What to Expect When You're Expecting, But Make it Modern

Pregnant or thinking about becoming pregnant? In this practical guide built for the moms of 2026, we walk through the art of choosing a pediatrician, what to expect during your hospital stay, common NICU experiences, and how to prepare yourself and your support system for life with a newborn.

Transcript

SPEAKER_01 0:06

Welcome back to Practical Parenting, the podcast that helps empower parents in the trenches, find joy in the process, and thrive through it all. I'm Christina Wales here with my co-host Dr. Terry Nowyn, Chair of Pediatrics at GBMC Healthcare. The famed book, What to Expect When You're Expecting, leaves a lot to be desired, but this episode will not. For moms who are pregnant or thinking about becoming pregnant, this episode is for you. We will be breaking down all of the need-to-knows, starting with navigating pregnancy and what questions to ask your obstetrician to what will happen after your baby is born, to what to expect if you have an unexpected visit to the neonatal intensive care unit. Get those pens ready to take notes because this will be a jam-packed episode. So let's get into it. Okay, Dr. Nguyen, let's start with pregnancy. There are tons of questions first-time pregnant women have, and I encourage all those women to write them down. Get the list out at every appointment with your OBGYN. No question is dumb. Trust me, they have heard it all before, probably more than you could even come up with. Dr. Nguyen, I'd love for you to cover two things for us here: birth plans and then picking a pediatrician. Which do you tackle first?

SPEAKER_00 1:17

Um, I can do either one, but I the one that I am uh most adept with is picking the pediatrician, right? Um, the birth plan, you're gonna work out with your obstetrician. Um, you know, I don't pretend that I am an obstetrician. I only want to deal with you after your baby is out. Uh there's a reason. I don't think. And really only the baby.

SPEAKER_01 1:37

I mean, I guess you have to deal with the mom, but I do, I do.

SPEAKER_00 1:39

It's a whole, it's um, it's very what I love is actually I take care of a family, right? We pediatricians don't only take care of the the baby or the child, we take care of the whole family because happy baby, happy mommy, happy family. So that's one of the first things that I say. And I remind fathers of that. Expecting fathers and fathers who, you know, the babies in front of them. So I think we're making what to expect when having a baby more complicated than it has to be. It's really easy. It's it's not easy, but let's just go back to basics. You want this baby, you're excited about the baby, you're you're nesting and you're preparing for the baby. Excellent. So as you're physically preparing for the baby, you're also emotionally working yourself to prepare for your baby, you're reading about what to expect. But I'm gonna say all of that is garbage until you have your baby. You can have the best questions from me when you're interviewing a pediatrician. And I don't know that you're gonna remember every single one of those um responses because there's gonna be nuances to the question. I actually would rather a parent who is interviewing me for um a prenatal visit to see if I might be a good fit for their family to have a conversation with me, you know, see if the fit is there, see if our parenting philosophies are jiving, okay? Because anybody can tell you to do this, you know, baby should be sleeping on their back, they'll be feeding every two to three hours, you know, breast milk is best, but if you can't, we'll do formula. Like that's rote, robotic, AI could do that. But the piece that's really important when choosing your pediatrician is can you look that person in the eye and can you really bear to keep getting advice from them for the entirety of your child's childhood and adolescence, right? Do you feel that you can trust them? They are safe, they um are expressing advice in a way that is um easy to digest and process. Are you able to um ask questions without feeling judged? Yes, right? Big one. Yeah. So I think it's really about um relationship, communication style. And, you know, not every pediatrician is for every family. Um, that's true for me, that's true for my partners. I mean, I think we have a wonderful group of pediatricians in our practice and advanced practitioners. I can concur, yes. Yes, thank you. Um, but you know, like different styles. So it's about style. So I I would rat I would um that's the one thing that you don't get out of the what to expect when you're expecting book is, you know, do you jive with the person? Do you jive with the philosophy of the practice? Okay. And what do I mean when I say the philosophy of the practice? Are you okay? I'm gonna give a very concrete example. Our practice, um, we do request that all pati all parents agree to vaccinate their children because we also reassure all parents that we only accept children uh whose families are gonna vaccinate um their children, right? So if so it's it's set up very clearly up front. If you've decided vaccinations are not for you or your family, or you want an alternative schedule, we're probably not gonna be a good fit for you. And I'm happy to explain why, because vaccines are based in research, evidence-based medicine. It's the best thing that we've come that's come along in pediatric medicine in the last century, right? Um, there's no debate in my mind about how important they are in keeping our children safe from diseases that used to maim children or cause more uh cause death. Okay. Um, and it's okay, we're in a free country. If you disagree, we are gonna be um, you know, very pleasant about it, but you know, we're not a good fit for you. And then there are parents who may want alternative vaccine schedules because they think that multiple vaccines all at once is a bit too much for their infant. I understand why um you may think that, but if everyone in a multi-thousand, like five to six thousand patient practice has their own vaccine schedule, guess what? There's gonna be increased errors and mistakes, right? So we want to have personalized and individualized medicine, but we also want to have some um processes in place to minimize medical error, right?

SPEAKER_01 6:23

Yeah, that makes sense. Yeah. Well, and also there's the trust factor too. Like if you, you know, if you guys disagree on something, just that one factor, how do you feel like you would respect their opinion on other things if you know you disagree on something that's open that important?

SPEAKER_00 6:39

Right. Right. And I really truthfully, you know, I mean it in all earnestness that um, you know, we all have to make decisions for what's right for our children and our family. And, you know, as a group, we as the uh pediatricians and advanced practitioners in our practice, our agreement is we stand by the vaccines. So that's nothing that we will compromise the care of the rest of our patient population for one or two individualized families. And we've had families who vaccinated their children early on and then changed their minds, perhaps after COVID. And, you know, we leave amicably, you know. I still love you and I still think you're wonderful people. Okay, this is a philosophical point that we cannot overcome and we can't um we can't compromise on this. Right, you know. So, yep, rapport, right? That that's the big thing that I'm establishing right there. Um, so finding that pediatrician, um, you know, and talk to um other friends and family members who have children and who are they going to? Um, you know, there's like there, there's like a whole list, and I have definitely encountered parents coming with the whole list, and I kind of have to giggle. I'm like, how much of this are you going to remember? And I I love the question like, what's your philosophy on child rearing? I said, My philosophy is. Do you want me to bring my children here? They can tell you? No, no. What's your philosophy? Our goal as um the um uh pediatricians and advanced practitioners taking care of your children is we are your guides. We are the guide through the galaxy of parenting, okay? We know the facts, we know the science evidence, but this is like your creation of what you want uh in your ideal family. You have ideals, and then you're gonna find out that you may fall short of some of those ideal expectations, but we're here as your coaches, right? We we hold the guardrails, um, we um, but we're we're coaching. We are not, I don't see myself in the paternal or maternal um, you know, um physician model, right? Like there are a couple of things I will tell parents, like there are absolutes. Um please sleep your baby on their backs, okay? Because we already know sleeping on their stomachs had increased rates of um sudden infant death syndrome. And you know, over the 20 plus years that we've been doing the Back to Sleep program, we've really decreased mortality from um sudden infant death. Okay. So that's that's you know, that's a kind of a no-brainer, no compromise. It's it's a fact, right? Um, I kind of feel vaccines, I know I'm getting old on the vaccines, but I kind of feel vaccines is right there for me as far as that as well. And then, you know, as an aside, a Dr. Terry aside, I say, I'm just not a fan of fruit juice. Neither is the American Academy of Pediatrics, right? But kind of jokingly, I say, all I want you to give your babies is either your breast milk formula, milk, or water. You know, when we introduce fruit juice, it's introducing unnecessary sugar, added sugar. Give your kid the fruits. Okay, but that's like a me thing. It's not like my partners are all saying that. They probably agree. But um if I say that and you're like, oh, she seems like really strict about that, maybe I'm not your doctor. You know. But um, my philosophy, my parenting philosophy is really um, what would you like and how can I help you get there? Yeah, you know, uh, and how can we help nurture your your children and you to be the best parents that you know you want to be and to raise the family that you want in your vision. So that's my parenting philosophy. Yeah. And then, you know, parents will ask about feeding and I and discipline, right? I say there's not a one, a one answer for each one of those questions. Right. It really goes back to, okay, so feeding breast milk is best, but if for some reason you don't produce breast milk, breast milk, uh, you know, breastfeeding is just turning you into tears, okay. I'm not gonna advocate for that because remember, happy mom, happy, happy family. Yeah, no. I'm gonna say, you know what, formula feed. Um, the people of my generation born in the 70s, the majority of us were 60s, ooh, 60s or 70s, or formula babies. And, you know, that was the rage back then. And we turned out okay, you know. I mean, we might be one or two IQ points short, you know, but you know, in general, we're okay. Yeah.

SPEAKER_01 11:22

Um so let's talk about like the few days after birth. So you're still glowing, you know, over meeting your tiny human. You have already forgotten the pain that you've been in. Um you're exhausted, Christina. Come on, let's be real. I was there twice. Um, so tell us what happens, you know, in those first three days when you're still in the hospital.

SPEAKER_00 11:42

Uh the what we do is that um, let's see, the nurses and the lactation consultants are helping you uh learn how to feed your baby, and they bathe your baby. There are gonna be some um vaccines um that are offered. The big one is the hepatitis B vaccine, and that is to help prevent hepatitis B, which can lead to uh chronic liver disease and even liver cancer, right? So we always offer it. The pediatricians always, the American Academy of Pediatrics still recommends that you get it at the first opportunity that your baby can get it, and that's you know, within the first 24 to 48 hours of life.

SPEAKER_01 12:24

Okay.

SPEAKER_00 12:24

Okay.

SPEAKER_01 12:24

So yeah, because you give birth, you're move it, you moved into um postpartum, and then you come to see the baby, what, the next day?

SPEAKER_00 12:31

Or with the I so the pediatricians um or um the nurse practitioners are seeing the baby within 24 hours. Okay. Okay. I want to clarify something. Nowadays, mostly the babies are being seen by the hospital um pediatricians or nurse practitioners. A lot of community pediatricians have chosen to not come into the hospital from their practice to um do the newborn exams.

SPEAKER_01 13:00

Okay.

SPEAKER_00 13:00

Um, because it's really a time and travel issue, and there really is a um an absolute that the babies have to have uh been checked out in the first 24 hours. Okay. And we are at GBMC and at all other hospitals that deliver babies, we are staffed with um practitioners uh andor uh pediatricians who are there 24-7 for the newborn babies. Got it.

SPEAKER_01 13:27

So it it it's really might not necessarily see the pediatrician that you chose moving forward. It would be something else.

SPEAKER_00 13:33

For us in our practice, because we are affiliated with the hospital and we're in close proximity, we'll probably do a social visit, okay? But um the um the care the providers here at the hospital um will offer the hepatitis B. They will give vitamin K shots to the babies because if you're deficient in vitamin K, that can cause uh and you have a bleeding disorder that can um have severe consequences, let's say if your baby boy is getting a circumcision, they could bleed endlessly. So across the board, we also um offer vitamin K. And it had not been a topic of debate before, but it's become a topic of debate, and I'm going to say that we should get the vitamin K. It's it's like you know, preventive things that we can do that would ward off um any um bad outcomes. Okay, so the vitamin K shot, hepatitis B, and um we also apply erythromycin ointment um on the eyes for the babies after they're born. Why? Because uh, if there was any possibility of transmission of uh gonorrhea or chlamydia through the birth canal, we've eradicated that with the application of the erythromycin ointment. Okay. Um that's about it as far as kind of what things are they doing to your baby. Um and we do check um children's bilirubin levels before they leave the hospital. And the beautiful thing is that we have something that we can scan just on their skin and their forehead to get that level. And if it's concerning, then we might do a blood draw.

unknown 15:12

Okay.

SPEAKER_01 15:13

And then can you touch on NICU experiences for a little bit? I know that some parents, you know, they hear that and they're thinking there's got to be something severely wrong. And that's not necessarily always the case. So, you know, maybe if can you name some instances where a baby would have to go for a little bit, and then what can they expect, you know, if that's an experience they have to go through.

SPEAKER_00 15:31

Yeah. So for some parents, they'll know that their child will, their baby may will have a higher chance of going to the neonatal intensive care unit, the NICU, right? Those would be babies who are being delivered before term. Okay. And term or close or near term. Okay, so term babies are defined as any um baby at 38 weeks or higher of gestation, right? So I know 40 weeks gestation is what everybody says, but 38 weeks, you're full term. Um, but you might be a 36 or a 37 weeker. So then we consider those near terms. And for the most part, they do well because the baby's lungs mature at 34 weeks of age. Okay, so before 34 weeks, your lungs aren't so mature, and yeah, you're probably gonna have a NICU stay. Okay, so if your baby's being delivered early before 34 weeks, but there are things that if um your obstetrician and the uh neonatologist already know that this is what's you know, your baby's gonna be delivered early, um, they can do um things to help with the lung maturation. Okay. Give medication. Okay. Um, so in those instances, you know that, and a neonatologist probably will have spoken with you as well to prepare you for the delivery and where your baby may be going to after the delivery and not to the full-term nursery. And why? Uh babies whose lungs are not mature will need some kind of respiratory support. Uh, it may come in the form of oxygen or uh a nasal CPAP, which also provides oxygen, or maybe even uh a ventilator. Okay. Um so in those cases you would know ahead of time. Okay. Or if you came in and you're very early, you know, much earlier on, say in the late 20-something weeks of gestation, early 30-something weeks of gestation, there will have been a neonatologist who has talked to you and consulted with you about what to expect when you deliver and after you deliver your baby. Now we have this new group of um babies who are needing some uh NICU care. And these are the new, these are the close-to-term babies. Um they are 36, 37 weekers, or maybe even full-term, 38 weekers. And we're finding in the last few years that there's more of these babies who are being um transferred to the NICU after after they're giv after they're born. And for those cases, we may not have expected that they would end up in the NICU, right? Um, and why? It's usually around respiratory issues. For some reason, the baby is um having some fast breathing, irregular breathing, requiring some oxygen, requiring some extra care, and they will go to the neonatal intensive care unit. But those days are pretty short, they're probably five to seven days. Okay. And you can um all of the babies who are in um the neonatal intensive care unit here at GBMC are in their own rooms. Um, and so, and you as a parent can be with them as much as you'd like. Um, and they're getting one-on-one nursing care. Uh it's the difference between the neonatal intensive care unit versus the mother-baby unit here is that the baby can't be in your room. So if your baby is born, is well, is, you know, does not need any extra care, they're actually going to be rooming with you in your postpartum unit. Okay. And the nurses will take the baby out to do vital signs and do cares, but the baby will be with you. So those are the big differences for, you know, the much younger, um, younger babies, I'd say probably the under 36 weekers, you're probably prepared, right? The um close to term 36, 37 weekers, there's probably has been a conversation that it might be, but the much younger from your OB, um, but the much younger um deliveries would you will have spoken with the neonatologist. The neonatologist is a specialist in only babies. Okay, so I'm a pediatrician, I'm a general pediatrician. I take care of babies from day one until they graduate from my practice. It's supposed to be when you're finished with college at about 21, but you know, that's debatable for some of my patients if they're listening. They know who they are. Um, and then I get another opportunity to take care of their children, which is actually really wonderful. Um, so I sidetrack. But um that's does that answer the question that you have?

SPEAKER_01 20:27

Um, I mean, is there anything else that you would add to that parents should be prepared for?

SPEAKER_00 20:32

Or do we cover I think um the most important thing I want to stress with parents is as long as you're trying really hard to take the best care of your baby and you're following the guidance of your pediatrician, your practitioner, you're gonna be able to do that. And listening to this podcast. And listening to our podcast, you're gonna be fine. Yeah. You know, um children need love, um, they need attention. You're usually, you know, blossoming over with that. So, what I would like to recommend is take some time from the busy flurry of it all to just you know, be with your baby, be present with your baby, watch them as they sleep, um, you know, hold them, watch their breathing, watch their sleeping. It's one of the most common things that you can do for yourself. I always uh for moms who get, you know, you're you haven't really gotten the hang of breastfeeding, and you're kind of flustered, you're not getting enough sleep, you're tired, you know, you're grumpier than you thought you would be, you cry at the drop of a hat. I say just drop everything, take a moment, breathe, watch your baby sleep. Make eye contact with your baby when you're holding your baby and make that connection, okay? That's what's gonna help you. That's what's gonna Help soothe your nerves and your baby's nerves because if you're up and you know, if your energy is nervousness, franticness, that will reflect in your baby, okay? They have this sixth sense, they are so closely bonded, and dads also. I know dads nowadays are so involved and they're wanting to be a part of it all. I love it, okay. Maybe you can actually just, you know, what are tasks that dads can do that we don't need moms for? You know, dads can help by changing the diapers, doing the laundry, whatever. And you may have the perfect plan before the baby is born, but then baby comes home and you're like, oh my gosh, we didn't know there'd be that much laundry. Oh my gosh, we didn't know that there was gonna be this much attention. And then you shift. And that's the beauty of it is that you know, parenting, there's no exact science, there are guidelines, um, there are guardrails, but you know, you have to fit it to your own family situation and what you can tolerate and what is doable for you. Okay. And I think dads can go through some postpartum depression also. So I want to really also bring it back to focusing on the parental unit. Like everybody is so invested in taking the best care of this baby, and then we're not taking care of ourselves at all. So if family and friends want to help, tell them, can you do the laundry? Can you bring dinner? You know, that's can you do yeah, right? Can you help with some house chores? No, please don't be a family member visiting and just sitting there waiting to be served on because I barely brushed my teeth this morning or changed my clothes. So I'm sorry, I can't entertain you. And the other, oh, the one other thing I forgot to mention, um, what to expect and what to do before you have your baby, is for close family members who are going to be in contact with your baby, I want to remind the grandparents and and then the close aunts and uncles, please go get your protussis um vaccine updated. It's probably been decades since you've had the protussis vaccine, right? So your immunity has probably worn off. Um, the infant will not have received their first protussis vaccine until they're two months of age, okay? So there's this two-month opportunity for a child to be exposed to someone who is carrying protussis unknowingly, and that's a serious thing. That's whooping cough. And babies don't whoop, okay, when they have whooping cough, they stop breathing. And I was unfortunate enough or fortunate to experience that um during my training. So, yes, please insist on close family contacts, um, updating their pertussis vaccine. And if you're in flu season, if you have family members who are gonna be in contact with the baby, yes, please go get your flu vaccine. I'm gonna stay away from the COVID vaccine because it's just, I would still recommend it if you're gonna be in close contact with a baby. Um, it's because the baby has no immune system. Baby's immune system comes from mom, okay? And unless mom has antibodies that she's passing to the baby, baby has nothing else. So, what might be a cold in you and I can be a really big thing in the baby. Because remember, it's their lung capacity. Right. Their lungs are teeny tiny. They have much, they don't have much reserve, even for just a viral cold, okay? And then the other thing I wanted to add on to that is RSV vaccine. So during RSV, respiratory synstitial virus season, which is October through March usually, mother, pregnant mothers can now receive the RSV vaccine for themselves. And if they receive it during pregnancy, it's later on in pregnancy, and if they have it within um two weeks of delivery, their babies will not need to get the RSV immune globulin after birth. It is not a vaccine for the babies, it's actually immune globulin, but it is um administrated through a, you know, a needle. So parents may think it's a vaccine for the baby. Person who's getting the vaccine is mom. If mom gets it, then you save your baby the needle. And that's only for babies who are born between October and March. But this year, um, it was recommended that we extend the vaccination for moms and RSV immune globulin for babies through April because the season, you know, the virus season can extend. Right. Okay, so I forgot to mention that when we were talking what to expect when you're expecting. So please update your protestis vaccine if you're the parents or if you're close family members. If you're in flu season, please get the flu vaccine. I would recommend COVID vaccines also for the adults who are in close contact with the babies. And for sure, I would recommend the RSV. Uh, and then after the baby's born, you know, the hepatitis B and the vitamin K and the urethromycin ointment for the babies, and then an appointment with your um pediatrician or advanced practitioner two or three days after you leave the hospital.

SPEAKER_01 27:20

I'm actually glad you forgot to mention that because I think it just proves the point that there is so much to think about and so much information that you're going to be taking in. So, you know, just be gentle with yourself and ask questions. Don't be afraid to ask questions and write things down or whatever you need to do to feel more comfortable about it because it is a stressful time. There's a lot of new information, a lot of things are changing. And we didn't even touch on the emotional and mental aspects of being pregnant or postpartum. So, you know, just like you said, be gentle with yourself, take your time, focus on the baby in front of you, you know, and all those things, and don't be afraid to talk to your pediatrician or your OBGYN about things that you're experiencing or your baby is experiencing. Um, they have definitely heard it before. So and ask for help. Right. Okay, no one's gonna judge you.

SPEAKER_00 28:04

Yeah. This is your first baby, even if it's your second baby, you know? It's gonna be different. Yeah, it every child, even if they share the same genetic pool, they're gonna present differently. Yeah, you know, one baby, one child of yours may have some um feeding difficulties. The next one might have some sleeping difficulties, right? So it is um it's different for every child, but that's what makes parenting fun, by the way. Yeah, it was just cookie cutter, like you did it once and you know how to do it, and you're just gonna do the same exact thing on your next child and your next child. Yeah, so it might become boring. So parenting is never boring. Be flexible. Like that's that's really one of the biggest messages that I share with my expectant parents. I said, there is no the babies don't read the textbook on being a baby. Okay. So we need to be able to flex with them and we need to be able to flow with them. And if you have a good support system that can help you with that flexibility and flow, you'll be in a better space. You know, so true. I don't, I don't have absolutes for you. You have some absolute expectations. My job is to help you ease down some of those, given whatever circumstance you're in. Yeah. And then my biggest thing is please remember to look at your baby, make eye contact, bond with your baby. That's more important than, you know, changing that diaper really regularly, clocking like when the next feed is and how long the baby fed for. I say, you know, once the baby is giving you at least three wet diapers a day, stop keeping track of it. There are parents, you know, at their two-week visit still tracking every diaper, you know, how long the baby's feeding. I'm like, baby's gaining great weight. Whatever you're doing, it's working. Yeah. So stop note-taking, okay? We are not running a neonatal intensive care unit. We're just raising a baby that is incredible, right? Yeah like the best thing that's probably happened to you. Um, and we want to help you find joy in that process. Like truly. This is why I do pediatrics. Is I mean, the babies are pretty awesome. And then I get to help you and your baby and your child, like through the whole span of their childhood and uh into their young adulthood. Yeah. So I'm enjoying it as much as you are. I'm probably enjoying it more than you are in the beginning because I'm not up with the baby every two hours. Um, but give yourself, um, be kind to yourself, give yourself grace, give grace to your spouse, give grace to your family members, okay? And it's it's okay. Every almost everything is is repairable.

SPEAKER_01 30:43

Yeah.

SPEAKER_00 30:44

Remember that. Okay.

unknown 30:46

Yeah.

SPEAKER_01 30:47

Well, I hope we, yeah, yeah. Well, hopefully we've given you a good checklist of things to do, and um, good luck.

SPEAKER_00 30:54

And enjoy. Yes, yes. Enjoy your baby. And when you are really stressed out and the hairs are standing on your head, just take a moment, look at your baby, watch them sleep, watch them breathe. It will be so soothing for you. All right. Okay. We'll see you in the next one. All right, thanks.