“Mailbag #4: What does the Fox say?” – with Dr. Nathan Fox

Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I am your host, Dr. Nathan Fox, an OBGYN 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.

Hey everyone, welcome to our fourth Mailbag podcast. I’m going to be taking this one alone, no guest, it’s just me and the mailbag. We’ve been getting a lot of questions from you guys for the Mailbag. Thank you so much for sending them in. Keep them coming, and we’ll keep doing these podcasts.

So let’s get right to it. Our first question today is from Lauren, and Lauren had a question about a velamentous cord insertion. “Hi. Recently diagnosed with velamentous cord insertion. Currently 23 weeks, and taking my pregnancy day by day. Should I be as scared as I am? It’s hard at times to get excited because I’m so scared of something bad happening.”

First of all, Lauren, thank you for sending in the question. I hope your pregnancy is doing well. We just had a podcast that we dropped in mid-October on umbilical cord issues, and velamentous cord was one of the issues that we discussed, so definitely you can refer to that podcast for a more lengthy discussion. But in general for a velamentous cord insertion, I would say the short answer is I wouldn’t worry that much. Essentially, a velamentous cord insertion is when the umbilical cord that’s going from the baby to the placenta, its attachment to the placenta is a little bit different or unusual, compared to how it normally inserts into the placenta.

Normally, the cord sort of plunks right into the middle of the placenta, and then the three blood vessels that are inside the cord are sort of fanning out along the placenta, starting from the middle of it, like the center of a bullseye. With a velamentous cord, the cord sort of inserts into the membranes, into, like, the plastic saran wrap that’s to the side of the placenta, and then those blood vessels have to course through that very thin membrane, to the placenta.

There’s a couple of potential concerns with this. One of them is that if the placenta and the cord are sort of built unusually, maybe it’ll also mean that the placenta will function unusually, leading to things like fetal growth restriction, or maybe preeclampsia, and I would say statistically, that’s probably correct, that if you have a velamentous cord insertion, there’s a slightly higher chance of these things. But it’s not a crazy higher chance, and all that really needs to be done is you have to be watched for it. So when we see someone with a velamentous cord insertion, we just do serial ultrasounds, checking the baby’s growth, and if it’s normal, it’s normal. And it’s not so much different than if you had a whole host of other things for which we check growth of the baby, you know? We do it in IVF pregnancies, we do it in all twins, we do it in women with diabetes, we do it… I mean there’s a whole cohort of people who are getting serial ultrasounds to make sure the baby’s growing well, and usually everything’s fine.

With a velamentous cord, there’s some other unique things. Potentially, if this cord insertion is very low in the uterous, near the cervix, one of those blood vessels could cross over the cervix, leading to what’s called a vasa previa, which is a much bigger deal. So one thing is I would just be sure to ask your doctors, “Did you check that this is not a vasa previa?” Presumably they did, because it’s a common thing to check if you have this. If this cord insertion and placenta area is on the top of the uterus, it will not put you at risk for vasa previa. It’s really only if it’s low down. The way to check is a vaginal ultrasound, and just to make sure there’s no blood vessels, these are fetal blood vessels that are near or covering the cervix.

And the final thing with a velamentous cord insertion is in labor, sometimes during contractions, those blood vessels that are semi-exposed can be compressed, leading to fetal heart rate decelerations in labor, not so different from if the cord itself gets squeezed during labor. And so sometimes that happens, oftentimes it doesn’t, and ultimately it’s not something you’re going to know until you’re in labor. But if it is happening, it’s not always concerning, but if it is happening and it is concerning, then it’s a possibility that you’ll need a C-section in labor for that reason.

But again, a velamentous cord insertion itself does not mean you need to have a C-section, it just means something that we’re going to watch in labor, again, which we watch for everyone in labor. It just means maybe statistically, your chances are a little bit higher. So I hope that answered your question. Overall, it is something to be monitored, and to know about, but usually leads to no consequences, fortunately.

Okay, next question from Megan, or possibly Megan. I’m sorry, I don’t know the pronunciation of your name. And it’s regarding cholestasis, or atypical preeclampsia. Okay, “Hi. New to the podcast, and I did see that you have had some episodes on cholestasis and preeclampsia. I gave birth to my son in 2022, when he was 31 weeks, and had a nine-week NICU stay due to what my doctors believe was ‘atypical preeclampsia.’ But I went to antepartum for testing for cholestasis due to also having itching on my hands and feet, and then on my belly. Even though my OB is ‘leaning towards’ a diagnosis of atypical preeclampsia, they still are not fully sure if it is cholestasis or preeclampsia, and won’t know for sure unless I get pregnant again.

When I was in the antepartum unit, being tested, I was also at one point called an enigma due to meeting symptoms for both diagnoses. I guess my concern is if Dr. Fox has ever heard of this type of case, or had any experience with my type of case, and what his advice would be, especially if I wanted to try and have a second child. Which also coincides with the next question, of it being safe or logical to have another child without having a clear diagnosis, and running into the possibility of another NICU stay, and also the effect on my own health.

Thank you very much, and sorry if there isn’t a clear question in there.”

Well Megan, there are actually two clear questions in there. Very thorough and great question, or series of questions. And as some background for our listeners, yes, we’ve had a podcast on cholestasis, yes, we’ve had a podcast or two on preeclampsia, and just to review cholestasis is a condition where, essentially, your liver when you’re pregnant does not process something called bile acids. Normally they build up in your bloodstream, and essentially they lodge under your skin, causing a lot of itching. It’s not actually dangerous in terms of the mother’s health. It’s not a liver disease that persists, it goes away after delivery. It does not have any negative effects, typically, on your health in pregnancy. It’s annoying because of all the itching, horribly annoying, and very troublesome because there’s a lot of itching.

The concern is predominantly fetal. For some reason, having these elevated bile acids in your blood does increase the risk of stillbirth. And because of that, we watch very closely, although it’s unclear if that actually helps, but predominantly we deliver early because of it. Exactly when depends on the situation. Thirty-six, 37, 38 weeks, whatever it is, we deliver a little bit early so that nothing happens to the baby, and once the baby is born, the baby’s fine, and then the condition in the mother goes away. But one of the things that happens in cholestasis, and part of the diagnosis is on blood testing, the bile acids can be elevated, but also some of the liver enzymes can be elevated. All right store that away for a second.

Preeclampsia. Now, preeclampsia is a totally separate condition, for totally separate reasons, and it manifests differently. Preeclampsia is basically a condition where in pregnancy, a woman’s blood pressure starts to go up. It’s a condition of the placenta, meaning it only happens during pregnancy, sometimes right after delivery. And basically, the blood pressure goes up, and a lot of other things can happen. You can have protein in the urine, and you can have a lot of effects on the mother and baby. It can be dangerous to the mother’s health, which is different from cholestasis. It can be dangerous to the baby as well. One of the things that can happen in preeclampsia is if it’s severe enough, your liver enzymes can be elevated. So as you remember from cholestasis, your liver enzymes can be elevated, and from preeclampsia your liver enzymes can be elevated, so there’s some overlap.

Atypical preeclampsia, different people mean different things when they say that. Usually, atypical preeclampsia means we think you have the condition, like the problem seems to be preeclampsia, but it’s not presenting classically. And usually what that means is your blood pressure is not elevated. So if someone has all the other features of preeclampsia, like let’s say they have protein in their urine, their liver enzymes are elevated, maybe the baby’s, you know, measuring a little bit small, maybe she has headaches, whatever it is, but her blood pressure is not elevated, it’s a little confusing to us because classically with preeclampsia, the blood pressure is always elevated. In fact, part of the diagnostic criteria for preeclampsia is that the blood pressure is elevated.

So if we think someone has this condition, but for whatever reason her blood pressure isn’t elevated, we either have to say she doesn’t have this condition, it’s not preeclampsia, or she has it, but we’ll call it atypical because it’s not really how we typically would diagnose it. And so it sounds to me, Megan, like you had a situation where there was a bunch of things going on, you had itching, you had elevated liver enzymes, but they thought there might be more than just classic cholestasis, and maybe there was a preeclampsia picture. And in those situations, it frequently is confusing, what did you have? Did you just have cholestasis? Did you just have preeclampsia that was atypical? Did you have both? Did you have something else entirely? And it’s not always known.

You know, as we like to say, there’s a phrase in medicine, patients don’t always read the textbooks. Meaning when we look in a textbook, and we say, all right, this is what cholestasis looks like, and then we see another paragraph that says, okay, this is what preeclampsia looks like. And a patient comes and she has, well, not really one, not really the other, but she’s got something, we have to figure out or do our best to figure out what exactly it is, and sometimes we’re successful, but often we’re unsuccessful, and we don’t know. So I would say it’s not terribly unusual that we could have someone who had a situation, had a condition, and we can’t pinpoint exactly what it is, because it didn’t really fit neatly into any single diagnostic criteria.

And that does happen. Cholestasis and preeclampsia frequently have overlap. Preeclampsia and something called gestational thrombocytopenia, where people’s platelets are low sometimes overlap, because that could happen from preeclampsia, or it could happen for other reasons.

And ultimately, as you said, what do you do about that for your next pregnancy? So I would say the first thing I would do, and I don’t know how much of this you’ve already done, obviously, but the first thing I would say is probably it makes sense to have a pre-conception consultation with a maternal fetal medicine specialist. Have someone look over all your records, all of your lab tests, get your story in detail, exactly what happened, look at all the results, and try to figure out, if possible, what happened. Is it possible to clarify that it was cholelstasis alone, or preeclampsia that was atypical alone, or both? And that might help give you a better sense of what is the risk in an upcoming pregnancy.

Now, I will say fortunately, not everything recurs, and just because you had something in one pregnancy, it does not mean it’s going to happen in the next pregnancy. It’s hard to give you a specific answer of what you should do in the next pregnancy without without knowing all the details. But I would say I would try to do an investigation between pregnancies, to try to figure this out, generally with someone like a maternal fetal medicine specialist. It could be an obstetrician who has a lot of knowledge and experience. It doesn’t have to be a maternal fetal medicine specialist, but this is what we do for a living.

And I think that that’s also a lesson in general not just for you, but for everyone, when we have situations in pregnancy that are complicated, confusing, and with a difficult situation, whatever it might be, and we’re trying to contemplate what to do with the next pregnancy, it’s really good to have a dedicated appointment, meeting, consultation with someone between pregnancies to try to sort that all out. In the upcoming book Emily Oster and I are publishing in April, basically, most of the book is about that. It’s about what do you do after a first pregnancy that sort of ended in a way that was unexpected, hence the title of the book, “The Unexpected,” and then what do you do for the next pregnancy? And so many of the times we talk about do a thorough investigation between pregnancies.

Again, it doesn’t mean it’ll lead to an answer. It might not. But at least you’ll know you’ve uncovered as much as humanly possible before the next pregnancy. Thank you for the email, and good luck to you.

All right, next question is from Sarah, and it’s regarding the consequences of a prior ectopic pregnancy. Okay, “Hi, Dr. Fox. About two months ago, I had an ectopic pregnancy. It ruptured on its own, so I did not need a procedure, but I was given a dose of methotrexate. My experience with my OBGYN during this whole process was not great. I will be changing doctors.

I’m wanting to know if you could explain where this leaves my body moving forward for future pregnancies, increased risk of recurring ectopics, possible scarring of fallopian tube, would my next pregnancy be considered high-risk? My husband and I want to start trying again soon, but I feel like I have so many unanswered questions.

Context, if needed. I’m 26 years old, in good health. This was my first pregnancy.

P.S. I learned about your podcast from “The Toast” episode you were on. I’m a huge Toaster. Thank you.”

Well, Sarah, thank you for the email. I am also now a huge Toaster. Thank you for joining us. I’m sorry you had the ectopic pregnancy, and I’m also sorry you did not have a good experience with your OBGYN, and that you need to be changing doctors.

In terms of your question, so again, some background on ectopic pregnancy. Ectopic pregnancy, as you know, Sarah, but maybe some of our listeners don’t, is when you have a pregnancy that implants somewhere outside of the uterus, right? Normally, right, in a pregnancy, the sperm and the egg meet each other in the fallopian tube, which is what connects the ovary and the uterus, and then, when the sperm and the egg meet, they become a zygote, then become a blastocyst, and eventually an embryo, and it travels through the tube, back into the uterus, and then implants in the uterus, and then you get an intrauterine pregnancy.

But every now and again, the pregnancy, unfortunately, implants inside the tube itself, and that’s called an ectopic pregnancy, or a tubal pregnancy. Now, the embryo can also implant in other places, in the abdomen, on the ovary itself. Those are also ectopic pregnancies, but those are more rare locations. The very most common place an ectopic pregnancy will end up is the tube, the fallopian tube, that is.

And it sounds to me like you had one, and then you said it ruptured on its own. Generally, a rupture means like something very dramatic, where you’re bleeding internally, and you need surgery. So probably what happened is it didn’t really rupture through the tube, but probably got expelled through the end of the tube, back into your belly, and then in those situations, they just sort of go away on their own, and you typically don’t need surgery. When it ruptures, that means the tube basically blows open, and you are bleeding internally until you have surgery. That is a life-threatening condition that is severely painful, we call it a ruptured ectopic.

Now, if someone has an ectopic pregnancy that’s not ruptured, but we diagnose it, you could either choose to do surgery, go in and remove the tube, or you can go in, sometimes remove it from the tube and correct the tube, fix the tube. We don’t do that so much anymore because it seems like if you try to fix the tube, you end up with a damaged tube afterwards, and probably a high risk of ectopic again. So usually, the treatments of an ectopic pregnancy is surgery to remove the tube and ectopic entirely, which leaves you with one tube on the other side, you can still have babies after that, it does not seem to affect overall fertility.

There is another treatment, as you mentioned that you got, something called methotrexate, which is a…it’s a form of chemotherapy. It’s not the kind of chemotherapy that in the doses we give would typically give someone all the classic side effects of chemotherapy, you know, like the nausea, the vomiting, the weight loss, the hair loss. It does not do that. It typically only affects the developing embryo in the fallopian tube, and it can successfully treat ectopic pregnancies without surgery. Not 100% of the time, but it has a high rate of success. If it’s unsuccessful, you either need to keep getting doses of it, or move on to surgery. But it seems to me like you did not need methotrexate…sorry, you did not need surgery, you had methotrexate, and you’re wanting to know about your next pregnancy.

Well, good news and bad news. The good news is most people who’ve had an ectopic pregnancy, and it’s treated, whether it’s with methotrexate, or whether it’s with surgery, do go on to have healthy children, intrauterine pregnancies, and things tend to go very, very well. That’s the good news.

The bad news is you do have an increased risk, statistically, of having another ectopic pregnancy. Now, whether that’s because there’s some underlying factor that caused you to have an ectopic, and it’s still there, or whether it’s because that tube in which the ectopic landed was damaged in the first place, and since it’s not removed, it’s still there. We don’t really know exactly why it is, but statistically, you do have a higher chance of getting another ectopic pregnancy. And so, all we typically recommend in that circumstance is when you get pregnant, you have an early ultrasound to check where the pregnancy is, make sure it’s in the uterus. And assuming it’s not an ectopic, meaning it is in the uterus, you should be good to go. Meaning having a prior ectopic pregnancy I guess makes you a high-risk pregnancy, but really just at the very beginning. And if you ultimately have an intrauterine pregnancy, which is the likelihood, then it really should not affect the rest of your pregnancy.

Okay, next question is from Madison, and it’s regarding gastric bypass. “I’m 32 years old, who had a gastric bypass in 2020. Since that time, I’ve lost and maintained 150 pounds of weight loss, bringing me to 165 pounds. I’m ready to start planning for family, and want to understand what my complications may be as a gastric bypass patient. I live a very healthy, active lifestyle, and plan to continue that, but my partner is deeply concerned with my ability to carry a healthy child. Thank you in advance.

Also, Dr. Fox, I heard you on “The Toast,” and wow, you are amazing. You made all of the scary things feel so much better. Thank you.” Well Madison, thank you for that. Another Toaster has joined us. Thank you so much. Thank you for the compliment. I really do appreciate that.

In terms of your question, first of all, wow, awesome. That is amazing. One hundred and fifty pounds of weight loss, brining you to 165 pounds, congratulations. That is amazing, and I am really happy for you, and I’m sure you feel great. In terms of pregnancy, generally people who’ve had gastric bypass or other bariatric surgery procedures do well in pregnancy, and most of the data shows that you do better than you would have if you had not had the procedure, and not lost the weight. So meaning there might be some risks to having had the surgery, but it seems that the benefits of having the procedure, meaning the weight loss, and entering pregnancy with a lower weight probably give you overall benefit, lower chance of hypertension, lower chance of diabetes, lower chance of cesarean. So I think that it’s good.

In terms of the actual risks, well, generally the biggest risk would be if you had some sort of malnutrition because of the gastric bypass. It depends on the exact type of gastric bypass you had. But generally, we just recommend people continue to follow up with their bariatric center, whether it’s a nutritionist, to make sure you’re getting all the vitamins and minerals you need, make sure you are having some weight gain in pregnancy, make sure the baby’s gaining weight, and that’s the main thing that we sort of follow. Occasionally, because of the intra-abdominal surgery, people can get sort of complications related to that, like internal hernias, or scar tissue and whatnot, but those tend to be rare. I would say overall, I wouldn’t worry too much about your ability to have a pregnancy. Again this is something you can discuss with your doctor beforehand, but most likely you should do well.

Okay next question is from Shelby, and it’s about miscarriage. “Hi, Dr. Fox, have loved the show from the inception. Also enjoy “The Toast,” and love the intersection between you and Jackie’s second pregnancy.

I’m a 33-year-old healthy female. I had one early six-week miscarriage, followed by a healthy pregnancy, the child is now one, and just went through another miscarriage at eight weeks. Hard to say, I’m sure, but are these recurrent miscarriages something of concern? I’m already seeing a fertility specialist, and he doesn’t seem concerned, but wanted your opinion. Thank you, thank you in advance.”

Shelby, thank you for the email. Again, I love the fact that you’re a listener, and that you’re also a listener of “The Toast,” and that we were able to intersect those for you. I’m really sorry to hear about your recent miscarriage, and of course the first one. I’m happy, obviously, you had a healthy pregnancy in between them.

In terms of your question, technically the definition of recurrent miscarriage is three consecutive unexplained pregnancy losses. Sometimes people will say two, and again, sometimes that’s modified whether you did or did not have a healthy child at all. So technically, having a miscarriage followed by healthy child, followed by miscarriage would not put you in a category of recurrent miscarriages.

Now, what’s the difference if you categorize as recurrent miscarriages or not? Well, it’s not so much the nomenclature or the category, the point is for the vast majority of people who miscarry, it’s not related to anything that’s “wrong” in the mother or the father or the uterus, or anything like that. Usually it’s just related to sort of bad luck, that when the sperm and the egg met, there was an abnormal number of chromosomes there, and because of that, nature has evolved in a way that those pregnancies, when there’s an abnormal number of chromosomes, miscarry early. And so the majority of early miscarriages are just due to a genetic imbalance to a genetic abnormality in the embryo that was present from the very beginning. These are not the type of genetic conditions that one would carry, it’s just sort of a bad luck phenomenon. And because of that, the early miscarriages tend not to have implications for future pregnancies.

The chance of that happening is related to one’s age. So like, let’s say someone who’s 20, the chance of having a miscarriage early is about 20%, give or take, whereas if you’re 40, it’s a little bit higher, it’s, you know, 35%, 40%, 45%, somewhere in that range. But it’s still just a chance phenomenon, and so the next time you get pregnant, your odds wouldn’t be any better or worse, they’d be the same, unless you waited many, many years, and just you happen to be older, and your odds got worse because of that reason. But it’s not because of having a miscarriage.

However, there are some causes of miscarriage that are related to either condition of the mother, or the uterus, or whatever it might be, and so the only way we can figure out who has those is trying to decide who is more likely to have one of these. And so someone who has multiple, multiple miscarriages obviously is more likely to have an actual problem, versus just bad luck, or someone whose miscarriages are later, for example, like not at six, seven or eight weeks, but they’re at 12, 13 or 14 weeks. It’s more likely that there’s an actual problem going on, or other things that we sort of look for when we take a history and discuss all these things.

And so someone who is 33 years old, and healthy, and had two early miscarriages with a healthy pregnancy in between, the overall, overwhelming likelihood, fortunately, is that there’s nothing that’s “wrong,” but you’ve just had some bad luck, and some good luck, and maybe sort of statistically you’ve had worse luck than average. But your story is fortunately not, at least from what I can tell from your email, is not striking for any underlying problem that would put you at any increased risk for miscarriages moving forward. Again, no more so than anyone else your age would have. And so that’s probably why your fertility specialist doesn’t seem too concerned.

Obviously, with all these, the details matter, the exact nature of the miscarriages, was there genetic testing on them or not, you know, other issues, so this is very general. But I think that that’s probably why your fertility specialist does not seem too concerned. Again, it’s not that no one thinks it’s bad to have a pregnancy loss. It’s awful, and it’s like, it’s terrible. But the question is whether it has implications for future pregnancies, and fortunately, usually they don’t, especially if they’re early, and especially if you’ve had healthy children otherwise.

Okay, last question for this Mailbag podcast is from Laura, and it’s related to oxytocin, and painful contraptions. And Laura you called me out, and I appreciate it. I am open to criticism. Here we go. “I’m just listening to the episode on induction. I love all the information, as with all of the other episodes I’ve listened to. However, I have to push back on the comments about Pitocin contractions being the same as natural contractions. You said it’s a false belief that they are worse because they come on faster. Let me share my experience.

I’ve had two very fast labors, one induced with Pitocin, and one with castor oil. Absolutely, hands down, the Pitocin induction was much more painful. I couldn’t even move, and barely breathe, and I would say those contractions came on slower than the castor oil induction. The second labor I was able to peacefully move around, and cope with the pain. I understand this is my own anecdotal experience, but I’ve heard similar experiences from others. Please explain the evidence you have for the contractions being the same. Or can you agree a woman’s lived experience may be different from what you have experienced as a male physician, never having labored yourself? Please consider this possibility so women aren’t caught off guard and traumatized by an unnaturally painful labor, like I was.

Thank you. Love the show.”

All right, Laura, first, fair. Very fair. I myself have not labored, I do not know what a contraction feels like. I’ve never had one myself. You are 100% right, and if I implied anything otherwise, apologies to all my listeners, number one.

In terms of your question, so my data is just from data on strength of uterine contractions from various devices we use, like manometers. My data is based on, again, anecdotal, taking care of a lot, a lot of women who have been in labor, who have experienced contractions. I think maybe the issue here is not so much the data, but…I might have misspoken. I actually did not go back and listen to the words exactly what I said on the podcast, so I can’t tell you for sure. But my thoughts are not that definitively, oxytocin contractions are not painful, or not more painful, the point is it’s quite variable, and I would say that one of the variables, obviously, is whether it’s your first labor or second labor. I would say for a lot of people, the contractions in their second labor might be less painful than their first. Again, sometimes that’s just because it’s shorter and quicker typically than the first. And again, these are all generalizations. Any person can experience anything, obviously, and so I’m just giving generalizations here.

I think the point I was trying to make, or I hope the point I was trying to make, because this is what I think, is that it’s not that the oxytocin drug itself causes more painful contractions. The point is that oxytocin is essentially, biologically the exact same, the one we give synthetically is the exact same as what your brain produces when you are in labor-causing contractions. So it’s not that if I give someone oxytocin, Pitocin, they will therefore have more painful contractions than someone who goes into labor on their own, they won’t. But if I give oxytocin in a way that gives them stronger and more painful contractions than they would have normally had, or naturally had, then sure, it’s going to be more painful.

So for example, if someone’s labor was naturally going to be a contraction every four minutes, that lasts 45 seconds, that was X-level of pain, and I give them a lot of Pitocin, and now they’re contracting every two minutes, and they’re more strong, and they last longer, yeah, those contractions are going to be more painful. But it’s not the drug itself, it’s that I gave someone a drug that made them have more contractions than they would have had otherwise.

If you sort of flip the situation, if someone’s natural labor was going to lead to very strong contractions every two minutes, that lasted a minute, and someone who’s getting induced maybe has contractions that are every…less frequent, last less amount of time, and are not as painful, then it would be the opposite. Then, the natural labor will be more painful.

So the point, again, overall, I hope I’m not rambling, is that the reason one has pain from a contraction in labor is related to the strength of the contraction, the length of the contraction, and the frequency, how often they’re happening. And obviously, everyone’s response to pain is different between people, and sometimes between pregnancies. But just sort of why a contraction would hurt is how strong is it, how long is it going to last, and how frequent does it come? It’s not did I get oxytocin, or not get oxytocin. Now yes, if you gave oxytocin, and caused more painful contractions, sure, it’s going to hurt a lot more, but it’s not from the oxytocin. That was sort of my point.

And the conclusion from that is it’s not that one should necessarily be afraid of the oxytocin itself, it’s that the goal of the oxytocin, of the Pitocin is to sort of induce or augment, and create a natural state of labor, or what would have happened naturally, and that’s why we titrate the dose we give. We give a small amount, we sort of build it up, and then we can even remove it back.

I hope that explains it. I am sorry if I offended you. Obviously, I did not mean to imply that I have experienced contractions myself, because I have not. Thank you, Laura, for the email. You are all welcome to call me out on anything I say. I’ve got my big boy pants on, and if I say something that you disagree with, absolutely tell me, and I will address it, I’ll apologize, and hopefully we’ll just come to a good place altogether, and I thank you for your help. Laura, thank you for the email. I really do appreciate it.

All right, and I hope you all enjoyed the fourth Mailbag podcast. We’re going to keep doing them, please keep sending in your questions. Have a great week, everyone.

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 relate 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.

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