Oversharing - Baby Steps: Emily Oster's Roadmap for Pregnancy Uncertainties

Episode Date: May 3, 2024

In this third episode of Baby Steps Season 2, presented by First Response, Jordana speaks with economist and author of "The Unexpected," Emily Oster, to explore pregnancy complications and the importance of informed decision-making in navigating them. Oster addresses topics like recurrent miscarriage, racial disparities in maternal mortality rates, and the emotional toll of fertility challenges. She emphasizes the need for personalized healthcare interactions and supportive providers, while advocating for increased research into the experiences of pregnancy and mental health during fertility struggles. Overall, Oster aims to empower individuals facing these challenges and provide solidarity in navigating them. Learn more about your ad choices. Visit megaphone.fm/adchoices

This episode is brought to you by First Response. First Response recognizes that not all pregnancies are the same, and neither is the road to get there. The First Response brand is fervently committed to supporting, sharing, and empowering all pregnancy journeys and providing accurate information, especially to those struggling with infertility, loss of a baby, and maternal health inequities. With a variety of tests that detect pregnancy hormones early and often, first response is there for you every step of the way. All First Response pregnancy test products are available for purchase at all major retailers in store and online. Be sure to pick one up today. Hello and welcome back to Baby Steps. I'm Jordana Abraham and I'm back with my big sister, Dr. Naomi Bernstein, yet again for season two of Baby Steps.

So excited for this. So who do we have on this week? So today we have a repeat guest, our only guest of both seasons, economist Emily Oster. And I was really excited to have her on because I had her on last time. But this time I had her on to talk about her new book, which was so relevant to. everything we're talking about. It's called the unexpected to back up. She's written multiple books about like pregnancy and then like child raising and they're all sort of based in like data and studies. Her first book was expecting better and it's all about like the studies about pregnancy and like it kind of is supposed to like relieve anxiety because it's basically saying like a lot of the stuff that your doctors tell you is like really bad is like you know the studies say are not necessarily as harmful. Basically, the whole premise of her books is sort of to reduce anxiety through data, which is why I was really excited about her newest book, which is called The Unexpected. And the book

is solely about dealing with pregnancy complications. So I love that because it's like a lot of the data is around these like, you know, seemingly normal pregnancies, but up to 50% of people suffer from some sort of complication in pregnancy, whether that's, you know, it's first trimester miscarriage, second trimester miscarriage, still birth, or just like issues that, you know, where you wind up having a healthy baby, like gestational diabetes or even like complications that you could have after you give birth. So it really like runs the gamut of all of these things that can go wrong. And like, again, 50% of the time, like something is not ideal in the pregnancy, which is like a pretty big statistic that people don't really tell you

about, you know? Right. Totally. And I think it is always helpful. I think the best of this podcast is that it normalizes not just things behind, you know, pregnancy complications, but the fact that these things happen to so many people. And I love that Emily Oster, she really has such a calming presence because I think in the age of all of the kind of fear mongering marketing strategies, that, you know, companies are using to try to get you to buy their products, hearing from someone who's, you know, deep into the research and the data behind all of this helps you feel like you can get a clear, neutral perspective on what the facts actually are versus what we're seeing on Instagram and social media and what's kind of being pushed to make us feel scared when

it does sound like a lot of this is very common and she just has such a calming presence. And this new book sounds like it's really specifically for the listeners of this podcast, like pregnancy issues versus general child rearing stuff. Exactly. And a lot of the guide for this book is like the first half of the book is really just like telling you sort of like how to make a game plan for trying to get pregnant after having one of these complications, whether it's a miscarriage or like, you know, again, like one of these pregnancy issues that comes up from time to time.

So it basically gives you like a roadmap to how to approach your next pregnancy and the important questions to ask. And some of them are like, why did this happen? Is there anything that can be done to prevent it? And just kind of like giving you the research around the statistics behind these things, how likely is it to happen again and what you can do to mitigate it? So it's very like, I think if you have a super anxious brain, it really helps sort of like, it helps give you direction for coming up with a plan after you've had a tough time.

Totally. It seems like the perfect book where information can actually make you feel better instead of what I think a lot of times is like information overload can just make you end up feeling worse and get you down a rabbit hole. So it sounds like this is the type of, you know, this episode and this book are perfect for using information to help. you create a plan and execute your plan and be educated versus just consuming huge amounts of information that end up just making you kind of spiral into an anxiety wormhole. So I'm really excited to hear what she has to say. It's a great episode and let's just bring her right on. And we are back with Baby Steps. I'm so excited to welcome back a season one fan favorite,

it, a personal hero of mine, I'm going to say, in the fertility and parenting space. Welcome back Economist and author, Emily Oster. I'm so excited to be back. Thanks for having me. Of course. We're excited to have you back. And it's a special episode and it's a special time to be speaking to you because you are about to release. I'm not sure when this episode comes out. It might already be out. Your book, The Unexpected, is out April 30th. Yeah. This is a different kind of book than the books that you've written, right? It is a different. different kind of books. So my other books are, they're about pregnancy and parenting, and they're kind of really about my own experiences. You sort of said, like, why did you write this? A lot of it

is sort of tracking through my experience of pregnancy and parenting. And this is a book that's really motivated by the questions that people have asked me in the decades since expecting better came out around things that didn't go the way that they hoped in their pregnancy. And they came asking for answers. And this book is trying to answer those questions. Right. And this book is specifically about that, which is pretty amazing because, I mean, I, again, I'm a huge fan. I think I've talked about this on the last episode. In my first pregnancy before I miscarried, I read like, almost your entire book, except for the birth part. I was like, I'll read that when I get a little closer. And then it didn't wind up getting there. But I still felt like so incredible

about the information you were providing. It made me feel a little more at ease about everything happening, even in a situation where it didn't work out as it wound up not. And then I started following you on Instagram and you also do these amazing Q&As. And I do see a lot of them are about these pregnancy complications. And I remember thinking, like a year ago, like I wish there was, you know, I wish she could just do those. So I could have a, you know, a specific place to answer all my miscarriage infertility questions. And then you came out with this book or you're coming out with this book and you must have read nine and I'm sure thousands of other women's minds. Yeah, I hope that it is helpful.

I mean, I think this is, it was in some ways a complicated book to write because we wanted to figure out how we could best serve this set of questions. And so when people come, the sort of first thing they always ask me is like, well, is it going to happen again? You know, what can I do to, what can I do to prevent this? And the book talks about a range of complications from miscarriage to hypermesis, gestational diabetes, postpartum depression, sort of the whole range. And I, I, can answer the questions, like what is the data say about recurrence? What is the data say about treatment? But what was harder for me to see was how do I help people navigate that? Like,

one of my goals in all of these books is to help people with the decision making, with feeling confident, feeling this feeling of like I am able to be empowered to be a participant in my own journey, my own pregnancy journey, my own parenting journey. And the thing that's hard in these places is that it really is very medical and it really requires a lot of personalized interaction with the medical system. And those interactions are really hard to feel empowered in because we don't always have the information that we need. And so the sort of crux of this book is a, it's co-authored with Dr. Nathan Fox. We talk about data, but he also talks a lot in his parts of the book about how to navigate conversations and about how to script conversations and how to figure out with your

doctor, what are the right choices for you given whatever is your circumstance. So I kind of think that's that's another way in which this book is quite different from the other books and I hope will be helpful. Right. And you wanted to include a doctor for this one. What was the thought process behind that? Yeah. So a lot of people have asked you, did you include a doctor because the medical stuff in this book is more complicated? And the answer is no. All of my books have medical editors. And so Nate is the medical editor in this book. But his role goes much beyond that because I really feel like, what is hard for many women, what I hear from many women is hard for them in these situations is they don't actually understand what happened or how to talk to their doctor about it.

And they go in and they have a lot of questions and the time is very limited and they're not even sure the way into the conversation. And so what I wanted Nate to bring, what I think he does bring to this, is from the doctor's side, you know, how should you have this conversation? What is a really good version of this conversation look like where you can understand your particular situation, your particular risks, and what might be the right next steps for you. Right. And that was like a very key, I think, part of the book in reading it in the beginning, is it really like, obviously, the second part of the book is about all of the research on these

complications, what the, you know, what the studies say. But the beginning part of the book is also, I think, equally important because it really just tells you like how you should be thinking about these things and how you should go about, you know, diagnosing your own personal issue. you find with, you know, with a healthy pregnancy, the studies are pretty like straightforward. You know what I mean? Like coffee, no coffee, alcohol, whatever it is. With a more complicated pregnancy or with an inability to maintain a pregnancy or keep it to term, it feels like sometimes the issues are like so specific to the person or you get a, you get your own special cocktail of like things that are going wrong. So even if, you know, even if you have multiple of these things,

I think the script that you have for getting your information, bringing it to your doctor and finding out the path to go is almost like the most helpful part. Yeah. I mean, I think when we look at data, we're often getting the answer to the averages. And in some of these, like, less fraught things, like, can I have a cup of coffee or, you know, can I have a glass of wine? And even, like, the averages are pretty informative. Like the data can sort of tell us something that is somewhat prescriptive.

Here, you know, telling someone, well, the recurrence risk of preeclampsia is, you know, 30% or whatever. That's actually not applicable to almost any individual because it depends the exact timing that you had preeclampsia, you know, how severe it was when it occurred in the pregnancy, what the symptoms were. So the data, it's something to glom onto. Like it's something to, that I think people want to see and there's information about treatment that we can give. But ultimately, because it's so varied across people, what you need is a way into the, is a way into the conversation. Right. And people, I think the ultimate question that people have when going through these things, I mean, especially if the pregnancies didn't work out, which is I think a lot of what

this podcast is about, is like, am I fucked or is it going to happen for me eventually? Yeah. Yeah. You know, obviously no one can really tell you that 100% for sure. And it's hard when they're, with the, to untangle the data with that. Because you're not, it's hard to get, well, this is your percent chance that it's going to be fun. Right. Yeah. And I think. it's, uh, this is the sort of core question like what in all of these complications, not just in pregnancy losses. Like, is this going to happen to me again? Right. And like, is it, you know, or, or am I going to be okay the next time? And could I do anything about it? I think in some ways miscarriage, particularly first trimester miscarriage is, is like the hardest among the hardest ones to

answer that question. Because so much is just chance. And to the extent that it's not chance, it's not something we understand that well. And so often we're just telling people, well, like, just, you know, try again. Like, we don't know why it happened this time. You know, if you have another one or two more, then we'll do some additional follow-up. And I think that that kind of, like, uncertainty is so, so hard to sit with. It's so hard to sit with. Why do you think there's not more data on, like, you know, because, again, the book says,

and, you know, that's what everything that I've read, it seems to be, like, if you just keep going, like eventually something kind of works out. But why isn't there like more concrete information there? So generally in the first trimester, we think about 90% of miscarriages are a result of chromosomal abnormalities. And most of the time, those are just by chance. You know, the risk increases with age. There are chromosomalities we know about. There are ones we don't know about. So in some sense, we tell people to keep trying. They tell people to keep trying. because the answer is like, well, it's probably nothing, it's probably not specific to you. Or if it's specific to you, it's in a way that we don't totally understand and we wouldn't be able to fix anyway.

Right. And so the best we can do is just have people keep trying. But somehow the messaging, which comes across not explaining that, like here is what could have happened and here are, you know, here are the things we could try, but here's why that wouldn't be relevant. We're not giving people that explanation. We're just saying, oh, keep trying. And if, you know, you have two more miscarriages, come see me. and that's like, well, why too? Look, what?

Where'd you come over that number from? You know, why not after, why don't we do this testing after one miscarriage? Which is a very common question people ask. Like, if you've had three miscarriages, there's some additional testing they'll do. Why don't you do that testing after one? Right. A reason you kind of do discuss that in the book or maybe that's more in Dr. Fox's explanation is that sometimes you get, you do these like miscarriage panels, which there's a lot of them.

There's, I mean, I've had them all. There's MRIs. There's, you know, like the. blood tests, there's the karyotype test, there's all that stuff. But sometimes you find information that isn't even relevant and then you're kind of stuck on that. And it could just be chance and then you work yourself into this like medical tizzy. Yeah. I think Nate has a focus on a lot. I think this is right on sort of thinking about testing as providing an answer that would help in some way. Right. You know, that we sort of want to think about the choices that we make as moving us in a

direction that would be helpful for the future as opposed to just collecting information with which we can do nothing. Right. Sometimes that information is helpful or can make us feel better, but we can also attach to it in a way that's unproductive. Right. And not particularly helpful. And then you also talk about maybe it's more, again, it's, I'm not sure.

We're a team. Yeah. It's a team. Okay. You guys are like a team. I'm not sure if it's like this is your section. This is a section. We can speak in different voices, but yes.

I'm like, I'm sure she's read his parts and vice versa. I've read his first. Nate and I are very close. I'm sure. No, and the book reads like super cohesively like that. But I do like that there is some sort of delineation of like, you know, even at the end of each chapter where you have like your summary and his summary. Like here, your takeaways from different perspectives. Exactly. So do you feel like there is a sense of like overtesting with fertility issues or not necessarily?

I think not necessarily. You know, when people are looking for answers, doctors want to serve those answers as much as possible because telling someone, I don't have anything to offer you is not, does not feel good. So I think there definitely is a sense in which, you know, some of this is a sort of search for answers that we might not have. But sometimes when we do this testing, we do learn something. So, you know, there's always a trade. off in kind of for a small number of people, there are, there are, let me say this differently.

So when we have pregnancy loss, miscarriage first trimester, second trimester miscarriage, there are some conditions that people can have, which could make miscarriage risk higher. So, you know, there are, you know, balanced translocations in, in your genes, which are are uncommon, but not that uncommon, which can make miscarriage more likely. So there are things like that where we could learn them. And then in some cases, they would suggest a different path forward. So always when we're thinking about additional testing, we're trading off the fact that, you know, the testing is invasive, that it can cause anxiety, that it can cause stress. And we're trading off that against some small amount of information we might get.

And so I think that's, we think about the testing. Some of that trade up is really about individuals and how you feel, how you're going to feel about this testing. So for some people, the experience of going through that kind of testing is very stressful. And for some people, it is very reassuring. And when we have conversations with our providers about how to approach this, a huge piece of it should be, you know, what do you want? Like, what is going to feel right for you as the way to deal with this as opposed to saying, well, everybody, you know, over this age gets this set of tests and under this age get this set of test and with this characteristic gets this set of test because the answer is it should. matter how you engage with them, not just what the medical details are. Right, which can kind of make it hard to, I guess, from the patient perspective of like, well, I don't know, like what should I

test for? But also, you know, I mean, there seems to be like a balance of, I want you to tell me what to do, but also I know my own body or, you know, doctors get it wrong sometimes. Yeah. No, so Nate and I actually have a piece coming out around the time of the book in the Atlantic take about exactly this question of like, how can we bring together the expertise that the doctor has and the patient has in a way that's not frustrating? Because I feel like for both sides, there can be this frustration in these conversations where patients are coming in saying, you know, well, here's my stack of documents and this is exactly what I want. I did my own research. And the doctor saying, well, like, that's not relevant for your condition. Or the patient feels

like the doctor says, well, here are these two options. You know, you choose. And the patient feels that they don't have anywhere near enough information and you're the doctor, why aren't you, why aren't you telling me? And so our view is that the right conversations here recognize that, you know, the patient has expertise in themselves, in what they want, in how they feel, in what their condition was like for them. And the doctor has some expertise in the medical aspects. And which of those should weigh more actually depends on what kind of decision you're talking about. And there are productive ways to combine that. And there are productive ways to combine that. but often we don't combine those in the productive ways.

Right. That makes sense. Would you say the book is for anyone who's had any sort of previous pregnancy, whether that came to term or not, it doesn't seem to necessarily be geared towards people who have not been pregnant yet? Right. I think it is, it is, there are, I see there are two audiences for this book. So I think one, the clearest is people who have had a previous pregnancy that was complicated

by one of the things we talk about in the book. and that's about 50% of pregnancies. Wow. So, you know, that's a lot of people. The other audience, I think, is people who would like to understand the experience of their friends, cousins, sisters, family members, people in the world who have had these experiences, which I think we don't talk about enough and we don't. And as a result, people end up feeling more alone than they should. but the core audience is people who have had one of these complications. Right.

It would be better if everyone had like a general knowledge of these things because then, you know, if someone's like, well, you know, what's your issue with this pregnancy or like why is such a big deal? Like you wouldn't have to explain what these things even mean. And people feel like, I mean, hyper-emesis, which is like severe nausea and vomiting is the one that in some ways comes up almost the most in people being dismissed because a lot of people are nauseous in pregnancy. Right. And the distinction between like, I, you know, like I didn't feel great and I had to eat some saltines and like I threw up a few times.

And like I was, you know, in the hospital getting for a week getting IV fluids because like I couldn't keep anything. Like those are really different experiences. And so a lot of people who had very severe forms of this to say like somebody told me like, you know, my friend sent me a text saying like, did you try the ginger gums from whole foods? And when I got that text, I was in the hospital getting IV fluids. I was like, yeah, I thought of the ginger gums. Like, thanks so much. And she's like, I wish people had understood. Like, this was a really, really debilitating experience and not a thing that could be addressed

with different gummies. Yeah. I think, I mean, I feel like I'd only really heard about how intense this was beyond the norm with the Amy Schumer. Yeah. She had, like, a documentary or something on that. And at first I was watching that. I'm like, all right, this is this whole documentary about Amy Schumer is like just having

a little morning sickness. Right. And then you get deeper into it. It's like, actually. Yeah, right. And I think there are many things like this where we don't, you know, a lot of trauma and in birth, I think, again, people don't talk if it's embarrassing. You know, people don't want to, you know, people don't want to talk about prolapse where like your vagina is hanging out of your body. Right.

People don't want to hear about that. But they should. Yeah. I mean, I think they should because it's kind of like, again, I think there's like this ignorance and I can say it for myself even before, you know, having a lot of friends. who went through traumatic births or hearing about any of this thing of and you talk about this in the book of like you had a healthy, the baby was healthy

what are you thinking about? Why are you still harping on about this? What's the big deal if like, you know, you weren't sure if the baby was going to make it? They did. Like, or so I think that there's a lot of that and again, I can speak for myself having done that so it's not even anyone's fault

just that I don't think that anyone has a sense of like what any of this even really means and this book is a great to outline. And again, I was like, I gave it to, I gave it to my husband after. And I was like, you should just read this whole thing so that if any of this stuff happens, I don't have to, I don't have to explain it to you. That's good. Yeah.

And I think that it's amazing what you're doing in this space. And you talk about this briefly too, but can you talk about like the studies on black female mortality? And, you know, because that's a subject, I think, that there's, there's a lot of opinions on and you, you're able to untangle the data and, like, really say what's going on here. Yeah. So the maternal mortality rate in the U.S. in general is very bad.

It's much higher than many of our peer countries. And the maternal mortality rate among black women is two to three times as high as among any other group and particularly among older black women. And it's what's so striking, there are many striking terrible features of that fact. But one very striking feature is that. that it is not solely or even largely an income story. So sometimes when you'll hear talk about this, particularly from certain parts of the political spectrum,

we will hear, well, it's not, it's not about race. It's just about income and, you know, outcomes for poor people are worse than richer people. That's actually not true in this case. So the maternal mortality, morbidity, that's like serious complications for black women at the very top of the income distribution, like the top 10%,

are actually worse than the bottom 10% of white women. So it's sort of race is trumping income there. And so it's clearly suggest there's something going on in black communities in the way that they're interacting with the or the way that providers are interacting with patients that we really need to figure out what it is and how to address it. Right. And you said that I think you looked at people who had immigrated, you know, black women who had immigrated and they had not had that issue before they got to this country.

So even further. Yeah. And it grows with more time in the country. So one of the sort of systemic racism stress, like allergenic stress across the life cycle is something that comes up a lot in discussing this. And I think has a potentially pretty significant role on top of just the idea that that providers are not listening, which is. a point that many people have made. Right. And then I mean, this book obviously like then seems like

particularly important for anyone who might be being dismissed or anyone who might be like a victim of racism in in their medical care. Yeah. Yeah. And I mean, I think I feel both positive about that and also like, because it feels like what I want to say is like being informed is a way to like make sure that you're getting the care that you that you need. And if you know about these complications, if you know what's happening with you, then it is a way to make sure that you're getting the best care. But like, oh my goodness, are we telling people that you have to be an expert? And now it's your job. Right.

You know, so I think I like, I'm, yes and also like, ah, I really would prefer that that was not the way things operated. Totally. I think I had the same thought. It's like, here's your book to be empowered, but also like, it's not your job. Right. Yeah. And I think there's one view of this, which is here's your book to be empowered so you can

make the right decisions for yourself. And so you can, you know, participate actively in your care in a positive way. And I think that's a positive spin. The spin of like, you need to read this so you can make sure that people are not dismissing your complications. I hope that that is not true. But sadly, feel it might be. Well, anecdotally, I've heard that like many black women then prefer to do maybe like a home birth or something like that when actually that can be even more risky if you have any pregnancy complications, but they probably feel like at least I can control the people that I'm surrounded by. So I think there's been some, certainly some discussion of this is a really interesting new effort called Birth Fund, which is founded by Elaine Welteroff and with a bunch of very impressive

support, which is about getting midwifery care to black women. I think that's a potentially really, really interesting and important idea for getting like culturally sensitive, good, high quality medical care to people who have not had as much access as they should. Right. So you're saying up to up to 50% of people suffer one of the many, the many complications that you write in the book, whether that's preeclampsia, miscarriage, first semester, second semester, stillbirths, finding out that was more common than previously expected. What do you think is the right way to go into a pregnancy? Is it to expect that something will go wrong? Or is it to? No. No. I don't think people should go in expecting something to go wrong. And I think that we should go in informed and prepared for that

possibility, but I think there's a difference between being prepared for that possibility and spending all of our time focusing on all the things that could go wrong. So people have asked, like, should I read this book before I get pregnant? I'm not sure. I think, I'm not sure I would, I'm not sure I would recommend it necessarily. It might stress you out, I guess. It might stress you out. And, and, you know, I think that that, of course, that means that 50% of pregnancies don't have these complications. So there's always a fine line between informedness and, and kind of anxiety that like pre-anxiety, sort of anticipatory anxiety, which we don't, which we don't need. Right. Going back to what you were saying before about the high female mortality rate.

Yeah. I thought like the U.S. is supposed to have like the best health care systems like in the world. So why are we so, why do you think we're so much higher than other countries? Like isn't this where people come when they need a good doctor? Yeah. So, uh, I don't think we have a great. answer to this question. One thing is actually it's extremely difficult concept to measure. So even sort of where we fall in the cross-country comparison is like super in the weeds. But where we fall in the cross-country comparison depends a little bit on which set of numbers you prefer. So the CDC has a set of numbers that they like and other people have a different set of numbers that they

like. And it's not obvious. It's like people disagree about which one is the, which one is the right number. Generally, though, are both our maternal and infant care is not where it should be relative to our peer countries. And I think some of that is actually about lack of support later. So you're thinking about maternal mortality or even infant mortality as kind of things that happen in the hospital. But actually, a lot of it is about things that happen later. So after people are home, stroke, or other kinds of cardiovascular events that can happen when people don't have the kind of access to medical care, the kind of doctors that they should.

They don't have the kind of check-ins that they should with a medical provider. And I think that that may be something that's missing on both the mother and infant side in the U.S. Right, which could help attribute that, I guess, very high number. So some of the maternal mortality is mental health related. So is like postpartum. Yeah. Okay. Oh, I didn't even think of that as something that they would include in that.

in that this gets into the ways in which this is a very complicated thing to define. Right. What would you suggest someone do if their case seems to like be on the bad end of the data, right? Like they seem to continuously feel like they're on like there's a 65% chance of something working. They seem to continuously be on the 35% chance or like whatever's work seems to be happening for them is going against the data, what the data would say. I guess I have two pieces there. So one is that is a situation in which you really want to have a provider that is not just good, but is good for you.

So really thinking about you, do you have someone who you can work together with? Because in many of those situations, there's going to be a lot of repeated attempts to get pregnant or to stay pregnant or to address symptoms or whatever it is. Having someone that you can work with on that, that you trust and where there's a real partnership. is going to be even more important than it is for some other people. I also think, and Nate uses this phrase some in the book, that there's this idea of, like, radical acceptance, that, you know, when we are the, when things happen that are just the chance, you're the 35%, not the 65%, there's this tendency to be like,

well, why, you know, what is it about me? Like, what, why did this happen to me? The answer is like, a lot of times we just don't know. And all we can do is say, like, It just was bad luck. We have to kind of move forward accepting that. And that's really, really hard. Right.

Yeah. I mean, you get that. And it seems like sometimes you'll get that a lot where it's like, oh, this is bad luck. Well, it's like, well, how many bad luck situations are we going to have? But again, like, I think something that was encouraging, even in, you know, we're looking at your statistics on miscarriage rates or recurrence rates with one miscarriage, with two mass carriages, with three miscarriages. something that I found encouraging in your table, which I bookmarked here, my very cute bookmark, was that if you have over three miscarriages at six weeks, that's the highest percent chance of likelihood it's going to happen again. And it's still only 33.7 percent chance.

Yeah. I mean, I think some of those miscarriage numbers, like when you put them together, they have a sort of, there's a reassurance because miscarriage is really common. So I think we have some numbers in there as well from some places where women have had many, many kids. So they're doing these studies, people who have, you know, seven or eight kids. And basically almost nobody gets to having six or seven or eight kids without having at least one miscarriage. And so there's like a sense in which the sort of frequency with which this happens then has a kind of positive side, which is, you know, sometimes it doesn't happen.

So do you think that skews the data then a little bit? like if someone has eight kids and they have one miscarriage just because of chance, forgive me if I don't know anything about data and I'm saying this wrong, versus like someone who just can't seem to take a pregnancy to full term and they keep having miscarriages is like the number almost like too optimistically high for them because those are getting those numbers in different ways. Okay. Because we're getting those numbers in different ways.

So you can ask the question, if someone has had two miscarriages, what is the chance they will have another like sort of separate from asking the question if you took people with many many kids. Got it. How often have they had a miscarriage? Okay. So the data still applies. The data still applies.

Which again, to me, seemed like it's more than 50 percent chance that it doesn't happen. Yeah. So that was a nice. I mean, it's funny. You read, I think when you're going through this, you look for things that that keep you going that make you feel like there is hope. And I think that's what this book really does also, is it kind of like it takes things. things which feel really heavy that feel really like, I don't know how I'm going to like get to

the other end of this. And it gives you a game plan. And it kind of makes you, takes the edge off a little bit because most people, I would imagine, even though they're going through most of any of these problems do come out on the other end. Yeah. Yeah. And I think it's really about feeling empowered to engage with this in a way that that helps you move forward. So one example is we we sort of talk at the beginning about the kind of key questions you want to ask. And one of those questions is, why did this happen to me? And I think we can ask that question. We always ask that question.

Like, why did this happen to me? Like, why was I this? And Nate has a reframe on that question, which is you do want to ask why did this happen to me, but not, like, is it my fault or why did I, you know, why am I being punished in this way? But just what are the factors about my case that might make this more likely to happen to me? So to take that question, which sounds. like it's going to lead us down a sort of rabbit hole of fault or shame or guilt and to frame

it as like, this is a productive question. What can I identify? Are there things I can identify that we could change or things I can identify to help me make, help me understand this better that would ask just like why, why specifically did my risk factors contribute to this or did they not? And it just happened by chance. And so I think that's in some ways a little bit of an encapsulation of some of the empowerment we're trying to generate in the book, which is not to ask this in a despairing way, but to ask it in a moving forward way. Right, in a more almost empowering way.

Yeah. I think it's a good way to manage anxiety, to be totally honest. I mean, that's why I wrote the first book. That's what all my books are just about managing anxiety. Which I mean, again, if you're at this very anxious person. Yeah, I'm as well, and especially I think when you don't, I think what causes the most anxiety is this feeling of a lack of control.

Yeah. And so what this book does is it does give you sort of a blueprint for like maintaining some more sense of control, even though obviously. Ultimately, you don't have a lot of control. Right. Which I get from all your books, but also from even your Instagram stories of your Q&A is like even when there's no sense of control when the baby's born. Right. So it's probably a good. People are trying to collect data about like how often their kids sleeps and they put them to sleep and they close the door.

this amount. Should they be talking at this point? Right. Yeah. It's like if I put the plant in in this corner, he slept better. Right. Should I hang an egg? No, don't hang an egg. So let's say you've been having a few first trimester miscarriages and you make it to the second trimester. Is there a heightened chance of a second trimester miscarriage if you've had first or are they completely different? There's almost nothing in obstetrics is completely different. And so the answer to that question was going to depend on your particular situation. But, you know, so if you knew that the first trimester miscarriages were all a result of chromosomal abnormalities, and then you made it to the second trimester and you would test it

for those, then, you know, you've kind of ruled out the thing that happened before. There are a small number of conditions which contribute to miscarriage in both trimesters, which if you had had multiple miscarriages in the first trimester, you probably already would have tested for. So like with anyone else your miscarriage, rates way, way down in the second trimester, even if you've miscarried before, but it's likely slightly elevated relative to someone who hadn't had that before just because we know many risk factors link across. Right. Contribute to others. Okay. So can you talk about the distinction?

Because I didn't know this either, and I think this is probably important for anyone who knows anyone who's gone through any of this, is the difference between like a second, like a miscarriage and a preterm birth or like there was a whole there seems to be like a line in which they yeah they define certain yeah so so generally when we talk about first trimester miscarriage that's the simplest thing that's a miscarriage with in the first 12 12 weeks and then typically we would discuss a second trimester miscarriage as a miscarriage between 12 weeks and 20 weeks of pregnancy and then after 20 weeks the fetus that is not alive when it's born would be a stillbre. birth. And then we get around 22 or 23 weeks, you get into a range where a baby could survive

outside of the womb. And then we would talk about preterm birth. So sort of this is well defined other than the period from maybe, you know, 20 weeks to like 23 weeks where sometimes that would be a stillbirth. Sometimes it would be counted as a preterm birth depending on kind of exactly what happened. You're in the sort of threshold of viability around 22 or 23 weeks. Right. And so a baby born at 24 weeks that's not alive would be a stillbirth. Yes. And the book it says that's a lot more common than people think. Sounds scary, but it's still, it's still very uncommon. It's still very uncommon. It's just, I think when we say that, we don't say that like because that you should be afraid of it. But because I think there are many things which are less common that we talk a lot about, like Down syndrome. So the risk of we do a lot of chromosomal testing. People are generally aware of the possibility of having having a baby affected by Down syndrome or. one of the trisomies. Silver is actually more common than those.

Than that. Yeah. Right. And, you know, it is, I mean, they happen. Right. I mean, yeah, I said it was, I think it was like one in 160, which is, you know, not high, but not as low as one would imagine, you know. And I guess you don't really like, you see like, you still, I mean, you see like Chrissy

Teigen or you see it when it happens to like a celebrity, but or maybe someone that you know or someone that you know who knows someone. So I think getting the actual statistics does kind of, again, like normalize it for everyone who's living in the world and knows someone. It doesn't feel like as big of a mystery or as big of a one-off. Yeah. I mean, this is perhaps the place where I think people are the most in need of someone else who has gone through it and the most alone.

there are some decisions that have to be made if you've had a stillbirth about delivery. There's a really great organization that focuses on this. And sometimes people write to me, he wrote to me at some point, like said, like, I am in the delivery room. And I just had a miscarriage. I just had a stillbirth at like 39 weeks. Like, do you know anyone I can talk to? These are some people I often will send somebody like that too. But this experience of just like, I don't know.

anyone else who has gone through this and like this is just the most profound grief filled and yet somehow unlike if you lost a baby after it was alive, you know, where people would come around you. It's, I think it's almost like people don't exactly know how to interact with a stillbirth. Right. Is it like, is it a miscarriage? Is it a, like, where exactly is that? And I think it's just devastating. Oh, totally. And I mean, that's obviously like almost. when you think about like the worst thing that could could happen of all these issues, it does feel like it's pretty high up there, not to minimize anything else. But it does, I mean, that's really, I think the, the fact that 50% of people go through something

like that just kind of goes to show, I think, how little most people know also because like you don't really hear, like kind of like what you were just saying, you don't really hear about it. No one really knows anyone who's going through the same thing as them. And so it's, especially with like pregnancy complications or miscarriage. is it can feel like your case is like so specific to you that like no one else will get it. Yeah. And do you think that's the case in most cases or are they like kind of underlying themes? I think there's some underlying.

There's some underlying themes. And I, you know, my sense is when people have these complications, then the other people have had them will come out, you know. I mean, miscarriage being probably the most common of these. I remember before I had any kids at all thinking like, well, miscarriage. That's a very uncommon thing. And then, of course, as soon as you have multiple friends who are having kids, then multiple people have had a miscarriage. And somehow it's like, because we don't hear about it, we don't talk about it.

And I think that's all of these things end up seeming quite hidden and unusual. But then once you have them, then they're kind of everywhere. If you don't mind me asking, did you have any of these complications? No. No. I did not. Okay. Which is why I say that this book is really.

really a book that was inspired by the people I talked to. I was super, super lucky. I mean, I guess there's some vaginal tearing discussion in there that had that. That's pretty standard. It's one of them. It's one of them. But yeah, I was very lucky. And this is for other people.

Was there a part of you that was like, I don't want to touch this because like I'm scared of the people's, I don't know, intense reaction. Because it's a very, you know, if everything goes fine, it doesn't feel, maybe it doesn't feel quite as intense. Like I think there's a lot of intensity around this, this fertility complication thing. Were you like a little scared of people? No. I mean, like, I, I hope that this book will help people.

And I think it was like that, that was the goal. here is to say I would like to have answers when people ask me, when people ask me questions, I would like good answers. I would like something I could point them to. I would like them to be able to have the kind of empowerment in these moments that I feel like I had in my less complicated pregnancies. And so I'm not. So I did not have hesitation there.

Yeah. Well, it's interesting because the, you know, the percent chance of getting any one of these issues is low in itself. but the chance of getting any of them is higher is high exactly but you know you write about this too you hope no is the first book you hope no one reads yes no it's usually when i'm like everybody go by my book i'm like i please don't buy i hope you don't need it if you do i'm glad it's there but uh but i would prefer i mean even if you have a friend i think who is going through this it just it helps i think anyone who who is going through any sort of fertility issue or fertility complication or unknown it can feel

like you also don't want to tell people because you don't want to like have to explain it. And you're like, well, it's like the numbers and the lining was like and they're kind of like, they're kind of like, they're not going to have any idea what I'm talking about. So what's the point? Yeah. And I mean, I think the other reason I would like people to be, to be exposed to this is because I think there are a lot of places here where we end up by saying, well, I wish there was more research on this. And the only way to get research to get money for research and the only way to get money for research is for people to be aware of a problem existing and be and be talking about it because that's how you drive that's how you drive money and so you know i somehow i guess i would say is the only people i really hope read this are members of

congress so maybe i could get them all like send them a copy send them a copy yeah what's one thing you wish there was more data on that you just that there's just isn't that much on sorry that's such a hard question because the answer is every everything all of the things i wish that we had more information on how people are experiencing their pregnancy and experiencing, especially in these kind of situations, what we can do to make the lived experience of this better. We spend so much time when we talk about outcomes focusing on, you know, well, did you have the condition again? You know, what was your blood pressure?

Like, did, you know, what, oh, was it, did we push the preterm birth back to 35 weeks rather than 34 weeks. And we almost never spend any time collecting data that would measure, you know, was I happy with the experience I had? Did I feel confident? Did I feel empowered? Did I feel comfortable? You know, was my mental health taking care of? I would like us to collect that information more so we could think about things. So we could prioritize that as something we that would be part of a positive intervention. Right. I mean, I think I saw this stat maybe on your or something about maybe it was somewhere else, but something about like if the mental toll

of having a miscarriage is sort of like being diagnosed with cancer or is like has a same. Yeah, that wasn't mine, but yes, that is. I think that is what people say. Yeah, it's like it's a, I mean, it's extremely significant. Right. And I guess that's even that, I mean, that probably wasn't on your thing because that probably sounds like a hard

one to measure also like. Because we don't measure. I mean, we don't measure this. We don't have, like we just don't have good data on, on these, on those kind of outcomes. Right. Okay. For the next few weeks, we'll be bringing you a segment called positive reinforcement presented by first response. We know that waiting for the positive test is exciting, but also stressful. No matter what you're struggling with on your journey to conceive, we're here with a little positive reinforcement.

The information provided herein is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or the use of medical devices. So from the data, I mean, in the book you write that with time and continue trying and sometimes invent interventions nearly all, all couples will have a successful pregnancy. And this is every reason to be optimistic. What do you think is the most encouraging thing in the data that you've seen for people, like generally, for people on this journey? That we have made progress over time and that we are understanding more about what causes pregnancy loss and causes these things. and there is a lot of research ongoing about treatment. You write that, you know, like 90% of the time a miscarriage is due to a chromosomal issue or an abnormality.

You write that it's pretty much never your fault, right? I read that, yes. Is there a case where it is your fault? I think because like there is a, you know, there's always something in the back of your of your head of like, what could, what would make it my fault? So I would never use the word fault. Okay. ever. I think what the way you could ask that question is are there ever circumstances in which there is something about your physiology that that resulted in this? And the answer to that is

yeah, there are there are situations. Some of them are chromosomal. So there's a there's a thing called the balanced translocation where pieces of two of your chromosomes switch. And it's it's fine for you because you have those genes. They're on the wrong chromosomes, though. And if you pass a copy and it's your, and you don't pass both copies at the same time, then that is a, that can cause a, that can cause a miscarriage. And so, uh, so there are things like that, which again, I would, is that your fault? No, of course not.

You're asking. I would like like, like a behavior. Is there a behavior or like, you know, aside from I assume binge drinking or like, binge drinking, you know, very heavy. heavy drug use, a serious accident or like abuse, sort of violence can result in a miscarriage. There aren't a lot of other, there aren't a lot of other things beyond, you know, like, I mean, again, sort of drugs, particular drug usage. It's not like using too much perfume or.

It's not using too much perfume or dyeing your hair or, you know, going to hot yoga, which you shouldn't do, but it's not going to cause a miscarriage. It's not having a massage. It's not the laser treatment that you accidentally get. It isn't waxing. It's not that you used the wrong hair care product. Okay. I mean, that is,

I think that's quite encouraging to know because I think that that's sort of what, you know, you said it's not your fault. And I get, you don't, it's the word fault, but it's like, I think when most people are thinking that,

it's like, did I lift something too heavy when I shouldn't have done it? Or like, is there a chance that that was the reason? And you're saying like, nothing in the data really says. Nothing in the data would say any of that. Okay. Yeah. Well, that's one thing to feel, I think, a little bit better about because I think that a lot of these things do feel internalized and they do feel like they can drive you into like a kind of mental spiral of like I need to do everything completely perfectly even when I'm trying again. And that can almost worsen like what you were saying before about like the mental health toll of it on an already stressful thing of like I can't, you know, I have to if I ate an inorganic berry, then I, uh, I have to. If I ate an inorganic berry, then I, uh,

I've basically like, I've done this to myself. No, and I think when we phrase it sort of 90% that, you know, 90% of the time, this is a chromosome, or Melanie, 10% of time it's something else. What doctors mean by that is generally like 10% of the time, it's something, some other aspect of your physiology that maybe we could understand. Not it's something you did with your hair gel. Right. And so, but I think people hear it's like, well, 10% is my fault.

Like, well, no. Right. Not your fault. So when doctors recommend these lifestyle changes or, you know, you know, maybe suggest or you read online about these things for conception. Like, what is the point of that if that doesn't... Give me an example of something that you're thinking of. You know, if there, if you say, you know, take all these supplements and maybe that'll

help the pregnancies stay. Is that... We have very little evidence for things like supplements for almost any supplement in fertility. You know, occasionally there'll be like a little bit of a study here, here or there, although a lot of the stuff is kind of p-hacked. I think the sort of two things I think are happening in those recommendations. So one is that sometimes there's a value in telling patients something to do because people like the idea of doing something. And there's no reason to think some of these supplements wouldn't be like that they

would be bad. Right. And I think some of the stuff you get recommended is like you should exercise, don't smoke, you know, don't drink too much. these are like sort of standard recommendations that we give to people that are probably good for you in general. Right. And this is a time when people are focusing on them on their health.

So like maybe it's a good time to get them to quit smoking and start, you know, vigorous walking. Right. But it doesn't seem to be the case that women who are more likely to miscarry are less healthy. Not walking. No. Or taking less supplements. Right.

That's their issue. Okay. It's not the supplements. Thank you to our sponsor First Response. For nearly 20 years, First Response has supported Resolve's mission to empower the infertility community through providing resources and support for individuals and couples on their path to parenthood. Resolve.org is home to many resources for the infertility community, including free support groups, books, and more. Resolve is dedicated to ensuring that all people challenged in their family building journey are empowered by knowledge, supported by community, united by advocacy, and inspired to act. All first response pregnancy test products are available for purchase at all major retailers in store and online. Be sure to pick one up today.

This has been so helpful. Thank you so much for coming on. I feel like what you're doing with this book, especially, and it feels like you're really giving back to a community, especially if you haven't even suffered from this yourself. It's like a true, it's a true handbook to anyone, I think, going through anything or who knows anyone who's going through anything. And I think that's almost all of us if we actually knew. people in our lives intimately, you would know at least one person going through something in this

book. And I mean, I know I focused mostly on like the miscarriages, first, master, second, trimester, that kind of thing. But there's so much here, even if you get past that stage, there's fetal growth restriction, there's pre-inclasia, there's gestational diabetes. No, and I really, I think what's great about this conversation is like you approach the book in exactly the way we want, which is to have to read the first part and then read the parts that are relevant to you. And so, so I think that's, that's what we're hoping. That's the sort of handbook nature, nature of this. Yes, for sure. Like I said, I read the first part. I read the part that was great for me. And then I'm going to keep it in case, you know, it's like weird. It's like,

hopefully I'll have just, I'll get to the point where I can have gestational diabetes. That would be wonderful. And then I'll have a guide for it. Exactly. It's like, you know, everything feels like, well, at least I got pregnant or like at least like, there's, There's positive ways to look at. Always in positive. Yeah, I'm hoping to get gestational diabetes in the near future. Thank you so much for going on. This was great.

And go check out the unexpected sold, I assume, everywhere books are sold. Thank you so much for having me. It was really a treat. Of course. Baby Steps is produced by me, Jordana Abraham, and Shannon Sison. Editing by Jorge Morales Pico. Guest booking by Ali Friedlander. And be sure to follow at Everything's Fine on Instagram.

Thank you to our sponsor First Response. A lot of us test more than once. That's why First Response created the triple-check pregnancy test kit, which includes three different tests all in one box. The kit includes the early results pregnancy test, one digital pregnancy test, plus one rapid result pregnancy test test that gives you fast results in just one minute on the day of your missed period or any day thereafter. Each test in the kit offers a different way to learn your results, so when the time comes, you feel as confident as possible. All First Response Pregnancy Test products are available for purchase at all major retailers in store and online. Be sure to pick one up today. Betches