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Welcome to Birth, Baby!, your go-to podcast hosted by Ciarra Morgan and Samantha Kelly, seasoned birth doulas and childbirth educators from Austin, Texas. Join us as we navigate the intricate journey of pregnancy, childbirth, and postpartum care, offering invaluable insights and expert advice. Through candid interviews, personal anecdotes, and evidence-backed content, we aim to empower families with the knowledge they need to make informed decisions. Whether you're seeking guidance on prenatal care, birth planning, or navigating the early days with your newborn, we've got you covered. Tune in to Birth, Baby! and embark on your parenthood journey with confidence.
The information provided on this podcast is for general informational purposes only and is not intended as a substitute for professional medical advice, diagnosis or treatment.
Always seek the advice of your qualified health provider with any questions you may have.
Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast.
Reliance on any information provided here is solely at your own risk.
Welcome, this is Birth, Baby!
Your hosts are Ciarra Morgan and Samantha Kelly.
Ciarra is a birth doula, hypnobirthing educator, and pediatric sleep consultant.
Samantha is a birth doula, childbirth educator, and lactation counselor.
Join us as we guide you through your options for your pregnancy, birth, and postpartum journey.
Thank you to our listeners for your continued support.
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This helps us gain visibility to other people that could benefit from listening in.
Hello, everyone, we have Dr.
Romy Ghosh with us today, and she is going to chat with us about all the things about having an OB take care of you while you're pregnant and in labor.
So will you please introduce yourself, Dr.
Ghosh, and tell everybody who you are?
My name is Romy Ghosh.
I am an OB-GYN, Board Certified, who works in Austin, Texas.
I grew up in Austin, Texas, went to Texas A&M University for my undergraduate, went to Texas Tech El Paso for my medical school.
And then I did my residency at the University of Arizona in Tucson.
That's a lot of education, friend.
We look pretty young for doing all of that.
I also did a master's in public health as well.
I was doing my medical degree.
So I did that concurrently.
Yeah, yeah, you know, medical school isn't hard enough.
So I decided to do a master's on top of that.
So I did that during the four years of medical school.
And that's through the University of Texas at Houston, El Paso campus that I did my master's in public health.
So you've just hit all of the major Texas schools and have like no specific loyalty to it.
Yeah, I mean, I think my brother and my sister-in-law went to Texas A&M for undergraduates.
So they're very much partial to that side of it.
But I particularly not like, I love where I went to school, all of my schools.
So no specific loyalties here.
I love it.
I like it.
So let's just jump in because we have a lot of people that ask us kind of the difference between getting OB care, getting midwifery care.
They have a ton of questions.
So we're going to kind of go through some of these.
One of the first things people ask us is what kind of routine tests or procedures and pregnancy they're going to have.
So dating ultrasounds, that sort of thing.
Can you kind of go through those for us and what people can expect?
So as far as, sorry, let me just quieten my phone.
As far as prenatal care, I think that there is a lot of crossover between the two.
I think in obstetrics, sort of what is, we usually start prenatal care, your prenatal care is usually started with, some offices start with like an intake examination.
Some people start with an ultrasound.
At our office, we start with an ultrasound and we have you do an intake with either one of the OBs or one of the nurse practitioners that works at our office.
And what the first visit usually entails is doing a dating ultrasound to make sure that you're how far along you are is concurrent with the ultrasound because as many of you may know, in the first trimester pregnancies, fetuses grow at the same rate.
And so we correlate or not correlate your ultrasound with how far along you are, which helps us keep tabs of your pregnancy as far as pregnancy moving forward, et cetera.
At that visit, we'll go over with you all of your medical conditions that you are coming into the pregnancy with, whether that's high blood pressure, asthma, heart disease, any chronic conditions.
If you're on many medications, seeing whether or not those medications are safe to continue during pregnancy.
We make sure that you're taking a prenatal vitamin.
We typically will do a physical exam, make sure you're updated on your Pap smear, et cetera.
Then during either that visit or early subsequent visit, we will do prenatal labs.
And those labs entail us checking a blood count, your blood type.
We do rubella testing, syphilis testing, HIV, hepatitis B, hepatitis C, gonorrhea, chlamydia testing.
And rubella, I can't remember if I said rubella, but we do those tests.
And then we will oftentimes offer genetic testing as well.
That includes what's called aneuploidy testing, which is to test whether or not the baby could potentially have a genetic condition that could affect their health long-term during the pregnancy.
And then potentially doing what's called recessive gene cure screening to see if the parents could be carriers of certain conditions that could affect the baby after the baby is born.
And then moving forward, what we typically do is we see someone every four weeks during their pregnancy.
Most of the checks are just making sure the heartbeat is present, make sure the baby's growing appropriately with their screening examinations.
That usually entails after 24 weeks doing what's called a fundal height to measure the distance from the pubic symphysis to the top of the uterus.
And we do an ultrasound at 20 weeks of pregnancy to look at the anatomy of the baby, see how baby's growing at that point.
We do four-week visits up until about the third trimester.
And at the third trimester, because things are becoming, medical issues are more likely to come up in the third trimester, we start seeing patients every two weeks monitoring their blood pressures, their fundal heights, seeing what kind of issues are coming up for the patient.
In the early third trimester, late second trimester, we'll do what's called your glu-cola testing, which is for diabetes or pregnancy.
We do that as well as recheck a blood count to make sure you're not getting anemic.
And then the same Texas requires an HIV and syphilis test in the third trimester as well.
And then we start seeing you weekly at 36 weeks.
36 weeks, we will typically do a GBS screen.
Some, depending on who you get prenatal quick care with, some people will do a third trimester ultrasound though.
That's not a requirement.
And then we do weekly visits up until birth.
Starting at 36 weeks, those weekly visits start?
Yes, yep.
Awesome.
And then is that also when cervical checks start?
We don't do cervical checks at our office, just because they haven't really been shown to be particularly useful as far as predicting when labor is about to start.
We love that about you.
We will do cervical examinations if a patient requests it.
If they come in with signs of labor and we're wondering if they're in labor, if they feel like their bag of water has broken and we're evaluating for that, we want to know sort of where they are.
Or the most common reason we check if someone is not in labor or we don't suspect labor is if we're doing induction planning.
So if there's a reason that a patient is either requesting or needs an induction of labor, we typically will check the cervix to get an idea of what kind of induction they're going to have, whether or not they need certain medications or whether or not they don't need a certain kind of medication.
Samantha, I know that you probably don't have a whole lot of time to listen to the podcast, but we actually did an episode recently about cervical exams and that's exactly what we were saying.
And I remember you had a post on social media at one point where, I'm sure it's still there, but it was talking about cervical exams and kind of how they're not super needed.
And I was like, man, that was really courageous because a lot of it is do routinely do that.
I mean, I did it too.
I did it too until I came to the practice that I'm at and they just didn't do them.
And having not done them for several years now, it didn't really alter my practice at all.
And so I think there is that expectation.
And I think a lot of us are taught to do several examinations in the end of the third trimester, but just because you were taught one way doesn't necessarily mean that's evidence-based.
And so based on evidence-based practice, I stopped doing them just like my other partners did.
Yeah, and we love that.
I mean, I think there's so many different...
That's one thing that as I've been working in this realm that I've really learned is that every provider has different reasons for doing things the way that they do them.
And there might be some legitimate reasons that some providers do something and other providers don't based on their patient population or their own personal experience or whatever else.
And there's also, I mean, we see it all the time, but there's so much research out there.
You can almost find research to back up any sort of opinion anywhere.
So it's interesting.
So when you have patients that decline these kind of routine items, how does that affect the care that they receive from their provider?
I think it depends on what you mean by affecting care.
I think we are always going to suggest the standard of care for every patient, and pregnant patient, because every single test that we do has a purpose, has a reason, and every single one of us who's trained long enough in this field has seen a consequence.
We've seen babies affected by hepatitis by a mom who's HIV positive, by a mom who's diagnosed with syphilis, and a baby that has complications related to that.
At the end of the day, like it was always a conversation when someone declines, why are we declining?
Here are the potential outcomes.
So it doesn't, we would never terminate care of a patient just because they declined to have a certain test done.
But I do think oftentimes if we don't, if they opt not to do something, we try to do some sort of compromise or alternative testing in that case.
I would say the vast majority of patients who come to see us for obstetric care, it's very rare that I have a patient decline testing.
And I think there's usually a good conversation if that were to happen.
And oftentimes that conversation, if you spend enough time with a person explaining the whys, I find that once you spend the time with them, they will oftentimes change their opinion and be like, okay, I think that it's a reasonable thing to go ahead and do the testing.
Yeah, that's our question we get from people because we have the whole gamut of types of people who hire us, right?
We have people who want all of the checks and everything and all the extras.
And we have people who are like, I don't even want a doctor, you know?
And so we talk with them kind of about, and then we'll get into a little bit later with you what it looks like to have a baby with an OB in the hospital.
But we have people almost wanting to have kind of midwifery or even a free birth with an OB in a hospital.
And we're like, okay, well, there's some incongruency there.
And that's just not really the kind of care that you signed up for.
So I love that you guys take the time to explain these things because I think what we see sometimes is that some OBs are just dismissing people's worries.
I mean, like, this is ridiculous.
Like, evidence shows it.
Well, what evidence?
You know, they want to know the why behind everything.
And I know you guys take a lot of care of those people.
That's hard to do, to spend that much time with people.
I agree.
I mean, I think, yeah, I think, I think, you know, the vast majority of people get obstetric care.
About 98% of births occur in a hospital.
So I think when it's really hard for anybody to deviate from the type of care that they give a certain patient, right?
And so I think the more that you can sit down with a patient and describe to them and explain to them sort of why you want to do things.
And you will occasionally have patients who are like, no, I don't want to do that.
And that's completely their prerogative.
I've had patients who've only had two prenatal visits that we did their birth, you know?
And we've had patients who tried to come into our office every single week because they were so concerned about their pregnancy.
So everybody's different.
And again, we try our best to educate our patients based on the best evidence that we have.
Yeah, it does get, I think it gets really, I think it's hard for parents because there's so many things.
Pregnancy is just such a different experience than anything else.
We talk about this all the time.
It's so different than anything else that they've ever experienced in their lives, really.
It's this natural physiological thing, but then there's also all of these potentials that could come up and there's all these things that you really have to learn on the fly with all these testing and, okay, well, but why do I need a glucose test?
I don't have diabetes.
Why would I need that?
Oh, well, because you can develop diabetes in pregnancy and this is why.
And my blood pressure and whatever, and my sister's mom had blood pressure issues once upon a time, so maybe I have blood pressure issues, too.
And there's just so many, just learning on the fly, and so many people don't do good childbirth education, so they don't necessarily know about all these things in pregnancy.
And I think it's hard for, especially in the OB model of care for y'all, to be able to spend that much time with every client.
I mean, how many people do you see on a regular day in the office?
So on average, I see anywhere from 26 to 30 patients a day.
I have colleagues that see up to 40 patients a day.
I know there are some obstetricians that have, like, we're busy, up to 60 patients a day, sometimes even more.
And so I do think that it is hard, especially in practices that do see a lot of high volume.
It's hard to get in all of the teaching that you want to do.
The joy in what I do, the way that I like to practice is I enjoy the teaching part of it.
Like that part is what keeps me coming back because there's a lot of medicine that is very stressful to deal with.
But the teaching part brings me joy.
So it's something that I like to focus on in my practice.
But I can also see how the system is not set up in a way that is going to be able to explain every single test that we give to patients.
And so I think that can leave people feeling a little like, well, why are we doing all this thing for this incredibly momentous occasion in their life?
So, rest assured, there is a reason that we're doing all these things that we do.
But it is hard to sort of fit that into an appointment where you don't have as much time as you would like to have.
And then you run into people looking, getting all their information about tests on TikTok or whatever, and it's just such a widespread.
I tell people all the time, like Google and the internet has all the right answers.
They also have all the wrong answers.
And so it's hard to curate that.
And as obstetricians who trained in the medical field, it's hard to sort through all the data, all the studies.
And that is a skill that takes a lot of time.
And I think it's hard when you're a patient to look at, if you are not medically trained and you're not scientifically trained, it's really hard to look at that and be like, well, what of this applies to me?
What is true?
What is not true?
And that is very incredibly difficult, I think, for patients to navigate.
And I think one of the things that we find is some providers like you guys are like, yes, doulas, please.
This was great.
This was great collaborative care.
And then there are some OBs or even midwives who are like, nah, you don't need a doula, whatever.
Those people, I think, don't realize how much, well, hopefully a good doula.
I mean, I know not everyone is the same, but what we should be doing is helping with the back end of this.
We know where the good research is.
We know on evidencebasedbirth.com how to guide them through those things and whatever.
And so it's so nice to be able to provide some of that because then it does take a little bit of the pressure off of the OB for time-wise, trying to shove all of this information down their throat in a short period of time.
And then they can come with their extra questions.
Yeah, what I usually counsel patients to do is if they're not sure what they want their birth to look like, I usually say, do a childbirth class.
Figure out what you should be expecting.
Figure out what the options are.
If you need extra support, I think that's where a doula comes in great, because again, the way that we're set up, we're not, I think sometimes people are unclear, they're not quite sure how the OB plays into it when it comes to when you go to the hospital to give birth.
And so I think like having extra support, because I wasn't always doula friendly.
I didn't know that.
I was not, I mean, I trained somewhere, I trained in Tucson and people may or may not know this, but Tucson is a very alternative medicine-y type place.
And so there were a lot of people in Tucson that would come in with doulas.
I would say that my experience with doulas as a resident was very different in which it was constantly this clash of like, hey, we have these concerns about what's going on versus the doula wanting to be respective of their clients and sort of coming ahead to help with them.
And so it was, the way the doulas were introduced to me were by a co-resident was, doulas are friends that you pay for.
That was sort of how doulas were sort of explained to me when I first came into this field.
And so I think my viewpoint on how doulas play into Birth has definitely changed the more that I've worked with them and I've worked with doulas here in Austin and been able to see what benefit they can be, especially to those people who are wanting to try to do it without an epidural or wanting to do it without an awful lot of intervention.
And I think our studies are pretty good at backing that up is that doulas have been, we know that continuous labor support decreases the risk of C-section, has better outcomes for babies in certain circumstances.
And so I think we'd be really blind to ignore that data when it's so obvious.
Well, we do know that there are definitely the ones that are going head to head.
That's not quite us.
That doesn't really help anybody.
But okay, so-
Y'all are fabulous.
So changing gears a little bit, kind of going back to the testing sort of aspect.
Can you explain which vaccines are offered to people in pregnancy, which those are and kind of when in pregnancy those are offered?
Yeah, so I would say there's two to three-ish vaccines that are typically recommended during pregnancy.
And so it's like two of them are seasonal.
So the one that we give everybody during pregnancy is the Tdap vaccination, which is the tetanus, diphtheria and acellular pertussis vaccination.
Pertussis is the pathogen that causes whooping cough, and whooping cough in babies can be quite serious and can land them in the ICU.
So we give moms, and this is essentially what all vaccines are during pregnancy, we give moms vaccinations during pregnancy, not really for mom and partially for mom, but mostly because what happens is during getting a vaccine during pregnancy allows moms to create something called antibodies.
So they create their own natural antibodies against the vaccination.
So the vaccination doesn't really get to the baby, it's the antibodies that the mom produces.
So this is mom's natural antibodies that cross the placenta, and these antibodies stay around baby's circulation for about six months after the baby is given, or after mom is given the vaccination.
And it takes about six months for babies to develop their immune system.
And so babies typically don't get the DTaP vaccination, which is the childhood version of the Tdap vaccine until about two months of life.
So really in the first six months, the baby gets protected from mom getting vaccinated with the Tdap.
The other vaccination that just came out recently is the RSV vaccination.
And that's seasonal, given in the third trimester during RSV season.
And then the third vaccination is the flu vaccination.
And we give that seasonally too.
And that's given anytime during pregnancy.
And what about like RhoGAM?
How does, I know it's not technically a vaccine, but it is like a shot that some people receive.
And it's not something I know a lot about.
And I know a lot of our clients don't know a lot about it.
Yeah, and I think RhoGAM is one of the most important medications you can get during pregnancy if you are RH negative.
So RhoGAM is a immunoglobin that you're given.
And so in RH negative moms, basically the way, this is confusing.
So I'm gonna try to simplify it as much as I can.
So imagine on your red blood cells that you have a little flag on your red blood cell or you don't have a little flag on your red blood cell.
Someone who is RH positive, let's say A positive, B positive, AB positive, O positive, those positive people mean they have the RHD antigen on their red blood cell, which means they have a little flag on their red blood cell.
People who are negative do not have that little flag on the red blood cells.
So in moms who are RH negative, we do not typically know what their baby's blood type is.
And the vast majority of people are RH positive.
So their baby, especially if their partner is positive, either has a 50 to 100% risk of being RH positive.
This is based on just genetics.
Okay, again, I'm trying to really simplify something that's a little bit difficult to explain.
I usually have to draw this out for patients for what it's worth.
And so if mom is RH negative and baby has this little flag or antigen on there, the surface of the red blood cell, what can happen is mom can develop, or the pregnant person can develop antibodies against that red blood cell.
Meaning the mom can develop basically immune factors to attack the baby's blood type because of that flag.
Because your body, mom's lack of having that flag is what triggers this immune response.
Because when your body sees something that it hasn't seen before, then your body wants to attack it, right?
That's how we fight off infection.
If you get infected with the flu, your body sees the flu and goes, wait, this does not belong to us, and tries to attack it.
So if there's any risk of bleeding between mom and baby, which can happen to the placenta, and any of that baby's blood circulating through mom's blood can happen, or the pregnant person's blood, mom's immune system can make basically fighters or immune reaction to that, and that can go across the placenta and attack the baby.
What RhoGAM does is RhoGAM basically puts a plug around that flag and prevents mom's immune system from reacting to it, and basically hides the baby's antigen, the RHD antigen from mom.
And so basically, it's a way to cloak baby from mom's immune system.
Usually, with the first pregnancy, it's not so bad if you don't get RhoGAM, but what happens is your body gets sensitized that as soon as you have the next pregnancy and that baby happens to be RHD positive, then what happens is that baby can have really severe medical conditions, including stillbirth, if the mom has not been properly immunized or gotten the medication RhoGAM.
I don't know if that, hopefully, that makes some sense.
Yeah.
And my mother-in-law, actually, she was telling me one time, she heard me over, I think, talking with a client on the phone when she was here visiting.
And she was like, do you know that we didn't have this shot a long time ago and that I actually should have had four other siblings?
And I was the only one who lived, but I was very sick and had to have multiple blood transfusions as a baby.
Wow.
It can cause really severe anemia to the fetus.
That's so wild.
It was really engineering her perspective.
So it's one of those tests that, you know, some people can get, again, I think people get like, they hear like, oh my gosh, it's some sort of injection, but it's so important and highly, that's one of the things that I'm like, highly, highly recommend that I will counsel patients multiple times if I have to, to discuss giving the injection.
I think that leads into our next question really well.
We know that there's-
I mean, I think there's always gonna be things that people have different beliefs, different preferences around.
And, you know, again, we support everybody of, you know, no matter what their wishes are, as long as they are, you know, informed of all of the decisions and choices around making those decisions.
But for people who are, you know, choosing to decline certain tests and procedures, are there any that you, like, you know, your top few that you would say, I really, really, really recommend that you do those, even if you are gonna decline other things in the future?
Yeah.
I mean, I think you probably phrase it the way that I would phrase it, is I think all of the testing that we do is necessary and has purpose.
If I were to rank them, if I were to rank the top two to three, the top three in no particular order, because it's hard to rank them.
Like I said, I am a believer in that.
I think there's good data to support this of the testing that we do.
So the top couple of ones that I would recommend is the 20-week scan to look at the anatomy of the baby, because that is when we typically will find out if there's any anatomic abnormalities going on and whether or not your baby needs some sort of intervention or if there's something lethal going on so that you could be prepared for that.
There's a lot of information that we find on the 20-week scan.
Now, most of the time you do the 20-week scan, everything looks great.
But again, having seen as much volume of obstetrics as I have had over the last however long 12 years that I've been doing this, the 20-week scan is typically when we will start seeing major issues.
Another one I would recommend is the gestational diabetes testing.
Gestational diabetes is a disease that's caused by insulin resistance brought on by the placenta.
And while I think there are some people who want to decline it because they don't feel like they have risk factors for it, you can go into a pregnancy having zero risk factors for gestational diabetes and still test positive.
And some of the concerns we have about gestational diabetes goes beyond just like a baby being too big, which is why I think a lot of people are like, well, I'm not too worried about that part.
It relates to a baby having issues with blood sugar management and Billy Rubin levels, jaundice levels, and ICU admission and things of that nature that I think are really important.
RH and rogaine, so if the patient is RH negative.
Beating rogaine if they're RH negative.
To be clear, I think all the testing that we do is worthwhile and would recommend, but those are probably my top three ones that I do a lot of pushback if someone is against doing testing for that.
Yeah, we serve, I know 98% of people have babies in hospitals, but I would say it's closer to like 60-40 with our practice as doulas, just because the people who tend to hire doulas are a little skewed for our numbers.
That 20-week anatomy scan also can be so telling, especially if you're having an out-of-hospital birth, because if you plan an out-of-hospital birth and you find out that your baby has an abnormality, that you may need immediately to have some intervention with for your baby afterward, that is so important.
I had a client have that where we had to have a nephrologist on staff at the hospital.
They called one in to be there.
She was already planning a hospital birth, but they ended up being able to call another specialist in just to be there for when her baby was born, which was really, really helpful and could be potentially life-saving.
So I think that people don't realize it's not just a silly little, I want to measure the baby and get the key pictures.
It's really a lot of information can be determined.
And figure out where the placenta is too.
If you have a full placenta previa, we're not going to generally feel like nobody's feeling that in a fundal exam most of the time.
And that is something that would be a serious concern in a vaginal delivery if you've got a placenta in the way your baby can't come through there.
So we've talked a little bit about pregnancy.
Can you talk to us a couple of the things that you see routinely that you guys do in labor?
So when someone comes to the hospital and they're coming to check in, what are some of those routine things that they can expect to have in labor?
So typically at a hospital, let's say that someone comes in through, so typically what happens when someone comes in believing themselves to be in labor, we have them go through LND triage.
And in LND triage, that is like emergency triage.
What they do is we determine the acuity of what's going on.
What typically happens is both mom and baby get monitored.
So we get some vital signs from mom.
What is her blood pressure?
What is her heart rate doing?
Does she have a temperature?
We monitor baby.
We look at the fetal heart rate.
We look at the contraction pattern.
We will typically ask to check their cervix.
I would say 99% of the time, we do occasionally.
If someone really doesn't want me to check their cervix, I won't.
And if we decide that someone needs to be admitted, then typically they will get lab work drawn.
Usually that entails getting a blood count done, mostly because the vast majority of my patients get epidurals.
And so in order to get an epidural, you have to have certain parameters met on your blood count in order to be eligible for an epidural.
And then when you get moved over to a labor and delivery room, the standard of care is to do something called continuous monitoring, which is where we monitor the baby's heart rate the entire time and the contractions the entire time.
And then we will monitor your labor.
And for everybody, that looks a little bit different.
Typically speaking, in the active phase of labor, we tend to check the cervix every two hours.
Now, sometimes I don't feel it's necessary to do that.
Sometimes I do feel it's necessary to do that.
It just depends on the clinical scenario and what's going on with the patient, what medical issues are going on.
If there are higher acuity medical issues going on, I want to make sure that the labor is progressing appropriately.
If someone is pretty low risk and they're just...
I've had patients where I've done maybe one or two cervical examinations the entire time they were in.
I've had some that I didn't do any and then I waited until the baby came out.
It really depends on the situation.
At our practice, we take care of a wide range of patients from the very low risk to some of the highest risk sickest patients that I've ever seen.
And so I, myself and my partners, who I absolutely adore, are very good at determining what kind of monitoring each patient needs.
I think this is so important.
I have to say something before I forget it.
It's so important when people are listening to this, if you are wanting an OB for your next baby that you're having or whatever, finding an OB that treats you like an autonomous individual human that is not just, oh, I deal with all the high risk people, so we're just going to treat everyone high risk.
Dr. Ghosh, this is why you're one of the only practices that we refer to, is because you are treating people for who they are, not for what they could potentially have wrong with them.
And we see so many providers wanting to do all of the interventions for every person.
And just your explanation of when you do cervical checks for people explains how you're treating those people individually.
Okay, fine, you can go now.
That was exactly what I was going to say.
I think that individualized care and shared decision making is such a huge part of the medical model of care and pregnancy.
And there are practices that don't really do that, and there are practices that do a really good job at doing that.
So I think that's one of the things that we really counsel our clients on is making sure that you're choosing a provider who is going to take care of you in the way that you need to be taken care of.
And that looks different for everybody.
Some people are totally fine with every intervention in the book.
Some people want a more individualized approach to their care, and I think finding someone that's going to work really well for you in this pregnancy, because each pregnancy is different.
We all know, we've all seen people with the craziest of first births, and everything went wrong to baby came flying out in the car on the way to the hospital on their second birth.
So I think getting that individualized care is just so important.
And I think what I hear a lot from patients who see us, because I know that we have that reputation out in the ether or whatever, I tell people all the time, when people ask us, are we low intervention?
I don't think we're low intervention or high intervention.
I think we are appropriately interventional.
There's no real such thing as low intervention or high intervention.
It's like what level of intervention is needed in order to maintain the safety of the pregnant person and their child within the sphere of their autonomy, but also making sure that you have to balance autonomy with, if I think a baby is acutely in danger, then the discussion that is had is going to be different than whether or not we need to do continuous monitoring on a completely normal non-acute situation.
So it very much is like trying to tailor it to where each patient is at, because every patient is different, every birth is different.
And when you're saying that, you know, that difference is a patient being able to go in at their birth and trust the things their doctor is saying versus going in and wondering if every single little thing is tricky.
And we don't want you to start off your experience that way.
We want you to go to a doctor to start with that you can trust.
And that's one of the things we tell people when we are recommending you guys, is, you know, if Dr.
Ghosh is saying something is really needed, I mean, it's probably true.
She's not going to try to trick you.
You know, she is really going to consider your situation.
And, you know, I think all OBs are genuinely well-meaning.
I think where they're coming from might be different.
What I usually recommend is, I think that if you have certain feelings about how you would like to your birth to go, I think before you even get pregnant, you should be chatting with the people that you are wanting to birth with to see what kind of, how they are, what their philosophy is on birthing, because that's definitely something that I will go over with patients when they ask me those questions.
Because I've had patients who have transferred from either other OBs or even midwives, and they're like, hey, my experience was less than satisfactory.
And the question isn't, well, let me do things my way.
It's like, what happened with that experience?
What do you want differently?
And is that something that I can offer you?
Because sometimes it is, and sometimes it's not something that I can offer to them.
And so I'm not going to be everybody's cup of tea.
And that's okay, because there is a provider for everybody that's out there.
And I think the more armed you are with that information before going into pregnancy, the better experience that you have.
And the more trust you have going into your birth with your birthing provider, that is going to lend itself to you having a better birthing experience.
Because I have had patients that we took their birthing preferences or birth plan and we flushed it down the toilet because of the situations that happened during their birth.
But then after the fact, they were like, you know what, my birthing experience is great, because I trusted my provider to make the decisions that needed to happen to get me to where I needed to be, to where I felt heard, well taken care of.
And I and my baby got out of the situation safely, whatever that looked like.
And that's the difference between birth trauma and not birth trauma.
People can have the most traumatic of deliveries physically.
And like you said, everything going out the window and just these crazy experiences that differ from everything that they had planned originally and still walk away feeling like it was a good experience, like they were supported and taken care of and that it was good because they were, like you said, part of that decision making process and working with a team that they trusted and felt like they were heard and listened to.
And I don't feel like that can be overstated enough.
Like that piece is so important.
And truly, that's why Ciarra and I do what we do.
That's why we have this podcast.
That's why we work with clients in the way that we work with clients because everybody is going to have a different experience and walking away feeling good about it, having a positive experience no matter the outcome is our number one, biggest, baddest, best goal.
Absolutely.
Absolutely.
I mean, I think what I have learned over the last, you know, over a decade of doing this, which is like insane that I've been doing this for that long, but is that at the end of the day, people just want to feel heard in their care.
And there are times that, like, you know, there have been times I have failed at that as a provider, and those times really suck, or like where your communication with your patient wasn't what you wanted it to be.
But I have found that the more that you were able to communicate with someone about why something happened, like, you'll see me after every single birth, I will debrief with my patient.
Whether or not it was like two seconds of pushing and like I barely did anything, or if it was three hours in the vacuum with a shoulder dystocia, I will also debrief with that patient.
Because I think it allows them to understand what happened with their birth and feel like, okay, I had a moment to sort of process and ask my provider questions, and it doesn't leave any questions moving forward.
Yeah, I can tell you from our end, that makes all the difference in the world when we're meeting with our clients.
You know, week, two weeks, whatever, after delivery and chatting with them, you know, in the months and years afterwards, those are the moments that they're remembering and that they are speaking on with, you know, just with fondness.
Like that's, it's so big for people.
So we always, you know, hear the saying that, you know, it's not done until the placenta is out.
So in that, you know, a couple of hours immediately after birth, when, you know, we're dealing with the placenta, dealing with all of that kind of immediate postpartum period, what can someone expect as far as procedures and things that, you know, might be happening?
Yeah, so typically most of these have been trained in something called the act of management of the third stage of labor.
Most of that is to decrease the risk of bleeding.
So most obstetricians will give, we give the placenta about 30 minutes to come out.
Most of us, including myself, will do, especially if someone has an epidural, we'll do a fundal massage to help with delivery of the placenta.
And then 99.9% of the time we give postpartum pitocin.
Postpartum pitocin has been shown to decrease need for further intervention and risk of postpartum hemorrhage.
And so I'm a big believer in that.
That's also one of my top five things that I feel like there's good evidence for.
And usually once the placenta is out, we do a perineal evaluation, seeing what kind of tearing there is, and seeing if there is tearing, if there requires any sort of repair.
And a lot of those, I know that you're not the baby nurse and you kind of hand the baby off, that part you hand off to someone else.
But they can expect that they can, they're going to have to have all of those little, not have to have, they can of course decline anything, but offer little checks on baby and things as well.
So typically speaking, the babies will get erythromycin, that women in the eyes for infection prevention, hepatitis B vaccination, and then a vitamin K, which is to help with basically brain bleeds.
The two interventions that I would, again, I believe in all the interventions that we do for postpartum, but if I were to rank them, the postpartum pitocin I think is important, and then the vitamin K injection.
I know there's so much conversation about vitamin K, but to me, there's absolutely no question.
And this is backed by literature about the vitamin K.
About 1 in 60 babies would be affected by an intracranial brain bleed if they were not given vitamin K.
And so 1 in 60 babies, if you delivered at our hospital, which we're predicting about 10,000 births at our hospital, that's a huge number.
And so big, big fan of vitamin K.
Such a funny thing to say, like fan of vitamin.
I'm a big fan of vitamin K.
It's just like, I mean, it's fan club.
We hang out.
So what is one thing that you wish all patients planning a birth with an OB now, like specifically with an OB practice?
Or maybe it's overreaching.
I think it's, I think just like midwifery or doula care, we're not a monolith, right?
We have certain standards of care that we should be upholding.
And to me, upholding standard of care is incredibly important.
I, and I think that most OBs try to, to adhere to a standard of care as like established by the greater medical community when it comes to birth.
So like from the American College of OBGYNs.
But it's hard for me to be like, what should you expect?
I think everybody has a different, every individual person is going to have a different experience with every individual OB.
So it's really hard for me to be like, this is what you should expect this to be.
I think that's too, it's too hard to say because everybody's experience is different.
There are people who have had great birth experiences with me and some people who probably never want to see my face again.
And that's those people's experiences.
And I can't, I can't, it's hard for me to be like, this is what you should expect as a doctor.
It's sort of like, I'm sure you guys have experiences where someone recommended a provider for whatever reason, for whatever medical reason, family doctor, surgeon, whatever.
And they were like, yeah, the best experience is this doctor and you went to see that same provider and was like, I had a horrible experience with that provider.
But I do think, for the most part, most obstetricians do have the best interests of their patients in mind.
I think a lot of times the difference comes into how they wish to achieve that method.
Yeah, and not the bad guy.
Yeah, I think the biggest thing there, and I think what you answered is exactly perfect because the best thing to know is that y'all are individuals just like anybody else.
We're not everybody's cup of tea either.
Not everybody hires us and that's okay.
We see stories on Facebook of all of these parents saying they had an excellent experience with so-and-so.
And we're like, oh my gosh, I saw a nightmare birth with them.
Like they were awful, you know, but that wasn't that person's experience.
And there's no need to go and tell our story, you know.
So I think that that is the biggest thing is like finding somebody that matches what you're wanting and being open to, you know, not loving them maybe as much as the other person that recommended them.
It's not always going to be the exact.
And your medical situation isn't the exact same.
So we have people come to us and be like, my sister-in-law had X, Y, and Z happen.
And they're telling us things.
And I'm like, there are so many pieces missing to this story.
I feel like I'm not saying your sister-in-law's experience isn't true.
I'm just saying, I think the way you're interpreting it, there are some missing pieces that may make it make more sense.
So, you know, do your own research, you know, interview those doctors or find them on social media, see what kind of information they're putting out there and see if that is a good fit for you.
And I think if you're...
My advice for anybody, this is hard to do, but like my advice for anybody who is wanting to birth in a certain hospital or with a certain provider, talk to the labor and delivery nurses.
Those people, they know.
They know and they can tell you, hey, if you want this kind of birth, this is who you want to see.
If you want this kind of birth, this is who you want to see.
And so, again, there is an OB for everybody.
There are patients that have transferred to our office from other OB offices because they felt that our philosophy of care was better.
And we've had patients transfer out of our practice because they felt like another OB's practice.
There are enough births and enough providers in the city of Austin that there's someone for everybody here.
That's for sure.
That's for sure.
I know the hospital you're at has like something like 700 births a month or something crazy right now.
Maybe it's more than that now.
I don't even know.
It's crazy.
We're predicted to have somewhere between 9,000 to 10,000 this year, which is just an incredibly wonderful and crazy amount of births to be witness to.
It's glorious.
We love it.
Austin's place to be if you're having babies, apparently.
That's great.
So how can people find you, and are you in your office taking new patients at the time of this recording?
Yeah, so I am with Austin Regional Clinic, the North OB office.
I work with five other amazing obstetricians and two amazing nurse practitioners.
We're a group of all women.
We all practice very similarly to each other.
We do something called the collaborative care model.
So our pregnant patients meet all of the different providers in our office.
The six of the OBs are the only one delivering clinicians.
But we have you meet everybody so that you're comfortable with whomever is able to attend your birth that day.
We also have gender-affirming care as well.
So if we have gender diverse folks who want to find a safe place to deliver, that's something that's also a priority at our office.
You can find us at...
What is it?
So our Instagram handle is at ARCnorthaustinobgyn.
And then my personal Instagram is at Dr.
Dr Romy, R-O-M-Y, Ghosh, G-H-O-S-H, on Instagram as well.
And we will put those in the show notes for all of you people who are like...
Don't write down, and I'm in the car with my screaming kids and one AirPod in my ear listening to this podcast.
We appreciate you taking your time to talk with us more than you can know.
We are so thankful that we have you to refer to.
You having providers all in one practice that practice so similarly is exactly why we're able to send there.
You know, every once in a while, we love an OB at a different practice, but we're like, it's an on-call model, friends, and you could get so-and-so, and they're not going to be with what you're saying you want.
It's just not congruent.
So we thank you for upholding that and for treating people like individuals and for caring about doulas and caring about getting information on to people.
Well, I'm so happy that you asked me on.
I love talking about prenatal care.
I love educating about prenatal care, so thank you for having me on, and hopefully some of this information is helpful to you guys and hopefully whoever is listening to this.
Yes, thank you so much.
We really appreciated this.
Thank you for joining us on Birth, Baby!
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