June 28, 2024 • 32 mins
Ever wondered how to navigate the uncertain terrain of pregnancy complications with confidence? Join us as we welcome Professor Emily Oster, an economist from Brown University and a celebrated author, who brings her latest data-driven insights to the table. In this episode, we dive deep into her new book, "The Unexpected: Navigating Pregnancy During and After Complications," Co-authored with Dr. Nathan Fox, an OBGYN. The book shares personal experiences and valuable advice on preparing for medical consultations and understanding past pregnancy challenges. Emily's journey into the world of parenting data is not just enlightening but also empowering for expectant mothers aiming to make informed decisions.
Listen as we discuss communicating risks and probabilities effectively, and transforming abstract data into meaningful, understandable information for patients. We also explore how USA and UK maternity care models differ. This episode is a treasure trove of insights for expectant mothers, healthcare professionals, and anyone passionate about enhancing maternity care.
Want to know more?
https://profilebooks.com/work/the-unexpected/
https://parentdata.org/
Instagram @profemilyoster
Thank you all for listening, My name is Florence Wilcock I am an NHS doctor working as an obstetrician, specialising in the care of both mother and baby during pregnancy and birth. If you have enjoyed my podcast please do continue to subscribe, rate, review and recommend my podcast on your podcast provider.
If you have found my ideas helpful whilst expecting your baby or working in maternity care please spread the word & help theobspod reach other parents or staff who may be interested in exploring all things pregnancy and birth.
Keeping my podcast running without ads or sponsorship is important to me. I want to keep it free and accessible to all but it costs me a small amount each month to maintain and keep the episodes live, if you wish to contribute anything to support theobspod please head over to my buy me a coffee page https://bmc.link/theobspodV any donation very gratefully received however small.
Its easy to explore my back catalogue of episodes here https://padlet.com/WhoseShoes/TheObsPod I have a wide range of topics that may help you make decisions for yourself and your baby during pregnancy as well as some more reflective episodes on life as a doctor.
If you want to get in touch to suggest topics, I love to hear your thoughts and ideas. You can find out more about me on Twitter @FWmaternity & @TheObsPod as well as Instagram @TheObsPod and e...
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Florence (00:00):
Hello, my name's Florence.
Welcome to the OBSpod.
I'm an NHS obstetrician hopingto share some thoughts and
experiences about my workinglife.
Perhaps you enjoy Call theMidwife.
Maybe birth fascinates you, oryou're simply curious about what
exactly an obstetrician is.
You might be pregnant andpreparing for birth.
(00:21):
Perhaps you work in maternityand want to know what makes your
obstetric colleagues tick, oryou want some fresh ideas and
inspiration.
Whichever of these is the caseand, for that matter, anyone
else that's interested, the OBSpod is for you.
(00:55):
Episode 172 the unexpected achat with professor emily oster.
Today I am joined by emilyoster, or professor emily oster,
who is a professor of economicsat Brown University in the US,
and she's here today becauseshe's author of several books
and has a lot of interest indata and particularly parenting
(01:16):
data, and she has a websitecalled Parent Data and her own
podcast.
And we're here today to talk abit about her latest book, the
Unexpected Navigating Pregnancy,during and After Complications,
which someone kindly sent to meto have a little read of.
So, emily, welcome to the OBSpod.
Emily (01:37):
Thank you so much for having me.
I'm delighted to be here.
Florence (01:40):
Would you like to tell my audience a little bit about
yourself, because I do have someaudience in all sorts of places
, but I'm not sure how many Ihave in the States and they may
or may not have come across you.
Emily (01:53):
Sure, so, as you said, I'm an economist.
I'm a professor at BrownUniversity, but I do most of my
work these days translating datafor pregnant women and for
parents.
I have four books.
My first book, expecting Better, is about pregnancy.
I have two books aboutparenting, cribsheet and the
(02:14):
Family Farm, and then I havethis new book which is about
pregnancy complications, calledthe Unexpected, and I run a
website called Parent Data whichhas newsletters and resources
for parents who like to makedecisions with data, which is my
academic and expertise and myfirst love.
Florence (02:34):
So how did you get into the idea of data for
parenting or pregnancy?
Emily (02:41):
I got pregnant is the short answer.
No-transcript for myself, andthat's the.
(03:17):
That's the origin of the books.
Florence (03:19):
Excellent and the unexpected, talking about
pregnancy complications.
Why did you decide to writethat?
Because that's an unusual kindof topic to go with.
Emily (03:38):
So I wrote Expecting Better, which is my first book
on pregnancy, about a decade ago, and since then I have had many
, many conversations with peopleabout their pregnancies, and
some of those are like thanks somuch for suggesting I can have
sushi.
But a lot of thoseconversations were about you
know, this thing happened in myfirst pregnancy I had a
(03:58):
miscarriage, I had preterm birth, I had preeclampsia, and I want
to know is it going to happenagain and what can I do about it
?
And so this book was one that Ifelt I wanted to give to many
of the readers who had asked methose questions over time.
And it isn't a book that I sawout there, it isn't a kind of
resource that seemed to beavailable, and although I've
(04:21):
said many times, I hope it is abook that people will not have
have to read, I would like it tobe there when they do need to
read it.
Florence (04:28):
Yeah, I liked in the book you talked a bit about
helping people with their futurepregnancies but also being able
to process and accept pastpregnancy events, and that's
something I see a lot as anobstetrician that perhaps people
turn up in my antenatal clinicpregnant, having not necessarily
(04:54):
resolved or understood what'shappened to them before.
Emily (04:59):
Yeah, so in I mean, these complications are.
They're complicated in manycases, and one of the themes
that we heard both before andthen after writing the book was
people who said you read yourbook.
I didn't understand what thatwas Like.
(05:26):
I was just told this is whathappened, but I really had no
idea why it might've happened orwould it happen again, or even
what what had occurred, and sosome of this book is about
helping people understand whathappened and then helping them
have a conversation with theirdoctor about what does this mean
for me going forward?
Because actually a lot of thebook is about facilitating those
(05:49):
conversations and trying tohelp people get to a place where
they feel heard and understoodand like they're making choices
that work for them that's why Ithought it'd be really great to
have a conversation, because Ido a lot of work on trying to
(06:10):
improve women's experience ofmaternity care.
Florence (06:11):
It's not just about did you have a caesarean or did
you have a assisted vaginalbirth or what happened
afterwards.
It's about how did you feelabout it and what are the
memories you have of it and alot of psychological side of
things.
And a lot of what I try and dowith this podcast is try and
(06:33):
explain some complications orproblems in a way that I might
do if a woman was sat in frontof me, trying to make it a bit
more intelligible and get themto understand what's going on.
So I felt like your book kindof really fitted with the work
I'm trying to do.
(06:53):
I like the idea of reallypreparing for your conversation
with your doctor or in the UKthat would possibly be also with
midwives which come on to andnot necessarily as common in the
States.
But tell me a bit about why youthink that kind of preparation
(07:16):
is so important.
Emily (07:19):
One issue is that our time with our providers is quite
limited, and so I often feel,you know, if you had two hours
to process something with yourdoctor, maybe you wouldn't need
so much of a script and youwouldn't need to be so prepared,
because you could just starttalking and you would get there
but and your doctor would havetime to explain.
(07:40):
Okay, here's what happened here, you know.
But in the reality, where timeis pretty limited, it can be
very effective for people tohave gotten enough understanding
that they know what to ask andthat they know that the
conversation they're having isin service of answering
questions that they need fordecisions.
Right, it's so easy to startthese conversations with like
(08:03):
why did this happen to me?
So one of the things we talkabout in the book is that
question why did this happen tome?
Where often people will come inwith just like I want to
understand why did a bad thinghappen to me?
And like the world can't answerthat usually, and your doctor
probably can't either.
But, there's a way to frame that, to say, well, why did this
happen to me?
Are there things in my riskhistory?
(08:25):
Are there things in the sort ofmedical circumstances that we
should think about?
For me, going forward questionand turn it from a kind of
existential, unanswerablequestion that's about basically
grief into a question that'sabout how can I move forward in
a way that is going to give methe best chance of a good
(08:47):
outcome for the next pregnancyyeah, I liked the fact that you
you actually wrote about havinga script to have the
conversation, and sometimes Ihave women that turn up with a
long list of questions and andthat's great.
Florence (09:03):
Actually, I really like that is it great it?
is because, I mean, sometimesit's a little bit concerning
because, like you say, I've gota time constraint and I look at
the, the piece of paper, and I'ma bit like whoa, but it means
they're gonna get from me whatthey actually need and what they
actually are interested inknowing.
(09:25):
Because when you have aconversation you never know.
You make an assumption aboutwhat that person wants to know
and what you need to tell them,but they may have something
totally different on theiragenda.
So I do find it helpful whenpeople come with their questions
.
Emily (09:42):
I also think, just to add to that this situation can be
quite scary for people, and soit's a hard environment to
remember your questions.
Yes, you come in.
It's an expert.
There's a little bit of a powerimbalance.
You're nervous, you're worriedabout what someone's going to
say.
To just imagine that you willremember all of your questions
(10:05):
is unrealistic, and I think somany of us have had this
experience of leaving and beinglike ah, I meant to ask this and
it's right back in my head assoon as I'm out of the room.
So writing things down isalways a good plan.
Florence (10:16):
I liked your script because it was quite structured.
Things down is always yeah.
I liked your script because itwas quite structured and I'm I'm
different from you.
I am not a data structureanalytical person, so to have
some kind of key anchors so youtalked about the four f's and
the four key questions kind ofmade sense to me and I liked
(10:37):
what you said.
I'm flicking through your bookhere because you said something
about the first question offraming the question.
Yeah, and it wasn't quite assimple as what.
Why did this happen?
Framing the question it wasactually a bit more complicated
(10:57):
than that in terms of you'vewritten about clarifying
priorities and framing thequestion about am I going to
have a pregnancy now or am Igoing to have a pregnancy in
three months or a year orwhatever?
That it's a different questionand I hadn't thought about it
like that.
And that's I quite like thatidea because sometimes I see
(11:18):
people postnatally and they askme when should I think about
having another baby?
Should I think about havinganother baby?
Is it sensible for me to haveanother baby?
And actually that's something Icould relate to in saying, well
, yes, but maybe in two yearsrather than yes, now.
So I quite like the way youbreak that down.
Emily (11:38):
I think we have as, so this is a tool I use a lot when
I talk about almost anydecisions.
So I quite like the way youbreak that down.
I think we have as, so this isa tool I use a lot when I talk
about almost any decisions, andI think it comes up very clearly
here that when we are trying todecide about something hard, we
have a tendency to to not godeep enough into what are the
choices.
So we just say, like, should Ihave another baby or not is
(11:59):
actually not really a veryanswerable question, because it
it isn't really the full set ofchoices, it's not really the
thing you're choosing between.
It would be, you know, youcould ask should I have another
baby now, or should I thinkabout it again in a year?
Should I have it?
Like there are more concretethings and it's much easier to
move forward on getting theinformation you need.
If you've been clear at thisfirst step in what's the
(12:23):
question you want to answer, andeven when you come to your
doctor, you know, is thequestion like can I have another
pregnancy safely today or can Ihave another pregnancy safely
ever?
Florence (12:36):
Like those are sort of different questions and trying
to understand what you're reallywanting to answer can make
things more productive yeah, Iwanted to talk about how you
make data make sense to people,because so this book is
co-authored with Nate Dr NathanFox, who is an OBGYN in New York
(13:04):
, and, like him, I haveconversations every day about
the, the chance.
We tend to talk about chancerather than risk, now, the
chance of this versus the chanceof that, and and you know we
use figures like one in 200 orhalf a percent, or how you kind
(13:24):
of make data make sense topeople and relatable to their
situation.
Emily (13:33):
It's really hard and, in particular, making probabilities
understandable to people inways that are helpful for their
decisions is one of the I thinkis such a big challenge and it's
actually one of the things Nateand I talk the most about and
maybe disagree a little bitabout, in the sense that I think
for him, when he talks topatients, he thinks the kind of
(13:57):
most helpful thing is for peopleto understand sort of is this
like very unlikely to happenagain, reasonably likely to
happen again, very likely tohappen again?
And kind of getting morespecific than that is actually
not helpful, Whereas I alwayswant to be like well, is it 16%
or 18%?
And he's like as a patient, youknow why would you care, and so
(14:18):
we have a little bit of adifference there.
But I think there is a sense inwhich, you know, people have a
hard time understandingprobabilities and some of what I
like to do is try to frame theprobability inside something
that people would be morefamiliar with or would be more
tangible.
So the idea of you knowsomething happening one in 200
(14:40):
times Well, how does thatcompare to the risk of a car
accident?
Or if this, if you encounteredthis risk every day for how many
years would you expect beforeit happened once?
Right, so sometimes that'shelpful for people If you say
you know this is a risk in onein, you know 3,600, like.
(15:04):
Well, if you it happened everyday, you face the risk, it would
happen once every 10 years,Like.
But the thing is everybody's alittle different in what's
helpful for them in terms ofrisk numbers.
So often I'll try like sixdifferent things.
You know, here's one version,here's another version and
sometimes you'll be like oh, oh,okay, now I can understand, and
it's particularly good forsmall probabilities where we get
so focused on risks.
(15:25):
Once you've sort of told methat there's any risk of
something, it becomes very bigin my mind and sometimes we need
to back people out and say,okay, you know like, yes, that
could happen, but you know youalso could win the lottery, but
but you're not buying lotterytickets.
Florence (15:41):
Yes and so yeah, no.
That's a really good way ofthinking about it, because we
have this also, that sometimeswe say okay, with an older
mother, your chance ofstillbirth might be double if
you're in your forties comparedwith when you're in your 20s,
but the still overall risk mightbe six in a thousand versus
(16:05):
three in a thousand.
So it's still very unlikely.
But as soon as you say the wordstillbirth, everybody's
immediately you've lost.
Emily (16:13):
You say the word stillbirth and doubled in the
same sentence like you'vecompletely lost people exactly
yeah, so I think how to havethose data conversations is is
really challenging.
Florence (16:26):
I also like the way you were explaining different
uses of different data.
So the example of recurrencechance from like big, the
example of recurrence chancefrom like big lots of data,
(16:46):
registry type data and Isometimes feel as a doctor it's
almost like well, you can findout anything from that because
you've got right hundreds ofthousands of people.
Emily (16:54):
You've got everyone in, everyone in Scandinavia.
You know everything about themfor their whole lives.
You you can answer any questionabout recurrence.
Florence (17:02):
Yeah, so that kind of gives you your recurrence,
whereas whether somethingtreatment wise actually makes a
difference or doesn't make adifference, that kind of data is
not helpful.
You need much smaller andhopefully randomness controlled
trial data, smaller andhopefully randomness controlled
(17:24):
trial data.
But even that in pregnancy isoften really difficult because
people don't like to do trialson pregnant women nope.
Emily (17:28):
So yeah, and our our data on many of the questions, these
kind of causal questions, youknow, if I treated this
differently, if I did this,would the outcome be better?
A lot, lot of our data on thatis really poor because we don't
have trials, we don't haverandomized trials.
Even if we have data thatcompares groups who were treated
differently, it can be very,very difficult to know if that's
(17:50):
the way the thing you did totreat them or if it's just that
you know these groups weredifferent in other, in other
ways.
And so our the kind of firstpiece about recurrence.
We often know way, way morethan the second piece about.
You know what to what to doabout it yeah, and I also like
the simplicity.
Florence (18:06):
You were talking about modifiable and non-modifiable
factors, because it's quitedifficult for me when a woman
comes and actually she's gotsomething that I, I and she
cannot modify, it'snon-modifiable.
We just have to deal with it,and that's quite a good way of
thinking about it.
That was new to me, whichsounds really stupid.
(18:27):
No, actually yeah, I find itinteresting to kind of
understand that mindset and it'slike, oh yeah, I deal with that
every day, but I've neverthought about breaking it down
into those two things.
Emily (18:38):
You don't think about it like that.
Florence (18:40):
Exactly so.
That's great.
I know lots of people get intouch with you.
Do you find people do want toknow detail?
Because I know when I listenedto your parent data podcast with
Dr Fox, you had a little bit ofa debate about whether people
want to know detail or not, andyou've also alluded to that,
(19:06):
because we don't want tooverwhelm people, do we?
But the people that get intouch, with you?
Emily (19:08):
do they generally want detail?
Yeah, I think, yeah.
So I think, in some ways, nateand I's disagreement about this
is because the people who writeto me they wanted to know the
details, like that's, that'swhat they're looking for here,
and I think for a typicalpatient, it's more varied.
There are definitely people whofind you know, really
detail-oriented data stuff to bein some ways reassuring, and
(19:28):
then there are people who sayyou know, like I want to know
what I can do, or I want to knowthings that are relevant for my
decisions, but I don't need toknow every tiny piece of data,
like that's not going to help me, and I I think one of the
challenges that I I don't envyyou, but one of the challenges
as an actual practitioner isfiguring out which, who, who is
(19:50):
what person like, which is theperson who really wants to know
every detail and that's going tomake them feel better, and
which is the person who is morecomfortable not being quite so
in the weeds.
Florence (20:02):
Yeah, and that often you can get a sense of that from
a conversation.
But also sometimes I just askpeople are you a really detailed
person or are you not a reallydetailed person?
What would you like me to tellyou?
And we've recently switched toelectronic consent forms for
cesarean birth and that's verydetailed and they have to click
(20:24):
through a whole series ofscreens.
And some women have said to meno, I don't want to read all
this.
Thanks, just tell me the keythings that I need to know.
I don't want to read all this.
Thanks.
Just tell me the key things thatI need to know.
I don't want to know there's asmall risk of, I don't know,
hysterectomy or you know,because that's absolutely
terrifying at a point whenyou're having a baby so you've
(20:47):
got to try and tailor it, butit's, it can be challenging, I
think it varies for many peopledepending on getting back to the
modifiable versus notmodifiable.
Emily (20:57):
Like the thing that's that's tough is kind of being
told like there's nothing youcan do about it.
It's like it's this risk, smallrisk of this terrible thing and
there's absolutely nothing youcan do about it.
Why do you tell me yeah, likewhat, you know like what.
And for some people it's likeyou know, I want to be prepared.
And for some people it's likeyou know, I want to be prepared,
I want to be able to kind ofput in my head like what would I
do with that?
But if I think, for many morepeople, even people who like
(21:18):
detail, sometimes it's like well, I wasn't good, that's not
action, it's not action oriented.
You're just trying to scare me.
Florence (21:26):
And that's comfortable , or it's that medical legal
thing of yeah, we just don'twant you to say that we didn't
tell you exactly right.
Emily (21:32):
You could grow horns.
It hasn't happened.
But you know we just want to be.
If you do grow them, it willnot be a result of us yeah, yeah
, I listened to your podcastwith Senator Samra Brouk about
doulas.
Florence (21:51):
Yeah, I absolutely loved it she's amazing.
I love, I love both of you yeah,I love both of you the passion
you had for doulas and theevidence for doulas, and so part
of me was kind of, oh my god,we don't pay for doulas on the
NHS, so we're behind.
But I did think well, but wehave midwifery led care, for
(22:17):
which there is lots of data, andI was interested because I
think you said in the book onlyabout eight percent of births
are midwifery care in the US atthe moment, and so I wondered if
that was something thatfrustrates you or that you kind
of feel the data is there forbut isn't happening yeah.
Emily (22:37):
So it's gone up a bit over the last, maybe even five
years and it's like edgingcloser to sort of 10 11, which
is good.
But I think that you're this isa piece that I think I and many
other people find frustrating,because we do have quite a bit
of evidence that the midwiferycare model is at least as good
(22:58):
and probably in many ways betterfor outcomes, for at least you
know, and OB is also an option,but isn't the default.
I think there are a lot ofpeople who think that that that
(23:21):
model should be where we aregoing here, and it's interesting
because it's the model is.
It's so in some wayssufficiently unusual that
people's perception of what thateven means in the US is quite
different.
So if you tell someone you knowI had a midwife, many people
(23:41):
the first thing they will thinkis like oh you had an
unmedicated birth in yourbathtub.
Like that.
Midwife and home birth are likethe same thing, even though you
know, 90% of midwife birthassisted births in the US are in
hospitals, so that is, in fact,the typical thing, but it's not
what people have in their head,and so I think we need a little
bit of a shift there, and insome ways, I think we're going
to get it, because not for goodreasons, but because of dearth
(24:07):
of obstetricians in a lot ofareas of the US, and so the
midwifery care model is going toend up being a default in a lot
of rural areas.
About 40% of US births are paidfor by Medicaid, which is the
government coverage for peoplewith lower incomes.
Medicaid likes to pay formidwives because they're cheaper
, and so my guess is we'll get apush just for those reasons.
(24:30):
I wish we would get a push forother reasons.
Yeah, and it's not.
I mean, nate and I have talkedabout this a lot like cause.
This isn't for everyone andit's not going to be for every
birth, but I had a midwife withmy second kid and I would
recommend it to anyone.
Florence (24:44):
Yeah, it should be an option.
I'm also interested in waterbirth, so I don't know if you.
You saw there's just been a bigstudy published um the pool
study, about I'm trying toremember how they call it um,
it's not that water birth isbetter, it's it's a double
negative, it's not worse, right?
Emily (25:06):
I remember there's like a worse, exactly not inferior,
kind of that's it?
Florence (25:10):
yes, and water birth is something there's.
There's a bit in the UK.
It's not as much as there couldbe and we want to improve it,
but is there much water birth inthe US or that's kind of?
Emily (25:24):
I mean, that is much more something that would happen
mostly at home or in a birthingcenter.
So actually I gave birth in abirthing center, in a hospital,
and there was a tub, but youcould not give birth in the tub,
right?
So when the baby was going tocome out, well, like at the
pushing phase, you had to getout of the tub, yes, which was
bad yeah, yeah, so I think wehaven't that.
Florence (25:45):
That's another thing that might come, because, yeah,
I went to this conference acouple of weeks ago and they
were midwives from Australia andthey said, well, obviously we
have 14 pools because we have 14birthing rooms and and we were
kind of sorry, you have one inevery room, you know we're,
(26:06):
we're very excited when we havea couple.
So, uh, I can see like they'reclearly one extreme and and the
US is where the other?
Emily (26:13):
yeah, yeah, yeah, I mean it's very.
There are a lot of veryinteresting conversations here
happening now about these, aboutthese issues, even in concert
with some of the discussionswe've had about our terrible
maternal mortality statistics,and you know how much of this is
.
People are not being heard andthe model that we're using for
(26:33):
birth care, you know, needs tobe fixed in some in some
deep-seated way yeah, I thinkit's really interesting because
it's all the same problems, well, worldwide.
Florence (26:46):
I mean, I know, yes, your maternal mortality and
morbidity is worse than ours,but I don't know if you've heard
.
There have been multiplematernity scandals in the UK and
it's it's always about notlistening to women and them not
being heard.
I'm conscious we're about torun out of time.
(27:06):
I I think there's kind of two,two things.
One is I didn't know if therewas anything you wanted to ask
me as a UK obstetrician what doyou think?
Emily (27:17):
I do have question, which is you know a little bit maybe
from reading a book from sort ofhere, like what is the other
than the midwife, the midwiferymodel?
What is the biggest differencein pregnancy care?
Florence (27:32):
that's difficult because it is really the
midwifery model, I think.
The other thing might bescanning.
I think I think we're mostwomen will have a scan at 12
weeks and a scan at 20 weeks.
We won't routinely do thirdtrimester scanning.
(27:54):
We love scanning.
You can get you know you canhave like an ultrasound at the
mall yeah, exactly, people liketo go to the mall for
ultrasounds so I think I thinkthat's probably the other thing,
because you you talked a bitabout maternal fetal medicine
specialists and we do have those, but it more be you'd have your
(28:15):
pregnancy care with them if youwere complicated, rather than
go to them for a consultationand so on.
But yeah, I think I think that,and the midwifery led care, I
think we're a bit more low tech,maybe for a better word bit
less.
Emily (28:33):
I mean, it's sort of the same bit less medical.
Florence (28:35):
Yeah, exactly, yeah, yeah.
And finally, I try and end myepisodes with a zesty bit, a
kind of bit that you kind ofwant people to remember from the
conversation we've had, or toremember from, you know, your
book or anything else.
(28:55):
What would you, what would yousay your zesty bit might be?
Emily (29:01):
Oh my gosh, you know I this isn't zesty, but the thing
we just want people to get outof this book is that you're not
by yourself and that's not zesty, but it is.
It is really.
The message here is just you'renot, you're not alone, and I
think pregnancy complicationscan be really isolating and I
(29:22):
would like people to understandthat they're not doing it by
themselves.
Florence (29:27):
That is perfect, because I think what I mean by
zesty is, like the essence, thetiny little bit that you're
going to take away and not likea hot.
Emily (29:37):
It's not a, you don't mean like a hot take no, exactly
it has to be.
Florence (29:42):
It has to be yeah, and I think you're not alone, that
is.
That says it all.
I think that's a really greatplace to leave it.
Emily (29:50):
So thank you so much for coming on, so much it was such a
treat.
Florence (29:56):
So thank you so much for coming on so much.
It was such a treat.
I very much hope you found thisepisode of the obs pod
interesting.
If you have, it'd be fantasticif you could subscribe, rate and
review, on whatever platformyou find your podcasts, as well
as recommending the obs pod toanyone you think might find it
interesting.
There's also tons of episodesto explore in my back catalogue
(30:21):
from clinical topics, my careerand journey as an obstetrician
and life in the NHS moregenerally.
I'd like to assure women I carefor that I take confidentiality
very seriously and take greatcare not to use any patient
identifiable information unlessI have expressly asked the
(30:45):
permission of the personinvolved on that rare occasion
when it's been absolutelynecessary.
If you found this episodeinteresting and want to explore
the subject a little more deeply, don't forget to take a look at
the programme notes, where I'veattached some links.
(31:06):
If you want to get in touch tosuggest topics for future, you
can find me at TheObsPod, onTwitter and Instagram and you
can email me theobspod atgmailcom.
Finally, it's very important tome to keep TheObsPod free and
(31:30):
accessible to as many people aspossible.
Accessible to as many people aspossible, but it does cost me a
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So if you've enjoyed myepisodes and by chance, you do
have a tiny bit to spare, youcan now contribute to keep the
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(31:58):
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Don't feel under any obligation, but if you'd like to
contribute you now can.
Thank you for listening.
Hello, my name's Florence.
Welcome to the OBSpod.
I'm an NHS obstetrician hopingto share some thoughts and
experiences about my workinglife.
Perhaps you enjoy Call theMidwife.
Maybe birth fascinates you, oryou're simply curious about what
exactly an obstetrician is.
You might be pregnant andpreparing for birth.
(00:21):
Perhaps you work in maternityand want to know what makes your
obstetric colleagues tick, oryou want some fresh ideas and
inspiration.
Whichever of these is the caseand, for that matter, anyone
else that's interested, the OBSpod is for you.
(00:55):
Episode 172 the unexpected achat with professor emily oster.
Today I am joined by emilyoster, or professor emily oster,
who is a professor of economicsat Brown University in the US,
and she's here today becauseshe's author of several books
and has a lot of interest indata and particularly parenting
(01:16):
data, and she has a websitecalled Parent Data and her own
podcast.
And we're here today to talk abit about her latest book, the
Unexpected Navigating Pregnancy,during and After Complications,
which someone kindly sent to meto have a little read of.
So, emily, welcome to the OBSpod.
Emily (01:37):
Thank you so much for having me.
I'm delighted to be here.
Florence (01:40):
Would you like to tell my audience a little bit about
yourself, because I do have someaudience in all sorts of places
, but I'm not sure how many Ihave in the States and they may
or may not have come across you.
Emily (01:53):
Sure, so, as you said, I'm an economist.
I'm a professor at BrownUniversity, but I do most of my
work these days translating datafor pregnant women and for
parents.
I have four books.
My first book, expecting Better, is about pregnancy.
I have two books aboutparenting, cribsheet and the
(02:14):
Family Farm, and then I havethis new book which is about
pregnancy complications, calledthe Unexpected, and I run a
website called Parent Data whichhas newsletters and resources
for parents who like to makedecisions with data, which is my
academic and expertise and myfirst love.
Florence (02:34):
So how did you get into the idea of data for
parenting or pregnancy?
Emily (02:41):
I got pregnant is the short answer.
No-transcript for myself, andthat's the.
(03:17):
That's the origin of the books.
Florence (03:19):
Excellent and the unexpected, talking about
pregnancy complications.
Why did you decide to writethat?
Because that's an unusual kindof topic to go with.
Emily (03:38):
So I wrote Expecting Better, which is my first book
on pregnancy, about a decade ago, and since then I have had many
, many conversations with peopleabout their pregnancies, and
some of those are like thanks somuch for suggesting I can have
sushi.
But a lot of thoseconversations were about you
know, this thing happened in myfirst pregnancy I had a
(03:58):
miscarriage, I had preterm birth, I had preeclampsia, and I want
to know is it going to happenagain and what can I do about it
?
And so this book was one that Ifelt I wanted to give to many
of the readers who had asked methose questions over time.
And it isn't a book that I sawout there, it isn't a kind of
resource that seemed to beavailable, and although I've
(04:21):
said many times, I hope it is abook that people will not have
have to read, I would like it tobe there when they do need to
read it.
Florence (04:28):
Yeah, I liked in the book you talked a bit about
helping people with their futurepregnancies but also being able
to process and accept pastpregnancy events, and that's
something I see a lot as anobstetrician that perhaps people
turn up in my antenatal clinicpregnant, having not necessarily
(04:54):
resolved or understood what'shappened to them before.
Emily (04:59):
Yeah, so in I mean, these complications are.
They're complicated in manycases, and one of the themes
that we heard both before andthen after writing the book was
people who said you read yourbook.
I didn't understand what thatwas Like.
(05:26):
I was just told this is whathappened, but I really had no
idea why it might've happened orwould it happen again, or even
what what had occurred, and sosome of this book is about
helping people understand whathappened and then helping them
have a conversation with theirdoctor about what does this mean
for me going forward?
Because actually a lot of thebook is about facilitating those
(05:49):
conversations and trying tohelp people get to a place where
they feel heard and understoodand like they're making choices
that work for them that's why Ithought it'd be really great to
have a conversation, because Ido a lot of work on trying to
(06:10):
improve women's experience ofmaternity care.
Florence (06:11):
It's not just about did you have a caesarean or did
you have a assisted vaginalbirth or what happened
afterwards.
It's about how did you feelabout it and what are the
memories you have of it and alot of psychological side of
things.
And a lot of what I try and dowith this podcast is try and
(06:33):
explain some complications orproblems in a way that I might
do if a woman was sat in frontof me, trying to make it a bit
more intelligible and get themto understand what's going on.
So I felt like your book kindof really fitted with the work
I'm trying to do.
(06:53):
I like the idea of reallypreparing for your conversation
with your doctor or in the UKthat would possibly be also with
midwives which come on to andnot necessarily as common in the
States.
But tell me a bit about why youthink that kind of preparation
(07:16):
is so important.
Emily (07:19):
One issue is that our time with our providers is quite
limited, and so I often feel,you know, if you had two hours
to process something with yourdoctor, maybe you wouldn't need
so much of a script and youwouldn't need to be so prepared,
because you could just starttalking and you would get there
but and your doctor would havetime to explain.
(07:40):
Okay, here's what happened here, you know.
But in the reality, where timeis pretty limited, it can be
very effective for people tohave gotten enough understanding
that they know what to ask andthat they know that the
conversation they're having isin service of answering
questions that they need fordecisions.
Right, it's so easy to startthese conversations with like
(08:03):
why did this happen to me?
So one of the things we talkabout in the book is that
question why did this happen tome?
Where often people will come inwith just like I want to
understand why did a bad thinghappen to me?
And like the world can't answerthat usually, and your doctor
probably can't either.
But, there's a way to frame that, to say, well, why did this
happen to me?
Are there things in my riskhistory?
(08:25):
Are there things in the sort ofmedical circumstances that we
should think about?
For me, going forward questionand turn it from a kind of
existential, unanswerablequestion that's about basically
grief into a question that'sabout how can I move forward in
a way that is going to give methe best chance of a good
(08:47):
outcome for the next pregnancyyeah, I liked the fact that you
you actually wrote about havinga script to have the
conversation, and sometimes Ihave women that turn up with a
long list of questions and andthat's great.
Florence (09:03):
Actually, I really like that is it great it?
is because, I mean, sometimesit's a little bit concerning
because, like you say, I've gota time constraint and I look at
the, the piece of paper, and I'ma bit like whoa, but it means
they're gonna get from me whatthey actually need and what they
actually are interested inknowing.
(09:25):
Because when you have aconversation you never know.
You make an assumption aboutwhat that person wants to know
and what you need to tell them,but they may have something
totally different on theiragenda.
So I do find it helpful whenpeople come with their questions
.
Emily (09:42):
I also think, just to add to that this situation can be
quite scary for people, and soit's a hard environment to
remember your questions.
Yes, you come in.
It's an expert.
There's a little bit of a powerimbalance.
You're nervous, you're worriedabout what someone's going to
say.
To just imagine that you willremember all of your questions
(10:05):
is unrealistic, and I think somany of us have had this
experience of leaving and beinglike ah, I meant to ask this and
it's right back in my head assoon as I'm out of the room.
So writing things down isalways a good plan.
Florence (10:16):
I liked your script because it was quite structured.
Things down is always yeah.
I liked your script because itwas quite structured and I'm I'm
different from you.
I am not a data structureanalytical person, so to have
some kind of key anchors so youtalked about the four f's and
the four key questions kind ofmade sense to me and I liked
(10:37):
what you said.
I'm flicking through your bookhere because you said something
about the first question offraming the question.
Yeah, and it wasn't quite assimple as what.
Why did this happen?
Framing the question it wasactually a bit more complicated
(10:57):
than that in terms of you'vewritten about clarifying
priorities and framing thequestion about am I going to
have a pregnancy now or am Igoing to have a pregnancy in
three months or a year orwhatever?
That it's a different questionand I hadn't thought about it
like that.
And that's I quite like thatidea because sometimes I see
(11:18):
people postnatally and they askme when should I think about
having another baby?
Should I think about havinganother baby?
Is it sensible for me to haveanother baby?
And actually that's something Icould relate to in saying, well
, yes, but maybe in two yearsrather than yes, now.
So I quite like the way youbreak that down.
Emily (11:38):
I think we have as, so this is a tool I use a lot when
I talk about almost anydecisions.
So I quite like the way youbreak that down.
I think we have as, so this isa tool I use a lot when I talk
about almost any decisions, andI think it comes up very clearly
here that when we are trying todecide about something hard, we
have a tendency to to not godeep enough into what are the
choices.
So we just say, like, should Ihave another baby or not is
(11:59):
actually not really a veryanswerable question, because it
it isn't really the full set ofchoices, it's not really the
thing you're choosing between.
It would be, you know, youcould ask should I have another
baby now, or should I thinkabout it again in a year?
Should I have it?
Like there are more concretethings and it's much easier to
move forward on getting theinformation you need.
If you've been clear at thisfirst step in what's the
(12:23):
question you want to answer, andeven when you come to your
doctor, you know, is thequestion like can I have another
pregnancy safely today or can Ihave another pregnancy safely
ever?
Florence (12:36):
Like those are sort of different questions and trying
to understand what you're reallywanting to answer can make
things more productive yeah, Iwanted to talk about how you
make data make sense to people,because so this book is
co-authored with Nate Dr NathanFox, who is an OBGYN in New York
(13:04):
, and, like him, I haveconversations every day about
the, the chance.
We tend to talk about chancerather than risk, now, the
chance of this versus the chanceof that, and and you know we
use figures like one in 200 orhalf a percent, or how you kind
(13:24):
of make data make sense topeople and relatable to their
situation.
Emily (13:33):
It's really hard and, in particular, making probabilities
understandable to people inways that are helpful for their
decisions is one of the I thinkis such a big challenge and it's
actually one of the things Nateand I talk the most about and
maybe disagree a little bitabout, in the sense that I think
for him, when he talks topatients, he thinks the kind of
(13:57):
most helpful thing is for peopleto understand sort of is this
like very unlikely to happenagain, reasonably likely to
happen again, very likely tohappen again?
And kind of getting morespecific than that is actually
not helpful, Whereas I alwayswant to be like well, is it 16%
or 18%?
And he's like as a patient, youknow why would you care, and so
(14:18):
we have a little bit of adifference there.
But I think there is a sense inwhich, you know, people have a
hard time understandingprobabilities and some of what I
like to do is try to frame theprobability inside something
that people would be morefamiliar with or would be more
tangible.
So the idea of you knowsomething happening one in 200
(14:40):
times Well, how does thatcompare to the risk of a car
accident?
Or if this, if you encounteredthis risk every day for how many
years would you expect beforeit happened once?
Right, so sometimes that'shelpful for people If you say
you know this is a risk in onein, you know 3,600, like.
(15:04):
Well, if you it happened everyday, you face the risk, it would
happen once every 10 years,Like.
But the thing is everybody's alittle different in what's
helpful for them in terms ofrisk numbers.
So often I'll try like sixdifferent things.
You know, here's one version,here's another version and
sometimes you'll be like oh, oh,okay, now I can understand, and
it's particularly good forsmall probabilities where we get
so focused on risks.
(15:25):
Once you've sort of told methat there's any risk of
something, it becomes very bigin my mind and sometimes we need
to back people out and say,okay, you know like, yes, that
could happen, but you know youalso could win the lottery, but
but you're not buying lotterytickets.
Florence (15:41):
Yes and so yeah, no.
That's a really good way ofthinking about it, because we
have this also, that sometimeswe say okay, with an older
mother, your chance ofstillbirth might be double if
you're in your forties comparedwith when you're in your 20s,
but the still overall risk mightbe six in a thousand versus
(16:05):
three in a thousand.
So it's still very unlikely.
But as soon as you say the wordstillbirth, everybody's
immediately you've lost.
Emily (16:13):
You say the word stillbirth and doubled in the
same sentence like you'vecompletely lost people exactly
yeah, so I think how to havethose data conversations is is
really challenging.
Florence (16:26):
I also like the way you were explaining different
uses of different data.
So the example of recurrencechance from like big, the
example of recurrence chancefrom like big lots of data,
(16:46):
registry type data and Isometimes feel as a doctor it's
almost like well, you can findout anything from that because
you've got right hundreds ofthousands of people.
Emily (16:54):
You've got everyone in, everyone in Scandinavia.
You know everything about themfor their whole lives.
You you can answer any questionabout recurrence.
Florence (17:02):
Yeah, so that kind of gives you your recurrence,
whereas whether somethingtreatment wise actually makes a
difference or doesn't make adifference, that kind of data is
not helpful.
You need much smaller andhopefully randomness controlled
trial data, smaller andhopefully randomness controlled
(17:24):
trial data.
But even that in pregnancy isoften really difficult because
people don't like to do trialson pregnant women nope.
Emily (17:28):
So yeah, and our our data on many of the questions, these
kind of causal questions, youknow, if I treated this
differently, if I did this,would the outcome be better?
A lot, lot of our data on thatis really poor because we don't
have trials, we don't haverandomized trials.
Even if we have data thatcompares groups who were treated
differently, it can be very,very difficult to know if that's
(17:50):
the way the thing you did totreat them or if it's just that
you know these groups weredifferent in other, in other
ways.
And so our the kind of firstpiece about recurrence.
We often know way, way morethan the second piece about.
You know what to what to doabout it yeah, and I also like
the simplicity.
Florence (18:06):
You were talking about modifiable and non-modifiable
factors, because it's quitedifficult for me when a woman
comes and actually she's gotsomething that I, I and she
cannot modify, it'snon-modifiable.
We just have to deal with it,and that's quite a good way of
thinking about it.
That was new to me, whichsounds really stupid.
(18:27):
No, actually yeah, I find itinteresting to kind of
understand that mindset and it'slike, oh yeah, I deal with that
every day, but I've neverthought about breaking it down
into those two things.
Emily (18:38):
You don't think about it like that.
Florence (18:40):
Exactly so.
That's great.
I know lots of people get intouch with you.
Do you find people do want toknow detail?
Because I know when I listenedto your parent data podcast with
Dr Fox, you had a little bit ofa debate about whether people
want to know detail or not, andyou've also alluded to that,
(19:06):
because we don't want tooverwhelm people, do we?
But the people that get intouch, with you?
Emily (19:08):
do they generally want detail?
Yeah, I think, yeah.
So I think, in some ways, nateand I's disagreement about this
is because the people who writeto me they wanted to know the
details, like that's, that'swhat they're looking for here,
and I think for a typicalpatient, it's more varied.
There are definitely people whofind you know, really
detail-oriented data stuff to bein some ways reassuring, and
(19:28):
then there are people who sayyou know, like I want to know
what I can do, or I want to knowthings that are relevant for my
decisions, but I don't need toknow every tiny piece of data,
like that's not going to help me, and I I think one of the
challenges that I I don't envyyou, but one of the challenges
as an actual practitioner isfiguring out which, who, who is
(19:50):
what person like, which is theperson who really wants to know
every detail and that's going tomake them feel better, and
which is the person who is morecomfortable not being quite so
in the weeds.
Florence (20:02):
Yeah, and that often you can get a sense of that from
a conversation.
But also sometimes I just askpeople are you a really detailed
person or are you not a reallydetailed person?
What would you like me to tellyou?
And we've recently switched toelectronic consent forms for
cesarean birth and that's verydetailed and they have to click
(20:24):
through a whole series ofscreens.
And some women have said to meno, I don't want to read all
this.
Thanks, just tell me the keythings that I need to know.
I don't want to read all this.
Thanks.
Just tell me the key things thatI need to know.
I don't want to know there's asmall risk of, I don't know,
hysterectomy or you know,because that's absolutely
terrifying at a point whenyou're having a baby so you've
(20:47):
got to try and tailor it, butit's, it can be challenging, I
think it varies for many peopledepending on getting back to the
modifiable versus notmodifiable.
Emily (20:57):
Like the thing that's that's tough is kind of being
told like there's nothing youcan do about it.
It's like it's this risk, smallrisk of this terrible thing and
there's absolutely nothing youcan do about it.
Why do you tell me yeah, likewhat, you know like what.
And for some people it's likeyou know, I want to be prepared.
And for some people it's likeyou know, I want to be prepared,
I want to be able to kind ofput in my head like what would I
do with that?
But if I think, for many morepeople, even people who like
(21:18):
detail, sometimes it's like well, I wasn't good, that's not
action, it's not action oriented.
You're just trying to scare me.
Florence (21:26):
And that's comfortable , or it's that medical legal
thing of yeah, we just don'twant you to say that we didn't
tell you exactly right.
Emily (21:32):
You could grow horns.
It hasn't happened.
But you know we just want to be.
If you do grow them, it willnot be a result of us yeah, yeah
, I listened to your podcastwith Senator Samra Brouk about
doulas.
Florence (21:51):
Yeah, I absolutely loved it she's amazing.
I love, I love both of you yeah,I love both of you the passion
you had for doulas and theevidence for doulas, and so part
of me was kind of, oh my god,we don't pay for doulas on the
NHS, so we're behind.
But I did think well, but wehave midwifery led care, for
(22:17):
which there is lots of data, andI was interested because I
think you said in the book onlyabout eight percent of births
are midwifery care in the US atthe moment, and so I wondered if
that was something thatfrustrates you or that you kind
of feel the data is there forbut isn't happening yeah.
Emily (22:37):
So it's gone up a bit over the last, maybe even five
years and it's like edgingcloser to sort of 10 11, which
is good.
But I think that you're this isa piece that I think I and many
other people find frustrating,because we do have quite a bit
of evidence that the midwiferycare model is at least as good
(22:58):
and probably in many ways betterfor outcomes, for at least you
know, and OB is also an option,but isn't the default.
I think there are a lot ofpeople who think that that that
(23:21):
model should be where we aregoing here, and it's interesting
because it's the model is.
It's so in some wayssufficiently unusual that
people's perception of what thateven means in the US is quite
different.
So if you tell someone you knowI had a midwife, many people
(23:41):
the first thing they will thinkis like oh you had an
unmedicated birth in yourbathtub.
Like that.
Midwife and home birth are likethe same thing, even though you
know, 90% of midwife birthassisted births in the US are in
hospitals, so that is, in fact,the typical thing, but it's not
what people have in their head,and so I think we need a little
bit of a shift there, and insome ways, I think we're going
to get it, because not for goodreasons, but because of dearth
(24:07):
of obstetricians in a lot ofareas of the US, and so the
midwifery care model is going toend up being a default in a lot
of rural areas.
About 40% of US births are paidfor by Medicaid, which is the
government coverage for peoplewith lower incomes.
Medicaid likes to pay formidwives because they're cheaper
, and so my guess is we'll get apush just for those reasons.
(24:30):
I wish we would get a push forother reasons.
Yeah, and it's not.
I mean, nate and I have talkedabout this a lot like cause.
This isn't for everyone andit's not going to be for every
birth, but I had a midwife withmy second kid and I would
recommend it to anyone.
Florence (24:44):
Yeah, it should be an option.
I'm also interested in waterbirth, so I don't know if you.
You saw there's just been a bigstudy published um the pool
study, about I'm trying toremember how they call it um,
it's not that water birth isbetter, it's it's a double
negative, it's not worse, right?
Emily (25:06):
I remember there's like a worse, exactly not inferior,
kind of that's it?
Florence (25:10):
yes, and water birth is something there's.
There's a bit in the UK.
It's not as much as there couldbe and we want to improve it,
but is there much water birth inthe US or that's kind of?
Emily (25:24):
I mean, that is much more something that would happen
mostly at home or in a birthingcenter.
So actually I gave birth in abirthing center, in a hospital,
and there was a tub, but youcould not give birth in the tub,
right?
So when the baby was going tocome out, well, like at the
pushing phase, you had to getout of the tub, yes, which was
bad yeah, yeah, so I think wehaven't that.
Florence (25:45):
That's another thing that might come, because, yeah,
I went to this conference acouple of weeks ago and they
were midwives from Australia andthey said, well, obviously we
have 14 pools because we have 14birthing rooms and and we were
kind of sorry, you have one inevery room, you know we're,
(26:06):
we're very excited when we havea couple.
So, uh, I can see like they'reclearly one extreme and and the
US is where the other?
Emily (26:13):
yeah, yeah, yeah, I mean it's very.
There are a lot of veryinteresting conversations here
happening now about these, aboutthese issues, even in concert
with some of the discussionswe've had about our terrible
maternal mortality statistics,and you know how much of this is
.
People are not being heard andthe model that we're using for
(26:33):
birth care, you know, needs tobe fixed in some in some
deep-seated way yeah, I thinkit's really interesting because
it's all the same problems, well, worldwide.
Florence (26:46):
I mean, I know, yes, your maternal mortality and
morbidity is worse than ours,but I don't know if you've heard
.
There have been multiplematernity scandals in the UK and
it's it's always about notlistening to women and them not
being heard.
I'm conscious we're about torun out of time.
(27:06):
I I think there's kind of two,two things.
One is I didn't know if therewas anything you wanted to ask
me as a UK obstetrician what doyou think?
Emily (27:17):
I do have question, which is you know a little bit maybe
from reading a book from sort ofhere, like what is the other
than the midwife, the midwiferymodel?
What is the biggest differencein pregnancy care?
Florence (27:32):
that's difficult because it is really the
midwifery model, I think.
The other thing might bescanning.
I think I think we're mostwomen will have a scan at 12
weeks and a scan at 20 weeks.
We won't routinely do thirdtrimester scanning.
(27:54):
We love scanning.
You can get you know you canhave like an ultrasound at the
mall yeah, exactly, people liketo go to the mall for
ultrasounds so I think I thinkthat's probably the other thing,
because you you talked a bitabout maternal fetal medicine
specialists and we do have those, but it more be you'd have your
(28:15):
pregnancy care with them if youwere complicated, rather than
go to them for a consultationand so on.
But yeah, I think I think that,and the midwifery led care, I
think we're a bit more low tech,maybe for a better word bit
less.
Emily (28:33):
I mean, it's sort of the same bit less medical.
Florence (28:35):
Yeah, exactly, yeah, yeah.
And finally, I try and end myepisodes with a zesty bit, a
kind of bit that you kind ofwant people to remember from the
conversation we've had, or toremember from, you know, your
book or anything else.
(28:55):
What would you, what would yousay your zesty bit might be?
Emily (29:01):
Oh my gosh, you know I this isn't zesty, but the thing
we just want people to get outof this book is that you're not
by yourself and that's not zesty, but it is.
It is really.
The message here is just you'renot, you're not alone, and I
think pregnancy complicationscan be really isolating and I
(29:22):
would like people to understandthat they're not doing it by
themselves.
Florence (29:27):
That is perfect, because I think what I mean by
zesty is, like the essence, thetiny little bit that you're
going to take away and not likea hot.
Emily (29:37):
It's not a, you don't mean like a hot take no, exactly
it has to be.
Florence (29:42):
It has to be yeah, and I think you're not alone, that
is.
That says it all.
I think that's a really greatplace to leave it.
Emily (29:50):
So thank you so much for coming on, so much it was such a
treat.
Florence (29:56):
So thank you so much for coming on so much.
It was such a treat.
I very much hope you found thisepisode of the obs pod
interesting.
If you have, it'd be fantasticif you could subscribe, rate and
review, on whatever platformyou find your podcasts, as well
as recommending the obs pod toanyone you think might find it
interesting.
There's also tons of episodesto explore in my back catalogue
(30:21):
from clinical topics, my careerand journey as an obstetrician
and life in the NHS moregenerally.
I'd like to assure women I carefor that I take confidentiality
very seriously and take greatcare not to use any patient
identifiable information unlessI have expressly asked the
(30:45):
permission of the personinvolved on that rare occasion
when it's been absolutelynecessary.
If you found this episodeinteresting and want to explore
the subject a little more deeply, don't forget to take a look at
the programme notes, where I'veattached some links.
(31:06):
If you want to get in touch tosuggest topics for future, you
can find me at TheObsPod, onTwitter and Instagram and you
can email me theobspod atgmailcom.
Finally, it's very important tome to keep TheObsPod free and
(31:30):
accessible to as many people aspossible.
Accessible to as many people aspossible, but it does cost me a
very small amount to keep itgoing and keep it live on the
internet.
So if you've enjoyed myepisodes and by chance, you do
have a tiny bit to spare, youcan now contribute to keep the
podcast going and keep it freevia my link going and keep it
(31:58):
free via my link to buy me acoffee.
Don't feel under any obligation, but if you'd like to
contribute you now can.
Thank you for listening.
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