“Pregnancy and Life Through the Eyes of a Clinical Psychologist, Part Two” – with Dr. Aria B. Grillo, PsyD, MPA

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’m 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. How did that first pregnancy go with Hudson?

Dr. Grillo: So, with Hudson, again, I went and I worked with a fertility doctor, who…also a male. And, again, I was, like, a little leery, like, “What do you know?” And, of course, he was extremely knowledgeable in what he knew. And I said, “Well, you know, I don’t know if I want to do anything invasive, but I just had this experience, and I’m a little leery.” And he said, “Well, you know, there’s lots of options.”

I didn’t realize that you could just go to fertility doctors. You didn’t have to come in with a note saying, “Hello, I qualify for you.” You know, you could actually just go talk to them anytime. And that’s what I did. I set up an appointment, and I think we talked for an hour about my concerns and my medical background and whatnot. And he said, “Well, why don’t you try an IUI?” which I had never heard of that. And I thought, “Well, that sounds like a good idea.” And we did a medicated IUI, and I had friends who had done medicated IUI. I knew that there was, like, a one in three chance that it would work. But, to me, it felt like the support I needed, a little bit of handholding to help me during this time. And we were able to get pregnant with Hudson on the first try of the IUI, which they said could have been in part of having a miscarriage that the body was, you know, primed…

Dr. Fox: Ready, yeah.

Dr. Grillo: …and ready. And so I really was in this good window, and I felt emotionally ready to try. And I’m lucky that it works. So that’s how we came to you.

Dr. Fox: Okay, so…and the pregnancy itself?

Dr. Grillo: Everything. I mean, I think it’s also…and this is something I know you can talk a lot about. There’s a lot of medical terms that I think have not aged well.

Dr. Fox: Let’s list them.

Dr. Grillo: Well, let’s start with geriatric pregnancy.

Dr. Fox: That’s not a medical term. That’s a “People” magazine term. We don’t say that.

Dr. Grillo: Well, do you say AMA?

Dr. Fox: I’ve never said the term geriatric pregnancy other than to joke about it. Advanced maternal age, which isn’t much better, but a little better, that’s a medical term, which is not perfect.

Dr. Grillo: Okay, fair. Okay, also, AMA is confusing because I would see AMA in all these reports of mine. And I kept saying, “I’m agreeing with everything everyone’s saying.” Why is it…

Dr. Fox: Oh, against medical advice.

Dr. Grillo: Against…

Dr. Fox: There’s also American Medical Association. There’s a lot of AMAs out there.

Dr. Grillo: So we should have somebody meet about these acronyms. What about the term unremarkable?

Dr. Fox: Yeah, unremarkable is usually a term for, like, a finding. Like, you know, the heart appeared unremarkable, which means normal. But some people are skittish about saying normal because that means there’s no chance it’s abnormal. It means there was nothing that I could tell. So we usually say…like, in our ultrasound reports, we’ll say no abnormality found, meaning that’s sort of…as opposed to saying normal. But they’re all sort of euphemisms for the same thing.

Dr. Grillo: I mean, I think when anybody says, “How was your pregnancy?” I would say, “Well, how would you feel holding your breath for nine months?” You know, your brain starts going a little whoo whoo, because you are so tightly holding on to “Please let this work.”

Dr. Fox: Right. Do you feel that’s unique to you either because of your personality? Do you think that’s because of what you do clinically? Or do you think that’s true for everyone? Because, I mean, I see people who sometimes appear like they’re just going through the pregnancy blissfully, which is…that is remarkable. So I don’t think it’s everyone who has that, but certainly a lot. And I was curious why…you know.

Dr. Grillo: Well, yeah, like I said, I think, you know, when you meet one pregnant person, you’ve met one pregnant person. I know people who also work in the medical field who were annoyed by how many appointments they had to go to and would skip some, and they were like, “I’m fine, whatever.” You know, and then there’s other people who would put out a sleeping bag in the lobby. And I think I probably would have been that person with Hudson because I was just starting to really process what I had just been through. And there was a lot of fear and anxiety. Unfortunately, I think I also know too much. You know, there’s there’s that sort of ignorance is bliss about, you know, okay, well, between this week and this week, this could happen. And then, okay, now, once you’re at this week, then you have to think about do you want to do a CVS or if you want to do an amnio? Because then if you do that, then you might find out this and blah blah blah.

So that’s more, you know, my personal thought process. I don’t think I truly breathed a sigh of relief until I heard… I’m sure that’s similar for many people, especially people who have had any sort of loss or any sort of experience of this could go away. And at the same time, I think there’s a lot of people who trust the process, “Okay, I should come in…” You know, I mean, some practices you don’t have to come in as often when you either have a high-risk pregnancy or advanced maternal age. Perhaps you need to be here more often.

Dr. Fox: So much. I mean, I usually ask people all the time. They’re like, “How often do I have to come?” And I’m like, “How often would you like to come?” Right? I say, “We’re here every day.” So…

Dr. Grillo: Well, I think that’s important too, that the idea of choice is so empowering in this experience of pregnancy.

Dr. Fox: For many people. For some people, it’s debilitating.

Dr. Grillo: That’s true.

Dr. Fox: That’s what’s fascinating. Some people don’t…they’re like, “I don’t want to have that on my head. You choose for me.” “Okay, I’ll tell you when to come.” But, like, a lot of people really…obviously, just because we’re used to being autonomous creatures who make decisions for ourselves, and so it’s nice…yeah.

Dr. Grillo: Oh, that’s…I think there’s such a weight of should I, should I, should I, should I? And having that put on you, like, you make a choice, yeah, for some people, “I don’t want to make the choice. You’re the medical doctor. You make the choice.” But that’s why I think this is, again, such a unique field to be in. If somebody needed a knee replacement, no doctor is going to say, “Well, so here are my ideas.”

Dr. Fox: Let’s whiteboard this.

Dr. Grillo: Let’s whiteboard. Should we do laparoscopic? Should we do full replacement? Do you want to come to the case conference about your case? That’s just not something done. And yet in this field, it’s so fascinating to me, there is so much choice, and I think that also comes with a big red flag of where are you getting your information. When somebody comes in and says, “I am not doing this,” or, “I will not have this,” or, “You can’t do this because…” and then, to me, I’m like, “Who said that? Where did that come from? Is it rooted in your garden of trauma? Did you see it on Instagram and now feel loads of shame?” You know, so I think it’s such a precarious time. And when you think about 9 months, 10 months, maybe even a year if you’re doing any sort of procedures, I mean, that is a lot of time to wait for anything. And we are an anxious population of people, so… Especially New Yorkers, we wait for nothing. We don’t even wait for the light to cross on the street. So that does not help our anxiety.

Dr. Fox: It’s definitely there are geographic and, you know, cultural differences in how people approach medical care. That is definitely true. And so I tell people like…most of my people I see are like, “Yeah, I want this done yesterday.” “Okay, let’s work on that.”

Dr. Grillo: Well, that’s what’s really humbling about pregnancy as well. For many people, like myself, there was, “I want to do this now.” And I think it took six to eight months from that moment to have a pregnancy, a loss, a surgery, procedures, a pregnancy. Yeah, maybe six to eight months. So no immediate gratification. And then you had to wait another nine months, you know, until the baby came. But this is just how I am. I tried to be as involved as I could. So I wanted all the genetic testing. I wanted an amnio. I wanted all the appointments because, to me, it was helping me stay on track that everything is okay, everything looks normal, everything looks normal. And, for me, because I had had that horrible experience of no heartbeat and that sound, I needed that. And I recognize that, that not everybody needs that.

Dr. Fox: Yeah. It’s so interesting because literally last night I did a consultation last night with someone…with a couple, and they’re focusing on one decision right now. Should they do invasive testing, like a CVS or amnio? Should they not do it? And that’s a very good question to have a consultation about, to talk about. And what I was saying to them is, ultimately, this is one of the situations where it’s really a choice. And after all the conversation, talking about this and her age and her risk and her results, blah blah blah, I said, “It really boils down to what is your personality.” I said, “Because right now the chance of it being abnormal is very low and the chance of there being a complication from the procedure is very low. So, I mean, no matter what you do, right, even if you flip a coin, the chance it’s going to go wrong is 1% or less, right? Either way.” So the choice is really, like…I said, “You’re the one who has to sleep at night.” So I said, “Are you the type of person who would prefer to take a little bit of risk in order to get as much information as possible, get a little bit, or are you the type of person who’s like, if everything is going fine, don’t rock the boat, like, we’re good?” And I said, “Those are two very different personalities.”

I said, “Unfortunately, they frequently procreate together. And so you get two different people.” But I said, “How do you feel? Because I can’t tell you how to feel about a procedure. I can say what the risk is. It’s very low. But that’s not going to…if you’re a person who’s very anxious about a needle getting stuck in you, then you’re much less likely to choose that option. Or, on the flip side, if you’re someone who has a life experience personally or a friend or a colleague who had a baby with a genetic abnormality, you might be more likely to want the test.” And I said, “That’s not for me to tell you. I think they’re both fine. And their risks are very, very similar. And it really does boil down to who are you and the personality.” Like you said, it’s not like a knee replacement for that decision, because, you know, I mean, I guess sometimes it could be like getting your knee replaced versus doing physical therapy. Like, are you someone who wants to go skiing again? Are you not someone who wants to go skiing again? So that does come up to some degree. But it…and it should because, you know, decisions often are…that’s like what joint decision-making is supposed to be, right, where the person at the other end of my table brings to the table what they know about themselves and their personality and their fears and their life experiences. Because I don’t know that.

Dr. Grillo: Well, and it’s also how do we deal with our feelings in the event that the amnio does show something. You know, how…and there’s almost that anticipatory anxiety and fear of the what if. And I think that’s why this field is so, so important on your end. In my end is that we are constantly dealing with this great unknown, it’s not tangible. I can’t physically hand this thing to you. It’s all about your choices. How do you feel? How do you think you might feel? And having a real say in very big medical procedures is also something, I think, unique to obstetrics, because, yeah, if I needed a scan for my knee, I’m not going to be the one who’s the tech who’s doing it, I’m not going to be the one sitting up. You know, and that’s the other thing with amnios, with cesareans. You’re wide awake.

Dr. Fox: Yeah. Hello.

Dr. Grillo: You know, you’re part of these major procedures wide awake. So there’s also that that, you know, I think is unique to say this is a huge choice you have to make. And that’s why I think, you know, it’s really important instead of saying “but,” to say “and,” and that’s where you are in the sentence, you are the and. Like, it is your choice, and I see that at this point, you know, the likelihood of something is extremely low. I remember when I was thinking about getting an amnio, you and I met, and you said, “There’s a 99% chance that everything is fine.” And I said, “Well, what about the 1% chance?” And you were like, “Well, that’s…you are the type of person that’s going to focus on, but there’s still a chance.” And, for me, I needed to feel like, okay, that it’s…yeah.

Dr. Fox: That it’s the right decision. A hundred percent that’s the right decision for you, because 1% is not nothing. It’s not like one in a billion. We’re not…and it’s not an unreasonable number to worry about. One percent’s a reasonable number to worry about. Not everyone worries about it, but many do, and that’s cool. If I said it’s a one in a trillion chance, you’re like, oh, like, all right, that’s probably a little bit out there. But 1%, 100%, that’s a real number. Yeah.

Dr. Grillo: Right. And I think that is where, I know for myself and I know for friends that I’ve talked to, you really have to do that mere challenge of like, “I can look and see what other people are doing. But what do I think I want right now?” And that’s why having providers who can really hold your hand through it, literally and physically, and say, “It’s going to be okay. This is how this is done,” I think, is so, so important because there is so much misinformation out there. There are so many people who are posting misleading things about why you should or shouldn’t do different procedures, and that, to me, I think, is something that I tell all of my friends to be so, so mindful of. You can use the internet, you can research things, you can look up things and think of it as you are just cultivating questions to bring to an actual provider to go through them without making any decisions based on anything that you see.

Dr. Fox: Right. So you had a C-section your first time around. So, number one, what was that like for you? And then, number two, we’ll talk about the next time, your decision about whether to do it again or to try to VBAC.

Dr. Grillo: Right. So, with Hudson, I…you know, it’s interesting. And I think it’s so important for anyone who’s listening. It’s you know yourself. Your provider might know you for a few years, but you know yourself. And I just felt for whatever reason that I felt a C-section was going to be in my future. I didn’t think that I was going to be a person that was going to be able to have a vaginal birth for no other reason than I just had this inkling. There was nothing about it that swayed me either way. My thought process was I had no birth plan. I wanted to do whatever the team felt was safest, because at the end of the day, to me, I am not a surgeon, I’m not an OBGYN, I want to do what’s safest. And I had come this far, and I was very nervous and very worried but still so trusting of this team.

And, you know, I labored for 23 hours and was not progressing enough. So the decision was made to have the C-section. What I thought was really great was, you know, I was able to wait before I started the epidural. I was able to…the team came in and said, “Okay, now, we’re going to do the pitocin. And this is what this is about.” And when they said, “Okay, now, we’re going to prep you for the C-section,” I at least felt like I had some sort of part of the conversation in terms of wanting to make sure that I had the clear screen, wanting to make sure that my arms weren’t tied down, things that I could feel like I had some sort of control in the moment, because you are literally giving yourself over to this team who you’ve never met to deliver your baby.

Dr. Fox: To operate on you while you’re awake.

Dr. Grillo: While you’re awake. And that was at 3 in the morning.

Dr. Fox: And you could hear their banter. Yeah. You can hear them talking to each other about sports and movies while they’re operating on you.

Dr. Grillo: Well, that’s why I put on my playlist, and everyone was singing along. Ironically, after having left that all-female practice, which I had had not a great experience with, to come here to this wonderful practice of a variety of people and wonderful men like you, I ended up having an all-female delivery team that day for Hudson.

Dr. Fox: Cool.

Dr. Grillo: So, yeah…

Dr. Fox: Full circle.

Dr. Grillo: …great way to bring him into the world.

Dr. Fox: Full circle. And then the next time around, did you think much about VBAC, or was it sort of not for you? And…

Dr. Grillo: I thought about it. I thought about it in the sense that I’m not opposed to it. Actually, you and I met, and I said I’m not sure what I think about it, and you said there’s a podcast episode, VBAC to the Future, with Dr. Melka, who delivered Hudson. And I thought, “Oh, great. That’s exactly what I need. I need to listen to something that will help me either way.” And, again, I very much felt like I’m not sure if my body is going to dramatically do anything different than it did the first time. So I was open-minded, and I said, “Let’s schedule the C section. Now, I know…” I’m very type A. I like to have things on the calendar. “Let’s schedule it. And if things progress in a different way, then I was open to it.” But I was very thankful, and then ended up that both you and Dr. Melka delivered my daughter.

Dr. Fox: The dream team.

Dr. Grillo: Yeah.

Dr. Fox: It was a great day.

Dr. Grillo: It was.

Dr. Fox: It was a great… Now, we spoke during this past pregnancy, and you were talking…or we were talking about, you know, you’re an intelligent, thoughtful adult.

Dr. Grillo: I try.

Dr. Fox: And you made… Well, at least it appeared that way. And you made a decision again, like you said, very thoughtfully. “We’re going to schedule a C-section. If I go into labor before, here’s what we’re going to do. And here’s my plan.” And we were talking about how a decision like that, which is quite reasonable medically, makes a lot of sense for you personally that you felt that out there in the world there’d be many, many people who’d give you shit for that basically, for that decision.

Dr. Grillo: Oh, for sure.

Dr. Fox: And we spoke a lot about that and why that is, because it doesn’t…anyone listening to us would be like, “Why would anyone care? Why would anyone give you crap and judge you?” It’s so amazing.

Dr. Grillo: I would bet there are a lot of people listening who are like, “Oh, yeah, a lot of people give you shit.”

Dr. Fox: Yeah. Because we talked about this a lot, but we weren’t being recorded at the time. So, I mean, tell me your thoughts on that. Like, what’s going on in this world that people care so much about what others decide for themselves related to their pregnancy? I see very few people who judge others over what diabetes medication they take or, again, whether they have arthroscopic or open knee surgery. But for pregnancy, delivery, child-rearing, people are very interested in what others are doing.

Dr. Grillo: Oh, sure. Well, I think, look, if we look at even the last 20, 30, 40 years, we were talking about this before, it was a field that was dominated by white men telling women what to do with their bodies, how to raise babies, how to be pregnant. All OBGYNs were men. You know, I think it was born from this idea of others are going to tell you what you need and should do. And then what I think it’s also sort of transpired into is women, we hold ourselves to a very high standard. We look at other women who are holding themselves to a very high standard. And then it sort of goes inward where it’s like, we’ve talked about this, this woman-on-woman crime where there’s all this measuring, measuring, measuring, “Oh, I gained 20 pounds during my pregnancy. Oh, I gained 15. Oh, I gained 32.” So who does that isolate? The people that gained 50 pounds without doing anything but eating lettuce, and all of a sudden… So you end up isolating people from the conversation when there’s this sense of you should be doing things a certain way, “Oh, I didn’t go to a doctor. I had a home birth, or I went to a birthing center, or I did this and that.”

And while it should all be looked at people’s choices, somehow along the line, it started looking at almost a way for people to sort of measuring up, like, that you should be doing things a certain way or you shouldn’t be doing things a certain way. And I thought it was really interesting how many people when I said that I had a C-section, it was interesting some people were like, “But you tried first. You labored. So, you know, you tried.” And I was thinking, “Well, what do you mean? I gave birth.” “But, you know, you tried hard. You didn’t want that.” And I was like, “Well, I didn’t actually have an opinion either way.” And then I started to ask people, you know, “What are your thoughts about this?” And I think what’s interesting…and it’s unfortunate that there’s a sentiment that having a vaginal delivery is the achievement and having the C-section is the failure instead of the healthy baby being the achievement and that always being birth, whether you labored for 30 minutes or you labored for 30 hours, you know, this is an achievement. Also, don’t forget the previous nine months plus or take is also an achievement.

So I think it’s interesting that there’s this sense of things being wrong or wrong choice or I was interested about how many people didn’t want an epidural at all and saying, like, “Why? Where is that coming from?” And some people saying, like, “Oh, well, you know, it runs in my family. You know, it’s not something we’ve done.” Okay. And then other people are saying, like, “Well, I read, you know, or I saw on somebody’s page that if you do this, you know, that you could have…it could expedite labor, and you’re not able to walk, and then this, that, and the other, and then you’re not going to experience your birth.” And, I mean…

Dr. Fox: Right. You won’t bond with your baby, and they’ll grow up and become criminals, and, you know, horrible, terrible things will happen.

Dr. Grillo: So I think, you know, like I said before, it’s so important when you meet with your patients, when I meet with my patients, you have to validate what they’re coming to you with, even if you’re like, “This makes no sense.” It’s rooted in something. You go back to where is their garden. If they have completely saturated themselves with panic information online, they are not going to be able to grow in a meaningful way. So it really is like, “Okay, where did that come from? What did you learn?” And, you know, there was a lot of information about really going both sides, like, “Oh, but, you know, if you have a VBAC, then X, Y, and Z could happen.” And then other people are saying, like, “A VBAC is the best way to go.” So I can imagine someone who’s not in the health care world feeling very overwhelmed, very scared, maybe even some shame about, you know, “I just want to see section. Is that possible?”

Do I have to have some sort of, like, battle wound here to say I tried, even though, of course, with a C-section, you literally have your scar? But it’s just fascinating to me that it’s this conversation about how are providers explaining things and what information are we getting from outside sources that might be swaying us in terms of decisions we’re making about ourselves. Because you can have the armchair doctor that’s like, “Well, you should absolutely not have an epidural, and you should bounce around on a ball and give birth.” Or maybe that’s not actually the way you should. But, again, it’s trying to have that conversation is walking a really fine line.

Dr. Fox: Yeah. It’s so interesting. Remind me, you’ve run marathons or no?

Dr. Grillo: No.

Dr. Fox: No. Okay, so I have. And my son just ran the marathon, and I was just thinking…

Dr. Grillo: Oh, wow.

Dr. Fox: Yeah, yes, he’s awesome, yeah.

Dr. Grillo: I am really good at clapping.

Dr. Fox: That’s great. Yeah.

Dr. Grillo: At Mile 22. It’s a great mile. Right on the turn to fifth. I am really good at cheering. Yes.

Dr. Fox: Good clappers. I was clapping for this one. But I was thinking about it, so the running community is a very supportive community, right? People who run tend to support one another. And if you’re…let’s say you want to, like, compare pregnancy and birth to a marathon. You have long time training, massive day, really hard, people are like once-in-a-lifetime experience type of thing. So there’s many different ways to train for a marathon. And you can go online. So this is the best way. That’s the best way. This is better. That’s better. Nutrition and timing and lengthy runs and all these things. And there’s a lot of…people talk about that. But what ends up happening is once someone says, “I ran the marathon,” every other person who’s ever run a marathon always says, “That’s amazing. I’m so proud of you. What was your time? That’s terrific.” And it doesn’t matter if someone ran in six hours or two hours. They’re like, “That’s such an accomplishment. That’s amazing. I’m so proud of you,” and so supportive. No one ever goes back and says, “Oh, that wasn’t very fast.” It just doesn’t happen. People are always so supportive. Whereas in the birthing community, right, a lot of different ways to get from point A to point B and different things, and then after someone gives birth, there’s still judgment after it. Is it the craziest thing? And people are like, “Oh, yeah, I can’t believe, you know.”

Dr. Grillo: Oh, yeah, and they’re like, “Oh, my baby was 8 pounds. Oh, my baby was 7 pounds, 3 ounces. Oh, my baby was…” I mean, I was saying this to a friend the other day, that I think that if there was a way for pregnancy…I almost…I feel like the length of pregnancy is this great equalizer, where it’s about usually nine months that you will be pregnant. And if there was a way for someone to be like, “I gave birth in five months,” or, “I gave birth in two and a half,” that they would somehow find a way to make that an achievable goal. But I think it’s just this…it’s the measuring, measuring, measuring. How much weight did you gain? How long did it take you to get pregnant? How much did your baby weigh? Did you have a vaginal birth? Did you have a C-section? You know, and it’s fascinating. And then, as you know, now you have a baby. Then it becomes, well, are you breastfeeding? Well, why not? Are you doing formula? Well, which one? And so it just becomes this vicious cycle of internalizing a lot of shame and guilt and fear and frustration and not wanting to come forward with a lot of questions that I think are so important.

And I think that’s why, like with the running community, I have found that there are good communities. I’m part of a mom’s group, Sugar Hill Moms, and shouting them out. And there’s Facebook groups that I am a part of. There’s the Moms of the Upper East Side, Moms of the Upper West Side. There’s moms of a variety of neighborhoods in New York City. And I find it so fascinating that women will say, you know, “I’m feeling really crappy because the doctor said this. Has anyone ever been through this?” And people will write in their thoughts. A lot of times it’s asking for providers, “What’s a provider who has good bedside manner? What’s a provider who has worked with people who have a history of high risk?” You know, and I think that’s such an interesting way of really uniting and helping each other. I also notice a lot of the posts are anonymous. And I think that that is very much a lot of women who don’t want to share or feel uncomfortable sharing some pretty big private things about themselves. I’ve noticed people will share anonymously if they’re like, “I’m going to have another C-section,” “I’ve had a C-section before.”

Dr. Fox: Oh, because you think they’re anonymous because they don’t want to be judged.

Dr. Grillo: Well, I was, like, Google searching cesarean, epidural just prior to coming in just to see, like, what the sentiment is. And it’s interesting because some people will straight up say, “Look, why would you do that?” which is interesting. You do not know this person. You have never met them. And you’re just, like, blatantly chastising them for their decisions. And hence why they’re anonymous. But I thought it was really interesting, you know, how many people do come forward and say, you know, “I’ve had three C-sections, and this is what I did. And this is how I prepared. And these are the post-op things that I did that were really helpful.” So I feel like I see a good amount of women supporting women. But I think we have to really look at the root of this of, you know, people measuring, you know, people who’ve had a vaginal birth. If you’re talking to a friend who’s had a cesarean birth, is there a feeling of, you know, do I feel any sort of guilt that you had one way and I had the other way? Or is it look at our beautiful babies?

But I think it’s really dependent on the person. I think there are some people that…you know, I’ve seen people who, you know, are having miscarriage after miscarriage, and they just cannot talk about it because there is that feeling of, “This is only happening to me, and I think…”

Dr. Fox: Right. “And it’s my fault.”

Dr. Grillo: “And it’s my fault.” Yeah. “And there must be something I am doing. Why isn’t this working for me? And, look, it’s working for you, and it’s working for this person. And this person has four kids,” when there’s just so much more under the layers. You know, and it goes back to what that doctor said to me about this happens every day. Yes, people get pregnant every single day, and people have pregnancy losses every single day. And people are having…there’s someone in the world having a C-section as we speak. You know, vaginal births abound. And then there are still going to be the people that are just absolutely afraid to ask the questions or feel like it’s a stupid question, you know, or it’s not pertinent to the pregnancy. And I think that’s what’s so important, is reminding every single woman, “Every one of your questions is important. Everything you’re thinking is valid. Fears are valid,” and being able to have that conversation to help them make really big choices. And so I think that is really what sort of ties it all together.

Dr. Fox: Yeah. So what would be your professional, and through your personal experience, advice? Right. So we have listeners who, let’s say, are about to embark on a journey, or they’ve just started, and maybe they’ve had a miscarriage or some complication or whatever it is, and they’re saying…all right, we’ve just laid out all the problems, you know, and all the ways people go wrong with this. So how would you advise people to go right with whether that’s getting their questions answered, whether it’s finding, you know, a doctor, midwife who they trust or finding a support group? Like, what would you give as practical advice to people?

Dr. Grillo: I mean, I would say I would give this advice to the people as well as the providers.

Dr. Fox: Fair.

Dr. Grillo: And it really is, you know, meeting you where you’re at. I think this is a really unique experience where you’re coming in, you’re explaining your medical history. I think that’s a really good moment for providers to really sort of turn on their, you know, medical hat to say, “Okay, this person has had either D&Cs or losses. You know, that might shift the way I say things, how I say them, when I say them.” Even someone who might come in who’s already had two or three kids, it’s about where are they at in this moment, right? So for someone who’s embarking on the journey, I would say think about what it is that you need from anyone who’s giving you any kind of information. Hold your providers to the same standard that you would hold anybody else. If you are having a conversation with somebody, and you are feeling like you are not getting your questions answered, don’t walk away. There’s a lot of times where people say, “Oh, well, you know, they were busy, and we didn’t have a lot of time. So, you know, I didn’t ask any of my questions.”

Come in with your questions. You know, lay the groundwork. Be part of the conversation. Be like, you know, “I have a bunch of questions. Should I ask them now or after we have our sonogram?” or something so that you can at least let the provider know that, you know, you would like to be part of the conversation. It’s also totally normal to say, “I’m not sure what to ask at this stage. What are some things maybe I should be thinking about right now?” Because I think, you know, there’s wonderful people out there that talk about all levels of pregnancy, and it can be very overwhelming if you pick up any of these books and you’re reading about what to do at nine months pregnant and you’re, you know, two weeks pregnant. So I think that’s also…help the provider let you know maybe where you should be at at this point, like, “Okay, we’re at this stage, and here’s what the next few weeks are looking like.” You know, really allow yourself to try to live in the moment as best you can.

You know, getting that news is so exciting, that you are pregnant, and yet…it’s like getting into college. It’s like, hey, about nine months from now, your life is going to totally change, but go back to history class and have a good day. It’s like the same sort of bizarre, like, what do I do with this information? Right? But it’s all about…you know, if you are a senior in high school and you just found out you got into college, you do not leave school and go buy linens for your extra-long twin bed.

Dr. Fox: You don’t decide what math class you’re going to take that day.

Dr. Grillo: Right. Yeah. You don’t get up and leave school. You got to go back. So it’s the same thought process of, like, okay, deep breaths. You are who you are. Remember why you want to do this. Really stay grounded in who you are, who your partner is, or whatever your life decision is that has got you to this point. And let’s look a week out, two weeks out. I would say even just three weeks out is enough to have a good understanding without getting too overwhelmed by just the massive amount of information and the massive amount of an unknown. And just like I would say to anyone in the psychology field, if you are meeting with a provider and you do not feel supported or heard, absolutely ask to speak to somebody else. You have absolute control over that, you know, and…

Dr. Fox: Yeah, I would also say you’re allowed to tell the person because sometimes we don’t know when we’re failing. You can say, like, the meeting’s ended, “Just so you know, I still have a lot of questions, or I don’t feel like I got this answered. Can we do that now, or can we set up another visit?” And something that’s supposed to be like, “Oh, my God, I had no idea. I thought I’d A plus. I thought I explained it perfectly.” And, you know, we don’t know always. You know, people might say…you can say, “I didn’t quite get that.” Like, for whatever reason.

Dr. Grillo: I don’t know if it’s black and white, like, a failure, but I do think…

Dr. Fox: You know, it’s like whatever…it’s communication. Listen, it’s a relationship. But, you know, patient-doctor, whatever, it’s a relationship, and they always rely on good communication in both directions.

Dr. Grillo: We’re all fallible in that way.

Dr. Fox: Yeah. And if someone is not communicating effectively or you don’t feel they’re trying to communicate, what I just…call them on and say, “Hey, this isn’t working for me. Can we try this another way or another time? Or maybe we need more time or…” Like, whatever it might be. And, usually, in our end, we appreciate hearing that, at least we should, because we know we have to do things differently, and, obviously, if the person doesn’t, and you’ve just upset them, all right, they’re not the right person for you. Like, great. Like, you know right away, time to go. But most of the people I run into would prefer hearing that than someone just walking out and being confused.

Dr. Grillo: Oh, absolutely. And I think it’s…you know, we are not mind readers. I say this to patients all the time. If you are sitting in front of me smiling and nodding, I am not going to take that as a cue that inside you are falling apart. You know, we are going to try our best to kind of pick up on things. But this is a real moment of self-advocacy across the board. It does not need to be some acute care question. If you have horrible heartburn, if your hair feels funny, if you feel like you’re gaining weight, and that’s really bumming you out, if you’re feeling you’re getting an early onset of depression during pregnancy, you know, these are all things to just say to your provider, like, you know, “These are some things I’m feeling. I’m not sure if there’s anything that can really be done.” But it’s just…you know, saying them out loud, I think, really helps them from being very isolating and getting that conversation started sooner.

I think a lot of people that I’ve talked to sort of either didn’t ask a lot of things because they didn’t think they were relevant, even though they were experiencing them in their body or they didn’t think they were acute enough to be of a concern, when it’s really, you know, you guys are on this journey together. You’re seeing each other all the time. It’s so important if you’re like, “Hey, I’m still having this strange pain. What do you think about it? Is there anything I could do?” And I think that’s something that you and I have talked about, that, again, you might see… I don’t know, how many people do you see in a day, would you say, for appointments, like, just regular appointments?

Dr. Fox: Somewhere between 8 and 40.

Dr. Grillo: Okay. So it really depends on the day.

Dr. Fox: Yeah, it depends if they’re hour visits or 15-minute visits. Yeah.

Dr. Grillo: Right. And I think it’s always good for a patient to remember that even if you’ve seen 8 people that day or they are your 39th patient, if you have questions, you know, making sure you can bring them or, like you said, maybe there is…you know, through the portal or through emailing, being like, “These are just some things I wanted to make sure to cover with you,” that you genuinely want to know, right? And so I think that’s another important thing for anyone on the journey, is knowing what you need, just like what you would need in any other situation.

This is an extremely personal, unique experience where there’s also so much information to help you, guide you on this incredibly unique personal experience to sort of help you along. And it’s really just what do you need and letting providers see who you are and meet you where they’re at. If you have patients that come in that seem very cut and dried, “Okay, I’m here. See you in a few months,” that kind of gives you a glimpse of who they are. If you see other people that seem very emotional, you know, notice that and, you know, what more might they need, maybe sort of giving them some prompts of, like, you know, “We could talk about this now. Is that something you’ve been thinking about?” Some people are totally overwhelmed. They don’t know what they need to know. And so what I would say would be, like, the main theme is meeting people where they’re at in this very unique journey.

Dr. Fox: Amazing. Thank you so much for coming in.

Dr. Grillo: Oh, my gosh. Thank you for having me. This was [crosstalk 00:39:13].

Dr. Fox: This was, yeah, as awesome as expected.

Dr. Grillo: We could talk so much more.

Dr. Fox: Yeah. We’ll have you back.

Dr. Grillo: Okay, great.

Dr. Fox: It’s all good. We’re local. No, really, thank you for coming in. This was terrific and really enlightening and insightful. And I appreciate it. I’m sure listeners appreciate it, too. But I know that, I mean, even if they don’t, I do.

Dr. Grillo: Well, listen, when I was pregnant with both of my pregnancies, I listened to this podcast. Yes. I think it’s so helpful for anyone who’s listening. If you have questions, those are valid. Thoughts and concerns, feelings are valid. This is really a time to really own that experience as you’re about to venture into this great unknown and a wonderful experience, and this team is here for you 100%.

Dr. Fox: 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, 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.