Talk With A Doc

Talk With A Doc: Lifecycle: Health For A Better World
Episode 02: Healthy Beginnings: Continuing the Prenatal Journey

Dr. Emily Norland
I really want to empower the folks listening to this podcast. If you feel like you're not being heard, please bring that up with your OB doctor. That is something that we care deeply about. And communication is hard, and that feeling heard and being seen is a tremendously important part of that relationship, and that trust of being able to hear this is what I need from you. I didn't feel heard when at our last visit that gives us an opportunity to apologize. And also, course correct.
Jennifer Semenza
Hello and welcome back to talk with the docs Lifecycle health for. Better world. Our goal for this podcast series is to help you boost your know how so you can take charge of your healthcare and enjoy better outcomes and quality of life for all your healthcare needs. Providence.org to find general practitioners and specialists in your area and the latest in healthcare news. In our last episode, we covered good prenatal care. However, not every pregnancy goes smoothly.
According to the CDC, 10s of thousands of women in the US face severe pregnancy related complications each year. Knowing these risks helps you get timely medical advice and make informed health decisions for you and your baby. I'm your host, Jennifer Semenza. We're going to dive into some of the challenges you might face during pregnancy. Whether it's dealing with morning sickness or managing more serious issues, we've got you covered. Let's get started. Doctor Nolan, welcome back, and thanks for joining us again.
Dr. Emily Norland
Thank you so much. I really enjoy our conversations and I'm grateful for the chance to talk about something that I love.
Jennifer Semenza
When people think about pregnancy, they often imagine, you know, the joy and excitement, maybe a little bit of anxiety, especially if it's their first child. But there are some common pregnancy symptoms and challenges to be aware of and so let's start our conversation today by discussing some of the more common and less serious symptoms that are often associated with pre. What are some of those common symptoms?
Dr. Emily Norland
You know, pregnancy is very physically demanding and in a way that's really different. Know we go to exercise class for 60 minutes or less and then. Take a break. People run. For four hours and labor takes a lot longer than. And so I think it is really important to recognize that a lot of pregnancy just is not comfortable. And then you're being bombarded with unsolicited advice and information, and that can be a lot psychologically during a pretty vulnerable time.
And so I'm glad that we get a chance to just talk about that and reassure people that what they're going through is real and that there are things to do to comfort themselves and that it's not necessarily a sign of something that they're doing wrong or something bad that's happening. Nausea can rear its ugly head frequently throughout pregnancy and just kind of know. And adjusting oral intake to give the body a little bit of space can be really. And sometimes we bring back those first trimester remedies that are tried and true.
Sometimes we lean towards. A nausea medicine. Sometimes we focus on bowel motility with hydration and soluble fiber or prunes. Grandma's remedy was apricots and prune juice. And then my own doctor recommended prune juice and apple juice. And who? I can tell you that that works like a charm. Wow, headaches can be common in pregnancy, and sometimes that's because the hormones of pregnancy are opening up those blood vessels.
And so, sometimes a little whiff of caffeine can help with that. Know sometimes. We're dehydrated, and so, you know, a little Tylenol every now and again. A nap can be tremendously beneficial or headaches. And then there's. Lot of like aches and pains as the body is adjusting to a baby that's growing bigger and a uterus that's growing bigger and the center of gravity is getting lower. And things like massage, a swim, a bath, some gentle walking, some stretching or occasional Tylenol, or lots of pillows in the bed so that your body is supported and held while you rest. Those things can really help.
It's a time where powering through and just pushing on, which is sort of what modern life demands of us, that doesn't always go along with those common symptoms getting better.
Jennifer Semenza
Sometimes it is about taking break. I imagine is it.
Dr. Emily Norland
Sometimes it's about giving the body space to just ask for what it needs and then responding to that, and that's good practice for when the baby's on the outside.
Jennifer Semenza
Yeah. Can you talk us through some of the medications that might be available for those or home remedies that you might recommend for your patients?
Dr. Emily Norland
Yeah. So for. Nausea. We talked about ginger tea. Bands for headache. Rubbing this pressure point in between the web of the thumb and first finger. Be helpful. A little whiff of caffeine, sometimes hydration. For the aches and pains of pregnancy, this is something where exercise can be profoundly beneficial, because if our muscles are strong, they can help our skeleton be more stable.
So exercise can be tremendously beneficial, and that also can lead to a shorter, faster labor, which is great. Sometimes for heartburn, sometimes eating some fatty food can make it better. Sometimes to make it worse, sometimes some water can make it better, sometimes make. Worse, that's a really. That's one where trial and error is just the best, but the over counter antacids are safe to take with the guidance of the OB provider.
Jennifer Semenza
The old wives tale that says that heartburn is a sign that you are. Baby is going to have a lot of hair and I have learned from personal experience that is, that is actually not the case. Grandson was born with an amazing head of hair and ended up with two haircuts by his 1st birthday.
Dr. Emily Norland
Uh.
Jennifer Semenza
Oh my gosh. My daughter had not one width of heartburn the entire pregnancy.
Dr. Emily Norland
Oh my gosh, that's fantastic. I would say that's one of our most common. Points of discussion as we're watching the baby, you know, watching the baby crown. Oftentimes family members will be. Is there hair you had? I mean it's.
Jennifer Semenza
It's not actually related, yeah.
Dr. Emily Norland
I love those. But yeah, true, true and unrelated.
Jennifer Semenza
So about those seemingly minor symptoms. Can they be a precursor to something more serious?
Dr. Emily Norland
Sometimes they can't be, sometimes they can be. This is where. Trusting our bodies and that great relationship between a patient and their OB provider can come in really handy because the OB provider can help patients. Kids make those important distinctions with clarifying questions and things like that. Yeah, headaches can often times be very, very common. But some headaches, especially a new headache that's more severe. Doesn't get better with Tylenol or is associated with changes in what we see in our field of view. Flashy lights that can be a sign of high blood pressure and pregnancy, or even preeclampsia.
Jennifer Semenza
Oh wow. And talk with us a little bit. Mood.
Dr. Emily Norland
Sure. Yeah. That's a great question.
Jennifer Semenza
When should we be?
Dr. Emily Norland
Pregnancy is a time of great change and great vulnerability. It is normal and appropriate and psychologically intact to have. Emotional responses to that and mood swings are typically just that. A swing of. Mood back and forth. That's relatively self limited, happens pretty quickly, resolves pretty quickly and when it's a cause for humor, kindness and doesn't really impact relationships or one's ability to function. You know that can be super normal. But if a patient, or if their family are noticing prolonged change in mood.
Dr. Emily Norland
That seems to be really impacting somebody's ability to do what they need to do, take care of themselves or is impacting the world around them, especially if that's lasting for more than a few days or a week or two. That's something to bring up and talk.
Jennifer Semenza
Yeah. And I imagine that probably keeping a pregnancy journal to kind of monitor some of those. Symptoms. It might be a really good tool for women to have to take with her to her providers. Right, it can be.
Dr. Emily Norland
You know some people you know do really well with that and like to write stuff down and keep track, you know, and whether that's a notebook or a list on their phone or. Text messages to themselves or to their partner, or maybe a my chart message to their provider before their visit? Can be really great. Not everybody has access or bandwidth for that. During pregnancy, and so I don't want anybody to feel concerned. Not doing a good job if. A journal or something like that doesn't work for them, but I'm fascinated by stories. I would love for more women to tell their story of what they go through. Pregnancy so that we get those experiences out there because they're really powerful.
Jennifer Semenza
I want to transition a little bit about. You know more serious pregnancy. Issues and concerns and of course we don't want to frighten any expectant people or women who are looking to get pregnant. There's a few more serious health conditions to talk about with this one. So there's a small number of people might experience other symptoms. What are some of the ones? Keep an eye out for.
Dr. Emily Norland
That's a really big question. I think that if ever somebody has a sense in their body that something. Not quite right. It's important to just sort of pause and take that in and try to identify what that is. Pregnant people will notice at every visit that we always ask about bleeding, leaking fluid contractions or cramping pelvic pain. And then after about 2022 weeks or so, we asked about how the baby's moving. And so certainly if any of those things is going on, we definitely want people to reach out to their provider and some of the other things are the same things that we watch out for outside of pregnancy.
If we feel pain or burning when we go to the bathroom and we pee, pain with urination can be a sign of a bladder infection. That's an important thing. To keep them. Mind and to address and treat in pregnancy if there are signs of a vaginal infection, abnormal discharge that doesn't smell good. Burns or itches? That's something that we can and should take care of during pregnancy. And I think a lot of people are concerned that if they raise those concerns with their doctor, that their doctors, they then provide medication. And there's legitimate concern about whether that medication is safe in pregnancy.
You know, if an OB provider is encouraging their patient to take a medication, that medication is something that we know about that we use commonly is safe in pregnancy. And also we're balancing that with the risk of not treating that thing. Whether it's a bladder infection or a vaginal infection in pregnancy there. Are often risks of not addressing a concern. So as the OB provider we can really walk patients through that rationale and that thought process and that's important that that's a partnership.
Jennifer Semenza
I know that there's a few specific health concerns that are really common within pregnancy. I'd love to ask you about each one and if you can just give us a kind of a brief overview of what it is and maybe what people should look for. Let's talk about gestational. What is that and and why is that a concern for some people?
Dr. Emily Norland
Gestational diabetes is a state in the body where the placenta. Makes hormones that cause our body to be more resistant to our own insulin, which is the hormone that keeps blood sugar in a normal range. And it's a condition that happens in pregnancy, typically goes away after pregnancy, and we have to screen for it because many times it does not present with symptoms.
So there's not a lot to look for. What we do is we do a blood test after. Drinking a sugar drink? We do a blood test to test the body's ability to bring. Blood sugar back into the normal range, and if that screening test is abnormal. Then we do a deeper dive with a confirmatory blood test, and if that test is not within the normal range, then we make the diagnosis of gestational diabetes, which is state of high blood sugar. And the first part is to meet with a dietician to talk about nutrition, and many times with some slight changes to what people are eating, how much and when. As well as changes and increases in activity many times we can with those changes bring blood sugars back into the normal range.
Occasionally medication is needed, but it's really important to recognize and treat gestational diabetes. Because if it's untreated, the baby can be big, which can increase the risk. C-section. But then also the baby can have trouble. Maintaining a normal level of blood sugar of sugar in the blood after delivery, and potentially there might be some metabolic challenges for the baby down the road. The good news is, if we recognize it and treat it. Those complications are much, much less likely.
Jennifer Semenza
Let's also. About hypertension and high blood pressure during pregnancy. That something to be concerned about.
Dr. Emily Norland
Yes, that's something to be concerned about. Can also be very sneaky. This is where that regular prenatal care just has profound benefits in terms of making pregnancy as safe as possible and pregnancy. Blood pressure can be elevated and sometimes people. Feel. Sometimes people have headaches or see things in their vision that they're not used to. Other times, people will feel very normal when their blood pressure is very high. And untreated high blood pressure can cause damage to the eyes and kidneys and liver, similar to untreated high blood pressure outside of pregnancy. Sometimes in pregnancy, high blood pressure can lead to preeclampsia, or sometimes preeclampsia, can develop on its own.
Jennifer Semenza
Right. And what is preeclampsia?
Dr. Emily Norland
Preeclampsia is a condition in pregnancy that can involve high blood pressure but also can impact other parts of the body as well the brain, the liver, the kidneys, the blood vessels and just like high blood pressure. It can sometimes make people feel very bad, but other times it can be present and not have any signs. At all. But I don't want patients to be afraid. Preeclampsia is something that we read about a lot in the news, for good reason. It can cause a lot of problems if it's unrecognized, but preeclampsia, when identified and treated can result. In a. Delivery both for mom and for baby.
Jennifer Semenza
That's great information. Thank you.
Dr. Emily Norland
You're welcome.
Jennifer Semenza
So for people who might have pre-existing conditions like hypertension or diabetes or other conditions that might complicate pregnancy, what precautions can be taken for?
Dr. Emily Norland
Oh, thank you for that question, because I think often times those patients are really afraid. And the. News is that obstetricians are really well equipped to help patients with this. My best advice is for folks with hypertension before pregnancy or diabetes before pregnancy. Is just get those conditions in tip top shape where. They're working really closely with their primary provider or their OB GYN so that their blood pressures are normal. Whether or not that takes medication, if it takes medication, don't worry, having well managed hypertension. Being on meds is much better than uncontrolled high blood pressure in terms of. For mom and baby.
Same thing is true for diabetes. If someone has diabetes, having their blood sugars in a really good range and their average three-month blood sugar hemoglobin A1C normal. Is a great place to start pregnancy. Those patients can look forward to some extra visits and a little bit of fetal monitoring in the third trimester. But all of that is just to really take the best care of patients that we can and make sure that mom and baby are both. Safe as possible.
Jennifer Semenza
Absolutely. What guidance would you offer to someone who has preexisting conditions that could endanger their life or the baby's life if they became pregnant?
Dr. Emily Norland
I think that planning a pregnancy is a deeply impactful choice. That can result in a safe and healthy pregnancy, and I think if someone is in reproductive age, asking themselves, do I want to be pregnant in the next 12 months, starting with that prenatal vitamin and next with? Some contraception and a visit to their doctor so that they can plan the safest pregnancy. Is just magical, oftentimes a safe and healthy pregnancy is possible. Might not be a low risk pregnancy. It might have some more visits. Some more tasks, but a safe pregnancy is usually possible.
Jennifer Semenza
That's great news. Really good news. And I know that No2 pregnancies are the same. Having had two children, I can tell you that's definitely true. Is it possible to experience different issues with each pregnancy and why is that?
Dr. Emily Norland
My mom would say the same thing. Her pregnancies with me and my sister were very similar. Then our brother, who's 11 years younger with me, that was a different experience altogether. Or it's part of being. Our bodies are changing all day, every day. Whether we're pregnant or not and things like our fitness, our weight.
Whether we've been pregnant or not before, all of those things can impact and that's one of the amazing, you know, oral traditions of obstetrics is those stories from one person to another. One woman to another about, you know, their own pregnancy history, whether it's the same or it's different. But we know now that DNA from babies travels and persists in Women�s bloodstreams for years after a pregnancy is over. So I think there's more to come on. You know how pregnancy impacts our body. It's just so exciting.
Jennifer Semenza
Yeah, I wanna move on to screenings to to really help people understand why certain tests are important to both the health of the the pregnant person and the baby. So what are the essential tests and screenings that people should have, and why are they so important? And can you break those down? Trimester flash.
Dr. Emily Norland
Sure. In the first trimester, at the first prenatal visit, they'll be a lot of blood drawn, some urine taken, and sometimes an ultrasound to make sure we know where the pregnancy is developing. We want that pregnancy to be in the uterus and. About. As big as we think it should be based on how far along somebody should be.
First trimester we're looking at blood type blood counts to screen for. We're doing tests for infections and we're testing urine for protein and also for infection in some ways to set the stage and also to identify conditions like anemia that might be present but not showing. Any symptoms and identifying and treating things in pregnancy results in a safer pregnancy for both mom and for baby. Also in the first trimester now, some patients will consider whether or not to do blood tests or and or ultrasound to test for the possibility of increased risk of genetic or chromosome problems with the baby. This is a deeply personal decision. That is something that patients and couples should discuss with their OB provider to determine if that's the right choice for them or not.
And fortunately. We you know most insurances now are covering these tests regardless of age. But that is something that someone might consider for some people, increased risk of a genetic problem with their baby would impact their choice to stay pregnant or not. For others, they would stay pregnant. Matter. But that would help them prepare for other people. That information would actually be detrimental and those patients probably should not choose to get some of those screening.
There is sometimes a second ultrasound in the first trimester to look at the early body parts of the fetus, and the little spot on the back of the baby's neck. For those genetic tests that I discussed. In the second trimester. About 20/21/22 weeks is typically when a detailed ultrasound that looks at all the baby's body parts, the brain, the spinal cord, the bones, the heart, the intestines, the placenta, the cervix. The uterus is undertaken, that takes about 90 minutes. And that tells us a lot of really important information. And whereas the placenta is it over the cervix. If it's over the cervix, we. Need to know that that's called placenta previa, and we make some modifications in prenatal care to follow that really, really closely.
And if the placenta stays over the cervix, the baby can't go through the placenta. And so that baby needs to be born by C-section. But sometimes that placenta, as the uterus grows, will migrate away from the placenta, from the cervix, rather and then a vaginal delivery is possible. But it's really important to know where that placenta. Is.
At the end of the second trimester and the beginning of the third trimester, we screened for gestational diabetes. We rescreened for an infection that's increasingly common in the United States called syphilis, and we also. Rescreened for anemia because some patients might not be anemic at the beginning of pregnancy, but the demands of growing an additional human might cause anemia. And this is a great opportunity to intervene and start iron supplementation if it's necessary. In the 3rd trimester, right about 35,36, or 37 weeks.
We would screen for a very common colonization, not infection, but colonization of a bacteria that is common in humans called group A Strep, GBS, and the reason why we screen pregnant women for that. The presence of this bacteria in the birth canal. Is GBS is an uncommon cause of a very bad infection for babies, and we learned through studying this in populations of people that if we screened pregnant women and gave pregnant women who are colonized.
With Group B strep, antibiotics and labor it drastically reduced the chances that this. Severe Group B strep infection happen for babies, and so that's a very, very common practice. And then some patients we talked earlier in the episode about patients with preexisting conditions or who develop things like gestational diabetes. Or hypertension and pregnancy. They might also get extra listens to the baby's heartbeat called non stress tests. NS. And that's a way to do some extra checking. On the baby.
Jennifer Semenza
That is great. And boy, that's certainly an education.
Dr. Emily Norland
You're welcome.
Jennifer Semenza
So thank you. This is talk of the Doc: Lifecycle, and I'm speaking with Doctor Emily Norland, a generalist obstetrician gynecologist and chief of the OB GYN department at the First Hill campus of Swedish Medical Center in Seattle, and we're discussing good prenatal care and how to best handle some of. More serious complications that sometimes occur during pregnancy.
We've been discussing kind of the essential physical healthcare, but what about mental health care? We know that most people are familiar with postpartum depression, but what about depression during pregnancy? Haven't we talked about as much?
Dr. Emily Norland
Yeah, that's a really, really, really good question. And depression in pregnancy is really, really common, even up to 27% of women in the United States will struggle with a mental health condition and in pregnancy. Potentially one in five women might have a mental health challenge, and so I say that not again, not to make people afraid, but just to let people know that you are not alone. But also that we're here to help support you through whatever it is that you're going through.
And depression can look like a lot of different things in pregnancy there can be. Behavior changes sometimes people. Really feel low and slow. Other times people feel pressured and activated. There can be emotional changes. Sometimes people feel sad, angry. Sometimes their emotions are all over the place. There can be physical changes. People can have no energy and sleep a ton. People will have trouble sleeping or staying asleep.
Sometimes depression actually looks a lot like extra worrying and sometimes anxiety and depression can go together. And sometimes there's issues with the way that the brain works. Thinking, concentrating, focusing. But I really want to reassure people that if. You're experiencing these kinds of things and they're persisting and they're having an impact on your ability to take care of yourself or do what you need to do or they're impacting your work or your relationships. Talk to your OB GYN about it, because there's things that can do that are very effective. And we'll help you have a safe and healthy pregnancy.
Jennifer Semenza
Doctors commonly screen for antenatal depression.
Dr. Emily Norland
We. There are really well validated tools and so patients can expect a questionnaire called the Edinburgh Postnatal Depression Scale (EDPS) at their first prenatal visit, likely again at that 28-week visit, where we screen for gestational diabetes and anemia. And then at their postpartum visit and that is a really, really normal thing. It's just a check in.
Jennifer Semenza
And what advice would you give to a woman who's suffering from depression during her pregnancy?
Dr. Emily Norland
Reach out. There's a lot of effective resources and experiencing depression doesn't mean that you're doing a bad job or not good enough, or not doing enough. Nerdy Dr. perspective, it's exactly the same as somebody that develops high blood pressure or. Diabetes. They're not doing something wrong. This is just something that happened. But it gives us an opportunity to adapt our care plan and there are really effective tools to help sometimes just talking about it and acknowledging what a person is going through is enough.
Sometimes seeking a therapist psychotherapy, cognitive behavioral therapy, or techniques that don't involve medicine that can be very helpful in developing those skills to understand ourselves, how our mind and emotions work. Impact how we're perceiving ourselves in the world can be tremendously beneficial. And there's also medications, and sometimes medication is necessary, and there's a lot of information about.
There's this is a studied area of obstetrics and so we can really engage with patients in a great, thoughtful conversation about. The reasons why we might consider medicine the benefits, the risks, but also talk thoughtfully about the risks of not treating depression in pregnancy.
Jennifer Semenza
And for the pregnant person, how can their support team really help manage the symptoms?
Dr. Emily Norland
Support can be really beneficial but can also be really hard to. Sometimes there's a lot of shame associated with mental health in this country in general. Specifically, it's overwhelming and pregnancy. And so support people can really listen and try and be very thoughtful about their own comments and support.
Pregnant people put a lot of judgment on themselves, and especially if they're struggling. They can be very, very self critical and so for a support person. You notice that an inquire in a really thoughtful way, and also sometimes that support person might really have to help do more than what they might typically do to get that pregnant person to care and sort of decrease the boundaries to. Self-care. A lot of compassion and understanding can go a long way during this time.
Jennifer Semenza
And how? Depression during pregnancy impact prenatal care and influence the baby's development and abort outcomes impacted them too, possibly.
Dr. Emily Norland
Yeah. Yeah, they are. Definitely they are. It's not. It's definitely depression, can make it really challenging for a patient to accomplish their prenatal. I mean, as we talked about, there's kind of a lot that goes along with that. And so that can be really hard. We even as doctors and. Offices have to be compassionate and curious when a patient's not coming to their prenatal visits. Untreated depression. Treat it so to start first with treated depression has actually very little impact on the baby's growth and development and on pregnancy.
And treated depression actually minimizes the risk for postpartum depression. When depression goes untreated, that does cause a lot of challenges, not only for the pregnant person, but also for the baby. When pregnant people don't treat depression or don't have access to. Treatment that can cause growth problems with the baby during. Early delivery actually by mechanisms that we don't entirely understand but might be related to less prenatal.
The babies more likely to be born at a lower birth weight and then now that we're studying and paying more attention to. Long term, you know there could potentially be some impacts to that child's cognitive and emotional and behavioral development. For pregnant people, untreated depression really impacts their ability to accomplish prenatal care, which then increases their risk for other complications of pregnancy like preeclampsia, but also after delivery. It affects bonding, successful breastfeeding, and then increases the risk for postpartum depression.
Jennifer Semenza
Oh wow.
Dr. Emily Norland
Yeah.
Jennifer Semenza
Switching gears a little bit, you know, before we conclude this episode, I really want to address some of the HealthEquity issues affecting pregnancy and childbirth and some of the ways that we're seeking to address those here at Providence to make sure that every person gets the. They. What would you say are the biggest barriers to HealthEquity for maternal health?
Dr. Emily Norland
I'm really grateful that you asked that question, Jennifer, and I'm proud of what we're doing at Swedish. And in Providence, to address those issues, efforts from within the institution of medicine. To address our legacy of oppression and systemic racism are long overdue. And it says a lot about the people working in the Providence and the Swedish systems that we care about it. We're talking about it, and we're working really hard to make changes.
I think systems work the way they were designed to work and. Both culturally and within the institution of medicine, there have been systems in play where bias has been embedded into how these systems work and. And it results in. Of different people, not for medical reasons, but for because of those oppressive and racist systems.
Our initial efforts to study inequality were noticing these different outcomes in different groups of people, but then our implicit bias caused us to falsely attribute those differences and outcomes to racial difference? When in fact, culturally and within the institution of medicine, systems of racism and oppression were resulting in those inequities, and so therefore we have to recognize that and work to give each patient what they need to achieve an equitable outcome, which for me in the world of obstetrics, is a safe and dignified birth for all of our patients.
And that results that requires a lot of listening to our communities. And paying attention to what they're telling us that they need and then also as individuals doing what we can to examine our implicit bias, ask questions and center our patients in our care. There's lots of cool things happening within the Providence system in this area.
Jennifer Semenza
Yeah, let's talk about some of those programs that we have here in place at Providence. Address those issues do. Can you give us some examples? I would.
Dr. Emily Norland
Yeah. I would be so proud to in Washington state there is a statewide initiative called. Team birth, which is a communication tool that is standardized for all patients. It comes from the Safer Deliveries initiative in Ariadne Labs, and it's a tool. Where the preferences of each patient are centered and included in all of the medical decisions. Are made. And the central unit of this system is called a team birth huddle. And that is where at key points in someone's labor and delivery, the entire team gets together, the patient, their family, hopefully their doula, their bedside nurse, and then their provider team to talk about how our patient is doing, how is. Labor progressing. How is the baby doing?
And then through that, every person has the opportunity to provide input from their perspective, and then all of that input is incorporated into the next decision. And then we have a care plan that spelled out on a board for all to see. For our patient, for their labor, for the baby, and then when is our next huddle going to happen? And any person on the team is empowered and celebrated. To call the team together to have a huddle, to discuss the plan.
And this program was originally piloted a decade ago here in the state of Washington. Now it's a Washington State hospitals initiative that all Washington hospitals that deliver babies will function in this manner. Team birth has been showed to reduce inequity in C sessions, for example. Example, it helps to when patients say that when their teams use team birth. They felt. They felt cared for. They felt respected. They felt involved.
When we look at how pain is treated, which is a very important and hot topic in both gynecology as well as obstetrics, the. Difference between how black patients feel about their acknowledgment of their pain and treatment. And white patients, that equity gap is closed and the reason for that is when we standardize our communication. That reduces the chances that implicit bias can sneak in to how a physician or midwife or care team is approaching that person's care.
Here at Swedish, my friend Sauleiha Akangbe founded the JUST Birth Network, and that is a tremendous program. Focused on bringing community to our patients in the hospital. It's a network of doulas cultural navigators. And others. Focused on our black, black, African, African American. Native American indigenous Hawaiian Pacific Islander populations. And bringing culturally congruent care to them into the hospital. And that is a tremendous initiative. And I know that other Providence hospitals in other parts of the country are doing similar things. Just fantastic.
Jennifer Semenza
That's so exciting and I know that we have other programs as. That information is available on those on for those on our website as well.
Dr. Emily Norland
That's fantastic.

Jennifer Semenza
Yeah, yeah. Before we wrap up today, I really want to give our listeners something to take with them. What advice would you give to a woman who feels her concerns are not being adequately heard by their doctors during pregnancy?
Dr. Emily Norland
Jennifer, I'm so deeply grateful to you for asking that important question. And I really want to empower. The folks listening to this podcast. If you feel like you're not being heard, please bring that up with your OB doctor. That is something that we care deeply about and communication is hard, and that feeling heard and being seen is a tremendously important part of that relationship, and that trust of being able to hear this is what I need from you.
So I didn't feel heard when at our last visit that gives us an opportunity to apologize and also course correct and that exchange helps to build trust and strengthen that relationship that is so essential. To provide to nesting our patient in a safe and dignified delivery experience, and so in the clinics, often time. If that doesn't feel comfortable or possible. You know, this is a situation where having a doula. Might be really impactful to be a resource to help with problem solving.
Sometimes a family member might be able to raise a concern if a patient feels too vulnerable. I do know and from personal experience when. Because I've made mistakes in the past, even though my intention is to always listen to my best ability, I am a human person, and when my patients have been brave enough to bring to me, hey, I didn't feel heard in the circumstance has been deeply impactful to me to be able to apologize, ask for what I can do differently. And work together on. It's definitely been rewarding for me and I think it's also been really important for patients. I just can't encourage people enough. It's OK to share that experience. With your OB provider and you deserve to be heard and we want to hear and listen to you.
Jennifer Semenza
Thank you for that great information. Is there anything else we haven't addressed that you'd like to speak to before we go today?
Dr. Emily Norland
I think a big thing is just to for me is to. If you feel like you're struggling, you know, with your mood, please reach out. And if you have thoughts of harming yourself or somebody else or thoughts of harming your baby. Please reach out and share that information because we want to support you. Want to help? You can and should feel better and treatment is possible, and the benefits of treatment really are enormous.
The risks of treatment to your pregnancy and to your baby are known and relatively small, whereas the risks of. Not speaking up and not treating depression are. We don't do a good enough job of normalizing that and talking about it, but we're working on it. Please, if you're struggling with thoughts of self-harm, please reach out. Immediately, that's an emergency. But if you're experiencing low mood, you think you might be depressed. Please bring that and share that to your obstetric care provider because we can and will help you through it.
Jennifer Semenza
That's really encouraging, Dr. Thank you so much for joining us. This has been a really insightful conversation, and I'm sure that our listeners are happy to have their questions and concerns addressed. So much for your time today.
Dr. Emily Norland
Jennifer, you're so. I'm grateful for the opportunity to connect with. Thank you for the wonderful conversation. And it's just so exciting again to talk about something I'm deeply passionate about and love so much.
Jennifer Semenza
I would also like to thank our listeners for joining us on talk with the docs Lifecycle health for a better world. I hope that we provided you with valuable insight and a deeper understanding of what to do when you're having some serious complications during your pregnancy.
Be sure to listen to our next episode where we will talk to Doctor Alex Hamlin, a pediatrician who's going to walk us through the first couple years of life. We'll talk about what milestones are important, caring for your newborn and what to do if you have a sick or colicky.
To get continued information on other important healthcare topics, please subscribe to talk with a doc on your favorite podcast platform. You can connect with us on Facebook, TikTok and X at Providence and on Instagram and LinkedIn under Providence Health Systems for additional information about this and other health related topics, please check out the Providence blog at. Providence, org.
To learn more about our mission programs and services, go to providence.org or download the Providence app. To access all this information and more. And Please remember the information provided during this program is for educational purposes only. You should always consult your healthcare provider if you have any questions regarding a medical condition or treatment and thank you for listening.
Here's a sneak peek at our next episode.
Dr. Alex Hamling (He�s the guest for our next episode of Talk with a Doc: Lifecycle)
And again, these all come about, you know, with the normal natural development of your baby's brain, when babies are born, you know, there's some thought that they should have maybe needed an extra trimester in the womb for development. And they don't have great muscle coordination most. Don't realize their hands connected to their body, and So what actually hit themselves in the middle of the night and wake up and wonder who did? Baby's muscle strength for their head muscles, neck muscles, truncal muscles for sitting up just take time to develop. You know and. Of these happen in the first few. Some of them take six months or nine months or longer to develop, and again, these are the times where through the well child schedule, through those repeated visits with your pediatrician or family medicine doctor, that you will have great touch points, opportunities to bring up any concerns that. Noticed. For your provider to be able to address anything that he or she has noticed on exam or through history and kind of following along and things like that