Birth Journeys: Lifting the veil on the birth experience
Did your childbirth experience go as planned? Then The Birth Journeys Podcast® is for you! We share powerful and transformative birth stories that illuminate the realities of childbirth. Hosted by a labor nurse and prenatal coach who specializes in transformational coaching techniques, this podcast goes beyond traditional birth narratives to foster healing, build trust, and create transparency between birthing individuals and healthcare providers.
In each episode, we dive into essential topics like birth preparation, debunking common misconceptions, understanding hospital procedures, and promoting autonomy in the birthing process. We also bring you the wisdom and insights of experienced birth workers and medical professionals.
This is a safe and inclusive space where every birth story is valued, honored, and deserves to be heard. Join us in exploring the diverse and unique experiences of birth givers, and discover how transformational coaching can empower your own birth journey.
Contact Kelly Hof at: birthjourneysRN@gmail.com
Birth Journeys: Lifting the veil on the birth experience
Progesterone: Navigating Motherhood's Hormonal Maze with Dr. Shweta Patel
Discover the underestimated power of progesterone with Dr. Shweta Patel, an OBGYN and women's health expert, who shines a light on its critical role in pregnancy and beyond. Gain insights into how this often-overlooked hormone supports everything from the menstrual cycle to postpartum health. Dr. Patel demystifies the scientific intricacies of progesterone, tracing its journey from conception to its protective functions during early pregnancy and its importance in postpartum birth control choices.
Navigate the cognitive whirlwind that new mothers face, as we unpack the hormonal rollercoaster that can leave many feeling foggy and overwhelmed. Through heartfelt anecdotes and expert advice, Dr. Patel illuminates the need for societal empathy and celebrates the resilience of mothers adapting to their transformative roles. Addressing the impact of hormonal shifts on mental clarity, we discuss the pressures of motherhood and the importance of support systems to ease this challenging transition.
Laugh along with us as we tackle the quirkier side of hormone research, dive into the complexities of hormone testing, and tease the rich content of Dr. Patel's upcoming book on women's health. From postpartum depression treatments to the importance of empowering women with knowledge, this episode covers a spectrum of hormonal health topics with a touch of humor. Whether you're intrigued by hormone dynamics or seeking advice on maternal health, this conversation promises to enlighten and entertain.
Grab The Book of Hormones here: https://amzn.to/4fjj6L1
Join the Bump & Beyond Online Community for moms & moms-to-be!
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Kelly Hof: Labor Nurse + Birth Coach
Basically, I'm your birth bestie! With me as your coach, you will tell fear to take a hike!
Connect with Kelly Hof at kellyhof.com
Medical Disclaimer:
This podcast is intended as a safe space for women to share their birth experiences. It is not intended to provide medical advice. Each woman’s medical course of action is individual and may not appropriately transfer to another similar situation. Please speak to your medical provider before making any medical decisions. Additionally, it is important to keep in mind that evidence based practice evolves as our knowledge of science improves. To the best of my ability I will attempt to present the most current ACOG and AWHONN recommendations at the time the podcast is recorded, but that may not necessarily reflect the best practices at the time the podcast is heard. Additionally, guests sharing their stories have the right to autonomy in their medical decisions, and may share their choice to go against current practice recommendations. I intend to hold space for people to share their decisions. I will attempt to share the current recommendations so that my audience is informed, but it is up to each individual to choose what is best for them.
This episode of the Birth Journeys podcast is sponsored by the Book of Hormones by Dr Shweta Patel. It's available for purchase now on Amazoncom See the link in the show notes. Hello, today I have with me Dr Shweta Patel. Dr Patel is an OBGYN and a women's health expert. She created GaiaWellnesscom, where women can meet with their women's health physician online. To GaiaWellnesscom, where women can meet with their women's health physician online. Dr Patel provides comprehensive women's health care online to women in Florida, north Carolina, virginia, indiana, tennessee and expanding to South Carolina, new York and Georgia, with plans to expand nationwide. And she also offers the Gaia Wellness Forum on Facebook, which is open to anyone who has ever identified as a woman and who is interested in contributing to women's health concerns. Today we're going to be discussing her new book, the Book of Hormones, which covers women's hormones from puberty to menopause and beyond. Dr Patel, welcome back and thank you for joining me. I forgot to mention we're going to be focusing on progesterone. Deep dive into progesterone. I love it. Estrogen gets all the credit.
Speaker 2:It's so not it yeah.
Speaker 1:Let's make progesterone happen.
Speaker 2:Yeah, if we were to rank them like in the Olympics, it would be progesterone would be gold, estrogen would be silver and what's the other one?
Speaker 1:Bronze would be gold, estrogen would be silver. And what's the other one? Bronze would be testosterone.
Speaker 2:Okay, I was gonna say, I don't know, oxytocin or oh, okay you had to go there, okay I'm sorry yes, sure is like important in pregnancy, pregnancy, but it's like they're in certain times, whereas progesterone is like they all the time. It's like a helicopter mom or something. It's like fully loaded and need. It has to be there, even the smallest changes, and we're going to notice. Estrogen is there as well, more like part-time. And then testosterone and oxytocin is like the vacation hormone, like it comes in for a really brief period of time but does a really big job. And then testosterone is probably like the zoom calls it's not really there but it's not not there. It's like virtual. It's the virtual hormone. It's a virtual hormone. Says so much about our libido, huh right oh, my goodness, it's completely there.
Speaker 1:My sex friend it's virtually there. Yeah, yeah, totally Okay. So I'm thinking, just because my listeners mostly either preparing for pregnancy, pregnant currently or postpartum and trying to just kind of manage all of that, how does progesterone play into that whole?
Speaker 2:process. It actually plays into every phase of that. Without the effects of progesterone, we wouldn't be able to get pregnant. We wouldn't be able to go from the first date, as I call it in my book, which is where, like the egg and the sperm meet and they have their little-.
Speaker 1:Hopefully it's not the first date when that happens, but okay, yeah, sure, with that happens. But okay, yeah, sure.
Speaker 2:Wedgie was the bear. I was speaking anatomically, chronologically, definitely not socially Okay, but if that's how it happens, that's roll with it. That is exactly how it happens. I think they even made a movie about it and Katherine Hagel was in it, they did yeah.
Speaker 2:So, outside of fertilization, when the fertilized egg actually comes into the world of the womb, there would be no world of the womb without progesterone, which is why that period of time between fertilization and implantation is where most women A don't know they're pregnant because nothing is seemingly different from the outside, and B the follicle, or what I like to call, like the nest from which this egg hatched, is very rapidly taking on the production of progesterone to sustain this fertilized egg until a placenta can develop. So it's almost like passing the baton, and if that small window of time where the baton is dropped, the whole game's over. And so the structure that I'm talking about is called the corpus luteum. It's literally the bruised up, dinged up cyst that we have that released the egg. It's like it went through labor itself, right, and now the egg's like trying to make its way down and everything's fine and it's loving its new home because it's been made nice and plush by this corpus luteum because of progesterone. So without progesterone there would be no nice little down comforter in the womb for this egg to snuggle into. And then as soon as maybe about week five to eight kicks in, that's when the placenta is actually like in existence, but still like a weakling, it's not really doing its full potential. But that's also all progesterone Like. The whole point of the placenta is, amongst other things, but it's progesterone production.
Speaker 2:So when there's not enough progesterone, because either the corpus luteum was straggling along or because the placenta was like I can't even, those are the times where you see those early pregnancy losses. Sometimes they're so early that a woman doesn't even realize she was pregnant, or it's what they call like a chemical pregnancy. It doesn't change the fact that if you were pregnant and if you knew about it and if you're trying, it sucks. But it's that one hormone amongst other potential causes. But that one hormone is so critical. That is how quickly it can go the other direction if it's not there in sufficient amount is so critical. That is how quickly it can go the other direction if it's not there in sufficient amount. And then, once the placenta is established, it fully takes over production of progesterone. Estrogen's there, the ovaries are producing estrogen. So we obviously are still a woman, we still have estrogen circulating in our blood. We don't become anharmonic.
Speaker 1:Okay, anharmonic I like it.
Speaker 2:I'm not anharmonic in harmonic are you? Is that what they call it? I have no idea, I just came up with it I love it.
Speaker 1:I think I should coin it, should people are going to go to their doctors and start saying am I in harmonic?
Speaker 2:what I don't know. Can you sing me a song? I'll tell you um um sounds like, but cuter, yeah, yeah that's another that's another term I really liked. I like using now is cuterous like I can't stop that yes, right, it's just so stupid, but it's cute. My cuterous is hurting we have stickers.
Speaker 1:I actually have a a cuterus down here somewhere. I bet you do I'm not going to dig for it right now.
Speaker 2:I know it's a plushie.
Speaker 1:Oh because you were looking down and you were like where do you?
Speaker 2:keep your uterus. Oh my god, look at those beady black eyes. I know For those of you that are listening.
Speaker 1:This is a actually it may not be an actual cuterus. That is a brand. I believe this is a uterus from giant microbes. That's very cute. And the ovaries, and help me, I guess these are the eggs that detach. But I'm trying to make an anatomical sense of this because, like, why do they detach, are they not the ovaries?
Speaker 2:No, they're not the ovaries.
Speaker 1:They are, but why do they?
Speaker 2:detach Because the ovaries aren't attached to the fallopian tubes. Oh, they're attached to, almost like I knew that, but like why I don't know why do they? Dangle? I don't know either.
Speaker 1:That's where I was like what, Maybe that dangly ovaries here?
Speaker 2:Maybe these are the ligaments?
Speaker 1:I don't know.
Speaker 2:No, because the ligaments come from the uterus. So it's anatomically Incorrect, but still cute. Still a cuter, super cute. Yeah, I don't like it.
Speaker 1:It looks like one of those mittens you wear. Yes, yeah, that's why it's cute. We were talking about the cuter. Thank you.
Speaker 2:Thank you. So if the placenta doesn't start making enough of progesterone after you're well into your second, like after you're done with your first trimester, and like the placenta is really supposed to be doing all of it on its own at this point, that's when you start becoming at risk for preterm labor, and it's part of the reason why we prescribe women progesterone in pregnancy, if they're at risk, either because they've had a preterm delivery in the past or if they are showing signs that they might be at risk for it. In this pregnancy, which is usually like, their cervix starts to become very thin and it's shown with like enough statistical data to back it up that it's worth trying to prolong pregnancy. That's at risk for preterm labor.
Speaker 1:Okay, so it's the progesterone that keeps the cervix from thinning.
Speaker 2:Melting.
Speaker 1:And then the progesterone comes from the placenta and then so if you have a healthy placenta, that's so, is it okay, which I'm trying to. I'm thinking chicken or egg, that's a great question. So where does the progesterone initiate from? Or does your body signal like how does that work?
Speaker 2:We have our own progesterone that is produced from our ovaries, but specifically the part of our ovary that hatches the egg.
Speaker 1:Okay.
Speaker 2:Now, when we are not pregnant, ie that egg waits and gets ghosted or gets stood up and nothing happens, our ovaries' progesterone production drops because the part that's hatched, the egg, doesn't get the memo like hey, they really hit it off. You're such a great matchmaker, oh my God, totes, great job. So the corpus luteum cyst starts to shrivel up and die, and this happens every month. Don't worry, nobody gets sad. We have millions of those potential infections corpus lutei.
Speaker 1:But I believe that is the plural. So yeah, I just, yeah, you just. It just sounds funny, I think we established that grammar was not an issue.
Speaker 2:No, we're not. We're not the grammar police here. No, we're not the anatomically correct police.
Speaker 1:We are not.
Speaker 2:The part where if we don't get the egg fertilized then we have a period. It's because of progesterone. Crazy. How does progesterone do so many things? I know it's just one of those really modest unsung heroes for real because everyone's always talking about testosterone. Estrogen is always oh my God, venus, oh your boobs and like your hair and there's a glow around you Also causes blood clots and stroke, but nobody talks about that. And what's the name of that geyser that just goes off? Old faithful?
Speaker 1:Old faithful.
Speaker 2:Yeah, like it's there. It's always there. It does a great job reliably. That's what progesterone is. It helps us get to pregnancy. If we don't get to pregnancy, our period happens as a result of the lack of progesterone. If we get pregnant, then it helps keep the pregnancy going, as in we have our own progesterone production from our ovary that sustains the egg until the placenta is grown enough to make its own progesterone, and that's when you start throwing up.
Speaker 1:Rude, it's the mom hormone. The mom's, like the, you know, manages the whole. All right, this person needs to go here. This person needs to go here. We're going to soccer in this car and then we're going to this birthday party. That's progesterone.
Speaker 2:It's the mom hormone, hcg is the part also that makes you. That's like actually what causes you to throw up, but it's like the placenta when it takes over and just goes through and everything starts going on auto drive, that combination of sudden exponential increase in our hormones is when you're hugging the toilet.
Speaker 1:That's so fun, so amazing. Speaking of which I failed to mention that I also have a placenta here.
Speaker 2:Stop it Now. That actually just looks like lips smoking a bent up cigarette. It really does.
Speaker 1:Okay, so keeps you pregnant, makes you throw up, which also keeps you pregnant. What about after pregnancy? Because I know I remember learning that we get the progesterone only pill or a low estrogen pill when you're breastfeeding. What's going on there?
Speaker 2:When you are in the immediate postpartum period, your body is still, though it should have, most of its mammary production situated, its mammary situation situated. I'm sure that there are women who are listening who've experienced that delay, where they're struggling and they're not producing milk yet and it almost feels like it's not going to happen. And so there is that window where the impact of your hormones can actually be negative if you are taking estrogen in particular, because too high estrogen levels can actually give the opposite message to your breast tissue and, without getting too technical, it would dampen the production of breast tissue and milk production. So, for the first few weeks, a woman shouldn't really be taking any kind of estrogen-based birth control or should only take progesterone-only birth control. Now, really, a woman in the first few weeks after pregnancy shouldn't be needing any birth control Leave her alone.
Speaker 2:Right, let her heal. Literally, let her heal, let the woman heal, let both of them heal. But of course, that's also not always a guarantee. We do, especially if there's someone who's at risk for unplanned pregnancy or because there are risks associated with that too. Having a pregnancy too soon after being pregnant health risks to mom and to baby, and so there is a benefit of ensuring that no pregnancy occurs in that time period, but ideally we can ensure that without any hormones. However, if we're going to start a mom on something, then either the low dose estrogen combination pills, like low estrogen, usually around four weeks onwards, or if it's something like you need to be started on something immediately, then a progesterone only option, because that will not interfere with breast milk production.
Speaker 1:That clears it up. The thing that I was thinking, though, my brain was going to when you talked about that delay of breast milk production, and I hear my patients ask me a lot, especially the ones that had a C-section, especially if it was like a planned C-section. They're worried that their breast milk isn't going to come in. Is that related to progesterone or is?
Speaker 2:that just a myth. I think that when there isn't that natural progression of oxytocin that results in labor, no hormone is an island. Literally, you can't say, oh, there's no impact on that, no, I'm pretty sure there is, we just don't care about it because it's not significant. So we typically say that the fact is, some women will start lactating even while they are pregnant, and so you don't need to have the labor experience in order to stimulate lactation. Stimulate lactation.
Speaker 2:So I don't think that C-sections, or especially like the scheduled C-section, where there's no exposure to labor, has a significant impact. But I don't think that it has none. And I think that ultimately, the biggest thing that impacts oxytocin levels outside of labor is bonding, which is why a woman continues to produce oxytocin and continues to also then generate prolactin, which is like symbiotically oh oxytocin, oh prolactin, prolactin, oh my God. That synergistic reaction makes sense because it's like okay, you see, baby, you start lactating. Okay, you start lactating, baby sees you, and so that makes sense. But I don't think it's dependent on it or is the only way to get to that equation. I guess yeah.
Speaker 1:I would agree, and it's all about risk benefits. There's always going to be some sort of impact on something when you make a choice to do anything. Absolutely.
Speaker 2:Even we're not on an island. No one's on an island, except for the people that are on an island. They're together on an island. They're enjoying their life right now. Let's go to an island.
Speaker 1:Yeah, sounds amazing, my oxytocin levels will go up.
Speaker 2:Yes, which is the other thing. It's like oxytocin levels go up all the time, even like when we are interacting with our children that are walking around no longer breastfeeding. So the impact of oxytocin on breast tissue is also very time dependent, so it's not going back to the. Does that have an impact on breast milk production? If you have a C-section because you're not exposed to as much pitocin or oxytocin, I don't think it's a critical one. Yeah, there's lots of impact.
Speaker 1:The stress hormone probably does something too.
Speaker 2:Yeah, you're not being sliced open or anything.
Speaker 1:Right, or you didn't just have a really long labor and opt for a C-section. You're not stressed out. No, there's a lot more to it. Okay, so we were talking about birth control options and how progesterone plays into that and the options with different doses of progesterone. Can you weigh in on that and explain that a little bit?
Speaker 2:Yeah. So the different options are there's a pill, there is the injectable called Stepo Provera, there is the implant, which is Nexplanon, and then there's the IUD, which is like the Mirena, the Skyla, the Kylena, et cetera. All these cool names Sounds like Kardashian sisters, but it's not so. The cool thing about the pill is that while it's a pill, you don't have to get a shot or have an implant put into you, and it's progesterone only also cool in the setting of not wanting to take something with estrogen in it. The caveat with the progesterone only pill is it's low dose of progesterone, and the reason why that's important is because on its own, not the most reliable contraceptive in conjunction with breastfeeding is less likely to fail when done in conjunction with breastfeeding, and that's because the dose is low enough.
Speaker 2:It's not like when you get the shot, where you're getting a three-month supply up front hanging around in the fatty tissue of your arm or thigh. This is a daily dose that needs to be taken, and even a slight variation in the timing of when you take it can impact its bioavailability, meaning like it wears off.
Speaker 2:So if you don't replenish it right when it's wearing off, you're creating windows of opportunity for failure. This is great, right, so fun. Yeah, why would a woman who's sleep deprived with a child and leaking out of her boobs accidentally forget to take her pill on time? Can't imagine. That's so silly.
Speaker 1:Nothing else going on.
Speaker 2:No, For all the other more perfectly ideal scenarios, it's a great option as long as you don't have changes in your weight, changes in your body temperature, changes in what else you're taking with it, like other medications, that could impact its absorption into the bloodstream first pass effect as well as the time. So just changes in when you take it. Yeah, it works great All those variables.
Speaker 2:Oh and changes in your breast milk, like in your stimulation, because the other part of the reason why and this is again a hit or miss in my opinion, but a lot of women think that breastfeeding is an actual contraceptive method. They're not wrong. It does have a suppressive effect on ovulation, but there's no formula for exactly how long somebody has to be on the boob and for how often. What's considered effective? So good luck with that. That's why, on its own, it's not technically considered a satisfactory contraceptive method, but when you combine the two they're perfectly imperfect together and so it's considered to be a better option. Now, if you'd like something a little bit more reliable, then yeah, the options of Depo-Provera shot, which is notorious for weight gain but does work in preventing pregnancy, also notorious for causing erratic and annoying bleeding, which is great because you're already having that, so why not some more? And you can't take it for more than two years executively, because it does have the effect of making your body kind of estrogen poor, which then affects your bones. And I do know women who take like depo shots every three months for years and years because they were never counseled about the impact it can have on your bone density, and so it's definitely be cautious. It's a great solution for unlimited window of time, but you don't want to be using that as like your long-term method of contraception. You don't want to be using that as like your long-term method of contraception.
Speaker 2:Yeah, or the IUD, which, in my opinion, is ZOG. Right, you can get it placed. Some places still offer to place it right after delivery. The failure or the propulsion rate was high enough where we stopped doing it back at the military, but you can get it as early as whenever and it's good for anywhere from three to seven years. Makes your bleeding lighter, doesn't make you gain weight, doesn't make you go crazy. If those things are happening, they're happening on their own. That's why I love it. Got one too. Huh, no more babies for me. You know what the best part is you get an entire election cycle. Yes, yes.
Speaker 1:FYI Run, don't walk. Yes, don't get your IUD placed right now.
Speaker 2:Yes, yeah, I said that in my book. I'm like I have the Mirena and it almost gets me through two election cycles. It's amazing, if I wanted a stretch, I could get to two.
Speaker 1:Yeah, now it's making me. Oh, no, I Okay, I'm good, I'm good. Yeah, you have some exciting options for postpartum hormonal regulation and mood regulation, which is fascinating to me. Tell us more about that.
Speaker 2:I think going back to, like, what's up with progesterone? Is it important? The placenta shearing and coming out, it is like a nosedive in our progesterone levels and the sad part is all we're doing is coming back to pre-pregnancy levels. But that is like going from being on the first class flight and then traveling on Greyhound.
Speaker 1:I was going to say in the luggage compartment, but Greyhound sounds better.
Speaker 2:We're not even by air anymore.
Speaker 1:We're not in the air anymore, so we're in the luggage compartment of the.
Speaker 2:Greyhounds sounds better. No, we're not even by air anymore. We're not in the air anymore, so we're in the luggage compartment of a greyhound. Essentially, we're like the worst of the worst. That's harsh, but yeah sure, and it's like we were fine with it before, right. So it's not that we're deficient in the hormone. It's that drastic change that causes us to act all sorts of the ways right, including, to some level, sometimes even postpartum psychosis. It's because of that drastic drop. If we were to take the drop that we experienced immediately after delivery and spread it out over a month, everybody would be fine, but since we spread it out over like an hour, it creates some real shit and we really depend on oxytocin at that point.
Speaker 1:It's amazing though how it like really functions, like it's like well, are we gooey with your baby?
Speaker 2:and completely like I don't care, that I don't know put back together. However, you delivered, my brain don't work my brain broke literally, but it's true, it is my brain. It's like why would mother nature think it's a good idea to break our brain right after birthing a child?
Speaker 1:it's like because all you have to do is cuddle that child, or run and cuddle that child, depending on right.
Speaker 2:No, because mother nature was banking on some solid alpha males that are like protecting and providing, and was not currently thinking about 2025 right I'm just saying, but I think the logic is, no, your job now is to just keep warmth and be a food source and everything else will be brought to you right, like food and protection, except we have to like get back to the other children or go work and or just figure out how to put the circuit breaker back on or something Like life goes on and we have to still use our brain while it's broken.
Speaker 2:And I say that in jest, but what I mean when I say our brain breaks is progesterone, though it usually only gets like the street cred for being like hey, what's going on? Guys, I'm here to reboot your uterus and then help the pregnancies feel nice and cuddly. You like my progesterone voice? Thank you. It's like such a basic, like unremarkable voice, right? Yeah, so, but progesterone actually is a precursor to a neurotransmitter in our brain. Wow, yeah, oh, no big, just kind of like a big deal with the GABA receptors and everything.
Speaker 1:Right.
Speaker 2:The ones that, like dopamine, like you, tickle those kinds of receptors. Yeah, so Super important, a little bit, yeah, and we can't make that neurotransmitter from any other way. It's progesterone or it's nothing, and so what happens is it's nothing. We're stuck with maybe. What is it? Serotonin, norepinephrine, epinephrine, dopamine, and then that fifth one, and so we're just dealing with four out of the five that we normally have. So just a 20% drop in cognitive functioning, nothing.
Speaker 1:Nothing, no big deal, yeah, okay, so we talked about that huge hormonal letdown After delivery, and then it stays at your pre-pregnancy level, but then everything else in your system has to, like, figure out how to live life again at that pre-pregnancy level. And so then it's since it's a precursor to neurotransmitters that are important for mood and like all of the things, mood and thinking, we'll just generalize it it's a precursor to brain function. Precursor to brain function. What about that? So are we shocked, now that moms have a lot of challenge, I'm shocked that they function. Let's flip that mindset around and be like hey mom, congratulations to you if you're still breathing after all this happened, yeah.
Speaker 2:You remember that it's front to back? Yeah, you do. You are an ace. Yes, because I would have not. I would have not with what you're working with. I would have thought. I would have been like what do I?
Speaker 1:do with this? Exactly, yes. And then we add on this entirely new experience of you're basically becoming a whole new person. You have to figure out who you are with all of this new body and the new everything, and then the new baby, and then all the things are working differently and nothing looks the same, nothing feels the same and I can't brain the same. But carry on. Everything's fine. Yeah, you should be so happy. When are you ready to go back to work? Six weeks, exactly. It's no wonder that moms are feeling a little overwhelmed and they can't always do it. I don't know how else to put that, but let's manage expectations. What is going on with society where moms just have to do it alone?
Speaker 2:Yeah. Or how about when a woman is back to work? And struggling and it's like gosh, all she's thinking about nowadays is being a mom. Yeah, yeah, no, fucking shit Sherlock.
Speaker 1:What else is there to think about?
Speaker 2:There's no brain work.
Speaker 1:Yeah, exactly yes.
Speaker 2:And that's not to say for women who want to go back to work. Great Again. If you're feeling it, go for it. I'd be stuck at front to back. That's where I would be stuck at. So, if you're, I would just breathe in and breathe out.
Speaker 2:Yeah, like I would seriously be just giving myself UTIs all day long, because, I'd be like Right, I tried making myself coffee the other day after I had a really busy shift and I drove home and I think I put the bottle of creamer in the microwave. Oh, I couldn't get to the point of making my coffee because the creamer was gone.
Speaker 1:That sounds really fun and confusing.
Speaker 2:Yeah, it's like a chicken and the egg about my coffee.
Speaker 1:Yeah, exactly what do I do? How do I coffee this morning? Right, I remember coming home and from a shift, while I was, like I don't know, like eight months pregnant, I had my lunch bag. I had my purse it was winter, so coat and my keys, oh, and my phone somewhere. So there was a pocket in the side of my lunch bag and so I just dropped my keys and my phone in there and I walked inside and my daughter came up and gave me a hug and my in-laws were in town. There was just a lot going on Because I had not finished eating my lunch because I'm a nurse and rarely does that happen I put my lunch bag in the fridge because I didn't want anything that was left over to spoil, because then I was going to take out the bad stuff and over to spoil, because then I was going to take out the bad stuff and the good stuff was going to stay for the next day.
Speaker 1:And I couldn't find my phone or my keys. I was so confused. I had the whole family looking for them and of course I found them in the fridge. And can I tell you the flack that I got from my husband when he's like why are you phoning your keys in the fridge? I was like it makes perfect sense, yeah that makes 100% perfect sense.
Speaker 2:If you know the backstory, my hands were full, that's why your battery was running low, so you pulled your phone to use up less power.
Speaker 1:I used my brain what little brain I had left to put my phone and keys in a safe place so that I could get inside the door. And then I was done.
Speaker 2:Why don't we talk about how you guys failed me? How about that? Right, let's talk about that.
Speaker 1:Yes, why didn't you guys know, logically, that I put my keys and my phone in my bag and put it in the fridge? Duh, but I found it later when I went to go make my lunch. But you know, this is a cold phone. It I found it later when I went to go make my lunch, which, but you, that was a cold phone. It was somewhat chilly. It was somewhat chilly, but it wasn't much long after, so it was fine, yeah.
Speaker 2:Cold calls. Ha ha, ha, ha, ha ha ha. So the whole point of the brain break is to demonstrate the value of progesterone, not just on its own, like that. Oh yeah, that's why things are as challenging as we don't let them seem they are, but also because one of the treatments that are currently out there and granted it's a very expensive treatment, so it's reserved for severe refractory cases of postpartum depression and or psychosis, which I think it's just unfortunate. I don't think it's always going to be the case. I think somebody is going to come up with a compounded version one day and hopefully we'll all just get to live a better life, but until then you have to really wait to lose your shit before you can have it. But all it is is a synthetic version of the neurotransmitter that we create from progesterone allopregnanolone.
Speaker 1:Ah, there it is, I think I remember. Okay, so is. It is ziranolone. Also Because there is a new medication that came out for severe postpartum depression.
Speaker 2:Are we talking about the same one? Maybe Still resto, maybe.
Speaker 1:Zirananolone. What is it? Yes, Zoranolone is a synthetic form of allopregnanolone. It's the only oral. Ah yeah, that came out a year or two ago and it's a 14 day treatment. So we've got the really expensive. I'm sure they're all expensive right now, but like the really expensive IV version. And then it appears that now there's an oral treatment and we have no idea how much it costs. But the point is, this is for really severe postpartum depression.
Speaker 2:Which is one of those things where I'm like, okay, it's severe if you have postpartum depression, but a qualifier like that in my world is like a slippery slope, because you're already dealing with a woman who's prone to guilt, complex and prone to I'm failing in motherhood, and so when you try to quantify whether their symptoms are severe or not, I feel like there's more women that will fall through the cracks. That's true.
Speaker 1:Yeah, I guess a better way to say it is the intractable, like we've tried other medication. I mean, at any point are we hoping that this becomes the new medication, like the first?
Speaker 2:I think it has so much to do with everything else. I think it has to do with your insurance and your doctor addressing it, and then your willingness to be on a treatment that is effective, because we tend to like to beat around the bush when it comes to doing things that work right Everyone's like. Isn't there something else I can try. First Again, because it comes with that taboo of oh, you're failing at what you should be doing, naturally, which is obviously already hair done, makeup on, wearing high heels and baking dinner for everybody while the baby is still out hanging off of one boob.
Speaker 1:Yeah, good luck. So if it's the precursor for the neurotransmitters that balance your mood, I guess it just depends on what end you want to attack the problem at. Do you want to start at the source, or do you want to?
Speaker 2:Yes, the way antidepressants work is that they slow down recycling. Yes, our recycling of our neurotransmitters. And that sounds like oh, why would you want to not recycle your neurotransmitters? Don't you want to keep using it? No, but the quicker we clear it out of our system, in our brain system, that's more opportunity to go without it. So it's like there's blood in the water and you're clearing it out, right, like we know, we want it to linger. We want the fishies to come. So antidepressants like Paxil or Welbutrin and Zoloft, these are your garden variety, costco grade antidepressants that everyone's familiar with. The way they work is they're not giving you the actual neurotransmitter that you are either deficient in or going through too quickly. They are blocking the hungry hippoing of that neurotransmitter.
Speaker 1:The hungry hippoing of neurotransmitters.
Speaker 2:You heard it here, folks yeah and only here, along with anharmonic yes, I think there's another one in there somewhere too. There's so many. We want those white little balls to stick around in the playing field for the hippos, right, we want those white little balls to stick around in the playing field for the hippos. And so, whereas treatments like Silresso or the synthetic version of allopregnanolone is that they actually give you the neurotransmitter that you are deficient in, so that it then allows for more balls to be there, not because the hippos have stopped moving, but because there are more balls and the hippos are like whoa, we're full, but this is great, except they're not full in a postpartum woman.
Speaker 1:Yeah, so, essentially, if you take the reuptake inhibitors, the traditional medications that block the neurotransmitters from being recycled, and that's not working, maybe it's because there's not enough neurotransmitters from being recycled and that's not working. Maybe it's because there's not enough neurotransmitters to recycle to begin with. That's where the problem could be the sudden decrease in progesterone. So then we maybe put back the progesterone, which is the precursor to those neurotransmitters we liked, and then now we can actually have functional reuptake inhibition or functional recycling of the neurotransmitters like to the speed and level that we would be able to maintain a mood that feels doable.
Speaker 2:Right, right. I guess the best way to put it would be like in terms of motherhood If your kids are hungry and there isn't enough food in the house, you don't tell them to become less hungry.
Speaker 1:Yeah, you just give them enough food to eat. If there's not enough food, they're going to be hungry.
Speaker 2:Hungry Correct, but the treatment it wouldn't be like just give them Benadryl so they go to bed hungry.
Speaker 1:That would be treating a woman with an antidepressant. Again, it works for the short term If there's enough neurotransmitters to make it work.
Speaker 2:Right, but that is why, and that's why not everybody is being treated with this drug. Who's not postpartum? Because that's a great idea. Why doesn't everybody get more neurotransmitter? And that's not the point. The point is, there's a very specific cause for this depletion, and so we're actually addressing the cause there, or dare I say, for once.
Speaker 1:Yes, and this kind of ties into this common argument that people will liken it to If you were lacking insulin in your body, would you replace it in order to stay alive? Insulin is also technically a hormone.
Speaker 2:Yes, oh it's like you read my book Right.
Speaker 1:So if we're just balancing the progesterone because there's a sudden deficiency in the balances off after a natural process leading to signs and symptoms of depression, which is just basically a neurotransmitter imbalance, then why so much stigma around postpartum?
Speaker 2:depression. Oh my God, why not? Because we can Right Exactly. Give us an opportunity to feel bad about ourselves and girl, you know we're going. We're going to. Yes, I'm bringing my laundry, yeah.
Speaker 1:Yeah, exactly. So maybe we can reframe this whole postpartum depression thing and just help people balance their hormones. That'd be great yeah.
Speaker 2:I would love it if we saw this as like the way we see taking our prenatal vitamins afterwards. You know how we judge women when they don't take their prenatal vitamins after they deliver a baby. We're like, wow, it's like you don't even care about yourself anymore. How are you going to get your iron back? You're still producing for two. Okay, right, so that was my judgy cis voice. So, just like that, you're going to take prenatal vitamins because you know that you've lost a lot of stuff. God knows all the stuff that you've lost, but you've lost a lot of stuff and you need to take your prenatal vitamins to help you while your body becomes to the point of being balanced again. Thank you, we are back to where you were, where nobody was trying to grow out of you or something.
Speaker 1:Yeah, you're not in a parasitic relationship anymore.
Speaker 2:Yes, and then you're off on your own Training. Those are off. Go ahead, girl. Exactly, yes, yeah, same thing, just like that Blood, I don't know, neurotransmitter, same Iron, all the important things. You don't have to wait for it to be such a big deal before.
Speaker 1:Yeah, you would give somebody blood if they had a postpartum hemorrhage. Why wouldn't you give them progesterone if they had a postpartum progesterone hemorrhage? Oh, that's the problem, or maybe you did with the blood leaving your body.
Speaker 2:I think one day, maybe in the far away, we will start giving everybody these kinds of treatments preemptively, just like right now. Some people think oh my God, why are you giving me Pitocin? Do I need it? Oh, I love that question. No, you don't need it yet. Your body used to do this on its own when we lived in the jungle. But since we don't live in the jungle and don't forage for our own food and do have things like obesity and high blood pressure and all these other medications that we take, and our body has become used to not doing what it's supposed to do, we have to help you out a little by making sure you don't bleed, because we don't want you to need a transfusion.
Speaker 2:Same goes for a feel-good hormone called progesterone, apparently, yeah.
Speaker 1:That'd be really lovely if we had all of those options just available. Yeah, wouldn't it be wonderful to be able to, like, when you do the postpartum CBC, could you do like a postpartum progesterone level and just like see where we're at in baseline? Or maybe like what I don't know, postpartum oxytocin level, and just figure out like how to maybe we yeah, too hard Right.
Speaker 2:I think that how much of it would be the validity of those things and the utility of those things versus the need for them. Are all three different ballgames, right? Unlimited resources, and we can just sit there, you and I, and be like these mad scientists that just tested everything and we're looking at a woman's levels of iron and estrogen and progesterone and oxytocin heck, even testosterone, just to be like okay, see, that's why she doesn't want to have sex. Guys, leave her alone.
Speaker 1:They'd be fixing the testosterone so fast if we did that Right. Oh my God, maybe that'll be the first one.
Speaker 2:Can you imagine let's come up with a finger stick testosterone test so that women can be like sorry, honey.
Speaker 1:It's physiologically not possible right now.
Speaker 2:Guys would be running out and buying testosterone for their wives.
Speaker 1:Yeah, They'd be like a little for you, a little for me.
Speaker 2:A little for you, a little for me, yeah, but I think that we don't have enough information to tell whether that would be effective or not. And I don't think that the reason we don't have enough information is because it's not necessary. I don't think it's. And I don't think that the reason we don't have enough information is because it's helpful. I think the reason we don't have enough information is because the costs don't necessarily justify the means, and when you don't have data because it's too expensive to generate, then you don't have data to prove it on a level where it can become cost effective. So then the whole. So there's just no money.
Speaker 1:There's a self-fulfilling prophecy.
Speaker 2:Gosh, I love those.
Speaker 1:Tell us what we're going to learn in your book. This was just one conversation about one hormone.
Speaker 2:I know, right, crazy. I'm a little less verbose on each topic, I promise. So you will not spend like an hour and a half understanding each hormone, but the tone and the informality is pretty much the same. That's why you're here. I should have probably consulted with legal before I published this book, because I don't even know if I'm allowed to say things the way I did. But I know I did and honestly, as my first born Mimi, my husky child mix, she passed away just about a little over a month ago and after that I had even less fucks to give about what I said so.
Speaker 2:I'm sorry You're going to have a lot of bleeps on your podcast, but that's all right?
Speaker 1:No, it's not, I don't bleep, I just put explicit and then we're done. Good yeah, I don't like censoring. Oh shit, here I was holding back?
Speaker 2:My goodness, I do. You should have told me that before. So yeah, outside of that, and then a lot more explicit. Just kidding, they're not that many. In fact, they're actually not. I think of myself as like the Ted Lasso of OBGYNs.
Speaker 1:Okay, I like that, yeah, making everybody play together as a team.
Speaker 2:I was thinking more like just cheesy, but yeah, okay, awesome, yeah, amazing, yeah. There may be a dad joke in there too.
Speaker 1:Oh, that's okay, I like dad jokes. And then your next work in progress after you take a nap. After this book, yes, Because my brain broke. No this book. Yes, because my brain broke. No, I'm going to get some Zorresso.
Speaker 2:Oh my God, we did Google how to say these things before, but one of the tests to see if you need it is to see if you can say it, and so obviously just kidding. Also, we're not getting any kind of kickbacks from any of these companies that we can't say names correctly.
Speaker 1:None of them.
Speaker 2:Especially after that. So what you can expect from the book is that it's not going to be the PowerPoint of books on the topic at hand. It's more like going to be a transcription of a conversation you probably would have had with your girlfriend, who happens to be a doctor, and that may or may not be a good thing, because the conversation is very natural and so it goes all over the place and somehow magically comes back to the point, kind of like this episode. Yes, like I said, it's kind of just the tempo. And in the first book, the book of hormones, obviously there's so many other hormones in addition to progesterone, including ones you don't think of as hormones, like vitamin D Booyah, and I don't mean the dick, the actual vitamin D like sunshine, and so I try to keep it organized by how it affects women. So we do talk about menopause, we talk about puberty. So if you have a teen or a tween and don't want to have to reinvent the wheel on that conversation, there's that, as well as birth control, trying to get pregnant, becoming pregnant, as we talked about in this podcast episode. But then crazy thing is, this topic of pregnancy is just so ginormous that it felt like a fire hydrant to the face when I was trying to incorporate it into something of an organized chapter that didn't go on forever like me right now and so I realized I'm like this is ridiculous, I'm not going to, I'm just I'm going to need to write a separate book. And so the chapter on pregnancy is as comprehensive as one can get without having written a separate book yet.
Speaker 2:And then, of course, there is other topics, such as things that we don't necessarily associate with being just a woman, but it still affects us harder than it does men, like diabetes and your thyroid and guess what your adrenals and cortisol. And then there's an entire dedicated section to just straight up treatment protocols, so that, in other words, you can feel confident that you know the options and you are not just relying on a very busy, frazzled new graduate doctor, who may be like running on short on time because they're busy seeing a bajillion patients and, though their heart's in the right place, they don't have the capacity to always cover everything. You can walk in there feeling empowered that you already have all the options you need to know about and have a more targeted discussion with your doctor. The goal is to make this a tool so that the doctor-patient relationship actually is improved. This is not like giving you what we don't want you to know. There's no such thing. We tell you everything. If we had more time, look at me, give me an hour on a podcast.
Speaker 1:I just want to tell you in a way that makes sense, so that you get the actual information Right.
Speaker 2:Exactly and so yeah, that's, and it literally does have dad jokes in it, like some of them are authentically produced, like their original Shwetha Patel dad jokes.
Speaker 1:Oh, I love it.
Speaker 2:Yeah, you want to hear one. Yes, okay, since you're insisting, why did the ovary stop ovulating?
Speaker 1:Just because Wait, what Just PCOS.
Speaker 2:PCOS, pcos.
Speaker 1:Oh my God, I was thinking like P. Oh my gosh, there you are, hi.
Speaker 2:It's me. I'm a middle-aged dad stuck inside a middle-aged woman's body. Oh, my goodness.
Speaker 1:That sounds gross. Not in that way. That should be a movie. They have the mom and the kid. Oh, the parent swaps, yeah, or the, what is it called? 13 to 30 or something like that 17, again with Zac Efron.
Speaker 2:I guess, there's a lot of them. Matthew Perry oh, rest in peace. And then the next book will be there's a lot of them. Yeah, matthew perry, oh, rest in peace. And then the next book will be everything on pregnancy, including some things I think that will be a little bit different from other books, but also combining different books together, which is like how to level up your experience in labor and delivery, down to including what to say and ask how to say it to nurses and doctors so that you get what you want. Birth plans yeah, love that.
Speaker 1:All the things like are we gonna keep calling them birth plans, because they're not really a plan. Birth goals, I call them perfect preferences or, yeah, vision, yeah so like, like goals, hashtag, birth goals.
Speaker 2:I don't know my head bobbing so much when I say it, but Love it.
Speaker 1:My Indians coming out. You're going to go Bollywood on me right now.
Speaker 2:Yeah, you did.
Speaker 1:Built in bobble, doll arrived is there anything we didn't cover that you want to talk about?
Speaker 2:so much, but not for this episode.
Speaker 1:Not for this episode we'll do it later, okay, yeah, dr patel, as always, it has been quite a pleasure. Thank you likewise, and if your book is now out, the book of hormones by dr shweta Patel is now available.
Speaker 2:Yeah, you can Google it. Preferably you go on Amazon because that's where it's published from. So if you do, if you're one of those folks that has Kindle Unlimited where you have like that it's included in your Prime membership or something you can actually read the book for free.
Speaker 1:Amazing.
Speaker 2:The other way that it is available is paperback. Again, you just go on Amazon and put in the book of hormones I don't think you can get a more straightforward name and it's hard to miss the cover. It looks nothing like a medical book on hormones. It's a woman jumping for joy. There you go. Or you can also, if you want to scope it out before you buy it, you can also just go on the page on Amazon and look at the sample. It gives you the first four chapters for free.
Speaker 1:Oh, wow, I know I was kind of like WT.
Speaker 2:I didn't know if I was happy or upset. I'm like good thing it ended on. A cliffhanger Was it the. Pcos joke. No, I gave that one ahead of time. That was a spoiler alert, all right.
Speaker 1:When you want to hear the joke about PCOS or why the ovaries start working or stop working. I'm messing it up. I'm not even Delivery. It is. It is. It really is. Okay, If you want to go read Dr Patel's book, go to Amazon and get the book of hormones and start learning about your hormones and stay tuned for the book of pregnancy or whatever that title is going to be.
Speaker 2:That's literally what it's called the book of pregnancy. Book of pregnancy.
Speaker 1:I like to keep it pretty straight and narrow, yeah, yeah, nobody's going to be confused about what it's about. Thank you, as always.
Speaker 2:Thank you for having me.
