“Mailbag #17: What does the Fox say?” – with Dr. Nathan Fox

Welcome back to Healthful Woman for a round of “What Does the Fox Say?” with host Dr. Nathan Fox. Today, we cover questions specifically about HCG and progesterone levels when becoming pregnant, tips to help with nausea during pregnancy, whether there are risks to the baby in the womb if the mother contracts influenza, and more.

Share this post:

Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. Everyone, now welcome to our 17th Mailbag Podcast, “What Does the Fox Say?” Our first question is from Nicole, “Hello. First, I want to say I love your podcast and truly appreciate all the helpful knowledge you share. I recently found out I’m pregnant but experienced bleeding roughly a day later. My doctor had me take blood tests two days apart to determine HCG and progesterone levels. I’m curious why my HCG would be going up but my progesterone is extremely low. What might they recommend or am I having a chemical? Thanks.” Okay. So, as some background, when someone gets pregnant and they take a pregnancy test, whether it’s a urine test or whether it’s a blood test, the thing that is being tested for is something called HCG, which stands for human chorionic gonanotropin. And essentially, it is a hormone that is secreted from the pregnancy inside the uterus. And so if it’s positive, that is what we use to determine that someone is pregnant.

HCG is frequently used also by people to gauge whether a pregnancy is a healthy pregnancy or an unhealthy pregnancy. Typically, that would be done in the time period before the pregnancy is properly seen on ultrasound, right? So, when someone gets pregnant, right? So, you conceive, in about two weeks later, give or take, you miss your period and that’s around the time a pregnancy test would first come positive. But if you went and got an ultrasound at that time, we would call that four weeks or it’s two weeks from conception. You wouldn’t really see anything on ultrasound, probably for at least another week. And even then, when you start seeing something on ultrasound, it’s this little empty sack and then it grows and it’s generally you’re not going to see an embryo with a heartbeat till around six-ish weeks, which is four weeks from conception. So, in that time period prior to seeing a heartbeat, people want to know, is this pregnancy a healthy pregnancy? Something that’s called a viable pregnancy or is it not? And so, one of the ways that’s sometimes done is by testing HCG levels serially because in a healthy pregnancy, the HCG, at least in the beginning part of pregnancy, basically goes up and up and up and up and up. Now, people have said it should double every two days.

That’s not exactly right, but basically it should be going up pretty steadily and impressively over the beginning part of pregnancy. So, for example, if someone has a positive pregnancy test, like, you know, on a urine stick at home. They come into the doctor’s office or go to the lab and they get an HCG and it’s 400. That itself doesn’t usually tell you that much. You can’t see anything on ultrasound. It confirms that someone is pregnant, but it doesn’t tell you if it’s viable. Technically, it doesn’t even tell you that it’s in the uterus because an ectopic pregnancy can have this as well. And then sometimes it’s recommended, “All right, go back and get your blood tested again two or three days later.” And in two or three days, if it, let’s say, still measures 400 or worse, it measures lower, probably this is not a viable pregnancy and either it means you’re miscarrying or in rare circumstances, it could be an ectopic.” However, 2 to 3 days pass and instead of 400, it’s now 800 or 1,200 or 1,500 or something like that. It doesn’t guarantee that it’s a normal pregnancy, but it certainly points in that direction and then generally you’ll wait and do an ultrasound sometime thereafter. So, that’s one hormone that’s used to track pregnancies frequently. Traditionally, there’s a lot out there on that.

Now, it’s not done in everybody routinely. It’s done very frequently by fertility centers because they’re, you know, trying to really track this very closely. It’s done sometimes for people who are concerned they might have an ectopic. It’s done for people who maybe they don’t know if they have a viable pregnancy and they have some symptoms and they’re coming in, but it’s not something that I do in every person who calls and says, “I’m pregnant.” Usually, it’s not done, but it could be done. Fine. Now, progesterone levels, progesterone is also a pregnancy hormone, but it’s a little bit different because progesterone, first of all, you could have progesterone when you’re not pregnant, right? There is progesterone in people’s bodies when they’re not pregnant, number one. Number two, in pregnancy, it’s not used in terms of serial levels to make sure it’s going up versus going down like we do at ATG. Number three, the progesterone comes from a different place. So, early in pregnancy, when someone gets pregnant, the place the progesterone comes from is actually the ovary from the corpus luteum in the ovary, which is where the egg came out from. And that corpus luteum secretes progesterone. And if someone doesn’t get pregnant, it secretes progesterone for a certain amount of time, and then it stops and the corpus luteum sort of goes away and you go on to your next cycle.

But if you are pregnant, the HCG that’s secreted by that pregnancy then keeps that corpus luteum alive, so to speak, and the progesterone does not drop and it sort of stays elevated. So, people sometimes will use progesterone levels to determine, is this a healthy pregnancy or not. And there are certain levels of it’s very low, it might indicate a non-viable pregnancy. And if it’s above a certain level, it might indicate a more viable pregnancy. And the data in this is a little bit more mixed and how to sort of use it in conjunction with the HCG. People do it a little bit differently. One of the things is that if there’s a low progesterone, sometimes people will say, “All right, we’ll give you extra progesterone.” And then others will argue, “Well, that doesn’t really work because the reason the progesterone is low is because the pregnancy is bad, not because the corpus luteum is bad.” And that’s sort of an ongoing, I would say it’s a debate, but most people believe that it’s not valuable to give supplemental progesterone or doesn’t seem there’s no data to support that it really improves the pregnancy. But some people do it and that it’s fine. It’s not dangerous to take extra progesterone. So, in terms of your question, why would your ACG be going up and your progesterone extremely low? Well, it could be several things.

It could be that in fact, this is a normal, healthy, viable pregnancy. And just for whatever reason, your progesterone is low. That’s one possibility. The other possibility is that it is in fact not a viable pregnancy. And definitely, there are non-viable pregnancies that have ACG that go up until a certain point and then it might peak. And so ultimately, the key is that in this situation, you might not know if it’s a viable pregnancy until a week or two when you could see an ultrasound and see if there’s a heartbeat and whatnot. But that situation is not so uncommon. Okay. The next question is from Russie. “Thank you for introducing me to the toast. I’ve had three babies, thank God, and had severe nausea and vomiting with all three pregnancies. I’ve been on Zofran and Diclegious, which both helped a lot. But even while on both of them simultaneously, I still was always nauseous and vomited multiple times a day. I would like to try for another baby now, but not looking forward to feeling so rotten for the next nine months. Is there something else you can recommend or something I can do different this time to help make this next pregnancy a bit more pleasant? Thank you so much.”

So, Russie, good question. Emily, Oster, and I had an entire chapter in our book, “The Unexpected, on Nausea, Vomiting, and Pregnancy and Hyperemesis.” And so you might want to look at that. It’s hard to answer your question directly because these things are very individualized, right? So, many, many women will have nausea in pregnancy, and many will have nausea and vomiting in pregnancy, and some will have what we call hyperemesis or hyperemesis gravidarum or HG, which is basically a really severe form of nausea and vomiting to the point that you’re malnourished or you’re losing weight and you’re really not just miserable, but you’re actually very ill. And so the treatments for all three are they’re not the same, but it’s sort of the same list of options. And you just use more and more based on how sick someone is. So, for someone who has nausea, either we treat it or we don’t based on how bad it is for them. Nausea and vomiting, the same thing. And then if they’re very ill, obviously we have to do a lot more. But it’s the hard part with nausea, vomiting, pregnancy, and the hard part with hyperemesis is it’s not predictable what is going to work in a given person or in that person in a given pregnancy.

And sometimes there are many things that don’t work and it’s hard to find the right thing that works. And so for someone who has a milder form of just nausea or maybe nausea and some vomiting, but not the severe illness and they’re just miserable. Typically we do a bunch of things, whether it’s trying to alter their diet, what they eat and when, or medications like you were on like Dicligis, which is a combination of vitamin B6 and Unison, which is an over-the-counter sleep medication, or even prescription medications like Zofran or something like Reglan or there’s other anti-nausea medications. And then there’s other things and usually we can get them to be a little bit better. Again, we’re talking about the people who are not so severely ill, gets them a little bit better. So, they’re a little bit less miserable until they sort of get to that point in pregnancy, hopefully, where things just sort of start getting better on their own. And so what I would tell you is it’s hard to know for sure, it’s possible that adding more medications or increasing your dose or trying a different medication might make you feel a little bit better in the next pregnancy. Again, also every pregnancy is different.

Obviously, if you’ve had it for three pregnancies, you would sort of expect to have in the next one, but you never know for sure is it going to be the same, better or worse just on its own. And for people that have more severe hyperemesis, that it’s really they’re very ill. We absolutely use many more things, and early because not only we’re trying to make them less miserable, but we’re really trying to keep them healthy during the pregnancy. So, it’s kind of a vague answer to your question, but it’s hard to say definitively what would or wouldn’t work for you. What I would tell you, though, is I would definitely before you get pregnant or very early pregnancy, but ideally before you get pregnant, speak to your obstetrician or to your midwife about, “What options might we try if it’s not working?” And if they don’t have a lot of experience with other options besides that, Dicligis or Zofran say, “Hey, can I meet with somebody who does treat more severe cases like hyperemesis.” Whether that’s a maternal-fetal medicine expert or whether it’s potentially a different obstetrician or maybe it’s a nutritionist or maybe it’s a gastroenterologist. I mean, it depends locally who does a lot of this treatment and maybe meet with that person before pregnancy and say, “Okay, what other strategies could we have in place so that if I’m really sick or if I’m really miserable and the things that I’ve tried to use aren’t working, we sort of know what to do.”

So, you have a plan set out. I found that that tends to make things at least a little bit better for most people. But again, it’s just a very difficult thing to know for sure. And we really don’t know enough about it to know definitely what would work for someone or what wouldn’t. So, good luck to you. All right. The next question is from Corey and Corey is asking a short question, but a great one. “What are the risks to the baby in the womb if the mother contracts influenza?” Okay. So, this is about flu in pregnancy. And the short answer to your question is basically flu is not a direct harm to the baby. That’s the short answer. However, obviously, if the mother gets flu, there could be consequences. For most viruses, when we’re trying to figure out what is the impact of a virus on a pregnant woman, there’s sort of two separate but obviously related things we’re thinking about. So, risk number one is what is the risk to the mother if she gets this virus during pregnancy? Is it going to be much worse than typical? Is it going to be the same? Is it going to be better? And for most viruses, when pregnant women get them, it tends to be worse than it would be if they’re not pregnant. For a virus that isn’t really a big deal for most people, like getting a cold.

All right. So, you get a cold when you’re not pregnant. It’s kind of annoying. It goes away. You get a cold when you’re pregnant. It might be a little worse. Maybe your cough lingers a little bit more. Maybe you feel down, have a running nose a little bit more. But it’s not like it’s particularly dangerous in either way it may take a little bit longer. And the reason that is, we believe, is because, pregnant women, their immune system, which fights off infections, is a little bit blunted in pregnancy. We believe that happens sort of evolutionarily. We believe it happens so that the mother’s immune system doesn’t attack the fetus in developing pregnancies. One of the ways it doesn’t do that. So, be it, the immune system is lowered in pregnancy. So, if you get an infection, it tends to linger a little bit longer. Now, for some viruses, that can be dangerous to people, but aren’t typically dangerous to sort of young, healthy people, some of those when you’re pregnant, you sort of become a different category if you were immunocompromised or maybe you’re older. So, flu is one of them. So, flu can be dangerous for non-pregnant people, but usually it’s not.

Usually, if you get the flu, you’re pretty sick. You’re pretty miserable for three, four, five, whatever days it is. Fever’s not feeling well, out of work, in bed, really feel miserable. And then you get better and you’re okay. The problem is when pregnant women get flu, it can be much worse than that. Meaning pregnant women with flu can get severely ill, can need to be hospitalized, need to have respiratory support. It could be pretty bad. And so for that reason, we really don’t want pregnant women getting flu. And so that’s one of the reasons that the flu vaccine is recommended for pregnant women pretty much across the board. Unless there’s some reason they shouldn’t get it, it’s pretty much recommended across the board. Now, interestingly when COVID came around, that was our big fear for pregnant women as well. That COVID, again, for most young, healthy adults who got COVID, it wasn’t so severe. Obviously, in a few cases, it was for young, healthy people, but predominantly it wasn’t. But the fear was, are pregnant women going to do much worse with COVID like they do with flu? And basically the answer was yes. So, statistically pregnant women did worse with COVID than non-pregnant women. But in terms of our level of fear, fortunately, it wasn’t as bad as we thought it might be, right?

I mean, because obviously COVID for elderly and for people with certain medical issues was horrible. It was much, much more dangerous than most viruses. But for pregnant women, while it was more dangerous for them, it wasn’t quite as bad as we thought it might be. Or maybe we were not just thinking it might be, but maybe just sort of worrying that it might be. So, it was sort of landed in the middle. Like, it wasn’t nothing to get COVID when you’re pregnant, but it wasn’t quite as disastrous as I thought it would be for most people. Obviously, there were some people who were pregnant who got COVID, who got very, very, very sick, unfortunately, and there was maternal deaths because of it. I mean, there were people who got very, very ill, but in terms of the numbers, how many pregnant women there were and how many got COVID, it didn’t end up being, I would say, as severe as we thought it might have been. But that was one of the reasons, since it was more severe, like the flu, that’s why the COVID vaccine was recommended for pregnant women, like it was for, you know, at least initially for certain high-risk subgroups, and then, you know, ultimately was recommended for everybody. And there’s still people arguing about that. And that’s fine, but that’s not what we’re talking about here today. We’re talking about pregnant women.

So, it was recommended and it did seem to be a good thing because there was definitely some increased risk for pregnant women. And so that’s sort of category number one with viruses isn’t going to make the mother much more sick. The second category of risk that we worry about, which is sort of what your question points at is, will the virus specifically harm the baby from getting it? Because we know that traditionally there are viruses that do. And so, for example, like, CMV is a virus that potentially could, Parvovirus is a virus that potentially could, Rubella is a virus that potentially could. You know, so there’s things that can do that. And the question is, is flu one of those? And as far as we can tell, flu is not one of those, meaning women who get flu in pregnancy, assuming that she does well, there does not appear to be an increased risk of things like birth defect or, you know, intellectual disability or whatever it might be that we’re worried about an outcome in the newborn and the baby and the child, it does not tend to be the case. So, that is good news in terms of that. So, it’s not one of those. One of the viruses that people think is a big risk to the baby, but in fact is a big risk to the mother is chickenpox, varicella.

For whatever reason, people always think that it’s going to be a risk of birth defects. Now, it can, but that seems to be a very, very low risk. The higher risk tends to be much more for the mother. The third thing, which was not part of your question, but the third thing related to infections and pregnancies, when there are vaccines, will it also protect the baby for afterbirth? So, that’s another thing that comes into play. For the flu vaccine, we give it predominantly to protect the mother from getting flu during pregnancy. There does appear to be some protection to the newborn from getting flu after birth but is predominantly given for the mother. COVID vaccine also predominantly for the mother. There did seem to be some level of protection for the newborns, but since newborns, fortunately, did not seem to get very sick from COVID, typically it’s not given currently. The COVID vaccine is not currently given as a strategy to protect babies because their risk fortunately seems to be pretty low from COVID. So, if one were to give a COVID vaccine in pregnancy, it’s mostly for the health of the mother, not for the baby. Flu is the same way for that vaccine. Okay. A complicated topic. Great question. All right. Our next question is from our listener, Rachel.

So, Rachel asks, “Dear Dr. Fox, thank you so much for dedicating so much time to this amazing podcast. I can’t even begin to describe the difference between my first and second pregnancies mainly due to your podcast. I feel so much more knowledgeable.” Rachel, thank you for that intro and I’m happy to have read it. All right. “At my 20-week anatomy scan, they couldn’t find the cavum in the fetus’s brain. I’m an Israelist. I don’t know if that’s the same word that is used in the U.S.” Rachel, it is. “At first, I thought that meant the corpus callosum, but it seems like this is something else. Anyways, I didn’t feel like my doctor explained it so well and Google was not all that helpful to get more info on it. Have you ever seen this? What does it mean in terms of having a healthy baby? Will the baby have special needs? Is there any reliable research on this, especially long-term outcomes? My doctor referred me to a pediatric neurologist. We spoke briefly about it and about doing further testing, but it seemed like there isn’t anything we can do to fix it. So, I decided to wait until the baby’s born to do any further testing like MRI, genetic testing, etc. Really hope you have some answers for me. All the best, Rachel.” Okay, Rachel, a very good question.

So, when we’re doing ultrasound in pregnancy and we’re looking anatomically at the baby and we’re focusing on the baby’s brain, there is a structure in the baby’s brain that is called the cavum septum pellucidum. Sometimes acronym CSP, sometimes it’s short, we’ll call it the cavum. But, yes, it is a part of the fetal brain anatomy. The main reason we look for it is not so much to ensure that the cavum is there or is not there. But when the cavum is there, it almost always indicates that the structure on top of the cavum, which is called the corpus callosum that you mentioned in your question, is also there. If the cavum is absent, then we are concerned that perhaps the structure on top of it, the corpus callosum, is also absent. Meaning the distinction is really whether the corpus callosum is there or not. The cavum to us is a clue on ultrasound to help determine that because it’s not as easy to find the corpus callosum or to diagnose it as missing as it is the cavum. The cavum is just an easier structure to see or not see just based on its shape and its flow of fluid, whereas the corpus is a little bit more difficult to do.

So, we use the cavum sort of as a screen for the corpus. Now, what is the corpus callosum? The corpus callosum, I’m not a neurologist or a neurosurgeon, but basically, it’s a part of the brain that sits on the top of the middle and essentially connects the right and left part of the brain, which is important. And there are definitely people who are born with an absence of the corpus callosum. Now, you would think that would be uniformly terrible because how could you walk about the earth without a connection between the right and left side of the brain, but that’s not the case. There are definitely people who have an absent corpus callosum who are fine or mostly fine or basically fine or whatever you want to call it. They don’t really know that they have this, but there are also people who have an absent corpus callosum who have significant problems. And that’s a very tough situation, obviously, in pregnancy, right? So, let’s say the cavum is absent and we suspect the corpus callosum is absent. What do you do about that, right? So, you could go searching to verify that, and test in pregnancy that’s diagnosed in one way or another would be an MRI. So, you can get an MRI when you’re pregnant.

And the radiologist, if they know what they’re doing and they’re good at this, can focus on the fetal brain. It can tell you is the corpus callosum there or is it not there? If it is there, great. If it’s not there, they can, number one, tell you that it’s not there. And number two, they can tell you, are there any other abnormalities that they see in the brain? Meaning is this isolated or are there other abnormalities? And as you may suspect, if it’s isolated, the prognosis is better than if there’s multiple abnormalities in the brain, right? You know, you don’t need a degree to figure that one out. That’s number one. You could also say, “Okay, let’s do genetic testing on the baby.” So, in pregnancy, at that time, it would typically be an amniocentesis or afterbirth, you can do genetic testing on the baby, whether it’s from a blood test or a cheek swab or whatever it is, and do advanced genetic DNA testing to see, again, if there is a genetic abnormality that’s found, and sometimes these babies who are missing a corpus callosum will have a genetic abnormality. If there is one that’s found, then the prognosis would obviously differ or would change based on which specific genetic abnormality it is, because there’s a wide range of prognoses based on the specific diagnosis.

If there’s no genetic abnormality found whatsoever, again, that either means that this is completely isolated, that the only thing that’s “abnormal about the baby” is missing this corpus callosum, everything in the MRI is normal, all the genetics are normal, that means that either is indeed isolated or there’s always the possibility, of course, that there’s something genetic that we cannot yet test for. And so when someone is pregnant and we suspect this or find this, one of the things we talk about is whether it’s worth doing an MRI or not. Another thing we talk about is whether it’s worth doing an amnio or not. And a lot of these conversations end in many different directions, right? So, some people say, “Yeah, let’s do everything right now. I want to know. I want to know as much as we can. I want to get the prognosis as best as possible so I can either plan for the delivery of this baby.” Some people will terminate pregnancies based on the findings, again, based on where they live, based on their own personal beliefs, based on how far pregnant they are. Obviously, that’s a very complex decision, but people make that decision, obviously. And or maybe just to know, or maybe to hopefully get a lot of reassurance that, you know, either it’s not missing at all, or if it is, it seems to be isolated, which would make the prognosis better.

Others decide, “Well, I don’t really feel like I’m going to do anything about this either way. I’m far enough in pregnancy or whatever. We can just sort it all out after birth and you can do all of these tests, MRI, genetic testing after birth and sort it out.” And so different people obviously decide different things on this. It does require a conversation to figure that out. In terms of what will ultimately be with the baby, it’s hard to say. It depends on the findings of the MRI, what the brain looks like otherwise, right? Is it true that this corpus callosum is missing? And number two, are there any other issues going on in the brain? Also, genetic testing. Is there anything global genetic going on with the baby or not? And then if all that is isolated, it’s a much lower chance that the baby will have special needs or any issues whatsoever, but there is always a percent chance. And honestly, there’s a percent chance in everybody. It’s just an issue of how much higher is the percent chance in this baby than in someone who has a corpus callosum. And this involves a lot of very detailed, long, and very tailored conversation to the specifics of the findings in everyone’s specific baby.

So, it’s hard to give a general rule that if this is a diagnosis, this will be the prognosis because it really depends on all the other factors. But there’s from the point that we suspect it, it’s a very wide range because it can range from totally normal to obviously much more significant issues. But a lot of that’s based on what is discovered either during pregnancy or after delivery with all the other advanced testing. Okay, the last question today is from Erin. “Hi, Dr. Fox. I’m a toaster and a big fan of your podcast.” Thanks, Erin. “I’m in my third trimester now with my second baby, third trimester, second baby. Do you think the protocol of not being able to eat while you’re at the hospital in labor is an outdated practice? I was in labor for almost two days with my first and pushed for over two hours and wasn’t allowed to eat anything. (I ended up sneaking a granola bar in).” Erin, I won’t tell anyone other than everyone who was listening to this podcast. “I just feel like I’d have way more energy if I was able to eat and don’t understand why we can’t eat. Would love your thoughts and opinions.”

So, Erin, it’s very interesting that you mentioned not eating labor as an outdated practice. It’s actually the opposite because I would imagine that over the history of humans delivering babies, the vast majority of them ate and drank during labor until actually more recently when people said you shouldn’t eat in labor. So, I would say that it’s a new practice and the question is whether it’s a good practice. The short answer is most of the data would indicate that it’s perfectly fine to eat during labor and as you said, it’s potentially helpful to eat during labor because labor is a workout. Your body’s working out and then you have to push, meaning even when you’re just laboring, your uterus is working, you’re burning calories and then certainly when you’re pushing, you’re burning calories. And so there is definitely logic to it that having some caloric intake makes sense, be that from solid food, be that from liquids with sugar in them and electrolytes in them, whatever it is. And so the question is why is there a practice not to eat in labor, not to drink in labor? And I think a lot of that came about during the same time period that many, many more women got epidurals in labor.

An epidural is a form of anesthesia or analgesia where it reduces pain, but one of the concerns is with anyone who’s getting anesthesia, usually, this is general anesthesia where you’re put to sleep completely. One of the concerns is if I do this on someone whose stomach has contents in it, they can vomit and some of that food contents and acid in the stomach can then not just come out the mouth, but go into the lungs, right? Comes up the throat and then down back into the lungs, which can be very, very dangerous to the mother, to anyone. And so that’s one of the reasons why in pregnancy we do our very best not to put women to sleep for C-sections or whatever, general anesthesia. Sometimes we have to do it in those ways we could do it safely, but it’s something we try to avoid because the risk in that medical term for that is called aspiration, where the food or acid contents from your stomach come up and then go back down into the lungs. And so the thought is we have women in labor who are at risk of needing a C-section and are getting epidurals and there’s anesthesiologists seeing them and the tenants in anesthesia is to sort of have an empty stomach.

And so it became more and more common practice to say, “You know what, maybe it’s not a great idea to eat labor. Maybe your stomach should be empty.” And then it sort of became all these varying rules around the country for women before C-section, women in labor, your stomach should be empty for how long, what can you eat, what can’t you eat? Can you have solid foods? Can you have clear liquids? And there’s all these different things that came about, but they’re not really evidence-based, meaning at least as far as I know, I don’t believe there’s strong evidence suggesting that women who labor with empty stomachs do better than women who labor with full stomachs or given the option to eat. And I think that most of the data points in the opposite direction. So, what I would say is my personal opinion from reading the data is that I agree with you. I think that probably eating and labor, again, it doesn’t mean you have to force for yourself. If you’re hungry and you want to eat something, you know, eat a little bit and you want to drink, you should drink a little bit.

It’s probably A, not a bad thing, and B, potentially a good thing as you mentioned, that’s number one. I would say that practices around the country vary from hospital to hospital, from doctor to doctor. And so you’re going to see widely different practices on this. And some of it is not up to you or your obstetrician, meaning if the hospital has a policy that you can or can’t do something, it’s very hard for the OB to override it or for you to override. I mean, I don’t I know this is a very complicated topic about what to do with hospital policies you disagree with as a patient, but it’s complicated and it’s not that easy to do. So, if this is something that’s very important to you or any of the listeners, you know, that’s a good question to ask like early in pregnancy. Hey, at your hospital, where you deliver your birth center or wherever it is that you’re going to deliver. Well, what’s the deal with eating? Like, is it allowed? Is it not allowed? Like, does it matter to me? And all those things. Because if it’s for some reason a deal breaker, you know, you should look into that in advance or just to least know is what I would say. This is all talking about people laboring with or without an epidural.

It is definitely different for people who are coming in for scheduled surgery, people scheduled surgery. Almost always the anesthesiologist is going to insist your stomach is empty. And that is definitely not my field. And I have no reason to disagree with them. I think that’s probably a good policy, whatever it is. I’m talking now just specifically about someone just coming either in labor, getting induced or, you know, whatever it is, planning to labor and hopefully deliver vaginally. All right. Thank you all for sending in the questions. We’ll see you all next week. Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.