E10: Loss Can Mean Something Different For Everyone ft. Dr. Nina Paidas-Teefey

When you’ve just heard “there’s no heartbeat,” even a casual “congratulations” can feel like the world is refusing to acknowledge you and the  reality you now inhabit. That  moment is where trust breaks, grief compounds, and dads default to  silence and isolation.

Today I’m joined by Dr. Nina Paidas-Teefey, MFM/Fetal Intervention & Director of Psychosocial Programs at The Institute for Maternal Health Fetal Care Center at Nemours Children's Hospital in Wilmington, DE, to unpack what “loss” really means in pregnancy and baby loss care. We talk about loss as the loss of normal, the loss of the future you expected, and the loss that starts the minute a family gets referred to a fetal center. We also get specific about the ultrasound room experience: the darkness, the waiting, the facial expressions you try to read, and the questions you don’t ask because you’re not sure you’re allowed to.

From repeated miscarriage trauma to the next pregnancy after loss, we explore how partners protect themselves through detachment, how clinicians can return control with simple choices, and why clear language matters when outcomes are uncertain. Dr. Paidas-Teefey also shares what providers carry home, how peer support and debriefing can prevent burnout, and why teams need to be trained not just in medicine but in listening.

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SUPPORT PATHWAY

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Transcript

Loss Means Different Things

SPEAKER_00 0:00

I think that there is something about loss that you really have to open your mind to what loss is to others. I think that working alongside the families that I've cared for has helped teach me that. And that was my turning point, recognizing really that loss can and does mean something different to every single person that walks through the door. And whether it's a loss of a normal pregnancy, whether it's a loss of a child, whether it's a loss of something you expected but then never happened, I think that that was very, a very profound realization for me.

Meet A Fetal Medicine Specialist

SPEAKER_01 0:46

Hi, I'm Kelly Jean Fay. And welcome to Dad Always, the podcast exploring what it means to be a dad even after baby loss. Welcome to another episode of the Dad Always Podcast, Fatherhood Beyond Loss. And I am very excited to have with me someone who, well, I'm going to let you introduce yourself, but I've shared this with you privately and I'll share it now publicly now that you're on the podcast, so you have to listen to it. You are one of the most incredible people that I've ever had the pleasure of working with and also supporting other families with. And to have you on the podcast, to have the conversation that we're going to have is truly an honor. It's been a long time coming, and I'm glad that it's finally here. So without delaying it any further, please introduce yourself.

SPEAKER_00 1:52

Thank you. Hi, I'm Nina Paytas-Teefey. I am a fetal, maternal fetal medicine doctor, but focused on fetal diagnosis and intervention. I am newly joined staff and part of the team at Nemours Children's Hospital. I have worked with Kelly on many different things as a wingman, as a colleague, as a friend. And really truly, I am the privileged one. I feel really lucky to be here and truly love what I do, but also recognizing in my space what I could do better. And loss is something that I continue to learn from and do every day. And I think that that's what brings me here.

SPEAKER_01 2:39

So for someone who I'm sure people from this audience may or have some kind of awareness of the space that you work in. But can you give me sort of an elementary education to what is it that you do and the general gist?

The Triangle Of Her Work

SPEAKER_00 2:58

Yeah. So I would say I work within a triangle. The first piece of that triangle is I am a maternal fetal medicine doctor that trained generally in OBGYN and then did a specialty fellowship or training within maternal fetal medicine. And then I kind of branched out even further in a niche subset of maternal fetal medicine where I am looking at babies every day, but in a different sense. So when a maternal fetal medicine doctor sees a pregnant patient that has something going on with their son or daughter, or something going on with the baby that they just don't quite know what it is, or they need a wing person to assist with that diagnosis, or they see something and the baby is ultimately sick with something that is going to impact them either within the uterus environment or and outside of the uterus environment. Sometimes there are certain opportunities that we have to intervene to help mitigate some of the risk to the baby. And sometimes those conversations are quite hard to have because there's risk not only to one person within the uterine environment, but sometimes more than one person in the setting of twins or triplets or more than that. But there's also a family, a mom and a partner or a support person and siblings and other people that are impacted by that difference. And families need to know more about it. So my first part of the triangle is really being a doctor within the space of fetal intervention and diagnosis. I'm a full scope practitioner within that space. I do fetal diagnosis. So I'm an ultrasound master. I actually can't take the full credit. I'm on a team of ultrasound masters, actually, of sonographers and coordinators and accessory staff, advanced practitioners. But then I also, in that same triangle, work with work as a surgeon. So I do different fetal interventions, full scope fetal intervention with the diagnostic piece. And then the third part of the triangle is really babies that have life-limiting differences. I help to individualize plans for those families and for the pregnant person and their the family. And I really focus on bereavement, education, knowledge, staff education, and then wellness of the family. So every care plan that we make in this field is truly to the patient and the family. And so there's no easy algorithm that you learn over time. You really don't ever have that. And so it's a very much individualized space. And I try to think of coping and attachment and loss, kind of within that framework of the triangle that I just talked about, in terms of educating myself, but also making sure those are the pieces that I'm paying attention to when I'm speaking with a family about a difference that can be helped or maybe helped or not.

SPEAKER_01 5:57

So I asked for an elementary, but you give me a college course, which is which film.

SPEAKER_00 6:06

Yeah.

SPEAKER_01 6:08

It just speaks to the nature of how involved and how passionate you are about this, which is one of the qualities that you just can't teach someone to have and to cultivate, which is what makes you well part of what makes you you and who you are in this field and the way that I've experienced working alongside you. So you mentioned the piece of bereavement and loss and sort of being in that experience as a family is going through it, also helping families plan through what that phase of their pregnancy experience is. Is there a particular instance that comes up to mind that surfaces right away when you think about something that has stuck with you and how if you could look at that as like, I don't know, maybe a turning point for you or revealing of something deeper that you weren't necessarily aware of prior to that? Is there one of those stories that sort of sticks with you?

SPEAKER_00 7:11

You know, I think loss in the environment that that we work is so profound and it is so different for every family and person that walks in the door. And so I think that really the realization that I had that loss is not just someone dying was the most important thing. Loss is loss of normal. And I I dislike using that word, but I think it actually it's a really important word.

SPEAKER_01 7:44

I think COVID made us really hate loss.

SPEAKER_00 7:47

It's so true. Yes. So I, you know, I think that there is something about loss that you really have to open your mind to what loss is to others. And I think you helped teach me that. I think that working alongside the families that I've uh cared for has helped teach me that. And that was my turning point, recognizing really that loss can and does mean something different to every single person that walks through the door. And whether it's a loss of a normal pregnancy, whether it's a loss of a child, whether it's a loss of something you expected but then never happened, I think that that was very, a very perfect realization for me.

SPEAKER_01 9:34

So let's get into the weeds of that as the main part of our conversation, which is let's talk about what loss is, or at least what someone walking, someone who you're meeting, a family, a pregnant person, their partner, their male partner in particular, right? Let's create those personas, and now they are sitting with you in your office and you're talking to them, and the conversation is very much so about the loss or potential loss of well, the potential loss. I'm not gonna put it of anything. So let's unpack from the perspective of each person in that room what loss is.

SPEAKER_00 10:19

The piece of loss is very individualized to the person specifically, right? So you can have a referral to me, right? In a sense, that's a loss, right? I'm the gal you never really want to see as a family. And and then you get to me because something's up. Whether it's someone doesn't know what's up or they do know what's up, and they're waiting to kind of give you more information and and you get to me in that sense. I think that, you know, the pregnant person is experiencing the loss of all the things at the same time that they thought was gonna be part of their experience of being pregnant. And that happens for a first-time pregnant person very different than it happens for a second or fifth time pregnant person. That happens for a pregnant person with living children. That also happens for a pregnant person that's had multiple miscarriages or losses. And I think that that bubble has like eight offshoot bubbles, right? So it depends on what trauma you've had in the past, what you consider your trauma as the pregnant woman or person. But I think the second person in that room is the support person. Generally, they're there, but also those that aren't there, maybe they're on FaceTime. You know, COVID introduced this concept of like bringing somebody wherever you go as your support, even though maybe they're not there in person. And I think that brings a sense of loss in a degree as well. So who's there in that room? And really who is the primary support person that the patient, the pregnant person considers their go-to, right? That being the dad, the dad piece is so critical at this juncture because dads, I feel, take on this burden of so much. They want to be the bravest, they want to be the best supporter they can be. They oftentimes live in the ambiguity of not even knowing what to ask because they want to support the person that's asking and is pregnant. And I think that there's a lot of loss there for them as well.

The Dad Experience In Ultrasound

SPEAKER_01 12:37

You know, it's interesting you say that, Nina, because in my own experience, walking into the OB office with my wife and walking into the ultrasound room, the multiple ultrasound rooms that we walked into, the four times that we were told, well, the other day she reminded me that I was only there with her for three of them. The first one I wasn't there for whatever reason. But being in those ultrasound rooms and myself not knowing that I actually had questions to ask. Like I had questions to ask. I didn't know how to ask them. I didn't know if it was okay to ask them, and I didn't know if I had just chalked everything and said, you know what, screw it, I'm gonna ask it anyway, if that was gonna make me appear to be X, Y, and Z. We've spoken about privately, but my experience has opened my eyes to perceive that the experience of many men like me who walk into the maternity space, not that the environment is hostile towards us in a physical way, but emotionally it definitely does not capture my or account for in a way for my being there in a way that feels as robust as my wife, for example. And you shared something with me the last time we were talking about this that I think it's obvious, but it's also very important to talk about. So why do you think that is in terms of the environment? Uh why do you think that the dad may or may not feel like anything he has to bring or anything that he has to, his very presence in that space is not as inclusive. Why why why would he feel excluded?

SPEAKER_00 14:38

We as professionals in this environment work really hard to get here, right? We do all this school, we do all this training. Now I'm very thankful that we're incorporating aspects of learned communication into these, into these training years that we have. But I don't know that we're really trained to speak to dads. We're trained to care for and focus on a pregnant person, right? And and we're mostly very good at that, and we're also lifelong learners. We think we're really good listeners. We think we are. And I think that that piece is very important because without that recognition, without really thinking about what we're going to be learning or listening to, we really can't possibly even take in the fact that a dad is there. We're so hyper focused on the pregnant person. And and, you know, for me, I'm so focused on the pregnant person, but also figuring out what's going on with the baby so that I can explain it in a way that the pregnant person in front of me is going to understand it. And I think that that actually is also a really important piece, right? We have to be able to sit in a space, a dark space, right? That's what the ultrasound space is, usually very dark. As a person with a lot of facial expressions, sometimes people can't see my facial expressions. They can't tell what I'm thinking. They, they, um, you know, I'm told by by my kids and my husband that they can read my expression and tell me what I'm thinking. But actually, in a dark radiology ultrasound room, you can't necessarily do that. I think also when the mom is laying down, they certainly can't see what I'm doing or what I'm thinking, right? But actually, who can? If you think about it really, really objectively, the person like you right now, looking straight at my face, can actually read me a little bit better almost than the person laying in the in the bed, you know, with a with an ultrasound probe on their belly.

SPEAKER_01 16:45

And we're trying to figure out, like, okay, so what is it that we read?

SPEAKER_00 16:48

What's going on? Yeah.

SPEAKER_01 16:50

That's exactly what's happening.

SPEAKER_00 16:51

And also, you think about sitting there, I'm not the first person you saw. You saw the ultrasonographer who was in the room before me, and maybe the person at the front desk who was there before me, and different interactions that you, as dad, have had with those individuals. Then sitting with the sonographer, you know, usually this is an hour-long ultrasound, right? You've sat there the whole time, maybe trying to make small talk or trying to do different something just to give your partner ease or you know, share a little bit of your grace. But actually at the end of the day, you've been thinking the whole time, like, what is this person doing? Right. And then they do the craziest thing of all. They finish. They get up and they walk out of the room and you're like, and they don't tell you anything. No, nothing, right? Like, oh, the doctor will be in soon. And then what? You know, in in my clinic, I'm sure my patients will laugh as they share this. Like, you know, because I am verbal and I listen, I take longer. And so my clinics, you know, they run a little behind that everybody will laugh at this. But I think, you know, to me, then you're sitting there waiting for me to come and tell you what's going on. Or here's my favorite thing, you know, you can go grab something to eat if you guys want. Oh, fantastic. Because what I'm really not right now is hungry. Like I just want somebody to come in and like talk to me about what's going on. So I think, you know, for the partner, there is a whole nother set of what's going through their mind in all of those just pieces that I just spoke about. And I think going back to what what the answer to your question is, people are not trained to think about that. Sure, you know, wisdom is experience and what you have learned and love over time. And my wisdom has trained my brain to recognize some of those things, but it's not something I was taught. It's not. And I am so fortunate. I was trained by some of the best people in the whole world doing fetal surgery, fetal therapy, psychosocial factors, perinatal psychology. I look toward these folks for everything. And a lot of it is really just something you experience, much like you as a dad sat in the rooms multiple times and experienced. And each time, right, as a dad, you came back with a different, oh my gosh, right? Like that little space in your heart, or or for me, it's in my heart and my belly, right? And you just have this feeling of, oh man, what are we gonna hear here? Right. And almost if you hear something good, it's like impossible.

SPEAKER_01 19:27

Oh, that's exactly what happened with the instance when we went to check and confirm that the pregnancy for my youngest son, for my last one, was actually a viable one because, and I've shared this on this platform before, my wife and I experienced two miscarriage losses prior to my firstborn and another two prior to the second one. So by the time we got to Eden and that pregnancy, like the pregnancy before, I was in the ultrasound room with my wife after she had gone to check the pregnancy at the time, just because I was like, hey, go check it out and see what happens. So she went by herself, she sent me a 12-second video of this little fish-like blob. And I was like, I told you, yo, we're pregnant again. And then the following week, I took time off of work so that we can go together and what have you. And in that ultrasound room, I once again heard, I'm sorry, there's no heartbeat.

SPEAKER_00 20:31

Yeah.

SPEAKER_01 20:32

So by the time we got to Eden, and my wife and I were like, you know what? We don't expect this to be viable, we don't expect this to go anywhere. And we walk in there. By then I was just like, you know what? If I hear those words again, it won't matter anymore because I've been here so many times. So the impact wouldn't be as hard as I've received it before. And then to our surprise, she was like, Nope, all good. Everything's fine. My wife and I were like, There is no way you're telling us the truth right now. I said, Doc, can you please number one check that there isn't another one? And number two, check that you're actually seeing the right thing. And she was like, I've been doing this for 20 years, man. I'm telling you guys are good. Go, uneventful, that's the goal. Till the day that I received my son and I held him physically in my hands, Nina. I did not believe that the pregnancy would have gone the entire way. And it's not until I held him that I I mean, I broke down and I was bawling in the OR for like the next hour as they were patching my wife up.

SPEAKER_00 21:45

Yeah, I mean, coping, attachment, trauma, you know, all these things, you know, flooded you at the same time because you had been kind of warding off or setting up your barriers to what you needed to do in order to. To support your wife, but also to support yourself, right? I think loss brings about a rewiring. And there's some literature about this rewiring in your brain so that you you protect yourself just like anybody would, right? But I think the other thing that I wonder is I hear I hear this not infrequently. You know, after a loss, you go to the next ultrasound, the next pregnancy, right? There's there's data on this, the the kind of emotional impact and the psych the psychological piece of the next pregnancy after a loss, right? There's even names for for that pregnancy or that that next child or or or experience. And I think that it would be interesting to know if that doctor, that day at at the ultrasound where the pregnancy was okay, said something a little different rather than nope, I've been doing this a really long time and it's all good, and y'all can get on out of here and have a great day. Go get a you know big ice cream sundae and celebrate great. If instead that provider had listened a little differently and said, Interesting that you're so worried about that. What brings that up in you? What brings what feelings are you bringing into the ultrasound today? Is the visit gonna be another 15 minutes longer? Yeah. But are you gonna potentially rewire something there that allows you to provide additional support in that pregnancy sooner than when you actually got to do it? Or is that gonna allow you a little bit of closure from some piece? And I'm not saying the whole loss because you're gonna feel it, you're gonna feel it forever. It's just you feel it in a different way over time, right? At least that's my experience with my losses. I think, you know, in time you listen differently. And when a dad or a partner says something like that to me in an ultrasound, I'm not the first one they see. So I'm already either set ahead because the provider did a great job in explaining like what the next steps are gonna be, or I'm a little behind because maybe they really didn't. And I think that I'm lucky to be in an area where the maternal fetal medicine doctors are so excellent with their communication, but not everybody's excellent with saying there's no heartbeat. That's not a good moment for anybody, and none of us want to say it, right? And and the last thing you need as a person sitting there waiting to hear is time and space without somebody in that room while you're thinking about all those things, as the pregnant person or as or as you.

Words That Shape Trust And Trauma

SPEAKER_01 24:47

Two things that I want to I want us to talk about in light of everything that you just said. The first thing is the the language of medical providers in that context and in that space, because I have a a story to share about two stories to share about that. And then number two is to the credit of that doctor who said, you know, nothing to see here. I've been doing this for for 20 years. If I could go back, walk into that building and give that doctor a hug, I absolutely would. Because I felt as though at some point she picked up on what my anxiety was. And then she did something about it. Sneaky. When she was doing it, I knew exactly what she was doing, and I appreciated the fact that she was doing it and she did it. She gave me homework, she gave me some sense of involvement in the process because my wife's iron levels were low. And so she was like, It is your job to make sure that she has good iron intake so that she don't keep getting poked and blood work and all of that jazz. Nina, listen, I was on my wife like a coach on a very lazy player on the team. Hey, let's go get the shake. Hey, did you take your pills? Hey, did you eat this thing? No, no, no, you can't eat that thing. You gotta eat this thing because the iron, and I was so involved, and that actually gave me a sense of distraction from all the other stuff that I had been carrying. Because she said, here is what you can do to feel like you are a part of this process. Saying that in itself is ironic to me because I've shared this with you also. My wife and I, we decided together once again, after so many losses, that we were going to try one more time. So I was already emotionally invested. We got physically together in order to conceive this baby. So this baby is a representation of a hundred percent of me giving over to a hundred percent of my wife and vice versa, so that we could make a hundred percent of a baby. Right? So somewhere along the process, though, I felt more detached from my wife, from my baby, because of the losses in between. But there is also something about having to go into those spaces and being made to feel like I was on the sideline initially, and not knowing that I could bring my concerns and bring up my questions and speak and use my own voice to find my or at least create a little space for me to be hey, I'm here too, dad is here. In fact, I'll be transparent with you. The reason why I said to my wife, every appointment that you go to, I must be there is twofold. One, she's a black woman, and there is no way in hell that I was gonna let her go into those spaces by herself just in case she needed advocacy in a way that I'm aware of that I could bring that advocacy to her. And number two, she's a black woman. I didn't want her going in there by herself so that they didn't think that, oh, here's another woman whose baby daddy don't want to be there with her. Right? So I had personal reasons, those strong reasons why I needed to be there, and I made myself to be there. And so I have that going on on the one hand, and on the other hand, it was just like, okay, so I'm here, but man, it doesn't feel like I'm here at all, or that the people don't care that I'm here.

SPEAKER_00 30:38

I don't. I'm a white doctor, and I think there's a limitation in that, no matter where I am and where I will be in my life. But I can hear you. And I think not only as a black man, but also as a dad, there's a piece of providers, regardless of your culture or race, that has to appreciate hearing that from a dad, in that you're thinking of that before you even come into the office and hear what you're gonna hear. And you feel that you need to be that advocate. I think hearing it really truly makes me want to let that dad advocate as much as they can. And so I think that where I bring that into visits or care, especially in the abnormal environment, is where do you think we're we're we're at today? Where are you at in the mind? What things have y'all been talking about at home that you really need to bring in today? You know, I remember one time a dad saying to me, Hey Dr. Paytas, I know we're talking about something going on in the brain, but I had this dream the other night and something was wrong with the hands. And I just don't, I can't get it out of my head. And so, you know what we did that that day? We took more pictures of the hands than the brain. And we took that minute or three minutes and we gave the dad those pictures to take home with him that day. He came back, I think, after the baby was born, and he actually framed one of those pictures of the hand for me. And and I have it still. And he said, like, this is your high five for like doing this for me and just allowing me to have a space where like somebody heard what I was saying. Everything else was happening to her, but that day something awesome happened for me and like I got a hand, and I was like, Oh my gosh, like there probably wasn't a piece of me that thought more about that that day or that week until until that picture came back to me. But it really made me think of how he was advocating for himself that day. And probably the rest of his time was spent asking different questions that they had talked about. But I think introducing that dialogue with another person in the room, shoot, even if it's the grandmother or the sister or somebody other than the dad, what have you all been talking about? You know, actually, a lot of people come into the office and they'll say something like, you know, my partner sent my sister today because he couldn't be here. And so she has a list on her phone of 16 questions that he wants her to ask, right? Acknowledging that statement and just turning to the sister and letting her be the advocate for the dad, that counts. And I think that, you know, time is a limitation, space is a limitation, but we can still incorporate those moments of advocacy for you, for a partner, for a loved one that that really actually truly mean a whole bunch to the coping of the pregnant person too. And that's what we all need to realize is that it's all connected, it's all linked. And some of it I won't understand. And some of it I'll screw up and I won't get as the professional provider in the room. But at least I'll open something up so that someone can come back in the next week and give me a hand with it.

SPEAKER_01 34:15

The other thing that I wanted to talk about is the language piece from the provider perspective.

SPEAKER_00 34:23

Yeah.

SPEAKER_01 34:24

So while I mentioned that this doctor was like, nope, nothing to see here. I've been doing this for 20 years. Again, I think she said that in a positive way.

SPEAKER_00 34:32

Yeah, totally. And how how much better could you feel? 20 plus years of experience? Heck yeah, this is amazing. That's what I want.

SPEAKER_01 34:39

And she was genuinely vested in seeing us because she knew how hard we had been trying for both of our kiddos. And there was a point where my wife got to, I think it was actually that pregnancy with my youngest son, where she had a full-blown panic attack in the office. And then as I'm trying to get my wife to help her cope through that panic attack, the doctor opens the door. She sees my wife having a panic attack. She starts having a panic attack. So now I'm caring for my wife and I'm chaplaining the doctor.

SPEAKER_00 35:17

Oh boy.

SPEAKER_01 35:22

Yeah. So she was very vested in that. Nevertheless, the language piece to me is also very important because the two stories that I wanted to share. One is that after one of the times we heard that there was no longer any heartbeat, my wife and I are leaving the ultrasound room. And someone from outside, I don't know if it was one of the tech, nurses, whomever it was, as we were walking, making our way to the exit, just casually said, Have a good day, guys. Congratulations. Without thinking about it. Now, there was no way for that young lady to know what was being discussed inside the room. There was no way for her to know that we had just gotten one of the worst possible news of our journeys, of our lives. Nevertheless, the space in itself didn't also help her consider the possibility, maybe, that not everything, not everyone who comes in here is gonna come out with something to be congratulated. The other story I want to share is that the first time or second time that the loss occurred, we were sitting in the presence of a medical professional, a doctor, who casually again said maybe you didn't say, but I'm gonna insert Don't be surprised if the first pregnancy doesn't stick. Just like that, Nina. And those words framed the rest of my experience. In fact, that was the first pregnancy. Don't be surprised if the first pregnancy doesn't stick. So by the time we got home and my wife was devastated, I didn't know why she was devastated. Because here is this person who I put my trust in, right? Because this is our first time. We have no idea what's going on or why nothing. There was no further information, there was nothing. It was just a meh. Don't be surprised if the first pregnancy doesn't stick. Pat on your back, going home, and I'm like, if the doctor said so, it's not a big deal. So in the background of all of this is this sort of exchange that occurs, right, between myself, someone in your position as a medical provider, there's a exchange, there's a currency of trust that happens here. And I put a lot of currency in your hands, and it feels like at least in that experience, and another experience that I could also talk about, but it feels like when that exchange happens, there are moments where the one holding the currency doesn't necessarily value or know to identify, to echo what you were saying earlier, that some really important exchange just happened here. And I have an obligation to be more thoughtful, careful, mindful about what I say, how I say it, how I frame things.

Clear Facts Plus Shared Control

SPEAKER_00 38:46

Yeah, you know, I think this podcast gave me an opportunity to give you a new nickname or deem you a new kind of guy. And I think, you know, we're gonna go with Iron Man, given your homework assignment and how well you did. But Iron Man has a currency of trust, right? He upholds a certain standard. And for every dad standing there or on the FaceTime or wherever they are, I think that there's a currency of trust, right? There's an obligation, there's an Iron Man behind every one of those doors. And with every piece of every story, mini story that you just told, there was a loss. There was a loss of a currency of trust. There was loss of hope. There was loss of clarity, there was loss of dynamic, right? There was so much loss in all of those pieces. And I think that, you know, I'm an educator. I teach next generation of doctors, fellows, residents. I think that we as professionals are very obligated to teach as much of what we know as what we don't know. I think that that's a really important piece to put into play with dads. You know, your podcast is the best example, but there's support groups for dads now. There's different kind of uh peer support options for dads specifically. There's supporting the support person. There, I was doing a bereavement course the other day, and there was a whole 45-minute session section on supporting the partners in a pregnancy where there's an abnormality, right? So I think that we're acknowledging the Iron Man more. We're acknowledging the kind of team dynamic, right? All of us healthcare professional, healthcare professionals, in the old school days, it was kind of like you had a shingle and like you did your thing and you were like the OB, you were the medicine person, you were the radiologist, you were all of the things. And now everybody's so subset trained and rooted in what we take care of that we kind of like forgot about this a little bit, but we've incorporated more of this team dynamic. And so, in a team dynamic, I think one of the most important things to do is educate your team. Educate your team. And part of educating your team is language that should never be used in an office, such as congratulations, see you next time. Because with that language, you pull a currency of trust away from the Iron Man and away from the pregnant person faster than they could have ever known. And so I think that the starting point is education and realization of your space, right? Education of your staff, not just the next generation of doctors. We got to do our people, we got to educate our teams. And then the next step is I think there's some pieces, and I'm sure you'll agree with me with even the experiences that we've had caring for families together. There's some pieces of just you can't say you can't say facts, right? Like it's like a non-negotiable.

SPEAKER_01 42:16

Yes.

SPEAKER_00 42:17

I have some non-negotiables that I think I I'll share with you. Like two of my top two non-negotiables when I'm talking to a family is there's something going on here, but and the baby, the baby may lit may survive, not survive. No. I don't I don't create ambiguity where ambiguity is not. There's a lot of ambiguity in my job. I live in a soup of ambiguity that I really dislike a lot of days. But I'm comfortable in my ambiguity space now. And I think one of the most important things I can say is I'm concerned your child will die. That's a scary statement, but it is a statement that needs to be said because parents in that state are already in an ambiguous, what the heck, what the heck? And in fact, they're hearing only so many things. And it may be that some folks don't like that I say that. That's okay. I'm not saying one for all. But I think that it's a really important piece to really create control and avoid ambiguity if you can. And I think you may have noticed that I didn't say your baby's going to die. No, your baby may die, right? Your son may die. If there's a lot going on inside of a little person that that concern is there for me, I'm not gonna shy away from it. I'm gonna tell you that's what I'm concerned about. This is big non negotiable for me. Yeah. And then really the other one is giving back control. Statements that give back. Control apply to everything we just talked about this whole hour. You know, if someone has given you the opportunity to be the Iron Man, you're gonna take it. If someone gives you the opportunity to see a hand when that's what you need to see, you're gonna take it. If someone gives you the opportunity to hold a hand of your partner, of your wife, of your support, of your team, you're gonna take it. And so I try to find, based on listening, what control I can give back in the conversation. I think it's really important to continue to think about how we're not the coolest people in the world. In fact, we're not cool at all. My son would tell you. But my job is actually recognizing and listening in a space that I am humbled to be there, and I can give back pieces of normal wherever I can to reincorporate that team's currency of trust.

SPEAKER_01 46:11

I brought up the perspective of the pregnant person in the room, how they experienced loss, the experience of the perspective of the dad or support person and how they experienced loss. And I purposely withheld from asking how do you, as the provider, experience loss until now? I don't think it would be fair to say that when you're in that space, you also don't lose something. So bring us into the your perspective as the expert, the medical provider, the one who receives that currency of trust and having to deliver the difficult news, the difficult diagnosis, whatever it is, the difficult thing. How does Nina process the loss? And what do you lose?

SPEAKER_00 47:06

I think that's a really scary question, right? Because we're not supposed to talk about that. Professionals, doctors specifically, right? And we've entered an age of comfort in therapy. Thank you, COVID. COVID did that maybe for us a little bit. We've entered a little bit of more of a realm of wellness and self-care. Woo, big word. I never knew about self-care before I started to think about this, you know. And I think that, you know, we're lucky for for that. I think that's an advantage. Residents and medical students and fellows are being taught about self-care. And so I think what you're asking is what's my self-care when my normal is different every day, right? And I think for a really long time, Kelly, I could never answer that question. But what I have found over time is that I have to let myself feel it. I thought for a good amount of time that I could just disassociate, maybe is a good word. Like I got home and I could drop everything and I would just be good to go. But teeny, tiny pieces of every family travel with me. And much like a loss that all of us have had at some point in our lives, we like we've lost some some something, right? You know, we've even lost a pen if you've never lost anything other than this. But I think what I've learned is to carry the loss of someone else, of somebody else's family. You have to find a titch of joy in it. And I know that sounds so silly, but that's what I do. I try to do it with every family that I see, because every family that I see has a loss. Whether it's a death or not, that's unknown. But there's some moment in every encounter that I have with a family. Maybe it's not on the first day, but maybe it's down the line or at a follow-up visit or at the delivery, or sometimes after a death, even like can you even imagine? There's a moment of joy, and that could be a moment of thankfulness, it could be a moment of thought, it could be a moment of peace, just a moment. It's not gonna last longer than that because it's scary in there. It's a scary space with a lot of uncertainty and a lot of unknown fear, anxiety, pain. And your doctors need to know that it's okay to feel that too. It's also okay that some of those experiences may not have any joy that you could find. And in that, you're gonna carry more of them home or over and over again as you come back to work. And if we don't realize that, and if we don't learn what to do with that, that's gonna create burnout. That's gonna create space where you're not able to enjoy your job. That's gonna create long periods where you're not gonna know if you're doing the right thing with your life or work and job dissatisfaction. And a really big thing that I think is important is hospital systems, right? Big hospital systems now have employee assistance programs and wellness teams. Again, COVID helped with some of this. But I think a lot of us don't utilize them. And I think in a fetal center, we have to be very specific about who is listening to this. Who is my peer support? Is it a family medicine doctor that I'm sure understands a lot about grief and bereavement, but actually has never seen neonatal loss in the delivery room that I just did? I think, you know, we need people that understand us, right? To get that peer support. I'm a big advocate of peer support. And actually, that's recent. In the past two, three years, I've learned more about it and been taught more about it. And I think that that is another piece, debriefing those different times that really actually I see stick with me, where I can't find that moment of joy. That's a clue to myself. Hey, Nina, this one's sticking with you a little bit more and you need a moment to regroup and to get some peer support. And, you know, I often find that in my team. And and I look forward one day, if I leave something in, you know, to my profession after I go. I think I would hope that it's kind of helping people recognize those moments in themselves and knowing that there's a support infrastructure in fetal centers or in pregnancy that not only supports the whole family, but also supports the staff.

SPEAKER_01 51:58

I I don't think I've shared this with you. In fact, I'm sure I've never shared this with you. I recall one of the times that we worked very closely together. And this was an unexpected bereavement. And coming out of the room, I saw how deeply impacted you were by that, as was everybody else around us, right? And I remember seeing you walk into an empty room. And so after I finished checking on a few people who were also very visibly impacted, I had made a mental note to send you a text message. And so I did. I sent you a text message, hey, I saw you in the room just checking in, you responded, and then I said, Would you prefer to be by yourself or are you okay if I come in and check on you? And you said, I welcome the company. So I walked in, we spoke for a while. Once you felt like you got to a place where you could step back outside, you did, and that was that. I didn't know the significance of that moment for me personally. Not just in terms of here I am supporting a colleague, here I am supporting someone who I admire, who I respect, who I care for. There was something extra that happened for me that it's not until this moment right now in this conversation that it's clicking. That moment has always stuck with me because I can now perceive that something about that moment began to heal something in me in my relation with my relationship to the moments in my own journey that I did not experience or witness that level of empathy from providers. There was a moment where my wife was going to get a DNC and the anesthesiologist walked in, gave his back to me the entire time, got up and walked away without acknowledging her pain, my pain, nothing. So that has stayed with me. That was actually what uh opened my eyes to the experience of fathers in these spaces that was deeply troubling and disturbing. That always is now a result of that experience in part. So that moment when we were in that room and just checking in on each other, me checking in on you, you feeling comfortable enough to shed actual human tears, like what in front of me gave me a portrait of uh medical providers within this niche that I had never experienced. And the value, the impact of that moment has now clicked for me in realizing how significant it was. So I wanted to share that with you in real time as it's happening in my mind to say thank you for that moment, and to also say thank you for giving me and us a slice of your time to have this rich and robust conversation.

SPEAKER_00 55:44

You know, I remember, I remember the exact day that you're talking about. And it it those moments where really it hits you like a brick. I think as time goes on, moments that you remember. You hold them very close in your heart and you take them to work and home with you every day, intentionally, because it's important. And I think that a lot of these pieces, especially the podcast and the different topics that you talk about, are part of having difficult discussions, having difficult conversations, right? We're not taught about it, but actually if you have small difficult conversations, even if I have that sometimes on a hard day with one of my friends, right? You avoid kind of getting to a point where you're at this like a moment of like, I can't get anywhere and I'm stuck and I'm like about to lose my mind. And I think that as a professional, as a person that does what I do every day, I would much rather do the incremental difficult conversations and take that and unpack it than get to that top of the mountain without any kind of acknowledgement of pain or suffering or any of those pieces, fear that that I've experienced. And I think as soon as I knew that that was okay, I started to recognize a lot more about myself as a doctor. And then I was able to acknowledge the support person even better, right? I would love to tell you that that, you know, my husband taught me everything about that. He didn't. He's a great man and he is my BFF. But at the end of the day, you know, we're an excellent team. And he taught me about teams. And the fact that I could that day be on a team where someone on my team could acknowledge that I was in pain, I hope that for every person, Kelly. I hope that for every single healthcare provider that you have some team, whether it's your partner, whether it's your colleagues, whether it's your friends, that you can unpack a difficult day on the day or around the day that that happens and not ever get to that mountain. Because for a professional provider, that mountain is not where we want to be. We want to kind of be, I tell my son, float the boat. We want to float the boat, right? And every day, you don't know. It's gonna potentially be a difficult day in sixth grade where he is, or at the hospital where I am, or wherever you are. And so I think that, you know, finding my moment of joy came from that discussion with you for five minutes or whatever it was that we stood in that room. Some of it silent and some of it not. And I think that that moment of joy was found in the team that I was on. And I think that that piece is something that then you can bring to the family, who's the biggest centerfold part of your team.

SPEAKER_01 58:50

Nina, thank you so much. Thank you for who you are. Thank you for bringing your full self, your wealth of experience and wisdom and dedication to the families, the people that you meet on a daily basis, the team that you've constructed and are working for. I hope they know how incredibly fortunate they are to have someone like you. And I hope, not even I hope, because I've seen it with my own eyes, I know families over time will always come to the realization that Dr. Paytas was on their side. So thank you so much, Nina.

SPEAKER_00 59:32

Thank you for so much, Kelly. It was a pleasure. Thanks again.

Closing And How To Stay Connected

SPEAKER_01 59:37

Thank you for listening today. If you want to stay in the loop of what's going on at Dad Always, go to datalways.com to join the email list to receive updates. This podcast episode is dedicated to the ones we hoped for but never met. And the ones whose time with us was all too brief.