Birth Autonomy with Dr. Jen Lincoln

The Birth Book with OB-GYN Dr Jennifer Lincoln. Pro-autonomy! Pro-Consent! Pro- vitamin K for babies! Anti-shame and coercion! She hopes folks name their babies "OG" Anunoby.

The Birth Book

• Get your copy of The Birth Book
• Resources for The Birth Book
• Follow Dr. Lincoln on YouTube, TikTok and Instagram

💊Take Two and Call Me in the Morning💊

• Jen’s book recommendation: Roll of Thunder, Hear My Cry
• Marcus Tudrick on Instagram
• Paper Pepper healing Van Gogh

Thanks for listening to The Present Illness! 

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Credits

• Production by Arghavan Salles & Alyssa Burgart
• Editing by Alyssa Burgart
• Music by Joseph Uphoff
• Social Media by Arghavan Salles

Don’t take medical advice from random people on a podcast. This show is for informational purposes, is meant to be fun, and is certainly not medical advice. Please, take your medical questions to a qualified professional. Nothing we say represents our employers or anyone else. 

Transcript

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we see so much on social media about misinformation or people being made to feel like they're less than because they chose a hospital birth or they ended up with a C section or they chose a home birth. So let's give you the facts and then you decide what's best for you. Hey there, fellow nerds. Welcome to another episode of The Present Illness, the podcast where two physicians try to make sense of a world that is febrile and falling apart um and also underdiagnosed. I'm Arghavan Salles the surgeon scientist, and your friendly neighborhood Doom Scroller in Residence. And I'm Alyssa Burgart an anesthesiologist and bioethicist who tracks news and health law like their EKGs full of spikes and surprises. The present illness is where we dig into public health, politics, ethics, and culture with a scalpel in one hand and a meme in the other. As a note to our listeners, we often talk about tough topics that can be intense. And so if you need to take a break, we understand. We want to give a big thank you to everyone who's listening with some extra love to our subscribers and those who follow us on any of our platforms. And a special warm welcome today to anyone who is stumbling in from the Knicks game last night. I should say the Spurs were there too. The Knicks Spurs game last night, which was well, they were in the first half, right? They were very there in the first. I was like, how many threes are y'all gonna make? Um it was They had an excellent run in the first half. but Jen, do you wanna summarize for folks who uh well you they don't know you're here yet. We have a special guest today. Yeah, I was gonna say, you know, what's probably most important is that you have stumbled in from the Knicks game in the presence of not only Dr. Jennifer Lincoln, board certified OBGYN, but as it turns out, major Knicks fan. Huge. Mm-hmm. Grew up give people like a two sentence recap of the game from last night? Okay, two sentence recap is the refs tried to rig the game the first two minutes. Horrible calls. Don't get me started. Four letter words. Fourth quarter."OG" Anunoby. He like so many babies should be named after him because it was an amazing, amazing end. And let's just say um I am still unwell this morning. So yeah, I'm stumbling in as a, you know, born and bred New Yorker, but on the West Coast now. I used to be in love with John Starks and sorry Arghavan but I hated the bulls. Hated the bulls. Um, but that's okay. I love the bulls. So that's why she's apologizing. It's okay. We can get along now. It's been, it's been a good 25, almost, yeah, yeah, over 25 years since that rivalry. So I think I think we can be friends. Um, the the amazing thing about OG Anunoby that you mentioned for folks who didn't watch it, so it's like very close to the end of the game. I forget how many seconds, five or six seconds on the inbound. And thank you, 5.7 seconds on the inbound. And he, this player we're talking about, is the one who does the inbound pass and it goes to Jalen Brunson. Jalen Brunson takes a long three and and misses. That's okay. In the meantime, no one's paying attention to OG. And he's like running from the sideline to get to the ball. And he tips it in. And that ends up being the basket that puts the Knicks up by one, such that they have the biggest comeback in NBA finals history, coming back from 20 points, 29 points down to winning the game. And I do feel honestly a little bad Mm, I don't, but that's okay.'Cause I have a lot of thoughts about how this series has been going, but it is all good. We uh we've got till Monday now to recoup and recover and get mentally right for the next longest six hour game, it feels like ever. So we can do this. We can do it. So I'm glad to have the distract distraction stay with you ladies. This will be great. Yeah. appreciate you being here. It's such an honor to have you here. we're so thrilled to have you here. We had no idea that Dr. Jen Lincoln was a Knicks fan when we invited her on, so we're all learning a lot together. Dr. Jennifer Lincoln is a board-certified OBGYN whose passion is helping girls, women, and those assigned female at birth understand their bodies and feel empowered to advocate for themselves. She's also a lactation consultant, which I think is so cool. An author, a mom, and current president of the Society of OBGYN hospitalists, and Her first book, "let's talk about down there" to her social media content. I mean, we're huge fans of the work I became familiar with you online. Um, and so it's been really cool to see the content that you're making. And you're trying to make it so that no question is too embarrassing and no topic is off limits. And we're even more excited that in March you had a new book that came out, The Birth Book. It's a book, baby. Yay. Thank you. Thank you so much. I'm so excited to be here. I have been on a lot of podcasts, but you all hands down have the best intro. Like I just love it so much. With a scalpel in one hand and a meme in the hand. It's so good. So good. Because that is like our lives, right? It's so true. Yeah. Mm-hmm. Mm-hmm. I love it. I love it. all right. Well, I'm excited to talk about this book, which I devoured. it's called the birth book. I think that gives you a hint what it's about. Um, but yeah, basically, yes. Well done. Um The the book is organized in multiple different sections. You make it very easy for people to pick and choose. You know, if they have a specific question about some aspect of their birthing journey, it's very easy uh from the table of contents or from the index to be able to get to where they need to go. But in general, you you start out with who should your birthing team be? Who should your are you gonna have a midwife? Are you gonna go to a birthing center? Like where are you gonna go? Who and where is the that the name of that section, I believe. and so it goes through all the questions you should ask people about the capacity of a facility, whether it's a hospital or birthing center or whatever. What are the things they can do? What are the things they can't do? What do they offer? What do they not offer? Then you have a section on um when it's time. How do you how do you know is it time to have this baby? Then you have a section on the actual having of the baby, the the delivery. Um, and then a section on complications. Um sorry, actually before the section on delivery, it's the being in L D. And then you have the complications and then the delivery and then what happens after. And then importantly a section on stillbirth, which of course, as you say, no one wants to have to read um that section, but you have it there for folks, which is amazing. I want to highlight just a couple things that I think folks might find really helpful. Again, just to give our our listeners a an understanding of what's in this book. So you have very early on you have a list of things to ask about the hospital. So this is on in In case folks want to know, it's on page 14 in the book, or 15 actually. And starts with like, does my insurance cover this hospital? Um, can you care for my baby if my baby's preterm? Do they have an anesthesiologist and an OR available and physically present 24-7? So these are the types of very practical questions that I think a lot of folks may not know to ask, which is what I think is so cool that you have it all in here for people. You don't have to have insider medical knowledge because Dr. Jen is giving it to you in this book. there's a section on how do I know when to go to the hospital? Um, and then you have how to prevent tearing, which I think is something that a lot of pregnant people are concerned about. Um, understandably so. And there's so much talk about that on social media as well. but you have a section on what are the things people do? This is on page 201. What are the things that people have tried? What's the evidence for whether it works? And then, you know, you all you have a nice summary of whether you think is worth trying or not trying, or what's the benefit of doing it? Um, so things like their perennial massage, um, perenni support, warm compresses, etc. And I think the most important thing, my personal take that you have in here is different communication tips for how people can express their discomfort with someone on the care team. Or their discomfort with someone who's their own relative or friend or whatever who's in the room and they don't want that person there anymore. How to handle those situations. And you give people specific verbiage to use and you give them tips on who to talk to and how to say it, or like one part you're like, take ask the nurse to help you get into the bathroom, and then you can tell her that you really don't want your, you know, brother-in-law or whoever it is to be there. And then she'll take it from there. Um And also if you don't feel listened to importantly, right, by your care team. This is something that Ellis and I talk about a lot. And I know you talk about obviously a lot in your in your um content. Patients, you know, we we don't have the best reputation as physicians and and healthcare workers because patients are frustrated because they're not always hurt. So anyway, you you you give people specific things that they can do if they don't feel hurt. That's on page 139. anyway, so I just think it's Amazing that you have put so much information in this one place for folks, really through all aspects of the birth. And um it's with warmth and compassion, it's written inclusively, it's honest, um, and it's evidence-based, which I love as a researcher. Um, so anyway, I'll stop fawning there, but those those were um my highlights of the book. And I'd love to just start by asking you why you wrote it. well, first of all, thank you. You are now hired as my marketing person. So welcome to that job, because you're awesome. Um, but no, I wrote it because a book like this didn't exist. And there's a lot of pregnancy and birth books, and there's some really great ones out there, but there wasn't one that was written just like air quotes, just on the birth part, which as you can see it took up a whole book. Um, and by somebody who does it every day. And, you know, there are I'm not saying you have to have your book written by an OBGYN, but you see stuff online, you see misinformation, or you see other people who've written books who don't actually even practice the, you know, any sort of medicine. So it's really hard because, like you said, there's evidence, and true evidence-based medicine is also incorporating the values of somebody and the clinical expertise. So so much of my stuff I I, you know, give you the evidence on why something's good or what the study showed. And then I do have my little like Dr. Jen's thoughts in in the columns because I want you to be able to interpret like how strong is this evidence or what do I think? Not because I'm trying to get you to do what I think, but giving you that insider like into my brain, like what I'm thinking about. And I wanted a book truly centered on autonomy, which you highlighted, like, you know, communication tools, because I'm an OB hospitalist. I practice in a hospital. But I'm not going to assume that you want that or you have the same values as me. So let me just give you the information. Again, with what we see so much on social media about misinformation or people being made to feel like they're less than because they chose a hospital birth or they ended up with a C section or they chose a home birth. So let's give you the facts and then you decide what's best for you. And at the end of the day, no matter what you decide is your choice and you should be supported, and you shouldn't need insider knowledge. on how to get what you want and need, because birth can be very traumatic. And one of the most traumatic ways I think it is, is we see people who are like, I didn't even know I could ask that question. Or that that shouldn't have happened to me. so yeah, and those checklist, all those things to ask. Again, I feel like they're like my little hot tips, insider tips. Like one of my favorite is if you don't know the OBG, you know, you move to an area or you don't know an OBGYN or a midwife, call labor and delivery, talk to the nurses, because you all know. The nurses know us and they see us. They're like, this is the per if you want that, this is the person for you. If you don't want that, don't um and so all of those checklists and questions, they're in the book, but they're also on my website and not behind a paywall because I do, you know, people deserve um to be able to access that stuff. So if you go to my website, you can get those for free too. But but yes, they're also in the love the resource page on your website. I definitely perused it and just such a gift, especially for people who don't necessarily haven't found your book yet. They, you know, whatever. I thought that was really and it wasn't hidden. Like there's a lot of books where they're like, there's a resource page, but it's like an unlisted page. So I really appreciated that extra step. Thank you. Yeah. And I wanted people too, you know, specific things to talk about. So if you want intermittent fetal monitoring, cool. Are you gonna go to your OB and they're like, we don't do that? Well, on this website, you can print off the protocol that I referenced and say, What about this? So being able to be your own advocate. Um, you shouldn't have to, but this is the healthcare system we work in. So how do we help people while we're also working from the outside to make it better? The the other thing I really loved about the organization of it and is um the fact that everything is listed as a question, which is the way people do Google searches. And so I really felt Yes. I looked at it they're they're gonna go to TikTok. What would they type in? This Yes. And and in that was immediately something that I understood. And it made it so easy for me to scan it and be like, oh, I know which chapter I'm gonna find what I'm looking for. Um and I just thought that was brilliant. Um and so again, just everything about this book is it it just says, hey, accessible. We want you to find the information. This is this is not hidden, this is not supposed to be secret. Um, and so you're really, I think, shining a light on that culture that as a pregnant person you just sort of like wander into and you don't have any idea what you're getting into. And they're like, Don't worry, honey, it'll be okay. We don't want to scare you. So we're not gonna tell no, we can we can handle it. I mean, we've been doing this for generations, but right now we're in a time where it used to be that births did happen at home and you were around it, you saw it, you knew it. Now so many people the first baby they see born is their own. So how do you know what to expect, you know? Yeah. And I I'm about to push a baby out of my vagina, but you're gonna scare me by being honest with me. Like it makes no sense. I'm scared. It's I'm there's something weird that's gonna happen. Mm hmm. Yeah, I know. so much about it, right? As someone who has not birthed the baby, I'm the only one on this uh show today who has not. Um, you you just hear about it all the time and you see about it in TV shows and so on. So there's definitely a lot of um mythology around the birthing experience that I'm sure impacts um people's perspectives and that anxiety as they're going into it. Um, and you mentioned, I think, somewhere in the book about the more accurate and less accurate representations that we see. Um in the media and how that may not be super helpful to have some of these less accurate representations. I also love that um you really I don't know how this must have taken so much word, but you index like every every section references other sections. Like so if someone went to one specific section because they were interested in that particular issue, but like fetal monitoring comes up, you say, for more on that, go to this other section and you give them the the page number. Like again, I think it you it's it's clear you put a lot of effort into making easy for people to find what they were looking for in a very thoughtful um way. So thank you for doing that. Um I I wanted to ask you because what as I was reading the book, I was thinking as a physician, like why is this stuff not told to patients when they're pregnant? Like why why do you why do we need this whole book when like in theory When you become pregnant, when you go see your whatever uh provider you've chosen, like you should be able to get this information, but it's not there. So I was curious if you have a comment on what it says about our healthcare system. uh we're getting the results we're set up for. I mean, you might think on the one hand, well, you have so many visits with your doctor and midwife. You can talk about all this stuff. But when you actually think about the face-to-face time with your provider, it might be like six minutes. And I'm not even joking. Like you can time it, right? And you think about you get in the room and you do this urine sample, you do the blood pressure, blah, blah, blah. By the time your doctor comes in and you've got stuff to talk about. Then there's all this other stuff. And I honestly think a lot of it just gets pushed to the wayside because so much of what people might have questions about, they're maybe afraid to ask, or it just doesn't feel as medicalized, right? Like, oh, you don't need to worry about what are the best positions to push in. Like, don't worry, we'll just help you. You like trust us. And and I am not here to say, like, yes, there are, you know. Great, like the hospital I work at, I think we do a fantastic job of like educating on the fly and practicing evidence-based medicine and supporting. And there are other places where it's very patriarchal and very much patients are just churned through. And so I think a lot of this stuff just gets it feels fluffy and it feels not important enough. Like, you want to talk about how to reduce tearing? Honey, you don't die from a tear. So let's talk just about pre-eclampsia, because that's really important. And We're just not set up for success. And in a perfect world, you would have longer visits. You know, I know they're doing some of these modeling with midwife-based groups centering pregnancy, they're called, where they have hour long visits as a group. So you're all talking and learning. But when you get a global fee, which is changing, but when you get hardly reimbursed for the care that you provide, you're told by your insurance companies in your hospital you have to churn through patients, there's just no time. And you put on this extra layer of Well, it's not that important, right? It's just everything's natural. You don't need to worry about it. We're just gonna do it. It's gonna be fine. Just listen to us. it's hard. It's really I d and I just think there's a lot of misogyny that goes into it of like, you know, don't worry your pretty little head. Mm, mm. There's a there's an O B talk I used to give years ago called Like Regular Consent but with a Uterus about, you know, not not not yeah. I mean, happy to happy to share, but you know, about the there's so many things I see um not only as an anesthesiologist but as an ethics consultant about like listen, everybody's autonomy is not treated with the same respect. No, no. And I mean, we can talk all day about how in different states and different laws, but it's embedded into the psyche of people who think that once you're pregnant, well, it's all about the fetus and the baby. And yes, of course, and also like I'm a human standing in front of you, and it just gets so messy. And you don't see this in cardiac care or hip replacements or any and you know, where there's these very strict protocols of what they do and what they have to tell you and outcomes. And for us, we're just not We're just not set up for that success. So, you know, a book like this, I am hoping, can level the playing field a little bit. But also as I was writing this book, and I and I I've I've said this before, like I it it also is for the OBG WANs and the anesthesiologists and the midwives to be like, hey, we're not doing so great in some of these things. And I only realized it as I was reaching researching stuff for this book. I'm like, why was I taught this way? Why, you know. So we have, we have. maybe not some of us directly, but our fields have caused some issues, but it means we can fix these issues. And so I hope that we rise to the level that our patients know we should be at and that we absolutely can be at. Yeah. Well, as an anesthesiologist, I immediately went to the section on pain control and epidurals because I was just so excited to see, you know, what had been included. And um, it really took me back. I d I no longer practice OB anesthesia, but when I was providing that care in my residency, I remember so I mean, usually it was the patient's partner who was like, She doesn't need to talk to you. And I was like, I'm just here to say say hi in case. You have to meet me in a more like emergent way, which could be awful. So I was just hoping to say hi and get to know you and you would get to know me. And um, you know, but really having to teach myself how to sort of de-escalate some of those conversations because there's so much understandable fear and resistance that like people are like, Well, they're gonna tell you you have to have an epidural. And I was like, I'm gonna go take a nap if you don't want an epidural and that's fine. Like I I'm actually great if you don't want Exactly. Yeah. Mm-hmm, mm-hmm, mm-hmm. so yeah, I really appreciated the the question and answer information that you included there because I know that that's such a major point of anxiety for for patients and their families about like what do what do I want? How do I wanna think about it? And especially in this morass of um, you know. Now we have social media, but before then it was like the mommy blogs and like all of these things really whipping people into a frenzy about what is a good birth and what is a decision that a good mom makes. And and it's like it's really intense. Yeah, no, there's just so much of this like values and identity put on you, you know, how you're feeding your baby, how they came out. Did it really count as a natural birth? And I can't stand any of it because none of it is making us feel better about ourselves. And it's a lot of it is just based in this weird culture of like perfectionism and like and like this idea that like you're only good if you do this and and in no other field are we like, well, if you you know, got your tonsils out and you took well, I did an all natural tonsillectomy and I didn't take oop oop you. I it's just so again, I think it's a lot of like just misogyny and that even we have internalized as women. And I hate it because it's so unnecessary. Um, when you're already in a time that might that that you no matter how it went, you're you're sleep deprived, your hormones are crazy. Like you don't need an extra layer of guilt from your either yourself, your partner, the internet. It's so it's nuts. Yeah, I mean, I think you did a great job again as someone who has not given birth. I thought you did an amazing job of being like, and this is also fine. And this is also fine. And this is also fine. And trying to normalize this idea that we shouldn't be shaming ourselves because of choices we have to make, especially in a few different places. I think you talked about like if you have a birthing plan and then it doesn't work out because you had other medical issues that arose and things had to be done differently. That's okay. Like that doesn't mean anything was failed. Like that doesn't, you know, it's just that's fine. That's part of it. And so I love that you normalized for folks that there's no like one right way for everything to happen. Um and even though there yeah, there's definitely these narratives out there that there is. Like it has to be like this and and if it's not like this, then it's not really real. Um So I I thought that was really, really helpful. Um, you did, as you mentioned, not really make firm recommendations in a lot of areas. You give people a lot of information and then you give them the pros and cons, the risks and the benefits. I wondered if you might highlight like three things that you really do recommend for folks. Yeah. Yeah. Yeah. Yeah. Yeah. and I so much of our like obstetric culture, I feel like, is a lot of, but your baby could die, you know, and and then your baby could die. Like, I feel like there's a lot of fear-based and coercive counseling. And I I practice this way that I save that for when it could be true, not because I'm trying to scare you into something I want. And I'm also very clear when I'm like, you know. I don't love that decision, end of the day, but you know, so I try to be very like I try to be honest. And so the three things that I'm like, really? But again, your choice, but declining penicillin if you are GBS positive, because we know that universal screening and treating people with penicillin, if they do carry that very normal bacteria. it used to be one of the number one reasons babies went to the NICU and now they no longer do. So super life-saving, super cool, love that. Um, and very low risk. The second is the vitamin K injection after birth. And I can say this not just as, you know, I'm married to a pediatrician, but I wrote this book and I feel like it already needs a revision where I was like, well, you don't see babies having bleeds in their brains anymore because so many, you know, we do have routine vitamin K for the majority of people. You only see that in other countries. And now we just saw that ProPublic article that came out that now this is happening more because more people are declining this. Injection, which is not a vaccine, but it's just sort of gotten mixed up in this group. Um, and bleeding is really bad for babies, and it's a really safe thing. Hmm. Oh. neurosurgery in the babies that did not get vitamin K. And I I agree. Vitamin K. yeah. And and what what I think breaks my heart is that the parents and and I know you can't talk to these situations and and HIPAA and all that, but I can't imagine if this happens. And then these parents are like, my God, I made this choice and I made it because TikTok or Facebook told me something and holy crap, I had no idea. Like I don't think people oftentimes make choices trying to make bad choices. They're all trying the best that they can, but they just don't know where to get the information from. And we're in a world right now where There's a lot of mistrust, but I like that breaks my heart. Um, and then the third thing would be pitocin after birth for the prevention of hemorrhage. And I've had people decline it and they do fine, and I've had people decline it and they don't do fine, but it's one of those where it's a very safe. We have a lot of data to show that it works. and people just sometimes come in with these ideas that all of these things are bad as a whole. And I talk about it. And again, I'm not trying to coerce anybody because at the end of the day, I'm sure you guys practice this, especially as you get more experienced. At the end of the day, I go home and I sleep in my own bed. And my kids and my I used to, I think when I was in residency and first out, I was like, How could you do this? You take these things personally, you feel a lot of feelings. And I now feel that I I can only I can only counsel and know that I did a good job and document and and then I go home. And so you're gonna make the choice that's best for you, but I'm not gonna sit here and Force forcibly inject something into you. But those are those are the three where I'm like, let's just circle back one more time. Mm-hmm. who read the book, those do come through as ones where you're like, Yeah, this is I I really would caution against not doing this thing. And here's the reason why. Yeah. And you know, one of the things, you know, in all three of those recommendations is that, you know, and especially in this ecosystem of of misinformation and disinformation, there's a really strong naturalistic fallacy that people think like, well, if it's natural, then it's good. And therefore, if it's unnatural, then it's bad. And it's like, well, it's it is you can have a when we talk about vitamin K, it's that you can have an absolutely perfect baby and all babies are born without. enough vitamin K. It has the they're a perfect child who is absolutely and naturally born with low vitamin K because that's how all babies are born. And um but it's tough because the fear mongering around and the shame based stuff around you it if you don't have if it's not natural then it's bad. And it's like, well arsenic's natural too. So there's a lot of natural things that could be dangerous. I went to medical school in Yeah. No, I yeah, I say I went to med school in New Orleans and hurricanes were natural and that didn't go well for us. Um and it's just, you know, it's like I think they're and and I get they're afraid to get kicked out of that club, you know, of like, well the this is my identity now. It's become an identity and and to lose an identity and so so much of it is and you guys know that like my husband We're in Portland, Oregon. The vaccine rates are not as high as they are in other parts of the country. He spends a good part of his day trying to communicate with people. And he's like, the data doesn't matter. You have to build trust. And when somebody trusts you, then they're gonna use you as your source, their source instead of the internet. And that can be really hard when you're, you know, like me as a hospitalist or something else, but we just have to keep at it and and not. vilify people. Now I will vilify the people in power who should know better and and are, you know, manipulating and making money off of these things. Um, you know, big wellness and and all these people. But the average person, I do believe they're just trying to do their best and it's it's hard. absolutely. And how are they to know, you know, that this person who they've maybe followed for a long time on whatever platform is leading them astray, you know, because they they seem kind and they seem honest and and they probably in many cases are saying what they believe to be true. It's just that they don't have the scientific knowledge and background to understand how harmful their recommendations are. And so it's hard for people to understand that just 'cause someone seems nice and thoughtful and reliable when they're not a scientist doesn't mean they actually understand the things that they're talking about. And they're accessible, right? Like we all carry around these little pieces of glass, little glass computers in our pockets. And, you know, you immediately have someone's face. They're well lit. They they're leaning in. You know, all of these things, you know, they've got a they sound they have a great podcast voice. Um, you know, and so you've got these and then you scroll and it's like you scroll, it's a doctor, you scroll, it's a wellness influencer, you scroll, it's an ad for pants, you scroll, it's a you know, like Yep. And they sent a message in to their doctor who can't get back to them in six days, or they do come in, they see us, somebody's frazzled. You have four minutes. It's sterile lighting. Like we are I say this over we are set up to get the results we are. Like, do you want to go into a sterile room or do you want to go sit in a room for an hour and it's beautiful? And they took ten vials of blood, so you feel heard because they're running these tests, as opposed to the other person who's like, Well, I think it is it is It's just the natural way things go. When you feel you've been traumatized or not hurt by one system, you're gonna go to the other one. So we have to figure out like how do we how do we reach people? And then by God, could we regulate some things better? That'd be great. Yeah. And it's hard to be trust to you know, to present as trustworthy actors within those really significant constraints. And um and like you said, you know, for folks who are running their faux not medical, not regulated clinic, like they can charge thousands of dollars and like you can believe that your money's well spent because you got that time, even if there's not actually any safety or value added. Yeah. And so that's why I think it's so I mean, it's one of the reasons why what you do online, Jen is so important and also that you're putting out things like this book. you know, is to help people have access to, I mean, like you said, insider knowledge. Like you really are sharing that insider knowledge with folks in a really easy to understand way, mind you. Like it's not all jargony and like what is you know, you just really break down the studies and you're like, you know, studies suggest that this is not that helpful or studies suggest that this might be helpful and it's not gonna be harmful. So you could try it. You know, like you're very honest about what the data um tell us, which I think is very helpful. Okay, I have a random question. It's gonna seem very it's it's oddly specific. It's oddly specific. In the section where you're talking about the placenta and you're talking about like what various things people might want to do with their placenta, um, you talk about planting the placenta and that you kind of wish you had done that. Yeah. Yeah. Well, because I'm an East Coast girl, but I live on the West Coast now. So I gotta get a little crunchy. And I just, I don't know. I just think it's so dang. So the placenta's the coolest organ, hands down. And I will go toe-to-toe to anybody who tries to disagree with me. Um, it's it grows a human and then it like your body's like ding, we're done, and it comes out. And I talk in the book how I offer a placental tour because I love to show people their hard work. And most people are up it. And then their video, like it's a whole thing. We have so much fun. The ones that turn it down, I'm like, mm-hmm, really? Okay, fine. That's you know, whatever. But also I don't want you to pass out, so it's cool. Um, I don't know. And I just feel like in an era where, you know, some people are turning to other things to do with their placenta, which I discuss, like consuming it, which I don't love that idea, but again, you know, whatever. Um, I talk about the data and the potential harms, and but I I also feel like I can see why people want to have this like. you come into the hospital to have your birth and it might there's just not that like community or that aspect where we feel like we're we're still doing something that feels, I don't know, cultural I don't know. I know it sounds woo-woo, but I just love like this idea that you then you take it home and a lot of people here in the Pacific Northwest do it and they plant like a tree. And then you've got this tree that like and then they take the pictures with the kid next to the tree every year. And it's so cool. You just you just want to make sure you don't move. That's all That's what I think about it when you're like, Oh, but what if you ever leave? no. This is a 3 a.m. nursing um station conversation. They were like, well, do you put it in a pot? Like what do you do? I don't know. I was like, guys, I don't know, but I just think it's cool. But I also think this is such a um you know, and you you alluded to this previously, you know, this Medicalization is obviously a a major part of what's happened to birth, you know, in the last hundred years. And I think we have lost a lot of the not only communal care, but we've also lost that kind of communal experience for people who who want to have a birth in an environment in which the things, the bad things that could happen could happen. Um And so I f I really felt like you were alluding to that in that conversation about, you know, there there is something that we haven't quite figured out, where, you know, I'm also a little crunchy. And like, you know, how do we find that way to both get the high quality care that each of us deserves that is, you know, centered around our goals and values, where we're in an environment where we're seen, heard, and valued by our clinicians. And how is it that we still acknowledge the fact that like it's pretty freaking amazing that our bodies like can make another person? I mean, this the whole this whole like the entire future of the human race depends on this activity. And so uh, you know, it's I think it's cool for us to have a little more wonder about it. Exact yeah, wonder and whimsy. And you know, now that I'm thinking about this more, Argamont, like I think what I really love about this whole placento thing, like you have your baby, and then in this current world, like your friends, people like send you some meals, they pop in, but it's very we're very siloed and it's not this community anymore where we're like we live in these multi-generational homes or communities. So it's to me it's this idea like, and then a week after, like you're out there in your backyard with your fa it's just this family care. Which I feel like we're missing. And I have been in some of those rooms where there's the partner and the two girlfriends and the grandm and it's beautiful. And you're like, why is this making me emotional when I'm like dead inside from the world? And yet the it's because it feels like we're doing this community thing and it's the birth of a family. It's not just a checkbox, you know, she's pushing for two hours, da da da da da da move through, two postpartum. It's this idea that this whole family is changing. which again, like sounds like woo-woo and crunchy, but Yes, medicalization of birth has saved lives when you look at the maternal mortality from like eighteen fifty to now. And it's also caused some harm when you think about how they used to, you know, anesthetize women and like tie them down, like because they were given whatever gas, I should probably ask you, Alyssa, and like the twilight sleep and like how and everybody got four steps in an epesiotomy. Like we have to find a way where we're just where we're we're doing the right things, the right moment for the right time. And not just out of fear and litigation and how we were taught, which is unfortunately I think how a lot of how a lot of how it is because of the system, not because people are bad. Yeah. No, I mean I I think that's also another helpful thing that you talk about in the book is like here's a practice that we used to do. Here's why we don't do that anymore. Um, to give people that background. Um, well, thank you for explaining my answering my random question about the placenta. I was just so curious. I was like, that's interesting. Oh, one idea. practice on the East Coast after residency, they thought I was like the crunchiest midwife. And was like, you all have no idea. You have no idea where I came from. And and then I was like, okay, but we can we can be in the middle here and it can be beautiful. Um speaking up. So I have another question about, okay, this one's about doulas. So again, you are very balanced in the book, um, representing or talking about like what a doula could do to help and um and what they what they don't do. My interpretation, I want to just see if I was correct. My interpretation reading between the lines and all the various sections where you brought up doulas is that you you don't say this in the book, but that you're like pro-dula. Is that accurate? God, yes. Yeah. I mean, literally the data supports that having continuous labor support by somebody who's trained decreases your C section rate, decreases birth trauma, increases the chance that somebody will come to a postpartum visit. So and I think I put this in the book. If it was a drug, we would give it to everybody. Um, yeah. And I think that doolas go ahead. I was just gonna say and I I really appreciated that because I mean, I remember back when when I was in the O B land and just the disdain that some folks would talk about doulas and I was like, I don't know, it kinda seems like they're better than some of the partners that show up. I mean, I'm just saying they seem really like they're helpful. Yeah. And I think what happens in those cases is everybody remembers the one doula who got in the way, who was like not w was out of their scope of practice. And do those exist? Yes. And do the same kinds of doctors exist who talk down to pa but do we say all doctors are bad? No. So like I think that it just becomes it's a typically female, they don't have a degree, so they're very easy to crap on. And we blame them. And we also associate them with a patient who doesn't just nod and smile and say yes. And that seems to make our jobs harder. But as I've done this more and I have worked with amazing doulas, yeah, it makes my job so much easier. Like the nerd we're all like, thank God she has a doula, because it means that that's another person who can do this support, who can help, who can ask questions. yeah, and I think I think they're getting more normalized. I think we're seeing more of that. um as opposed to even ten, ten, fifteen years ago. But yeah, I think it's when people trash doulas, I'm like, honey, let's just hold on. Let me show you the data Well, and I one of the things that you just mentioned, right, is that um the the preference for a a uh compliant patient. And I think that it's such an important thing about how in medicine we oftentimes confuse compliance with autonomy and because that makes us feel good. And when you really are having that you know deeper autonomous consent conversation when you're having you're you're providing that education, you're able to have that back and forth, um, it is definitely more work. And it doesn't mean that somebody just blindly does whatever you want. Right, exactly. And do you know what it means too? They're gonna be less likely to sue me because they're gonna feel like we have a relationship and they really understood why it happened, as opposed to somebody who's like, Well, I I was just forced into this C section and it was horrible. So now I'm gonna sue. And I and I say that not just flippantly, but I'm in, you know, the second most sued specialty and which general surgery is the first. I had no idea, but I was looking this up for a talk I gave a couple of weeks ago to do as to be like, Hi, understand why sometimes we're crazy. Um And it was such a great talk, but this idea of like wouldn't it be like I love it when patients ask questions because I leave the room and I'm like, Okay, when I had them sign the consent form, now I know they really understood it, which means, yes, they're gonna get better care and I'm practicing better medicine and if something happens, they're gonna feel like like we were a team and they didn't feel like they were railroaded, you know. Yeah, and you can and you come back to that idea throughout the book when people when you're talking about different things and you say like, Hey, if you don't if someone's recommending this to you and you don't understand why, just ask. And you do again give specific verbiage for like, oh, like I'm I'm this is not what you said, but something like, you know, I can you help me understand why we're doing that? Or do we absolut do we really need to do that? Or are there is there another option? Or, you know, you give people the language um with which they can inform themselves through their or at least get that information that they need to understand what's happening, which I think is really, really powerful because as you said so much of the time, medicine is patriarchal and it's just like we're we're doing this now. we're like, oh, we're all brought up to like be polite and whatnot. And I I see this over and over again. And I'm like, we ask more questions when we're figuring out what car to buy or what outfit or details on our haircut. We feel more empowered to speak up there as opposed to when somebody's literally got their hand inside our body. And we're like, well, the they know best. Um you are allowed to ask questions. And I think we just forget that. So we need to tell people that so they can remember. Yeah. And constantly rewarded by being compliant. Mm-hmm, mm-hmm. Yeah. Yeah. Yes. Yeah. Yeah. Mm-hmm. Mm-hmm. Yeah. brought up to be a feral sailor. Ha The nicest possible version of Farol, I would say. Um, based based on what I know about you. Uh and I should have I'm gonna correct myself, I should have said paternalistic, not patriarchal, although there's probably a little bit of both. it's all yeah, they're all different branches on the same tree, so it's all good. Yes. Okay. This is I think my last question that I had written down, which is, well, it's not even a question. It's that I wanted folks to know that even as a physician, though I'm obviously not an obstetrician, even as a physician, I definitely learned some medical things um from this that I didn't know about. Um so there's I just want to highlight three things. So one was that there are so many different types of midwives. I had no idea. You have a table early on that's got all these different classifications of midwives and what the different training, certification, et cetera. Is for each of the different groups, which is so so helpful because I can imagine if someone is interested in having a midwife be the person who who helps them birth or is part of their team, if they were like me, they might not have known that there's all these differences. So super helpful to have that. Another was that I did not know. I mean, you can blame my medical school or me or whatever, but I didn't know that you could have preeclampsia postpartum. like develop postpartum. I mean that you didn't have it during Like it doesn't get enough play. I think we're getting better at it. But yeah. And that's like can be some of the most deadly. So I I love that you learned that. Yang, tell a friend. Yeah. Mm-hmm. Right. and the treatment is delivery. So once the baby's been delivered, you would think that that wouldn't really happen anymore. So really important to know that that still can happen post operatively and or post postpartum, I should say. And then you also give um some guidelines for what to look out for and you know when to call and so on. So that was great. Okay, the last one um was. I didn't know about this. I don't know if it's pronounced Jada, whatever the device is that you put. So this is a device that goes for folks who don't know, it's a device that goes into the uterus to help with postpartum hemorrhage. And I had a patient when I was in medical school that I will never forget who was having her ninth um baby and she went she had uterine atne just hemorrhage, hemorrhage, hemorrhage, hemorrhage. Um and yeah, when I saw that I was like, that would have been, that would have helpful. who inv invented that Arghavan? Not a doctor, an engineer, of course. Like, cause we're too busy providing the care. And it's literally just this little vacuum device. When you look at it, you're like, why haven't we done this yet? Um, and it works really well. There's another device too called a Bakri balloon. And I should mention this, like I have illustrations in the book, because I think words are or a picture's worth a thousand words, and I wanted to keep them very simple so people could be like, that's what is happening. Um I am not paid by Jada. I want to make that very clear, but I do love it. It's a great product. Uh-huh. Yeah. Yeah. with the vacuum, it sucks down the wall of the uterus to help um to stop that hemorrhage. That's very cool. So anyway, those are three things I learned. to ride, I shall say. Mm-hmm. that's obviously one of the, as you mentioned multiple times, one of the main things that is of concern is a postpartum hemorrhage and it can be definitely life threatening. Um all right. book took me down memory lane. I was very, very fortunate. Ooh. Ooh. I mean, I was very, very fortunate that the the births of both of my children were shockingly straightforward. I mean, having seen the terrible things that I'd seen in training physician, how did you get that? Like, God, mm-hmm. Lucky you. I and I hated it. I hated being pregnant, and I still knew that my entire situation was as good as it could have been. Very, very fortunate. And um, but yeah, I mean, so many of my core memories of training were things that I I definitely had not thought of in a while. And in in reading this book, I was like, ooh, ooh, those memories came back. Um, it is really important work that's happening in labor and delivery, and I And this the other thing that this made me think about that I that I hadn't thought about in a while is I remember when I was uh you know in training and I was still working in the OB area, you know, friends would reach out to me and be like, hey, I'm gonna like have a baby. I have no idea what it's like. And or friends coming in to deliver at the labor and delivery unit where I was working, um, and asking me to like be their anesthesia resident or asking me to come visit them. And How much insider knowledge we have simply from being aware of what that environment, what it's like. Who are the people who work here? Like, what is happening? What is all this? What are these strips of paper? Why are these things on me? And and I remember being pregnant and people like passing down, like, but you know, whatever, what to expect what you're expecting, or whatever the other books were. And and being like, wow, this really doesn't get into the stuff that I now know about. And so I feel like your book really beautifully, and again, I love, love, love. I cannot say enough about how much I love that it is written like what you would search for, whatever the search terms are that you're looking for. Um, so I just think this is going to be such a service to people who are heading into their birth and to their partners and people that support them. And I just think this is such a gift to to the community of people who are gonna find themselves In a labor and delivery unit sometime soon. thank you. I really that means so much to me. Thank you. Well, Jen, we're so thrilled that you have been here to spend this time with us. And we are hoping that you will join us for one of our favorite segments, which is take two and call me in the morning. And this is where we come up with something we can prescribe to our listeners, something that's bringing you joy in your life, something that you're finding interesting. And you know, what what might you prescribe to the people? Yeah. Well, this might okay. Can I do two things? Um, the first is read books because I am when the world stresses me out, I'm a reader. I always have been. And then I get stressed out and I forget to read and I get really grumpy, and then I pick up a book again, and then I just get lost in another world. So um, and maybe if you're not a reader, listen to audiobook, just something, just something that like, and I feel that books teach us so much about. I love historical fiction and I love to be like, okay, we all think we're living in the worst times, but let's talk about the 1400s. Like, holy crap, that was bad. Like you talked about the plague, you know, like people couldn't wash their underwear. That was bad. so anything you're reading now that you're uh really into? Or recently? what is it, Roll of Thunder or Roar of Thunder Roll of Thunder, Hear Me Roar. it's yeah, it's was written in the nineteen seventies. It's about nineteen thirties um life in Mississippi with uh people who were previously enslaved and it's not a feel-good book, but I'm reading it and I'm like, this book needs to be read by everyone right now. So that is my that's actually I have like two more chapters and I've been saving them because I just need to like I need something. the other thing is to be a sports fan and root for a good team like the Knicks, but to to like bring your kids into it. Cause the I am having so much fun now, not just watching the Knicks and also breaking out a full body rash because of them, but to see like my kids and like this is gonna like the 90s were like my moment. Now they're as kids, they're gonna be like, my God, remember in 2026 when we were there and mom was screaming and the neighbors were like, Are you okay? And we're like, We're fine. Um, these core memories, it's just so fun to like go down rabbit holes with your kids. So Sports, but pick a good team 'cause I'm also a Jets fan and that's a different journey for another day. So even even as a Knicks fan it's been a it's been a dry spell. It's been yeah, but you know what? It's just I mean the whole mom donnie and the city like it's just so good right now. Yeah. So I'd prescribe that, but also with a beta blocker, because it's also really stressful. It's really stressful. Mm-hmm. a good way. It's like folks who are not aware, a beta blocker will slow down your heart. So if it is racing, a beta blocker can be your friend. use that. Could use a my god yes. Arghavan, what's your what's your joy this week? Okay, I have discovered, as though like I'm the only one, I've I've come across a a new creator who I did not know before. Um, their username is Marcus Tudrick. And they are one of the more creative people I've come across on social media. So um I think the first videos I saw, um, they were talking about letters, like they were the letter A. Um At one point there was I think there was a letter D and they were like, Why is it A B C? Why isn't A B C D? When people say the A B C's, why did I get left out? Um and so these like that that are just so ridiculous. And you're like, Of course, why wouldn't you make a whole series about letters? they're random things. So one of the ones, I'm just gonna list a couple of the videos that I've come across that I think are amusing. One is um they've got like some accoutrement on their face that make them look sort of vaguely chicken ish. And it's why the question is, why did the chicken cross the road? And they're they're trying to explain why the chicken crossed the road without saying it because their manager says they're not allowed to say it. Their manager's sitting off screen. And so he's like, Trying to give some hints about why the chicken crossed the road. there is one with the letter Q, um, going back to the letter idea. And the word Q, like to stand in line, Q, U, E, U, E. And this creator is like, well, when they pitched this project to me, I didn't know that there were gonna be two U's and two E's and only one Q. But the whole word is I'm Q. I love it. billing? You know, like anyway. Um, so I'll put a link to to this person's account in our uh show notes. Actually, sorry, one more. One more is they're talking about they're they're a snake, okay? And and they and they're talking to someone who or they're in front of someone who supposedly is playing the flute and they're like, No, but I was gonna bite you. Wait, why are you playing that song? Wait, oh, that's I like this song. But wait, I wanted to bite you. And anyway, it's like The reaction of the snak yeah. The reaction of the snake to the the flute music. Anyway, just joyful joyful person. Yes. puppies and babies on social media. Give me a golden retriever all day long. Oh, golden retrievers. There's so many good golden retriever videos too. Um anyway, Alyssa, how about to the internet, this this one wanted some attention. This is, I know, who's simultaneously like squirrel. Yeah, exactly. But I love it. Uh yeah, or like what just happened. Yeah. just made a very brief appearance, insisted on attention and then left immediately. Mm-hmm. Mm-hmm. was looking for. Um but how about you, Alyssa? What what do you prescribe for post? Um, I love an art project that is like that you can watch emerge like on a video. I love when people do an art project and they like document how they're making it or they document whatever. And so I saw this person, their accounts called Paper Pepper, and it was restoring Van Gogh's ear and mending his broken arm. And the it started off what caught me is they it has like Van Gogh's. Beard, all you see is like the image of Van Gogh and then the hands of the artist. And they come in and they literally trim the beard like they have a layer of paper that's been painted to look like and when they give him a beard trim, like he looks, you know, more put together. You've seen this. And and then I was so curious about it. And it all looks kind of like it's one piece of paper, but then the the longer it goes on, you see there's like it's so complicated. There's all these pieces. Yeah. And yes, it's like fixing his, you know, they're like deck fixing his hair and they're fixing his his ear. And also throughout it, it's it felt like, you know, Van Gogh um died by suicide. And the whole thing is also like, how would you mend Van Gogh's broken heart? And it's like there's a point when they like open up this little thing in his shirt and they take out like his sadness and depression and they put in like love and yeah, I mean. Yeah. just it was real feel good, I won't lie. And we will put a link to it in the show notes and it was by it was simultaneously like very it felt very affirming of like anybody who's been through something really hard and it was beautiful and creative and I l I loved it. Mm-hmm. I agree. I saw that one as well. And I saw and then I watched a couple other ones from that person. But it was a tired mom and like rejuvenating this tired mom and giving her spa treatments and so on. So yeah, I that's a very um creative account as well. Amazing. Well, listen, those are all great recommendations. Jennifer, we are so thrilled that you came. We're so, so lucky that you accepted our invitation and came here today. Um, for folks who are listening, please pick up a copy of the birth book. It's amazing. There's all these free resources like we mentioned on on Jen's website. You can follow her at Dr. Jennifer Lincoln on TikTok and Instagram. Um, we're just we're so lucky that you were here today. no. Thanks for having me. This was so fun. Just like we're just chatting and hanging out and talking about placentas and puppies. Perfect. You know, heard it here first, folks. Yes. I love it. all right. Well I think that's it for this week's episode. If you didn't like what you heard, this has been the Dan Bongino show. If you liked it, don't forget to subscribe to The Present Illness, leave us a review, and tell your friends and anybody on the street, why not? We know that if you've listened this far, you have far better taste than to listen to podcasts like that. So make sure that you follow us on TikTok, Instagram, and YouTube at the Present Illness, and you can stay on top of all of our TPI related news. We will be back once again next week with more headlines, hot takes, and doom scrolling, hopefully wrapped in some laughs. Until then, agitate, hydrate, and take a nap. We'll see you next time on The Present Illness. Production by Arghavan Salles and Alyssa Burgart editing by Alyssa Burgart, social media by Arghavan Salles, original music by Joseph Uphoff. Don't take medical advice from random people on a podcast. This shows for informational purposes. It's meant to be fun. And it's certainly not medical advice from ourselves or our guests. 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