OB/GYN explains what men should know about childbirth complications and delivery risks

Vance Crowe [00:00:00] They just felt like they needed a, a fresh start. So I felt an enormous responsibility now as they're going into their next pregnancy, that everything turned out as best as possibly could. So when they had their baby and I handed Mikey to the mom, and that they were just tears. Joy, hi, I am Caleb Zi, a precision ag specialist living in Aurora, South Dakota, and you are listening to the Vance Crow podcast. Welcome back to the podcast. I'm glad you're here. Today we interview Dr. Tim Philpot, who's an O-B-G-Y-N that welcomes new life into the world as he delivers babies. We thought that he was a fitting first interview for our five part series, we're calling Memento Maori. Memento Maori is the Latin phrase that means, remember, you will die. And while that could have really morbid connotation, I like to think of it as a way to remind yourself that no matter how monotonous or difficult life gets, you will die. It will be over. And so the moments that we do have conscious on this earth are so precious. So we put together a series that would try and cover the lifespan and maybe talk about things that are all around us, but we don't think about every day. So our first interview is with somebody that delivers babies, and the next one is with a psychologist that works with college students to help them understand what the aging process will be like, so that they can make better decisions in the present about their finances, about the way they treat their bodies.

Vance Crowe [00:01:42] It's a fascinating conversation. Then we'll talk with an in-home care specialist, a person that delivers nursing and home care services so that people can stay living independently without going into a nursing home or retirement facility for as long as possible. After that, we bring in an estate planner and we talk all about what happens to your property after you die, and how big of an impact you can have on the world from beyond the grave. Finally, we'll have our fifth and final part of the Memento Maori series with a funeral director on Halloween. This conversation was particularly interesting because there's so much about the dying process that if youve never experienced it, you wouldn't know anything about, like what happens, who do you call? How does this work? What are you paying for? So we hope that you find not only this final episode interesting, but all five in this whole series to be something that really connects with you, something that are either parts of your life now, or things that you know you should be thinking about and preparing for. And really, as a whole, we hope that this really impacts the way you think about the preciousness and value of life. I know as the host of Legacy Interviews where I sit down to record people's family stories, I've had the opportunity to get a firsthand look at what is the most important experiences that a person has that they wanna pass on to their children and grandchildren.

Vance Crowe [00:03:16] If you're interested in having me sit down with you or a loved one to record your family stories, to write down or get into video, your wisdom that you've learned over a lifetime of living, then we'd love to have you visit Legacy Interviews dot com. There you can schedule a time to sit down with me in these studios and have a deep and fulfilling conversation that allows you to put this down on the record to pass down to future generations. If you're interested in watching these interviews with your family, which we hear from clients all the time, is the best part of the whole experience, and you wanna do that over the Thanksgiving holiday, then you need to get your interview scheduled by October 23rd. That way we'll have plenty of time to make sure the video and audio looks and sounds great. So if you're interested in having us talk with a loved one, go to Legacy Interviews dot com to find out more. All right, without further ado, let's go to the first of the Memento Maori series with Dr. Tim Philpot. Dr. Tim Philpot. Welcome to the podcast. Thank you. Excited to be here. So a man is about to walk into the, the birthing room. His wife is about to have their first child. What should he know about what's about to happen? Well, the the toughest thing I think for dads is to realize that they have very little control over the situation, and a lot of guys are used to having control in their lives, or at least think they do. So that's probably the hardest part for people is for, for the dad, for, for dads and husbands, is to just realize they're along for the ride and equally important, whatever their wife says you do.

Vance Crowe [00:04:59] How long? So I, I'm in the unusual position that, that I've seen a childbirth only via C-section, so I don't actually know what happens, but when we were sitting in the room waiting for childbirth to happen, we could hear the screams going on in the other. Right, right. A little disconcerting. And I think most people ha only have like a Hollywood version of what it's like for a woman to have a baby. How much pain is involved in it? Well, these days, at least at the institution where I practice, there's a majority of women do get epidurals. And so the pain is significantly decreased, of course, by that. But for those patients who do not have epidurals, the pain is almost universally described as the worst pain they've ever experienced. But I do occasionally have patients who handle it, like it's really no big deal. It's amazing. Like they just have that mental control where they, they don't experience pain in the same way, but for most people it's the, it's the most intense and prolonged pain they've ever had. And what's the rate of people taking epidurals? Why? For us, it's about 85%, 80. So 15% don't do it. Out of what, what are their reasons? Well, when you ask that question, most patients, we, some people call it going natural. That's a common phrase. We say unmedicated because sometimes natural people mean vaginal. But so for those unmedicated, the patients who decide to have an unmedicated vaginal delivery, oftentimes they choose that because they want to see that they can get through it. You know, it's almost, I think of it a lot like people who choose to run a marathon.

Vance Crowe [00:06:30] They can, everyone knows you probably can do it, but do you really want to do it? And can you prove it to yourself that you can do it? So I think that's where a lot of people are coming from. Some people worry that the medications given during an epidural might be detrimental or harmful to the baby, but there's really no evidence for that. But I think that's another reason that people might say, how does an epidural work? So the, the term epidural means it's on top of the dura, and the dura is a bag of fibrous bag that kind of surrounds the spinal cord and holds in all that cerebral spinal fluid. So when you hear about people getting a spinal tap, they're going under the needle. The, the, the procedure goes with a needle through between the vertebrae, through that dura sack and take some of that cerebral spinal fluid out. So a spinal anesthetic is sort of the reverse of that, where you inject medicine directly into that fluid, but the epidural is on top of the dura, so it goes near that sac. There's a catheter that then allows the medicine to diffuse through that dura sack. And that's how it affects the spinal cord and the, the pain signals that travel through there. And if somebody's going through a pregnancy and they decide I wanna do a natural vaginal birth, they get halfway through the stream and decide this pain is way more than I was expecting. Can you pop one in Usually, yeah, if it's a first time mom. So her labor would tend to take a little longer. For a first time mom, you probably have time to get that epidural in. But sometimes people are going so fast and they're going through something called transition, which is a very rapid increase in their cervical dilation and an increase in their pain and the pressure and all the, the experiences that they're having with, with their labor.

Vance Crowe [00:08:09] When that ramps up, sometimes that means they're almost done. And so trying to get them in position for the epidural process, which can take in some cases more than 30 minutes, there may not be 30 minutes. The baby's coming in the next three minutes. So the good news about that is the pain's gonna be over once that baby's out, or mostly, you know, as I think about it, like there's probably not very many other positions in the world that see, I mean, even though it's only 15% that see as much physical endurance of pain as somebody like an ob GYN well, and I would say that the labor and delivery nurses see a lot more than we do because they're with the patient for a much longer period of time. But yeah, it's, it's pretty incredible. And, and you know, you realize that we're all kind of built the same, that when you get to a certain point of pain, we all are gonna react in a very similar way. Like what I, I don't think I've ever actually seen. I, I certainly haven't seen labor pain. Yeah, you, I would say that's a, for a lot of people, it's an out-of-body experience. You know, they just might start screaming, they might start yelling, they might start cussing. They might, you know, be un you, you really can't communicate with them when you, you may look at them and they're staring at you with glazed eyes, but you know that they're not really hearing you. They can't follow your instructions. So it's, it's very much of an out-of-body experience for, for a lot of people. Have you ever experienced that much pain? Well, they broke my jaw when I was in first grade, and that was really, really painful. But I don't think it's the same because labor pain is so long, you know, it's usually hours and hours and sometimes in some cases days.

Vance Crowe [00:09:41] And that just takes an enormous toll on the, the psyche just, it, just that it's just keeps going, keeps coming, and you don't have an end in sight. Keeps coming. Right. And of course it's all for what we hope is gonna be very happy moments and something someone's been looking forward to for certainly their whole pregnancy, but maybe for decades. So that obviously motivates people, but it's still very intense. And how do you see dads reacting when things are really intense in the, in the room? Yeah, most dads wither a bit under that because they're something that they love is going through pain and they can't fix it. Dads are also sometimes in a tough position for these folks who wanna have an unmedicated delivery where they've been instructed for months prior not to allow the epidural to happen. Like even if I ask for the epidural, don't let 'em give it to me. And so dads are really put in a tough spot when that happens because they can see the agony their wife has or their partner's experiencing, and they're not allowed to suggest the one thing that will really help. So they try to do a lot of massage and you know, they've, they've probably been through lots of practices on how to get their wife through their partner through that experience. But it's tough for dads and most of the time they, they really sort of get pasty white and, and wither under that kind of intensity. When you're talking with people that are about to have a baby, what do you think is like the hardest thing for you to be able to communicate to them about what's about to happen? Yeah, I mean, honestly, the hardest thing for me to talk about is that it doesn't always go well, right?

Vance Crowe [00:11:19] And so everybody is expecting the birth of their beautiful, healthy baby. Nobody anticipates the baby's gonna have an issue, whether it's a serious issue or even a minor issue. And that is really, really hard to talk to people about because they're seeing it in a much brighter, happier light than those of us who have seen a lot of deliveries know it can go. And when somebody ends up having an, like either a stillbirth or, or a just a rough pre like a delivery, do you pretty much know when that's going to happen ahead of time? No. Oftentimes we don't know, you know, 'cause labor is long and in the beginning the baby's heartbeat looks great, but all of a sudden the heartbeat starts to look abnormal or the mom's blood pressure changes or she starts bleeding. And those are not things that we often can anticipate. Sometimes we know, sometimes we know a baby's got a genetic problem or something that we're anticipating trouble or a heart defect, for example. But oftentimes babies that get into trouble do it unexpectedly. And then were they things that in retrospect you could say like, ah, we should have known that, that, that that was coming or there things that just happened as an, as an accident? That's a great question. And the answer is we always think first. Should I have caught that? Should I have known? Should I anticipated that? Because I think that's a natural human reaction. You know, I, I wish that I could have undone a problem before it ever happened, but the reality is these are really, really difficult things to predict.

Vance Crowe [00:12:51] And some of them are 100% unpredictable. And so you just have to be ready to react. Yeah. I know one of the things that I talk with a lot of younger men about, 'cause no one prepared me, I was not prepared for losing a pregnancy, right. Like for having a miscarriage. Right. I first of all didn't know really that it was possible. I mean, I think I, you know, vaguely understood that, but like, not only that it was possible, but that it's actually relatively common. Very, yeah. I always tell moms that are going through a miscarriage that one outta three pregnancies ends in a loss of, of usually a first trimester miscarriage, sometimes a little later. And I think that, I don't know if comfort's the right word, but it at least it helps give perspective that patients don't feel like they're the only one experiencing it, which is probably how you felt when it was happening. And then what often happens that people come back and say, you know what? I talked to my mom, my aunt, my cousin, and they had one or two also. And I'd never known that. But I mean, it's sort of a sad way of saying it, but now that I'm in that club, people are more comfortable talking about it. It is, it's like a club almost. Like it's, it's one of those things that if you're talking with somebody that didn't experience it, it's not that they can't understand, but it's like the, if you find out somebody did go through it, all of a sudden you feel like you're walking along a path and not the only one that had to do it. And, and somehow guilt feels less in that way. Yeah, yeah. I agree. I, I think people experience that often.

Vance Crowe [00:14:23] And so it helps to know they're not that, that somebody's not alone the other, but the first thing I say to people when it comes to miscarriage, unless there's evidence of the contrary, which rarely there is, is that they didn't cause this to happen. That mo the vast, vast majority miscarriages were predetermined, you know, at the moment of fertilization, this particular genetic makeup wasn't gonna make it, but gets to a certain point before you de discover that. And so I think that gives people comfort as well. So as an O-B-G-Y-N, you are both seeing people at their absolute highest peak. They've just been given this miracle of life, but you also have to communicate some of the most, you know, frustrating, damaging news they've ever heard before. Right. That's very true. And, and when I first decided I was going into OBYN and started talking to people about that professional choice, most people would say, oh wow, you get this, be such a, a part of such a happy time in people's lives, which of course is true and what drew me to the profession. But you also have to be really good at giving bad news and and comfortable spelling that out very clearly and not unemotionally, but you have to stay objective in the process. And so the, the, the hard news can be an, an equal part of our job. Did you know that that delivering bad news was gonna be a part of this as you were like heading down this path in sort of a vague sense, but I didn't really know what are the bad things that can happen in the world of OB GYN and you know, it can, it can be very devastating and we're not really trained heavily in that area.

Vance Crowe [00:16:04] At least when I was in medical school, that was not a big part of our training, the whole communication aspect. It was more what you brought naturally to the, to the table. But it turned out that I was a good communicator with patients and could sort of strike the proper emotional tone. And, and so it, it, it flowed pretty naturally for me. So the question, I don't know, do you, maybe people are too embarrassed to ask you or maybe you get asked a lot, is why would a man go into being an OB GYNI had I, it's funny 'cause I had the same question to myself back when I was in medical school, which is when you have to make that decision. And my father, who was a general surgeon, when I told him about it, his response was, isn't that a woman's job? Which, you know, was a, a bit tongue in cheek, but he, you know, was a general surgeon. I guess that's sort of was the perspective and what IL learned. In fact, I, one of the people I still work with, a guy who was the chairman of our department was a few years ahead of me. And when I was in medical school, he was already a, an attending physician OB GYN. And, and I asked him that very question. I said, so what's it like being a man going into OB GYN? Can you, can you carry your career along? And he said a very memorable response, which was, there's always room for good doctors. So he said, just be good and, and if you love what you're doing, you'll be good, you know, good or hopefully great at it.

Vance Crowe [00:17:35] And, and everything else will kind of fall into place. And it was great advice. It worked, it worked that way for me. Yeah, I mean, and I think with the O-B-G-Y-N world, it's probably all word a largely word of mouth, right? Like when, when we were looking for one, you go ask the people you love and care about, who would you go to? So being a good one spreads probably rather quickly. Very true. It's a word of mouth business for sure. Unless you're in a subspecialty, you know, if somebody needs a, an oncologist for example, if they had ovarian cancer, usually that person gets referred by another doctor rather than word of mouth. But word of mouth is still very important for those folks as well. But yeah, that's, that's our biggest referral source of course, is other patients, it's really helpful if you take care of patients who are also doctors because then they tell their family and their patients about hopefully the good experience they had with you. Speaking of like other doctors, so if you had daughters and they were pregnant, but they were far away from you, you didn't know which doctor to send them to, how would you tell them to judge a particular ob? Well, that's a great question. I mean, I typically, I would say start by asking folks that you know, that have kids, you know, especially younger kids so that it's fresher in their minds. And ask who their OB was, what did they like about him or her? And, and start down that, start down that pathway. But my advice that everybody wouldn't just be my daughters, but everybody moving into a new town is call labor and delivery at the hospital where people seem to want to go to have their babies. You have to find that out by asking folks.

Vance Crowe [00:19:08] And those, the labor and delivery nurses will be very honest generally. Oh really? Yes. So maybe they have an ulterior motive, but most of the time they'll say, oh yeah, we, we've heard of Dr. Smith and we know Dr. Smith, she's here all the time and, and is fabulous. Or Well, you might like the partner better because of this or that. So it's usually a free and pretty reliable source of referral. Does your doctor matter in having a baby? That's, that's an interesting question. I think the answer's yes. I hope the yes, because that's one of the things that motivates me is to try to be excellent. But I think most people really want to have a connection, an emotional connection with their OB GYN. And so I think that is a very, it's a great comfort when you have that connection, you feel like there's a greater level of trust. And that's a huge part of what we do. Unfortunately, there's a lot, a lot of patients experience more of a, a group practice process where they might see a different doctor at each visit and they're not sure which of those four or five doctors will actually be doing the delivery. And that still works great for a lot of folks. We just don't structure our practice that way because we really wanna have a relationship with our individual patients as best we can. You talked about that connection, like what is it, can you walk me through from the beginning? Somebody first meets you all the way through? Yeah, I, I would say it starts with they've heard good things.

Vance Crowe [00:20:40] So they, their sister is your patient, so now they're coming 'cause they trust their sister's recommendation. So you're already off on a good foot, but now you have to live up to whatever they, whatever hype has proceeded the, the visit. And so I always wanna make sure that I get very quickly into what the patient's concerns are or what the patient's questions are. So for a new OB patient, obviously people want the general guidelines for what's, how, how do I behave safely in pregnancy? What are the things I should and shouldn't do? So that's more of a template. But I always early in the conversation say, let's start with your questions and I can fill in the rest. And, and I think hopefully people appreciate that and, and realize that I'm there to listen to them, not to dictate something to them. What can you tell about a Person based on the Questions they ask? Anxiety? You can tell pretty quickly. Yeah. So the, the anxious patients and I, we understand it's a very anxious provoking experience, anxiety provoking experience. But they tend to have lots of questions, lots of detailed questions. And, and, and oftentimes we'll just say, look, I'm anxious about, or I, I have a lot of anxiety. So you can tell that pretty quickly. And you often could tell us people have medical backgrounds based on the way they ask questions. And sometimes that's good. Sometimes that's hard because they feel like they should know more because they went through medical school or are in the nursing field, but they don't know OB GYN.

Vance Crowe [00:22:12] And so I always tell people, even even people that are ob GYNs that I've taken care of, I say, I always say, I'm gonna take care of you and talk to you like I do with everybody. 'cause I don't wanna leave something out and I don't wanna assume, you know, something. And you can always hit the fast forward button if you, if you feel like you're, you're, you're, you're comfortable with that particular subject. I know when we were getting ready to go through the delivery, we watched all these videos, right? COVID was going on and we were like, all right, we can't go to the regular classes, let's do this one online. And one of the things I noticed was that there was definitely an air of like adversarialness between like the person that was operating as the midwife and the the medical system. Where do you think that comes from? Yeah, it's, I I guess it's sort of a longstanding disagreement about the philosophy of, of labor and delivery where, you know, in the medical field, we're trained to intervene, give medications, do surgeries, cut a episiotomies, you know, those are sort of the things we have to be trained on. And a nurse midwife, for example, learns very differently that labor is a natural process that if you kind of stay outta the way and just support the mother that, you know, the vast majority of the time it will work out well. So it's really just different philosophies coming at the same problem. And so I think that creates some of that. I I hear what you're saying with an adversarial relationship, I think that's probably too strong of a word.

Vance Crowe [00:23:42] I would just say that it's philosophical differences. Oh, I was prepared. Like the way that the woman described it, you could tell she had dealt with some trauma. Oh, right. Like so, so like the look of fear and terror in her eyes. Right. And I think that she started her whole program as like a, I wanna make sure nobody has this happen to them. But I noticed that during the first delivery, I was very much like on guard, like, okay, I'm, I'm, you know, I gotta watch out for these on the lookout, these medical people, right? Because they're gonna try and do the western medical system to us. Exactly. And it, it definitely, I, I mean I can understand if you had a traumatic experience that you would want to convey that, but it didn't seem like what she was saying was so far away from what is maybe mainstream of upper middle class suburban families now. Right. And, and like anything, it's sort of how the message is delivered. But yeah, I, I think there, there's a healthy dose of both. It's appropriate and we have learned, and I would say that the OB literature has supported a more watchful waiting approach instead of a, if this doesn't happen by this time, you, me, better get in there and do a c-section. So like most industries, I'm sure it's sort of, there's a pendulum that swings back and forth, but I do think we're be, we have become, as an industry more patient and the data supports interven less intervention, which is I think good. Yeah. Probably not a bad thing to have all the, that that sort of tension there to, you know, I think if you're doing something every day and you're getting very, very efficient at it, you can start to take the people out of it.

Vance Crowe [00:25:16] And the midwives are, I don't, I don't wanna say more focused on people than doctors, but they're not a part of the system that says efficiency in order to stay alive. Yeah. Yeah. I, I agree with that. And I think it's an example of if you have a tool, you're more likely to use that tool as opposed to if you don't have c-section, for example, available to you, well you're gonna use a whole bunch of other creative solutions. And, and then there's always the legal aspect of, you know, well if you don't do something by a certain point and there's an injury of some sort, you know, were you responsible for that? And shouldn't you have intervened? And so that, that's also going on in the minds of, of the OB who's responsible in the midwife classes. They were talking a lot about self-advocacy and I found myself, you know, kind of rolling my eyes during this, but then I realized like, I'm an extremely disagreeable person and I like, can, I can speak up for myself. I would imagine that people do get a little overwhelmed in the system now that I've seen like it from the inside, right? How do you make sure people are stick sticking up for themselves or being heard? 'cause it's, it's such a confusing time. It's hard. But I also think that goes back to what we were talking about a minute ago in terms of building a relationship with a patient and you kind of know who's more like Vance and willing to speak up for themselves and who's going to sort of defer and not speak up when they really do feel like there's a problem. And so I think the, the physician should be a, an advocate for that patient who they know and have known for many months.

Vance Crowe [00:26:52] And the nurses are very well trained in that, in that experience as well. Kind of recognizing when a patient needs something but isn't, isn't saying anything. But boy, I think that is a great skill for moms to, to be, be comfortable with. What things should they be looking out for that they would need to advocate for themselves about? Yeah, I I mean the big thing in labor specifically is pain control. We talked about epidurals earlier and you know, what is their ideal scenario? I think most patients want to go into labor on their own and deliver vaginally, have everything go smoothly and, you know, experience some pain but not extreme pain. It's just not everybody gets that lucky. So it doesn't always happen that way. But to your question, I think patients need to know what is important to them and kind of put that out right away as, so once they arrive and they're getting settled into the labor and delivery process, the, the labor nurse needs to know what are their, what are their primary, other than obviously a healthy baby and a healthy mom. What are their primary goals? What's your relationship with the dad in all of this, right? Because he's not actually the patient, but maybe the one in charge. How does all that work? Yeah, I connect with the dads a lot because I'm a dad myself and I was the, I was the guy holding my wife's leg while our babies were being born. And, and I understand that and it, I was, I laugh with the nurses because I say seeing moms cry is very emotional experience, but when the dad cries, it gets me every time.

Vance Crowe [00:28:23] I mean, i, I start, I start getting teary myself 'cause it, it connects with something I experienced myself. So yeah. The, the dads. So I guess I lost my train of thought on what the dad, well you're building relationships with dads and, and you know, at some point there are times when the dad has to make life or death decisions. Right? Right, right. And so ke keeping the dad engaged throughout the process and hopefully I've met them through the labor or through their prenatal care so that labor's not the very first time that, that I'm interacting with that person. But yeah, it is, it's a, it's a big deal. 'cause sometimes dad has to speak for, for his partner. How, how often does that happen that they need to, that something happens? Life or death? It's, it's fortunately rare. Yeah. And, and moms are usually able to speak for themselves, but there are times, for example, when a mom is rushed back to do a c-section 'cause she's bleeding, for example, there's something called a placental abruption where the placenta tears away from the wall of the uterus and that's life-threatening to the baby because oxygen levels to the baby can drop very quickly. And so if the mom doesn't have an epidural under that circumstance, she has to have a general anesthetic for the surgery, which means she's all the way asleep. She's got a tube in her breath in her trachea, and she's on the ventilator. So obviously she can't speak for herself. And the dad might have to make a very, very hard decision during that surgery about, say, a blood transfusion or something like that. When, when parents are walking into the hospital, you know, they're, they're standing up, everything's going well.

Vance Crowe [00:30:04] What emotion do you think is the, is the right one to have as you're, as you're walking into there, what motion, emotion, what emotion, how they be feeling as they're walking in to have the baby at that moment? Yeah, I'd say excitement. You know, I mean, this is thrilling. This is gonna be something they will remember forever. And so they should be excited about it. That I'd say that's the primary emotion, but also kind of a willingness to accept, I'm not sure if willingness is an emotion, but an acceptance of the possibility of things are gonna go a little differently than they had scripted in their minds. Yeah. I, I, so the first time we had our daughter, the, the whole process took a really long time. The second time we had a planned C-section, so we knew pretty much exactly when it was gonna happen. Right. And I think the most valuable thing that ever happened to me was the 30 minutes or so while they're getting my wife prepped because I actually sat there and meditated and I, I had never done meditation before, an important thing. And I was like, this is all gonna go well. I don't even really know why we're doing this. And then we did have challenges, right? Like the oxygen levels of the baby weren't right. And I was really glad to have been so patient just before that because if I hadn't been, I'm fairly certain I would've felt more alarm as opposed to just urgency. Right? Yeah. That's interesting. I would say dads go one of two directions in that waiting chair, we call it.

Vance Crowe [00:31:37] They either get into a zone like you did, which was self-imposed, which is impressive that you made that decision. I wish all the dads would do that because the other thing we see is dads are just like, you know, wild animal in a cage. They're just scratching. They can't sit still. They're up and down. They're on their, you know, they're texting somebody, they have to go to the bathroom again, they have to get another drink of water. They're nervous, of course. And, and who wouldn't be there? But they go through something that is potentially dangerous with their partner. So I think meditation's a great, we should probably have a sign there to say this is how to, how to get into the zone. Yeah. And it's a really, like where, where I was, it's a really like non-descript place. It's just like you're sitting in front of some doors and there's a table over there. It's not impressive. Yeah, just, it's just like, you have no idea. Like, Hey, I'm gonna walk in there and when we walk out, no matter what, things are gonna be different. Yeah. Yeah. So I think you, you handled it beautifully. So I know we keep talking about things going wrong, but you know, when everything goes right, there's, I mean there's things to talk about. It's the miracle of life. But let's talk about things like induction and why you would choose to induce a baby to come as opposed to just waiting for it to come out. So there are times when mom is having a particular health problem, medical problem, like high blood pressure. So there's a condition called preeclampsia where typically it's in late stages of pregnancy, mom's blood pressure will rise. And the physiology of that is that there's a breakdown in small blood vessels throughout the body.

Vance Crowe [00:33:11] So the mom can bleed, for example, the mom can have seizures if there's bleeding, you know, fluid changes and bleeding into her brain. So it can get very serious and dangerous. And the cure for preeclampsia is delivery. So induction of labor, if that's appropriate, based on how far along the mom is, is often recommended in the setting of preeclampsia. But one big change that has occurred in the last several years is in August of 2018, there was an article that came out about a trial called the Arrive trial, A-R-R-I-V-E arrive trial. And it was in the New England Journal of Medicine, which is of course very prestigious. And it was a large study that looked at the risk of induction causing C-section. And what was remarkable surprised, the industry I would say is that the C-section rate was lower in the moms who got induced at 39 weeks or a week before their due date as compared to those moms who went on. And so the whole philosophy about induction started to shift when that came up because in my training we were taught something very different that c-section rates were much higher if you were gonna induce patients. So this study refuted that belief and, and was very well done. It was a large study that had a lot of patients in it. When you induce somebody, how does that work? So induction basically means get the process of labor started. So there's two different things you have to think about. The first is, is the cervix ready for induction? And that means is it dilated? Is it softened? Is it thinned out a bit?

Vance Crowe [00:34:42] The term we use for that is effacement. And so if the, the cervix is more on the ready side, like it's one and a half to two centimeters dilated and 50% a phase, then that patient can just move on to the second phase of labor or a second phase of induction. The first type of induction is prepping the cervix or getting it to soften it, getting it to open a little bit. We call it cervical ripening. And there's different medicines we use to do that. But that adds time to the process. You have a bunch of medicines at your disposal for basically three Yeah. Or three different techniques I should say. But, but they, and they have various situations that they're better used in. But once the cervix is moved past the ripening stage and is now ready for the actual labor to begin, we use Pitocin, which is synthetic oxytocin, a hormone that the brain makes. And when you hear the, when I hear oxytocin, I think of some radio lab I heard a long time ago on NPR talking about that's like the love chemical or something like that. What, what is oxytocin? Well, oxytocin has a lot of different functions in the body. We, we focus on it more because it stimulates the uterine muscle to contract. So that's the, that's the benefit of it. And the, and the, and that's what pushes the baby, right? So the, so the uterus is a muscular balloon basically. And when that balloon squeezes, whatever's inside that balloon is gonna come out the opening just like toothpaste does. And that's, that is a, well a requirement for a vaginal delivery. You have to have contractions. So the oxytocin or pitocin wait and that's what the contractions are, is the uterine bubble being down is the uterine balloon.

Vance Crowe [00:36:19] It's just a balloon shaped muscle. And when that muscle squeezes, the balloon gets smaller. Oh, I definitely didn't know that. Yes. I thought contractions were the opening of the, of, of the vaginal, like whoa, oh no, it's all up in the upper abdomen. 'cause this uterus is now enlarged into the upper abdomen. And so that muscle basically just, it goes from this size to this size by contraction and anything inside of it is getting expelled. And those contractions are the painful part. Yes. Now there's other parts of labor that are painful with, as the head's coming down, pushing down. This is more what you were referring to pushing down on the pelvic bones. So that's very painful as bones are being pushed apart and all the muscles that are attached to those bones and then creating a passageway through the vagina, that head is pushing on the rectum, it's pushing on the bladder. So all those structures are feeling that and there's varying degrees of pain from it. Yeah. I remember as we were getting close, Ann who's a physical therapist, would always talk about the laxity of her, of her joints. And it didn't make any sense to me. But it's because the bones have to like the, the, what is it? The ligaments, the pelvis has to expand. Yeah. They're letting go of how tons they are and then they come apart. Exactly. And then after a few months they tighten back up again. At least they're supposed to. At least they're supposed to. Yeah. And so I, I don't, I'm not sure whether we, I think we should keep going on the delivery part of it. So if in the vaginal part of the delivery, when everything goes like according to plan, how long does this take?

Vance Crowe [00:37:54] What is like, what's the general like? I've never seen one, right? So I don't actually know. Well you've seen Hollywood, right, right. As we talked about. Yeah. So the average first time mom, her labor will take about 18 hours and they from the first contractions all the way to, well from the time they're in labor. So labor is defined as regular uterine contractions with cervical change. So for example, somebody who's contracting, you often hear people, patients describe Braxton Hicks contractions, which are just very short sort of practice contractions that the uterus is going through for months, often before delivery. That's not really labor until those contractions get longer. Usually going from maybe 20 seconds long to a minute long and then produce some cervical dilation or cervical change. So from the time labor begins, on average about 18 hours is a, is an estimate, a good estimate for first time mom and and subsequent mom. So a second or later baby more average. Average is more like 12 hours and sometimes it's 12 minutes. So there's a great wide variation obviously. And when you're going through this process, you talked about c-sections, you know, not being prompted by induction. When do you decide, all right, we're not going the vaginal route, we're gonna go C-section. Yeah, I mean you talked about your second baby's delivery was a scheduled C-section. So sometimes it's a decision based on what happened in the, in the past. But I think your question more is about somebody who's laboring.

Vance Crowe [00:39:27] When do we make the call? Okay, this isn't working, we have to go to C-section. So there's some basic categories that, that would fall into. One is that the baby's not doing well. So we are monitoring the baby's heartbeat with a, a ultrasound device on the outside, which is more of a, like a motion detector so it can read the baby's heartbeat. And the other is more of a pressure detector. So it can read the contractions and through that external monitoring. And sometimes the monitoring gets changed internal through the vagina monitoring. But through that monitoring we can determine what the baby's heart rate is and the pattern of the heart rate, fetal heart rate tracing. It gives us an idea about the oxygen level in the baby. And it's not a perfect tool, but it's better than nothing certainly and, and has and has used in the vast majority of labors because we believe that it does give us valid information about the baby's oxygen status, which of course affects their overall health. If the baby's heartbeat tracing looks abnormal and there's certain specific patterns we look for, then we might say we're concerned. Or we might say this is no longer safe and we need to go back and do a do a C-section. Another category of reason for deciding on C-section is that the labor's just not progressing. So the patient dilates to seven centimeters. She has plenty of contractions, we've tried all sorts of different positions. She's been doing that for many, many hours and the cervix just won't go past seven centimeters. So that would be a situation where we'd say, well this is a, an arrest of labor and we have to do a C-section 'cause we just don't think the baby's gonna fit.

Vance Crowe [00:41:03] When I saw my first C-section, I was of course caught off guard, right? Like there is a lot of pulling and like, you know, like strength involved, right? Walk me through a C-section. So hopefully we're not rushing when we're doing a C-section. 'cause some of those more emergency scenarios you and I were talking about are much faster. And so you can't be as careful but generally say in a scheduled repeat C-section, we get make sure the patient is under adequate anesthesia. So that's the spinal anesthetic in many cases. And we test that. We pinch the mom's skin very hard to make sure she can't feel it. And we warn moms that there can be a sensation of moving. So I always remind people, if you've ever had Novocaine for dental work, you can tell that the dentist, you feel pressure, right? It's doing something, you know, there's, there's 10, there's touching, but it just isn't painful. So that's what numbing the, the pain signals will do. It doesn't numb the touch signals or the pressure signals as much. So mom's under complete anesthesia, we can make sure we, she, we have her prepped in everything in the area is sterile. We make an incision. Most people know it's sort of right along the pubic hairline and about 10 centimeters in length. So big enough to, to allow the baby to come out. And then we go through several layers. The last layer that we go through is, well I guess second to last layer. And each layer is another cut for you. Yeah. And it's the, the skin is usually cut with a scalpel, but then layers below that might be cut with a, a cauterizing tool that's called a Bovie, which cauterizes and cuts at the same time.

Vance Crowe [00:42:40] Then we might use scissors. And then this is getting to what you were referring to earlier, we're with pulling and, and strength maneuvers. Sometimes we actually stretch the tissues apart. So the abdominal muscles, you know, the six pack muscles, the rectus muscles, they're just separated in the midline or in the middle of the body. And we pull those apart 'cause we don't wanna cut them. 'cause muscles don't heal very well when you cut 'em, it's very painful. They bleed a lot. So we'd rather stretch them open rather than cut them open. And, but the uterus, we have to cut that usually with a scalpel. And then the very last layer is the bag of water, which we have to pop and then out comes the baby. And what can go wrong during a C-section? I'd say the primary thing we worry about is bleeding. So the uterus has an enormous amount of blood flowing through it. 'cause obviously it has to supply the baby with oxygen. And so that's almost always our, our first concern is that the mom could be bleeding excessively. Obviously while we're in the process of delivering the baby, our first concern is getting the baby out safely and, and not spending too much time. That could be putting the baby at risk if we're going too slowly. And then we do worry about infection. So especially in labor, if a mom is labored and then had a C-section, she's got a much more increased risk for infection either in the uterus or in the tissues around the uterus or in the skin incision. Why? So the bacteria that naturally live in the vagina, they're very healthy bacteria in the vagina. They, during labor when, especially when the bag of water's broken, now have access to the uterine cavity.

Vance Crowe [00:44:15] So over time the bacteria ascend, move from the vagina up into the uterus. And if things move along quickly enough, then that might not allow enough time for an infection to, to occur. But in a longer labor or the more aggressive type of bacteria that could create an infection. So you know, the c-section gives you this, we know when it's gonna happen. It feels like you're maybe in more control. What are the downsides of a c-section? Well, just these things we were talking about the things that can go wrong. So the chance for a blood transfusion is higher if you do the c-section, chance for infection is higher and the pain generally is higher with the C-section because that's really, well the skin incision is a, is a guaranteed pain. Whereas with the vaginal delivery, especially the mom who doesn't have any tearing of her perineum or the vaginal area when they deliver, she's gonna have much less pain after the delivery than the C-section patient. But some patients with a vaginal delivery do have terrible tearing or have large injuries to that vaginal part of their bodies. And so those patients can have enormous amount of pain as well. Yeah, I really don't know Certainty, I really underestimated, you know, my wife was swimmer, you know, six pack abs so I, I didn't really know anything at all about a c-section. But even less that I know about, well if you do a c-section now you are both a new mother and a post-surgery patient. And that was like a really caught me off guard because that's, that's a different thing, you know, she can't just get up and walk around and pick up the baby and do all the things that you would expect to be able to do after a pregnancy.

Vance Crowe [00:45:54] Right, exactly. And, and even an elite athlete like your wife is, you know, sort of not brought to their knees, but they're, they get slowed down by, by what we always refer to as major abdominal surgery, you know, it's real. And for the baby, what's the difference between doing a vaginal birth and a c-section? So, and, and you know, we talked about emergency c-sections, so that's kind of a different thing I think than what you're asking about because that the biggest difference there is that the baby would be potentially harmed seriously by waiting for vaginal delivery. So I think that's a, that's kind of a different category, but, but generally speaking, let's say you had a mom who could do either one and she elects to have a, a repeat C-section rather than attempt of vaginal delivery. Probably the biggest effect on the baby is that, and we're learning, I think we just barely know much about this, but we're learning that the baby doesn't get all the natural bacteria in the same way in the baby system because the baby gets what we call the, the bacterial flora. So that's all the bacteria that live in our system. We get those from our parents generally. And most of the time at least the belief is that initiate the, the initial exposure that a person gets to their bacterial flora is from their mother during childr while they're being born. And so obviously if you're born by C-section without any labor that bacterial exposure is markedly less. So we're trying to understand better, what are the best ways of making sure those babies get the proper flora in their system, even if they were born through a sterile cesarean section.

Vance Crowe [00:47:32] Is there a way to do it? Well people try, have looked at and, and attempted to do what's called vaginal seeding, which is to take some of the vaginal fluid and actually put it in the baby's mouth. But what has been shown from that is that there is a, an increased risk for introducing bad bacteria and babies, some babies have gotten very sick from that process. So I think the bottom line is we don't really understand how it happens in the healthiest possible way. So e eventually, someday I think we'll understand that better. So we'll be able to protect those c-section babies a little bit better. Yeah, I came to find out after a c-section that the pushing process itself actually like pushes all the fluid out of the baby and makes it so they're ready for the ready for breathing oxygen. Right. And that is very true. It's usually a very short-lived effect, but Right. It's the lungs are basically sponges full of fluid when the baby's inside the mom and through the delivery process vaginally that a lot of that fluid gets squeezed out and the baby's able to cough or spit a lot of that out. So they tend to be better breathers in that scenario. C-section babies, especially if there's been no labor, no squeezing of any kind, they tend to take a bigger drink of the fluid as they're, that's well how we describe it, at least as they're being delivered during the C-section. And so their lungs have more fluid in them and that baby has to fight a little bit more to get that fluid out. Yeah. I don't think I've ever had any color be more burned into my brain than the, than the blue that came from, from, you know, our daughter, second daughter not getting all the oxygen at first.

Vance Crowe [00:49:05] Right. And like, you see a pink baby and then they start becoming blue and then purple and that, that color in my mind, I don't think I'll ever forget. Right. You just instinctively know that's wrong, not good. It's the wrong color. Right, right, right. And you know, we, you, you hear people joke about holding their breath until they turn blue in the face, but that's really what does happen. And I laughed a little bit when you were saying that because I think every new, every person experiencing childbirth for the first time is shocked at that exact experience. But generally those babies pick up, you know, most babies pick up very quickly and if they aren't, there's a lot of methods and materials in the delivery room or operating room to, to get that oxygen to them. Talk a little bit about the feeling of joy when, when the baby comes out and now you get to hand it, what, what, what's going on in your brain? Joy for the doctor. Yeah. It, I, I'm actually getting a little chill thinking about it because it always reminds me of the, the experience I had becoming a dad for the first, second and third time and just how, how, what a blessing it is and how it changes your life in so many wonderful ways. And I, I sort of have this big flashback when I'm having that experience, especially with first time parents. 'cause they're so blown away by this happening. They can't even believe this is real. And I always tell patients it'll be two weeks before you really believe this happened. Yeah. Oh, I agree with that.

Vance Crowe [00:50:37] Hundred percent. Like this is actually our baby and this baby is staying here for the rest of our lives. Well, at least for the next 20 years. So it, it, I I have, I think joy is the right word. I feel a lot of pride because these are patients who I've gotten to know over the term of their pregnancy. And I'm getting to an age now where my kids are in, you know, in their twenties and thinking about their own children. And, and so I'm feeling very, maybe a little bit paternalistic or something like that where I'm just very proud that this young person has gone through this process, has made it happen, has survived it both physically and emotionally. And, and there's a lot of high fives in the room. It, you know, I had a cardiologist on one of my very first guests of the podcast and he talked about how most of the patients he sees, right. It's not good that they're seeing him to begin with. Right. You know, and then basically he had to come to terms with, in order to be a cardiologist over the long term, like I'm here to relay information and to help them get where they want to go. But it was really focused around death. Right. Your experience of it is wildly different than that. I agree. And I think that's a major reason I picked ob GYN 'cause I I was not as great at the death and the sickness as I was at the happier, generally happier or problem solving and ending up with something very good.

Vance Crowe [00:52:10] So you're, you're, you're absolutely right. I think that you have to ask yourself when you're going through your medical school training, what, what am I comfortable with? Yeah. Because he would, he like, he's a wonderful man, he's an exceptional doctor, but he does come off as maybe not cold, but but distant in some way. Right. Because you'd have to be Right. It's the same as being a funeral director. You have to both be empathetic to the people, but if you carry that home every night, you do. I don't know how you could possibly do it. I agree. So you have to put up a, I would think you have to put up a layer or two. Yeah. But yours seems more, actually seems harder. Right. It seems like you have to both be available for the joy, but then also not crippled by the grief if something goes wrong. True. And that's a, a very good word for it. I think it is crippling, obviously for the patient. It, it can be devastating and for us it, it takes a big piece outta your soul. How, how often do you have to deal with that? Fortunately, not very often, but you carry it with you. So it's, it's a cumulative thing. It's not Oh, sort of. You had a bad thing happen and you shake it off and, and walk away. You know, you remember those things as the physician and, and you carry with you. But that's an important part of being successful at this job is you have to be able to still function and not be remain crippled, you know? So for example, if something bad occurs, you, you know, you, you're gonna feel that it's gonna be in a very emotional for some period of time.

Vance Crowe [00:53:43] But you have to be able to move on and, and, and continue to, to stay objective. Yeah. And to be the professional in that sort of a situation. Like I think the natural inclination you were talking about, when somebody's experiencing huge amount of pain, they wanna swear or they wanna Right. You know, like have loud noises. You could be in a different pain than the parents, but pain. But yet you have to stay above water. Right. Yeah. And, and that was something I also learned about myself in training is that I, in that, in those situations when the, there's chaos, I was able to calm myself and stay focused. But you have to be able to do that 'cause it gets pretty crazy sometimes. If you hadn't been an OB GYN, what would you have used your particular set of skills for? I think about that sometimes. I really don't know. I, it, it, I always wanted to go into medicine. My, as I was saying earlier, my father was a general surgeon and it just seemed to have completely natural fit for me. But if I couldn't have picked OB GYN and had to pick a different, a different profession with inside, within medicine, it would've I'm sure been something procedural. You know? 'cause I really do like working with my hands and doing surgeries and doing, doing procedures. But I don't know what it would be. The, the thing I would miss is that generally I get to take care of people over a long period of time in their lives. Maybe even as teenagers. You know, I have some patients who I first met when they were teenagers, having difficulties with their menstrual periods, then they decided to have children and I went through that process with them and then they had some gynecologic problems later in life.

Vance Crowe [00:55:22] Maybe they developed breast cancer later in life. You know, those are all things that I would help the patient through. And that arc of the experience through a patient's lifetime is, is, I don't know if it's completely unique to, to ob g yn, maybe family practice obviously would be another, another area. But, but it's something I find very special. Have you delivered any children from the people that you delivered? Not yet. But, but are you getting to that age? My colleagues? Yeah. I'm at that point 'cause I've been, I've been in the practice 24 years. So my colleagues who are, are older than me have said it's a really wild experience, you know, to think, man, I delivered this person as a baby and now I'm delivering this person's baby. We earlier mentioned COVID and the complications. So Ann and I had our first child during the COVID times and it was, it was scary. 'cause this was back when we literally had no idea what was going on. We were watching images on TV where people would be dragging a body and if it fell out of the coffin, they'd just run away from it. Right. So it was high intensity. Scary. Yeah. What was the experience of, you know, helping mother, you know, pregnancy didn't stop, deliveries didn't stop. How did all that go? Yeah, you're right. It was very scary time. Mostly because we just didn't know a lot of things still dunno a lot of things. But the other problem, the other concern that we all had was what is the impact gonna be on babies? And, and when someone's pregnant, we don't know that till the baby's born, obviously.

Vance Crowe [00:56:53] And we're, we're doing various tests. So the, our most of us had the initial fear of, boy, if this affects fetuses in a dangerous way, this is gonna be a true calamity. Fortunately, that was not the case. And, and most babies, most fetuses and young children, even back in the beginning of COVID, were not having some did, but a very small percentage had any serious problems. But it was hard because patients couldn't have their team around them. There was even a time at some hospitals, I think New York is one that I recall, but it never happened for us at Missouri Baptist. But there was a time, there were places where patients were forced to have their baby without even their partner there. Oh, can you imagine? No, no. For the partner, for the baby and for the mom. I mean, it was just awful for everybody. We fortunately never got to that point, but it was, we did for a long time have it limited to just the, the the dad basically. In some ways it was a unique experience because like we had one nurse at a time. Right. There was nobody else around. Like it was a very insulated experience. I have to imagine unique for most people. I mean, unless you were out on the planes, you know, doing like a Laura Engles wilder type birth. Right. It wouldn't have been that just you and mom and one nurse or one doctor. Right. A Spartan crew. Yeah, I agree. It was a, it was a very odd time. We were lucky we didn't have any really, we didn't have too many super scary experiences. I did have one patient who got severely ill and had to have her baby by emergency c-section about seven weeks early.

Vance Crowe [00:58:27] So that was a very, 'cause she had COVID, her COVID was so severe, she was intubated and she actually got transferred down to Barnes. And it was, it was very, very scary. 'cause this was early on again, when there were basically no treatments other than supportive care. Yeah. And I guess if you were talking earlier about preeclampsia and all of the challenges with high blood pressure and COVID some sometimes strikes people really hard with Right. The amount of increase in blood pressure. Right, right. Exactly. So we, did you deliver babies with moms that were tested positive for COVID? Sure. Yeah, absolutely. What happens? Well, really not much. I mean, honestly, most of those moms did fine. We did have some moms have to go to the intensive care unit 'cause of their own breathing problems. Sometimes both bomb and baby were in the intensive care units for various reasons. So that was always very distressing. But most of the time moms 'cause they're young, healthy people otherwise would recover and, and it would, it would all be okay in the end. But we also had a special area that we took care of those moms on the fourth floor of our hospital. So you had to gown up and it was much more of a production to go in and take care of those folks. So you, yourself, as the doctor had to dress differently, were you Right. What, what all was your, how did your garments change? Well, we have a yellow smock basically that we wear that's supposed to protect our clothing. Gloves, of course we had to wear eye protection, we had to wear a mask. It was always an N95. And, you know, you just had to be trying to share, you know, aerosolized droplets as little as possible.

Vance Crowe [01:00:05] So what do we now know about COVID now that we've had some time vaccines, things like this? Well, as it relates to pregnancy, you know, the, the American College of ob, GYN, the CDC, both do recommend that pregnant moms get vaccinated against COVID. There does not appear to be any health risk of the vaccine itself to, to moms or to babies. And, you know, currently the, the Omicron variant booster is available and, and we're advising people that that's safe and effective and that it's, we leave it up to moms to decide, but that if they feel comfortable doing the vaccination, that it's a, it's a safe practice. Safe choice. What do you think is gonna happen with COVID in the future? Well, I'm like a lot of the people who really are experts who say this is going to become an endemic, you know, it's gonna be like the flu and colds and there'll be a season to it. And most likely we'll get an annual, or maybe it's every other year, a vaccine against the latest version of COVID, just like we do for the flu. So we talked earlier about, you know, the pregnancy, the, the having the baby, things that can go wrong. What about after the fact, you know, mom has the baby. How, how does she get back to normal? Yeah, I think we foc most OBGYNs focus a lot on getting moms better physically. But we certainly know that that postpartum blues, postpartum depression, postpartum anxiety, postpartum psychosis, you know, that these are very real things.

Vance Crowe [01:01:39] It's just hard. You can't see it physically. And, and it's a much more challenging issue to, to help moms work through. So again, we, we, we can focus more on the physical 'cause those are things we can see and, and treat more, more easily generally. But once mom is through the physical healing, we see people back at six weeks postpartum generally, sometimes quicker, but generally it's six weeks postpartum. And we try to take an assessment of their mental wellbeing. You know, are they handling the sleeplessness of a new baby? Are they dealing well with their families? You know, we ask questions like, do you want to take care of the baby? Do you, are you angry at the baby? Are you angry at your spouse? And we always ask, you know, and moms who are expressing the a concern about postpartum depression, we always ask, are they thinking about hurting themselves or hurting other people? What kind of answers do you hear to those? Well, you can almost tell the response, be in nonverbal cues. You know, you can just tell the, this person who you've known through their pregnancy seems to have a different personality. Or they're, they're very withdrawn or they're, they just seem exhausted. So those, those moms typically will just say, it's really hard and I don't have any help. The anxiety that I thought I had gotten rid of is now back with a vengeance. So, you know, eventually I think we can get a a, a really honest open response, but people are sometimes embarrassed by that, which they shouldn't be. And people are certainly frightened by it.

Vance Crowe [01:03:12] Do you, is this something that's the same as when you started in practice? Or is it, has it changed over time? Boy, I feel like the, the dialogue has gotten better. I think there's more comfort in talking that for that patients have more comfort talking about these things. And, and I don't know if it's the way I've looked at it differently or if the, as a society we've sort of shifted and that it's not a, something to be embarrassed about or consider a taboo. That it's just a well-known fact that it can happen to people who felt perfectly fine in the past, but now they're really dealing with some serious depression. I remember when I first heard about this, you know, like postpartum depression. You're like, okay, well maybe depression. But like, when you add in the insane amount of stress that goes on, I'm sure the physical toll in the body and then the sleeplessness. I mean that, that was the thing that even just as the dad, like that was so much harder on me than I ever thought in my wildest dreams. 'cause I had worked on ships where I would, you know, work several nights in a row. No, no big deal. This was a whole different thing. It is, and people can tell you about it. People can spell it out for you, but until you experience it yourself, you don't really know. And it is tough. And, and for all three of our kids, I remember vividly remember about a month in thinking, God, this is so hard. And like you said, I was just the dad. Right. So imagine what, what mom's going through. And so you did struggle with it. It was hard for you. Definitely. Like you, I imagine like the ob g yns got everything.

Vance Crowe [01:04:44] How did you balance it with your, with your wife? Like the duties and the responsibilities? Well, yeah, I mean, she would always fact check me. So whenever she had a question, you know, she would always take that question or, or my answer to her doctor and say, that's good to know. So, you know, Tim seems to think, and of course actually when our first was born, I was only in medical school, so I really was pretty worthless at that point as far as being an ob. But, but no, we, we always laughed about that. The funny thing that my wife went through, it's funny now, but at the time it was a little pitiful. I came home from a medical school class and she was, I still remember she was sitting at the kitchen table, just tears pouring down her face and she's flipping through my book that's called The Developing Human, which has all the horrible things that can happen to a baby. And she's doing this while she's like 20 weeks pregnant. And she was like, our baby has, you know, every problem in this book. And it, it, I started to understand that, you know, emotions were gonna be swinging more than usual. And when you think about the responsibilities of being up at night, these kinds of things, you have one of these jobs where you've gotta be sharp, you know, you've gotta be, how did you guys handle that? Yeah, it's, it's, it's a training kinda like anything else you go through physically where you, you, you have that time from when you get up out of bed to, you get in the car, you're driving to the hospital and you do, you really have to wake your brain up. So sometimes it's roll the windows down on a cold night, blast the music loud, you know, slap yourself in the face, you know, all, all the tricks.

Vance Crowe [01:06:19] Little cold water on the face helps. But you realize, look, I've got about eight minutes where I've gotta get, I gotta be on and ready to go. Especially if you're going in to do an emergency c-section or something. And you know, you can't afford to be shaky. So your part of the process is about eight minutes, you said? Well, I was saying to get to the hospital. Oh, okay. That's sort of your, that's like you have this time to like your, like your meditation you did before. Yeah. Your c-section, you know, you have this time to prepare and you know, it's eight to 12 minutes for me to to, to physically get there. So when we, when we were getting ready to have our child right, we waited a really long time. And I tell this all the time to young men, I feel like no one told me that there was a clock. I feel like I was kind of given this Peter Pan style, you know, hey, you just go live your life as much as you want and then when you're ready to be a parent, and now looking back on it, I think that advice or that that kind of cultural idea was really negative for me because it, it pushed us to making chances where we got into the position where like, Hey, if we don't make this happen relatively soon, it may not happen at all. Right. Have you noticed that cultural shift? Yeah, it's interesting. Yeah. I, I mean I think if we go back a generation or two, it was sort of like you get outta high school, you do college, you get married, you have a baby, and better have that all going on by the time you're 30. So yeah, I think careers have pushed childbearing later.

Vance Crowe [01:07:50] And advice like you were just hearing from parents or, or other people. Yeah. I could see how that would, would shift the timeline later. But you're right, there is a window of opportunity. The the, the fertility doesn't last forever. And so striking a balance is, is as usual probably the better option. What is the window well really drops at the, when a mom is 40 and obviously women have babies over the age of 40 naturally all the time. But it's, the odds are much, much lower. So I usually tell patients, you know, let's say I'm talking to a 28-year-old who says, I'm not really sure got this career and I'm not really sure when I'm gonna be ready to have children. What do you recommend? And I used to say, make your decision by the time you're 35. That doesn't mean you have to have a baby by the time you're 35, but you wanna make your decision about will I or won't I have a try to have children? And by the time you're 35, you really should have that decision in your mind. The younger you are, the safer it is because there's also a risk of things like down syndrome and that type of chromosomal abnormality that goes up with age as well. And so that's a, that's a competing issue with waiting, you know, in other words, waiting to have your career developed is a wonderful thing in many ways, but it also has a dis that disadvantage. Yeah. I, I fact check this with you. I have heard recently that there is a correlation with autism from the age of the father.

Vance Crowe [01:09:22] Is this something you, I I've read that too. And, and correlation is always a word that most of us recoil a bit when we hear because it's such a loose association or a loose, maybe non-scientific kind of a connection. So autism is one of those, partic is in particular one of those things that very little is known about its origin and what it's, what what associations actually lead to a problem. So whether dad's age pitocin has been implicated in a, as a cause for autism. Oh really? All sorts of things. The, the drug to induce, right. Whoa. So I, we, we, for years we've heard that as a, as an admonition from patients. We don't want any pitocin because we heard it can cause autism to which there's no proof. But yeah. So, but to, to the point you were making about the, the dad study, I read that as well. I, I don't know what that will turn into. And for moms that have a baby later, you know, the 30 5-year-old mom versus the 25-year-old mom versus the 15-year-old mom. What's the difference for the, how they're, how they bounce back and how this all works? Well, geez, I, yeah, 15 is a whole different category. 'cause I think just in terms of their, their lives, they're probably not prepared yet to take care of a baby 'cause they're still children but their bodies really aren't ready either. You know, they can physically become pregnant, they can physically have a baby, but their hips probably ha their pelvises ha probably haven't developed fully.

Vance Crowe [01:10:54] And they do have a higher risk for preeclampsia at very young ages like that. Their blood, they can not handle the physiology of pregnancy as well, so their blood pressure can shoot up. This is fascinating. 'cause my impression was that we've like delayed it from, you know, like whenever they were doing it in olden times and my imagination is 15. But you don't, you don't think that's, that's probably too young. Okay. Physiologically, I mean they're obviously all 15 year olds aren't the same. But as a general rule, I'd say that they're physically not really ready. Certainly emotionally, financially, all the other aspects are, are important too. Probably the sweet spot I, you know, like the ideal time physiologically, physically is around 20, early twenties when the body is really ready and, and lowest complication rates, that sort of thing. And then as they get into 25, 30, what makes, what becomes more, yeah, I'd say 25 is still within that window of, of optimal physical health and, and that sort of thing. 30 is still, I mean obviously we have lots of people who are pregnant at 30, 35 and, and in the upper thirties. And most of the vast majority of those folks do extremely well. It's just that the, it's odds these curves are starting to work against patients as they get closer to 40. I think that your field is in a really difficult position because in many ways innovation is kind of a, a scary thing. I think back to the time when they thought they had a drug for morning sickness and then it turns out, no, actually if we didn't understand exactly how this molecule works, we have, you know, created really dark things in the world.

Vance Crowe [01:12:34] How does innovation happen in the world of babies? Yeah, it's a it's a great point. I would say that we're, what was that, that drug that, well it might, it might be thalidomide that you thalidomide thinking Outide. That's right. Yeah. And there was another, there is another drug or was another drug called DES or Dathyl Sylvester, which was used to, to reduce miscarriage rates and that also had terrible effects on developing fetuses. And those are effects that would carry on throughout that patient's life. So we, we have some mo some women now who are generally maybe in their upper fifties and sixties who were exposed as fetuses to DES and they have these ongoing issues, mostly with their own reproductive tracts. Thalidomide caused limb defects, you know, where arms wouldn't grow to proper lengths and they would just sort of be a very short arm with a, a short arm with a hand on it. It was never marketed in the US And it's actually a great story that I'm gonna get the details a little wrong, but there was a woman who worked at the FDA when thalidomide was trying to be passed, and I wanna, I wanna say this was in maybe the fifties and it was being used in Europe and that's where some of the data was first recognized that it could have this birth defect if it was taken at just the wrong time. This woman at the FDA was a hero and that she recognized that there was something missing from the data, that it didn't appear to be as safe as it was originally advertised, so to speak.

Vance Crowe [01:14:07] And she blocked it and thank God, because she saved a lot of babies. And then when you think about the new medicine, you know, somebody comes along and says, Hey, we've got this new way to do induction. How, how, how does that even, how does that make it into the world? Right? It's a long climb, right? I mean, those companies have to go through enormous testing to prove that something is safe. So there's animal studies of course, and then it's very, very difficult to get a drug, especially a new drug tested in human pregnancy. It almost never happens. So usually what happens is a drug is not approved for pregnancy, but it's sort of out in the community and then it gets used by women who happen to become pregnant and then the data develops. Well, we have now a thousand women who didn't realize they were pregnant and they were taking this drug and there was no problem. So that's how safety data is. It's called a registry, A safety registry is sort of developed. Yeah, I, I feel like, you know, having worked in biotech, like it's always hard to introduce anything in the US particularly to humans, but you think about babies and you think like, no, nobody wants to be on the, nobody's an early adopter there, right? No way. Like it's like no way, right? 'cause you just have to hear one story, like the thalidomide story and you think, well, I'll just have nausea, you know, I'll just, yeah, I'll just do the natural childbirth. The right, exactly. Non-medicated, right? Unmedicated, right. So when you look back on your life, you're, you're a dad. How did being a dad change you? Wow.

Vance Crowe [01:15:40] It was always something that I wanted to be. So really, I think it was more of fulfilling a dream than it was, wow, this is something I never realized was gonna happen to me. So, and my wife felt the same way, you know, from early on in our relationship getting to dating and getting to know each other. That was something we identified immediately about each other, that we both wanted to be parents. And so it was again, a realization of a dream for us. And fortunately my wife was amazing and had great pregnancies and three unbelievable kids. And now looking back on, on being a dad, what do you tell your children about what it will be like for them to be a parent? Yeah, I'm actually gonna be a grandpa in January. Oh, congratulations. This is a very congrat relevant question. Congratulations. Thank you. Congratulations. Yeah. Our, our oldest has a daughter and she's having a daughter and yeah, I, I haven't figured out quite how to say that to them. Like what, what is being a parent really gonna mean to you? What, what are, what are the trials and tribulations? I think I'm still formulating that obviously in my mind, in my mind. But I think that our kids realize how much we cherish being parents and how involved we've been in our kids' lives. And my wife is amazing at, at staying in up to date with what's going on with them. And so I think they will mo hopefully model their parenting after that, you know, heavily involved kind of approach. When you think about the, all the questions you've been asked over the years about like, you know, about to have a baby, all these things going on, what are the, what's the question you think like, that's a really good question.

Vance Crowe [01:17:22] People should be asking this as they're heading into having a baby. Yeah. I love when people, particularly dads, you know, ask me, what can I do? Like how can I be helpful in this process? 'cause they realize what we talked about earlier, that they're kind of on the sidelines a bit and they're a bit powerless to really affect any significant changes in the process. So I love when dads ask that question and I usually just talk about, you know, of course being supportive and understanding that your wife is changing physically and emotionally and, you know, giving a lot of grace for, for all of those things. But I, I tell patients, if you're ever concerned about a decision, the best thing you can say to me to get my best answer is, what would you do if this was your wife or your daughter? You know, put me in the position you're in and ask that question. 'cause I say I I will be very honest with you because we're trained to give options. Oh, you could do A, B, or C. In my mind I'm thinking, well I would do C for sure, but A and B are certainly acceptable. And so when patients sort of gimme the freedom to speak freely about what would I do, I'm always as honest as I can be. Oh, that's interesting way to put that, that if they give you the freedom to speak that way. Because at its core, I know for me, I'm, I do wanna know, well what would you do?

Vance Crowe [01:18:52] Right? That, that carries a lot of weight with me. Yep. Yeah. And, and we, we don't wanna force somebody into a decision just because that's what we would do. 'cause maybe it's there's a religious basis or some other reason for making that choice. But when they ask me, no, no, it's go time and I'm gonna tell 'em exactly why I would make my, what the decision is and why I would pick that decision. And in the world of being asked questions, you have this difficult reality of things like malpractice and being sued. How has that impacted your being a doctor? Well, I mean it's something every, everybody who goes into OB GYN realizes as a, as a, a significant part of our careers. I, I recognize that when I was in residency. And so as a chief resident in your fourth year of residency, you have to give what's called a grand rounds, which is basically just a long speech that lasts for an hour or so. And so you get to pick your subject. And I picked medical malpractice in OB GYN because we were, we had no training on it. It wasn't really part of our OB GYN residency, even though it's a major, it's, well it's the like number three line item on my, you know, on my expenses. Expenses, yeah, yeah. So after number after rent and personnel. Yes. Wow. It's a huge cost. And so I wanted to understand more about it early on. And so I, I gave that talk and of course did a lot of research to provide, prepare for that. But yeah, it's, it's just a reality that we live with every day.

Vance Crowe [01:20:26] And I, I try to tell patients things that I think are significant risks, you know, and one example is shoulder dystocia where the shoulder of the baby can be stuck at the time of the, of the natural vaginal or the vaginal delivery. And know patients really don't have any understanding of that if they're not in the industry of, of delivering babies. And when a baby is predicted to be very big on an ultrasound, we worry more about that issue. Although it can happen to a baby of any size. And so you're that, that's such an interesting thing because you're kind of balancing between, I don't wanna freak the mother out unnecessarily, but I need to tell them enough that they have this wide view so it doesn't, it doesn't come off as malpractice. Right, exactly. And that's a great way to put it. It's funny 'cause I hate, I have a little bit of an argument with one of my partners who I've been partners with for, you know, a long time and she says exactly that. She says, well, I don't tell people that because I don't want to just freak 'em out. And my response is, well, but they need to know about it. I mean, it's something that can't happen and it's, it, this should be a shared decision. This should be a shared risk that we're all aware can happen and, you know, and try to get the best outcome. So you're right, it is a balancing act for sure. So we have gone through all the difficult parts of pregnancy all the way up to malpractice and moms recovering from, you know, surgery, things like that. What is, what's a joyful story? What's a, what's an experience you had where you got to hand a a baby off and have real joy?

Vance Crowe [01:22:01] Well, I, I have a great answer to that. I had a, a patient come to me who had delivered a stillborn at about 31 weeks, 32 weeks. And young couple, he, he was a, a training physician, delightful mom. And they were devastated. You know, this is a family, this is a couple who really, really wanted to build a family and, and they just had this devastating experience with another physician at a different hospital. And they decided to change. And they had gotten my name through various channels and they just felt like they needed a, a fresh start. So I felt an enormous responsibility now as they're going into their next pregnancy that everything turned out as best it possibly could. So when they had their baby and I handed Mikey to the mom and the dad, they were just tears of joy. It was just devastating and it just filled me with so much happiness and joy and pride and, and good things that this couple who really deserved to be parents and are wonderful parents, they finally got there. Then they, a few years later, they went on to have a set of twins. And a few years later my wife and I became very close friends with 'em. 'cause they're actually neighbors. So I get to see 'em all the time. So I'm, I'm getting to watch these kids grow up in this family. Wonderful. That's perfect.

Vance Crowe [01:23:32] If people heard what you had to say and they thought, hey, that's a, that's a care clinic I want to be a part of. How would they go about finding you guys? So my p our practice is called Women's Care Consultants at, we're at Missouri, our office is, we rent space at Missouri Baptist Hospital and I have myself and three other partners who are just fantastic ladies. It's Angela Reining, Jennifer Meyer and Sarah Cusworth. We have three great nurse practitioners as well. So yeah, we're, we're, we're happy to take care of people. That's what we do. I will say that my, my family, my wife and I were, we're guided to a path of like pure joy and feeling comfortable and confident and you really like, had a major positive impact on our lives. So it's been nothing but an honor to be here with you today, Dr. Tim Philpott. Thank you Vance. So, and it's been an honor to be here with you today and to help take care of your family and your, your wonderful wife, Ann. Well thanks. And we'll have you back on again sometime. I hope so. Thanks for sticking around to the end of the interview. As a special treat, we'd like to show you what it's like to be in a legacy interview with another clip from Ben Lawler talking about brotherhood starting businesses and his drive-through liquor business.

Vance Crowe [01:25:08] If you'd like to learn more about Legacy Interviews, go to Legacy Interviews dot com. Motherhood to me means, means love, you know, it means protection. You know, early on, gosh, I was number four out of six, right? So three older and two younger. And man, out of all my closest relationships, I would say my five brothers are right there at the top, right? So we talk on a regular basis, you know, over the years we've had some great business ventures together. Some have made it, others have not. But a few in particular are going back about five years. We bought a liquor store down in southern Illinois, drive through, right? So I have two brothers that practice law, they're in Marion, Illinois. I have two other brothers that work for Tom James. The three of us are with the Tom James company. And then the oldest still runs the farming business. Specifically, he's into cannabis and hemp. And we currently have the highest rated CBD product in the state of Illinois. But going back about five years, we acquired a liquor store, it was drive through and as brothers we were able to work on that together. So it was great combining our, our relationships and our business acumen to, to build a business together. When you were kids, can you think of a time when you got in a lot of trouble with your brothers? Yeah, I can think of a few right off the bat.

Vance Crowe [01:26:39] My older brother, Adam, who he's number three, right? So if I was born in 1980, Adam would've been 78, right? So Adam was a punter in high school, you know, long legs, just, just a strong dude. One day we were getting into it, right? Really, you know, pretty serious fight. We were trading punches. And I remember raring back to punch Adam. And before I could make a fist, Adam kicked me right in the hand and broke all four fingers. Oh, in advance. I don't know if you've ever tried to punch somebody with four broken fingers, it doesn't happen, right? So, so I hit him once, but it didn't really connect right. And we were right next to the swimming pool at the time, which my parents had just put in. And Adam saw that I was, that I was wounded, right? And he just, he took advantage and he just caught me right, right in the face, knocked me into the pool. And shortly after that, my father came home and he was pretty upset, you know, he said, boys, what's going on here? We, we explained the situation. He told me to sleep on it, right? I, these four broken fingers, I said, dad, I think I need to go to the hospital. He said, we'll go tomorrow. But that next morning, man, it was swollen and it was purple. And I knew that, yeah, we probably, we could have settled that fight, that disagreement a little bit differently. But I learned at that time to, to settle disputes with words instead of your fists.

Vance Crowe [01:28:12] When was the last time you physically fought one of your brothers? Well, I, I wrestled in college and I was on the boxing circuit for a while, so not at a very high level, but with the brothers, I would say it's kind of like the rooster complex. Whenever we go home, it's not full on fist fights, but there's a lot of wrestling matches, right? There's a lot of shirts being taken off. And who's the big dog? That's amazing. But fistfights not, not that often. Wrestling matches quite often.