- Hey guys, welcome back, this is such an exciting topic.
Is it fictional, is it truth?
Labor, delivery, pregnancy, myth or fact submissions.
These came from Instagram.
You submitted like almost 300 of them.
So, I'm gonna work through getting all of them addressed.
It is not all going to happen today, clearly.
That video would be very long.
Today we're going to be talking about pooping in labor
and delivery, getting pregnant with your IUD in place.
I forgot what the third one is, where did it go?
If having a medicine-free delivery is worth it.
And does having an induction
increase your risk of a C-section?
Before we go any further I would
like to talk about my shirt.
It is care of the one and only Philip DeFranco.
He sent it to me, not really.
Kind of, I purchased it from his merch shop.
But if he wants to send me something,
especially if it's sarcastic, I will take it.
It says why be informed when you
can use your feelings as facts?
I don't know, I felt like it was
appropriate, not gonna go into why.
Okay, on that note let's just jump into it.
That is what Philip DeFranco says, and he is incredible.
I don't know why you're watching me
if you don't know who he is.
(audio fast-forwards)
Don't leave, don't leave, you'll kill
my watch time, stay, stay!
Intro, intro!
(rhythmic electronic music)
Okay, I'm trying to talk slower.
Because a few of you nicely told me
I talk too fast, which I already know.
And I hate to inform you of this, but I'm talking like
at minus eight of my typical speed in these videos.
Then, some of you like totally trolled me
about the talking fast thing.
And I can't help it, I've already slowed down.
My brain goes this fast.
My speech follows right behind it, and then, yeah.
(exhales deeply) Okay, I'm trying to bring it down
a notch, bringing it down a notch, slower.
Trying to bring it back down to earth guys, I'm trying.
All right. (claps)
Maybe you should listen faster.
I'm gonna edit that out, that wasn't very nice.
I'm trying to be nice.
It wouldn't hurt you to listen faster.
All right, let's talk about pooping.
One of the most repeated myth or fact things
that you guys submitted on Instagram
was I'm terrified I will poop in labor.
Is this really a thing, does it usually happen?
Please, tell me it doesn't happen.
I wish I could sit here and tell you it's not a thing
or it doesn't happen, but that would be a lie.
I'm gonna spin this and talk about it more from an angle
of why you should not be worried about it.
First off, the mechanisms of having a baby are just
really similar to the mechanism of having a bowel movement.
The muscles you use, the location,
all of those things are just really similar.
So yes, people sometimes poop
while they are pushing and it's fine.
And actually, your medical team might be happy about it.
Because it just means you are an excellent pusher.
I was gonna say that like it was a punchline.
But it's not a punchline, it's the truth.
That's all I got.
I'm clearly struggling to like effectively normalize this.
So, I want to talk about what you
could maybe relate it to in your life.
If you are a mom, or if you know people who are moms,
or if you're just a human alive with a heartbeat,
you know that moms and dads change diapers.
So, if you think really long and hard
about changing diapers, you might find it
to be a little bit gross, when you think about it.
However, it is so extraordinarily normal
and a part of everyday life for any parent
or anyone who has ever been a caregiver
for a child that it's like a non-event.
I don't know how many hundreds
of dirty diapers I've changed in my life.
And it's just not a big deal, right?
Because it's normal, that's just what you do.
And that's kind of how pooping on labor
in delivery is viewed by your medical team.
It doesn't always happen, but when it does
it's so totally normal, it's a non-event.
We aren't worried about it, and you shouldn't be either.
It's not like a highlight of our job,
but it's also not a negative or our job.
Like, nobody goes home after delivering a baby
or working in labor and delivery unit and goes,
oh my gosh, somebody pooped on L and D today.
Because it's just, like, you just wouldn't ever talk
about it, it's just something that sometimes happens.
Now, some of you had questions about how do you clean it up?
What does this look like?
Is it like out there, and all this?
It's usually just not a big deal.
It's like it either goes into the bag that's underneath you
or we can covertly clean it up with a towel.
It's just not a big deal, guys.
I know that is so hard to wrap your head around it
if you've never been in the situation,
or you've never seen a baby born.
But we're so preoccupied by making sure you're safe,
your baby is safe, and that we can have
a happy delivery that it's just we don't think about it.
So, I wish I could ease your fears
because it seemed like there was a lot of fear
around this by telling you that it doesn't happen.
I hope that rather than trying to do that and lie to you,
I can just normalize that if it does happen
nobody thought twice of it, it's not a big deal.
So yeah, try not to worry about it.
I know it doesn't help, like I said
in the Downton Abbey video, it doesn't help
to tell someone not to worry about something.
That's not good advice.
But I hope it helps to know that it's just
a huge neutral non-event to every single person
who has ever worked in any capacity
around somebody who has delivered a baby.
So, there you go, let's just move right along.
Now we're going to talk about
having a baby naturally is 100% worth it.
I think by naturally, this question means
without medication or without anesthesia.
And it's very hard to answer.
Because I feel like that is extremely individualized.
If somebody wants to have a baby without any anesthesia,
then I think deciding will that be worth it
or not worth it to them totally depends
on their motivation for wanting
to have a pain medicine free delivery.
What I mean by that is if your motivation
to have a medication free delivery
is I just really want to experience this.
It's important to me, I want to see if I can do it.
I want to use HypnoBirthing.
Or I want to use Bradley method, or whatever it is.
It's just important to you to do that, then yeah,
you probably would think it was worth it.
On the flip side of that, if somebody's motivation
for wanting to have a medication
or pain medicine free birth is that they are terrified
of getting an epidural because they had heard
a horror story about something crazy
happening that they're just scared of.
And so they don't want to have the epidural placed.
Or they're just fearful of the anesthesia itself.
Or they have beliefs around
the anesthesia that are misguided.
Either they've heard something bad that happened,
and they need to talk about that.
Or someone in their life is pressuring them
not to get an epidural for some reason.
Those would be reasons that having
a medication free delivery may not be worth it to someone.
So, I think this comes down to motivation.
And I can't tell you yes or no that
that is or is not worth it for you.
I can tell you, no, it is not worth it to me.
And if you'd like to know why you can go watch
my birth story from packs, because I'm a big wuss.
But some of you aren't, and that's fine.
And some of you aren't big wusses,
and you still want an epidural, and that's okay.
Me personally, wouldn't be worth it.
I am a wuss, I would die.
(claps) Dead.
But that doesn't mean that's the right decision for you.
And it doesn't mean it would not be worth it for you.
If I'm talking too fast for you,
just click the little settings button down there
on the YouTubes and decrease
my speed to like 75% or something.
That's what I do because when I watch YouTube videos
I can't watch them in normal speed.
I watch them in 1.5 or two times speed.
It's just where my brain is guys.
I'm sorry. I'm Sorry!
I love the shirt.
I just keep looking at it and thinking, like, this is just
Philip DeFranco, thank you for supporting science
and neutrality, being an excellent news resource for people.
I love you, but not in a weird way, a YouTubey way.
I'm married, I think you're married too.
I don't love you like that.
I love your channel, Philly D, I love your channel!
Okay, what am I doing?
Why do you watch me dog, I am so weird.
Okay, next question.
I have show notes, one second.
Oh, this is a good one, okay.
If your uterus is heart shaped you will get pregnant
or you can get pregnant with an IUD in place.
Let's back this up and talk about
what all of those things mean.
The uterus can be shaped many ways.
And what we call arcuate uterus is known
to the general population as a heart-shaped uterus.
This isn't really a uterus that actually looks
like a heart, but the inside of the uterus
on imaging is kind of heart-shaped.
It's really just got kind of an indention in the top.
Arcuate, or heart-shaped uterus
is the most common non-typical uterine shape.
About three to 4% of the general population has a uterus
that is shaped kind of like a heart.
And there are a whole variety of other shapes of uteruses
that are much less common, but possible.
And maybe I'll do a video about
uterine anomalies at some point.
The question asks about IUDs, so intrauterine devices,
which I talked about briefly in my 24-hour blog
on my call day blog, are contraceptive
devices that go inside the uterus.
We place them in clinic.
There's progesterone one and a copper one.
And the reason somebody asked about this
is because the inside of the uterus being shaped
differently made them wonder if that would
increase the failure rate of an IUD.
So, to continue with this conversation
we need to know what is the failure rate of an IUD.
IUDs are very effective forms of birth control.
They fail about 0.5% of the time, less than 1% for sure.
And that's about the same as the likelihood
of getting your tubes tied failing.
So, your chances of getting pregnant
with an IUD in place are about the same as your chances
of getting pregnant if you tied your tubes.
But IUDs are obviously reversible.
The question basically wants to know
is a abnormally shaped uterus or a different shaped uterus
going to increase the risk that I'm going
to get pregnant with an IUD in place?
And the generally accepted answer is no, it probably won't.
Now, could it increase the risk
of the IUD becoming malpositioned,
meaning it's too low in the uterus,
or it's sideways, or something to that effect, maybe.
So, in order to decide if that matters we need to know,
does that make a difference in pregnancy rates?
The answer is in a progesterone IUD it probably doesn't.
In a copper IUD it might.
And the reason is because they work in different ways.
Progesterone IUDs absorbed progesterone into the uterus.
So, if they're a little bit off-center
or too low, they still work pretty well.
A copper IUD works a little bit more
by a local reaction, foreign body reaction.
So being in the wrong place may leave some
of the uterus exposed to normal conditions
and increase the failure rate.
The literature says uterine shape
does not probably make a big difference
in IUD failure rates, and certainly not
a big enough difference to change your recommendations
on whether somebody should use an IUD or not.
So, I hope that answers the question,
does having a heart-shaped uterus or an arcuate uterus
change your risk of pregnancy with in IUD in place.
And the answer is probably not.
Okay, next one.
Is it number four, are we on number four?
What did we talk about?
Okay, yeah, I think we're on number four.
Number four, maybe I should just stop making numbered lists.
Number four, the question is,
the submission is being induced
increases my risk of a C-section?
I love this submission, thank you for submitting this!
Why am I yelling, why do I love this submission?
Because this is such a commonly held belief,
not just amongst you guys, but amongst all of us
who work in labor and delivery.
We have long thought, particularly in people
who have never had a baby, that elective induction
would increase the risk of a C-section.
And last year an excellent study came out
that said this is actually not true.
I think in order to discuss this we need
to talk about what kind of study it is.
It is a randomized control trial.
And this is an excellent piece of literature.
The study said we're gonna put people in two groups.
These women are going to be
in the elective induction of labor group.
And these women are going to be
in the expectant management group.
What expectant management is, is we just wait
for you to go into labor on your own.
If a medical reason to induce you comes up
we move you to the induction group,
but you don't count towards the outcomes in that group.
Because you still were under expectant manage.
The women who were included in the trial were nulliparous,
meaning they had never delivered a baby,
relatively healthy, no pregnancy complications.
The women who were induced in the 39 week group
had not only a lack of an increased risk
of C-section, but a decreased risk of C-section.
I don't think anybody expected this.
Why was that, what happened?
Why did the women in the expectant management group
have an increased risk of C-section,
when we've all thought all along that inducing people,
especially people who've never had a baby
before increased the risk of C-section.
Some of the theories are that as you move through
the pregnancy the baby is less likely to tolerate labor.
Meaning, as you moved through the pregnancy the baby
is more likely to have placental insufficiency
or cord problems, which cause heart rate drops
or things like that in labor and necessitate
a C-section based on fetal complications.
I don't think we know 100% yet
why we see that, but it was significant.
For every 28 inductions you do
at 39 weeks you prevent one C-section.
This is super important guys.
Because we're moving towards trying to reduce
our C-section rates, and this could help.
Now, I don't think you should be forced to be induced.
That is crazy too.
This should be an individualized decision.
You are not a research paper, this is a discussion.
It is not you have to be induced at 39 weeks.
It's just an option.
In the group that was not induced at 39 weeks,
mom had an increased risk of C-section,
baby had an increased risk of needing respiratory support.
And mom had an increased risk of hypertensive
disorders of pregnancy and preeclampsia.
This is important too.
Because we as a group of OB-GYNs,
everybody who cares about maternal health
in the United States are working so hard
to decrease maternal mortality and morbidity.
And one of the biggest causes of maternal mortality
and morbidity is hypertensive disorders of pregnancy.
It's still extremely rare, not the disorder,
but dying from it or having severe complications
from it are still extremely rare,
but they are a big part of that group of bad outcomes.
How this changes my clinical practice
is that I kind of view the timeframe
between 39 weeks and 41 weeks to be a gray area.
So, before 39 weeks we shouldn't induce
you unless there's a medical problem.
Between 39 and 41 weeks, what this very good
randomized control trial on a very large population
of women says is that elective induction
does not increase your risk of cesarean delivery,
does actually decrease it, and may improve
both maternal and neonatal outcomes.
After 41 weeks, going into labor
on your own does not increase the chances
that you will have the baby vaginally.
It might actually decrease them as compared
to elective induction, according to this study.
So, all of that to say, this is your decision.
I never force people to be induced, I think that's crazy.
But you should know the information so that you
can make a decision that's best for you.
There are reasons that someone
individually may want to wait.
I think it's important that this
is out there and that women know about it.
Because the overarching thing that I hear is women thinking
that if I'm induced my C-section risk goes up.
And it's not true, it is not true
according to a very good study.
Obviously, as we talked about,
you're not research, you are a person.
And your decision-making should be individualized.
That's why we don't do the same thing for everyone.
It's just really important to have
the facts before you make your decision.
Be informed.
I am going to link all of this information,
as much of it as I can, in the description below.
If you liked this video, please give it a thumbs up.
And if you like Philip de Franco, you can also give it
a thumbs up because I'm wearing his shirt.
This shirt's so good, I just love it.
Thank you, Philip de Franco.
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