Hey, doc. I spent most of my career as an OBGYN saying pregnancy is not a disability, and I truly believed that. But after having my second, I now know that it is a lot more nuanced than that. And for some people, it is a disability, like it was for me. And I wanted to talk about it because I think Not acknowledging that is holding us back because as women physicians who are trying to make a name for themselves, prove their worth, especially if you're in a surgical subspecialty or male-dominated specialty, you want to be seen as being able to do it all. You want to feel that way for yourself. You know? You're, you're a badass. You're a doctor. You made it through all sorts of things, and lots of people do all sorts of things when they're pregnant, so you can do it too. And all of that is true, but sometimes that shit is disabling, and I think it is important to remind ourselves about that and to acknowledge that no, you may not be able to work up until the baby falls out of your vagina or exits your stomach. That may not be the path, and that doesn't mean that you are less than. It doesn't mean that you're not a team player. It does not mean that somehow you are deficient. It just means that you're pregnant. And I think it is important to highlight the difference between first baby and second. So I'm not saying if it's your first baby, everything is gonna be cool, but, you know, chances are first babies are less complicated than second bab-babies. You're younger, you may be healthier, whatever the case may be. That's certainly how mine was. It was quite easy. I still stopped working at 36 weeks. Thank you very much to California for having that precedent set and paid family leave starting four weeks before. yeah, just a quick segue. This whole idea that, yeah, I'm just gonna work up until the baby comes, it's just like, but why? Like, I know for the most part it is leave-dependent and therefore pay-dependent. You know, you want to save up all of your leave and unpaid time for afterwards. It just sucks that we have to make that choice because even though you can do it, just why? Like, it should just be a choice to say, "Yeah, I just wanna continue working," not a decision that's just accepted because you're not gonna have time or you're not gonna have your paycheck if you don't. Anyway The second baby, and this is something I used to tell my patients all the time, it's like everything feels different. And like everything else, it's not a guarantee. You could have a beautiful second pregnancy, and third, and fourth, and fifth. But physiologically, you do not have the same body that birthed that first baby. Everything is all stretched out, all the ligaments, all of everything from the last baby. Whether you had a vaginal delivery or not, everything is stretched out. You don't have the same type of support, so things hurt more. You may have more SI joint dysfunction. You may have more pain from whatever the thing may be. So thinking that, "Oh, yeah, well, first, first pregnancy, I was able to do it, and I'll just do the same thing," you may have a rude awakening, and that I, I had that as well. Luckily, I was already doing locums and could control my schedule. But yeah, at 30 weeks, I was out, six weeks earlier than I stopped the first time, and it was because of the pain and because I was driving six hours one way. But recognizing these things and acknowledging that this is a normal part of what it means to give birth is really important because if we don't talk about this, people are gonna continue to push themselves. They are going to continue to endanger themselves, working extremely hard past when it is comfortable, safe, et cetera. And I get just wanting to not be a burden. I get thinking that, you know, well, I was able to do it before. I get Serena Williams, won Wimbledon pregnant, and people run marathons and all this stuff pregnant. I should be able to do it too. I get all that. But that is unrealistic. It is not your journey, and that's their business, right? Even the last pregnancy, that was a past you's business. This is now. So if you are pregnant, if you are planning to have a second or third or fourth baby, don't just assume that everything is going to feel the same and that you're going to have the same capacity, and plan just in case. Second babies are rough, man. Second babies are rough, and pregnancy is rough. Pregnancy can be disabling. So the flat generalization that pregnancy is not a disability is incorrect. It is way more nuanced than that, and I apologize to all of the women that I did harm to by saying that when they came to me in pain. You know, you, you learn so much when shit happens to you. Because when these women would say, you know, "I can't walk," I am ashamed, deeply ashamed to say, a woman told me that once, and I still remember which room I was in in that job that I was in. She's like, "I can't walk." And I was like, "Yeah, but you walked in here, It's just like, first of all, that's rude as fuck. But I didn't believe her, but then it happened to me, and I was like, "Oh, I cannot walk." You know? It's like every step is extremely excruciating. So I mean, I could push through. I can step and feel like I'm gonna fall, endangering myself and my baby. But really, I, I can't. I can't. And probably as punishment for all the years that I did this practicing, the pain was worse after I had the baby. So not only could I not walk, I couldn't sit, I couldn't stand, I couldn't lay down for any length of time because everything hurt. So Yeah, it is sometimes a disability. Sometimes people like my wedding planner that, was able to plan my wedding, have her baby, and then continue planning my wedding, and that was her second baby, by the way. Some people can do it. Some people cannot. Some people are truly disabled by this natural, beautiful thing called pregnancy, and we need to recognize that for ourselves because of whatever inner beliefs we have about what we should be able to do while we're pregnant. And then very importantly, we need to acknowledge it for our colleagues and for the people that are below us, because eventually, or if not already, we'll be in leadership, we'll be making the rules. And if subconsciously or just overtly, we all believe, well, pregnancy is not a dis- disability, that's gonna affect our colleagues. So even if you're not a obstetrician and you never treat a pregnant woman, you never see her for a visit, this is important for you. Like it's going to affect the pregnant person who is your partner, the pregnant person who is the member of your department when you're in leadership. We need to make adjustments for it, and not in a way where they have to pay for it. That's... It, it's crazy to me that we continue to exist in this system where we get penalized for one of the most natural things that happens to half the population, and that is essential for the population to survive. We act like it, it is this thing that we choose to do on this side that gets in the way of your career, and it's your problem because you chose to get pregnant. Peeps, if nobody has any babies, the society has a problem. And this is not fiction. This is not an idea. We see many countries around the world where low birth rates equal problem for the economy and all sorts of things. So do I support These people in power right now who are trying to forcibly have women have lots and lots of babies so they have factory workers for their capitalist society, of course not. But having a baby, being pregnant, is not this personal f or a career derailment because you chose to do it we need to change these beliefs and ideas that we have, and even if we don't think we have, the minute somebody gets pregnant in your department and you're like, "Ugh, now I have to take more call," that's it. That's the problem right there. That's why I have to record this episode to remind people that sometimes you can be disabled by pregnancy, and you need to just worry about yourself and take care of yourself and not worry that you're gonna be affecting the entire department and people are gonna be mad. it's all related. If the person that I'm recording this episode for felt like it was this true honor For her to have a baby, and everybody understood that this was an important thing that she was doing, and it's just a part of life, and we've made provisions for it in the schedule with pay. It was worked into everything because once we know we hire reproductive-age women, this is what will happen. Like, if she knew all of that, there's no way she would still be working because she's in pain, and the amount that she works increases her pain. Her center of gravity is so far off with the type of work that she does, she could trip and fall. It is actually physically affecting her work. She would have stopped doing certain things a long time ago, put in to stop working completely at a certain point. this wouldn't be a question. So for the individual, for you, doc, if you're planning to have any more babies, or if you never had a baby and you're listening, good for you. Good job. Just know pregnancy may be wonderful. You may be running marathons and planning weddings and doing brain surgery and all sorts of things for the entire pregnancy up until the baby exits your body. Or you could be severely disabled and not even with a major complication of pregnancy, just with normal pregnancy. It could be painful, and it doesn't mean that you're less of a doctor. It doesn't mean that you don't deserve time off. It doesn't mean that you need to bend over backwards to make sure your colleagues have all of your calls covered, and you have to make up call, and your RVU should be calculated using time you were off. It doesn't mean any of that shit. All of those things are symptoms of the deep institutional problem of not only medicine, but Western society in general. Well, let's just say the US. So I hope that we can give each other some grace when pregnancy is at play. I hope we can give ourselves some grace and continue to put ourselves first in this very particular way, which may mean stopping work early, giving other people in our department more work, and letting ourselves down. Because that's another thing, right? When you thought you would be able to do certain things and then your body says otherwise, it's like a letdown for yourself. And that's almost worse because you feel bad enough letting down everybody else But again, if our minds were different, if our beliefs about pregnancy and working as a physician mom were different, maybe we wouldn't, we wouldn't feel as bad, So I hope this was helpful for you if you are currently pregnant and concerned about all of these things or thinking about having another baby. Doc, I've told you many times, worry about yourself. Worry about yourself and your baby. Everybody else will figure it out. They don't have a choice. And you putting yourself and your baby in danger, and I am not being hyperbolic and dramatic with that. Don't you forget, I am an OBGYN with over a decade of experience. I have seen what physical and mental stress can do to a pregnancy, preterm labor and all, all sorts of things. Even simple trips and falls and remainder of pregnancy in hospital because of chronic ab So when you look back and it's like, well, was it worth it? Was it worth it pushing myself this hard just to prove something, just to make up for somebody else's lack of planning because they knew about this pregnancy however long ago? Was it worth it? And most of the times the answer is no. All right, doc, so send this episode to a physician mom or an expecting physician mom who needs to hear this message. And for other physicians in general to start having some hard conversations about our beliefs and accommodations that we make for each other and for pregnant partners and, what, what kind of culture we are continuing to cultivate in medicine All right, doc. I will see you on the next episode of Stethoscopes and Strollers