1:51:56.439
<v Speaker 5>Goes and goes just fine.

1:51:56.600 --> 1:51:58.200
<v Speaker 1>Absolutely, and it is.

1:51:58.479 --> 1:52:03.799
<v Speaker 4>Beautiful and amazing and phenomenal to like see that happen

1:52:03.880 --> 1:52:07.280
<v Speaker 4>and to know that it happens so frequently. It truly

1:52:07.400 --> 1:52:11.080
<v Speaker 4>is like I get. I really love prenatal care. I

1:52:11.160 --> 1:52:14.080
<v Speaker 4>really love this whole process. I just love everything about

1:52:14.120 --> 1:52:16.280
<v Speaker 4>this and I really loved doing this even though I

1:52:16.320 --> 1:52:17.880
<v Speaker 4>know we focus a lot on the bad things.

1:52:18.040 --> 1:52:22.280
<v Speaker 1>Well, I feel like there's it's it's all about contextualizing

1:52:22.360 --> 1:52:24.680
<v Speaker 1>it is everything, yeah, right, Like you and I had

1:52:24.680 --> 1:52:26.800
<v Speaker 1>a lot of discussions about this, like how do we

1:52:26.880 --> 1:52:30.000
<v Speaker 1>balance this approach where we're not doing the what to

1:52:30.040 --> 1:52:32.760
<v Speaker 1>expect while you're expecting, like you just lay back and

1:52:32.960 --> 1:52:36.200
<v Speaker 1>back and have anyone else do the work. It's totally fine,

1:52:36.320 --> 1:52:38.200
<v Speaker 1>and it's like knowledge is power.

1:52:38.320 --> 1:52:41.719
<v Speaker 5>It is, and but we also can increase my anxiety

1:52:41.760 --> 1:52:42.040
<v Speaker 5>and it.

1:52:42.000 --> 1:52:44.360
<v Speaker 1>Can increase anxiety. And so I feel like this is

1:52:44.560 --> 1:52:46.880
<v Speaker 1>you know, we really did try hard to balance like

1:52:47.360 --> 1:52:50.280
<v Speaker 1>talking about what are the pieces that we feel are

1:52:50.439 --> 1:52:53.559
<v Speaker 1>valuable to talk about, yeah, and also while not talking

1:52:53.560 --> 1:52:56.160
<v Speaker 1>about everything that is valuable to talk about. Yeah. So

1:52:56.400 --> 1:52:59.600
<v Speaker 1>it's yeah, but it is. It's it's true, Like I

1:52:59.840 --> 1:53:03.240
<v Speaker 1>I hope we didn't make everyone be like oh God,

1:53:03.360 --> 1:53:07.720
<v Speaker 1>oh God for me, never for me or our our

1:53:08.040 --> 1:53:10.840
<v Speaker 1>you know, healthcare system and country is broken broken.

1:53:11.000 --> 1:53:16.240
<v Speaker 4>I mean I have no interest in having any other kids.

1:53:16.280 --> 1:53:17.240
<v Speaker 3>Definitely not absolutely not.

1:53:17.280 --> 1:53:17.639
<v Speaker 1>I'm done.

1:53:17.920 --> 1:53:19.840
<v Speaker 5>But there were moments in this where it's.

1:53:19.720 --> 1:53:24.799
<v Speaker 4>Like, oh, you know, reading, like relearning these things, and yeah,

1:53:24.840 --> 1:53:25.640
<v Speaker 4>it's it is.

1:53:25.960 --> 1:53:27.040
<v Speaker 5>It's a little bit of magic.

1:53:27.120 --> 1:53:29.120
<v Speaker 3>I feel absolutely yeah.

1:53:29.200 --> 1:53:31.760
<v Speaker 1>I mean I think I have never I have never

1:53:31.800 --> 1:53:34.599
<v Speaker 1>wanted to have kids. But throughout this series, I called

1:53:34.600 --> 1:53:37.240
<v Speaker 1>my mom so often to be like, oh, what about this?

1:53:37.360 --> 1:53:39.760
<v Speaker 1>Did she take a pregnancy test? Did you like, tell

1:53:39.760 --> 1:53:42.160
<v Speaker 1>me about your ultrasound? Tell me about your delivery? What

1:53:42.240 --> 1:53:44.479
<v Speaker 1>was it like? You know, she waited for one of

1:53:44.520 --> 1:53:47.479
<v Speaker 1>my brothers, Er was on, and she was like a

1:53:47.800 --> 1:53:50.600
<v Speaker 1>like a rabid Er fan, and she was like, I

1:53:50.640 --> 1:53:52.960
<v Speaker 1>went into labor and I waited. I watched Er and

1:53:53.000 --> 1:53:54.760
<v Speaker 1>then I went to the hospital because I didn't want

1:53:54.760 --> 1:53:58.640
<v Speaker 1>to miss it. Yeah, and that was before DVR. But

1:53:58.800 --> 1:54:01.240
<v Speaker 1>like that experience, it's like so many things that we

1:54:01.320 --> 1:54:04.760
<v Speaker 1>had never talked about before about pregnancy and thinking about

1:54:04.840 --> 1:54:09.080
<v Speaker 1>her experiences and it just that was It's been such

1:54:09.120 --> 1:54:12.880
<v Speaker 1>an amazing process to like do all this reading and

1:54:13.520 --> 1:54:15.000
<v Speaker 1>think about yeah.

1:54:14.840 --> 1:54:17.479
<v Speaker 4>Think about so many different aspects of it. Ah, if

1:54:17.479 --> 1:54:19.679
<v Speaker 4>you want to learn so much more, so much more,

1:54:19.760 --> 1:54:21.160
<v Speaker 4>we've got source it.

1:54:21.320 --> 1:54:23.639
<v Speaker 1>Oh my god, I feel like this was a one.

1:54:23.800 --> 1:54:26.200
<v Speaker 1>This is Yeah. I have a lot of books for this.

1:54:26.320 --> 1:54:28.600
<v Speaker 1>I know I'm gonna briefly because I've already mentioned a

1:54:28.600 --> 1:54:31.719
<v Speaker 1>few of them, mentioned him again, so Brought to Bed

1:54:31.760 --> 1:54:36.040
<v Speaker 1>by Judith Wollster Levitt, Tina Cassidy a book called Birth,

1:54:36.080 --> 1:54:39.720
<v Speaker 1>The Surprising History of How We Are Born. Barbara Ehrenrich

1:54:39.800 --> 1:54:42.960
<v Speaker 1>and Deirdre English wrote a book called Witches, Midwives and Nurses.

1:54:43.000 --> 1:54:48.040
<v Speaker 1>It's like a classic feminist feminist text. Rachel Moran again

1:54:48.080 --> 1:54:51.040
<v Speaker 1>blew a history of postprimum Depression in America. Joyce Thompson

1:54:51.040 --> 1:54:53.720
<v Speaker 1>and Helen Varney Burst a history of midwiffrey in the

1:54:53.800 --> 1:54:57.920
<v Speaker 1>United States. Laurel Thatcher Ulrich a midwives Tale, The Life

1:54:57.920 --> 1:54:59.880
<v Speaker 1>of Martha Ballard based on her diary, and again that

1:55:00.160 --> 1:55:02.080
<v Speaker 1>More Inferno by Catherine Show.

1:55:02.480 --> 1:55:04.040
<v Speaker 4>I had a lot of papers for this one. I

1:55:04.040 --> 1:55:07.280
<v Speaker 4>already shouted out a couple like that Lancet Global Health

1:55:07.320 --> 1:55:10.200
<v Speaker 4>twenty twenty four paper that was a global analysis of

1:55:10.240 --> 1:55:13.520
<v Speaker 4>the determinants of maternal health and transitions and maternal mortality.

1:55:13.920 --> 1:55:17.000
<v Speaker 4>Such a good read. There was also the paper I mentioned.

1:55:17.000 --> 1:55:19.520
<v Speaker 4>It was from the American Journal of Obstetrics and Gynecology,

1:55:19.560 --> 1:55:22.880
<v Speaker 4>titled the Fourth Trimester, a Critical Transition period with Unmet

1:55:22.920 --> 1:55:25.440
<v Speaker 4>maternal health needs. I think I might have said twenty sixteen,

1:55:25.440 --> 1:55:29.840
<v Speaker 4>it was actually twenty seventeen. And then the paper where

1:55:29.920 --> 1:55:33.160
<v Speaker 4>the map of postpartum depression trends came from was from

1:55:33.240 --> 1:55:38.280
<v Speaker 4>Translational Psychiatry from twenty one that was titled Mapping Global

1:55:38.280 --> 1:55:40.640
<v Speaker 4>Prevalence of Depression among Postpartum Women. But we have so

1:55:41.080 --> 1:55:43.120
<v Speaker 4>many more on our website, this podcast will kill you

1:55:43.160 --> 1:55:45.440
<v Speaker 4>dot com, where we list all of the sources from

1:55:45.480 --> 1:55:47.600
<v Speaker 4>this episode in every one of our episodes from all

1:55:47.760 --> 1:55:50.280
<v Speaker 4>seven seasons.

1:55:50.400 --> 1:55:53.760
<v Speaker 1>So many sources, so many. You know, we've said thank

1:55:53.800 --> 1:55:56.480
<v Speaker 1>you every single episode, and we mean it every single episode,

1:55:56.480 --> 1:56:00.720
<v Speaker 1>And thank you to every single person who provided a

1:56:00.720 --> 1:56:02.960
<v Speaker 1>first hand account, who sent in their firstend account, who

1:56:03.040 --> 1:56:05.000
<v Speaker 1>thought about sending in a first hand account like we.

1:56:05.480 --> 1:56:09.000
<v Speaker 1>We appreciate you. This is we. This series would have

1:56:09.040 --> 1:56:12.080
<v Speaker 1>not been the same by any means without.

1:56:11.800 --> 1:56:14.240
<v Speaker 4>You, No, it's it means the absolute world to us.

1:56:14.240 --> 1:56:16.080
<v Speaker 4>Thank you, thank you, thank you, thank you, thank you.

1:56:16.520 --> 1:56:18.960
<v Speaker 4>Thank you to everyone here at the exactly Right Studios.

1:56:18.960 --> 1:56:20.320
<v Speaker 4>Are really sad to have to leave.

1:56:20.120 --> 1:56:22.080
<v Speaker 3>Because we had so much fun doing this, I know.

1:56:22.520 --> 1:56:25.800
<v Speaker 4>Thank you to today Leanna and Jessica and Brent and

1:56:25.880 --> 1:56:31.120
<v Speaker 4>Craig and Tom yesterday, everyone all of you here, thank you,

1:56:31.360 --> 1:56:32.160
<v Speaker 4>thank you, thank.

1:56:32.000 --> 1:56:35.400
<v Speaker 1>You, ah thank you to Bloodmobile for providing the music

1:56:35.400 --> 1:56:37.600
<v Speaker 1>for this episode and all of our episodes.

1:56:37.640 --> 1:56:41.320
<v Speaker 4>And thank you to you listeners seven seasons in for

1:56:41.560 --> 1:56:42.800
<v Speaker 4>all episodes on pregnancy.

1:56:42.840 --> 1:56:43.280
<v Speaker 3>Thank you for.

1:56:43.240 --> 1:56:47.560
<v Speaker 4>Sticking with us, Yes in this short break between seasons.

1:56:47.600 --> 1:56:48.920
<v Speaker 4>Tell us what you want to hear more of.

1:56:50.000 --> 1:56:52.400
<v Speaker 1>Always we love to hear it. And a big thank you,

1:56:52.520 --> 1:56:56.080
<v Speaker 1>of course to our generous, beautiful, fantastic patrons.

1:56:56.120 --> 1:56:58.920
<v Speaker 5>We appreciate your support so very much.

1:56:58.920 --> 1:57:00.000
<v Speaker 3>We really do. Thank you.

1:57:00.640 --> 1:57:01.720
<v Speaker 1>Until next season.

1:57:03.040 --> 1:57:10.720
<v Speaker 5>Wash your hands, Sealthy Animals, M.