TRANSCRIPT EPISODE 6 – All About Pregnancy & Birth With Dr. Nicole C. Rankins

Transcript episode #6: 
high risk pregnancy with
dr. keisha reddick

Transcript

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00:02                                In this episode of the podcast, we're talking about high risk pregnancies and there's some great information here, whether you have a high risk pregnancy or not.

00:17                                Nicole: Welcome to the All About Pregnancy and Birth podcast. I'm Dr Nicole Calloway Rankins, a board certified Ob Gyn physician and certified integrative health coach. Every week, I break down topics, share birth stories, and interview experts to help you have your best pregnancy and birth. Quick note, information is for educational purposes only and is not a substitute for medical advice. See the full disclaimer at www.ncrcoaching.com/disclaimer.

00:46                                Nicole: Hey, hey. Hey. Welcome to another episode of the All About Pregnancy and Birth podcast. Today is the first episode where I am interviewing an expert guest and we have quite the expert guest for you today. Today I'm interviewing Dr. Keisha Reddick. Keisha is a board certified maternal fetal medicine doctor and also a dear friend. I mentioned her in the last episode. She was with me during the birth of my first child. And Keisha is the youngest of three children. She was born and raised in Columbus, Georgia. She graduated from Spellman College as today. She also went to Morehouse School of Medicine. She did her residency training and fellowship training at Duke University Medical Center. That's where we met and she's currently an assistant professor in Ob Gyn at Memorial University, Mercer University School of Medicine, the Savannah campus. There she serves on hospital committees and she's also active on community service boards within the Savannah area. She has three children and she's married to Dr. Bonzo Reddick, who's the associate dean at Mercer University School of Medicine Savannah campus.

01:50                                Nicole: Now this episode is a little longer than previous episodes, but I promise you it is worth your time. We cover a ton of great information from what is considered high risk, to genetic testing, to what you could do to decrease your chances of having a high risk pregnancy to how Keisha takes a holistic, individualized approach to caring for her high risk patients. So you're going to learn a lot whether you have a high risk pregnancy or not.

02:22                                Nicole: Now, before I get into the episode I want to remind you about the discount I'm offering on The Birth Preparation Course. I've been doing this to celebrate how well things have been going with the All About Pregnancy and Birth podcast, so until Friday, February 8th, you can get 20% off The Birth Preparation Course. I only discount the course three or four times a year, so this will not happen again soon. And there's a 30 day money back guarantee, so if you're not happy with it, you can get a full refund within 30 days. It is very easy for me to say how great The Birth Preparation Course is because I am super proud of it, but I want to share with you what a student who is in the course recently said after she finished going through the course with her husband.

03:07                                Nicole: She said the class was very thorough in its content. It was easy to follow along, well versed in its research and packed with insight and helpful tips. We feel better prepared for the birth of our first child. As a result, we would highly recommend this course to first time parents. So this could be you, head to www.ncrcoaching.com/enroll to join today and use the code celebrate to get 20% off. That information will be in the show notes.

03:38                                Nicole: Okay. Without further ado, let's get to the interview with Dr. Keisha Reddick. So Hey Keisha, thank you so much for agreeing to be on the podcast.

03:50                                Keisha: Well thank you for having me. I'm excited.

03:52                                Nicole: Yeah. Good. So the purpose of today's episode is to help bring some understanding to what is involved when a woman has what is considered a high risk pregnancy. So I thought we would start off by having you just tell us a little bit about yourself and your work and even your family if you feel comfortable doing that.

04:13                                Keisha: Sure. I am a maternal fetal medicine specialists. Some people also call us a high risk doctor or even a perinatologist. I trained at Duke with you for residency. I stayed there for maternal fetal medicine fellowship and then I went into practice for four years and now I'm in Savannah, Georgia practicing. I am married for almost 16 years and I am the mother of three children. I say I'm in the tpt group. I have a toddler, preteen and teen that's new. I have not heard of that. I have a teen this year, I have a preteen and I have a toddler, so I'm in that over 40 crew that has toddler, so shout out to all those women with the toddlers over 40.

04:57                                Nicole: So why don't you go into a little more detail about the training that you went through in order to become a maternal fetal medicine doctor or MFM doctor. And I'm going to use the term MFM just because it's easier to say.

05:12                                Keisha: For maternal fetal medicine doctors, the three years of training, we do specialized training with looking at ultrasound. So that's a good portion of my practice is doing consults and that includes those ultrasounds on babies for anatomy, we include genetic testing. In addition to that we learned to take care of women who are extremely high risk. So some of those are women who may have significant medical complications or some that are pretty routine complications such as high blood pressure. We also take care of critical care patients. So over the three years of your fellowship, the majority of it is spent doing clinical work. So you're learning how to read ultrasounds, you're learning how to do prenatal diagnosis, you're understanding genetics, you're understanding how to take care of high risk women in the hospital, how to do specialized deliveries, how to coordinate care with other specialists within the hospital.

06:07                                Keisha: The other part of that is doing research. Anytime you're doing a fellowship, you also need to incorporate research. So for about 18 months of your fellowship, at least when I was doing it, you devoted that time to doing research and that is original research that you're coming up with on your own. After you do all of that, you do take a board exam and you have to defend some of your research that you've done. Once that's all completed after the three years when you do your board exam, then you are a board certified maternal fetal medicine doctor.

06:34                                Nicole: Okay. So that is quite a bit of training folks that maternal fetal medicine doctors have to go through in order to take care of women who have high risk pregnancies, so they're very highly trained, highly specialized in what they do. So what are the top three reasons that women may be referred to see you? And you can talk about more if you'd like, but what are the top three things that you see?

06:59                                Keisha: I would say number one is if there is a concern on the ultrasound. So if there's an ultrasound finding that your Ob Gyn sees, they're concerned about the baby's kidneys, they're concerned about the baby's heart, they'll send you to us because we do a more detailed ultrasound. Most maternal fetal medicine practices are accredited for their ultrasound as well.

07:22                                Nicole: What does it mean to be accredited?

07:24                                Keisha: You have additional specialized training, specialized oversight in the things that you're looking for on ultrasounds then. So I was like, that's probably the number one reason why, one of the top ones as far as reasons why patients get referred to our practice.

07:40                                Nicole: Now do women need to like, should all women have this more detailed kind of ultrasound, or is what they get with their regular Ob Gyn sufficient?

07:50                                Keisha: Here's the thing, the actual risks for having a birth defect in any pregnancy is less than three percent. So there's a small percentage of patients that are actually going to have a birth defect. So you can start off with your, you know, as a low risk patient with your Ob Gyn. Now the second thing, why people get referred to us is maternal complications. So we get referrals for patients who have high blood pressure or have diabetes or maybe they have a history of a heart defect themselves or seizure disorder. Some of those conditions that moms have can actually increase the risk for the baby to have problems as well. So for example, women who have diabetes, some of those women are at a higher risk for having babies with a spinal defect or even with a heart defect.

08:37                                Keisha: So those patients should have a more specialized ultrasound. The other reason why patients get sent to us is for genetic testing. I think, you know, sometimes patients look at our practices, we're here to tell you something terrible about your baby or we're here tell you to not continue your pregnancy. I would say it is very far from that. A great portion of our practice is prenatal diagnosis and I often tell patients, you know, I feel like that's one of the things that I was led to do is to help you be prepared for your baby. I'm not here to tell you what to do with your pregnancy, but rather to hold your hand through whatever we're going through with this pregnancy. A lot of times patients get nervous about doing genetic testing because they think they're going to get information they don't want to know or they don't know what to do with the information though. Or often the patients will say, well, you know, I'm going to love my baby anyway, so it doesn't matter. And I'll say to them, well it does because you know why? We want to make sure we have everything lined up for you and your baby at the time of delivery. We want to make sure we're setting your kid up for the best chances of success and survival. So when I tell patients thatand I said, listen, this is what I feel like I'm led to do, is to help you be prepared for your child. I think that you know the different misconceptions about what we do leave the room and patients will say, you know what? You're right. Let's do everything we can to get all the information we can to be prepared.

10:03                                Nicole: So by the time patients see you, just to kind of take a step back about the genetic testing, is it usually that there has been something abnormal that's been seen on ultrasound and then they're referring a patient to you to do genetic testing to see if that will give them any additional information about what's going on? Or are you just seeing like routine low risk women for genetic testing?

10:28                                Keisha: The majority of our patients are advanced maternal age, which is defined as someone who is 35 or older at the time of delivering. So the majority of them are just coming in for that initial screening. I would say there's the other part of that population is also yes, the people who have had some type of abnormal testing or if they've had some concern on their ultrasound, that's the other group of folks who are coming to see us for prenatal diagnosis.

10:58                                Nicole: Okay. And we could probably talk about genetic testing on a whole other episode

11:02                                Keisha: Oh yeah, we could spend all day on that one.

11:05                                Nicole: So just to recap, top three reasons usually are to do a more detailed ultrasound because of there's a suspicion that something may be going on or mom has a condition that puts her at higher risk, like high blood pressure or diabetes or for genetic testing and to talk through the options and what it means for that individual woman to get a genetic test.

11:26                                Keisha: Right.

11:27                                Nicole: Yeah. Okay. Okay. So now she's referred to you. What can woman expect when she sees an MFM doctor?

11:34                                Keisha: Well, if they are advanced maternal age, which is probably a good portion of the patients, oftentimes those patients will see a genetic counselor. I think that they are an integral part of our practice. They've done specialized training in genetics, these are people who have an advanced degree in genetics. So they'll sit down and talk with the genetic counselor about their family history. A lot of times patients don't think about certain things from their family history and we have to trigger them and say, Hey, is there anything? Is there anybody that was born with certain problems? Is there anybody that's had to have surgery early in life? Because some things run in families and that may mean we need to do some additional testing. So those patients in general meet with a genetic counselor. They get a full detailed history and we also go over genetic testing options at that time.

12:23                                Keisha: Generally, after they meet with a genetic counselor, then they will have a detailed ultrasound by one of our sonographers. And in an MFM practice our sonographers have a little extra training because of the detailed scans that we do. And then after they meet with a sonographer and they have their ultrasound then they meet with a physician and that's at the tail end of the visit where I pretty much go over everything that's been done. Most times I will go back and do an ultrasound on the patient and just look over the baby as well and go over the patient's historyto get a full, you know, plan of care for the patient that I tell the patient and that I also send back to their doctor.

13:01                                Nicole: Okay. So they can expect that it's not just like come in and sit down and have a discussion. Usually they're going to get an ultrasound before they see you and they may have met with a genetic counselor. So it's a pretty extensive process.

13:16                                Keisha: It is, yeah.

13:18                                Nicole: Yeah. You know while I'm thinking about it, about genetic testing. I don't want to scare anybody. What percentage of women do you see have abnormal genetic testing results?

13:25                                Keisha: Oh, that is not a majority. I mean, I would say less than five percent of the time, you know, because if you think about it, you know the ones who're going to have the highest risk are those who are older because of our ovaries and our eggs are older. So those are gonna have a higher risk, but the majority of our patients were calling back normal results.

13:48                                Nicole: So see that's it. I just want everybody to kind of get that in your mind. You know, we're kind of preparing for the possibilities of things. That's why we're having this discussion, but most likely things will be normal. But it's still good for you to have an idea just in case because every pregnancy is different and the process can be a little bit unpredictable. Okay. So what questions should a woman ask when they see an MFM doctor? And the reason I say that is because you know, I know you and your practice style and you're a great communicator, but we have to be honest not all doctors necessarily do a great job of communicating. And I've certainly seen on my side where women come back from seeing the high risk doctor and they haven't, it's like they didn't understand half of what was going on. And that process can be stressful for a woman to get sent to an MFM doctor. So what are some questions that she could ask when she's in front of you to help make sure she has a good understanding about what's going on with her pregnancy?

14:48                                Keisha: I think the first thing is, you know, because we do talk a lot about genetics in our offices, really asking questions about, you know, the details about the test. Sometimes, you know, I think patients get the misconception that we can see everything on ultrasound and we can't, you can't. Ultrasound diagnosis is not 100 percent. Or that we can test for everything and we can't. We can get pretty close to getting some information, but we're never going to be able to, you know, say, oh gosh, we see everything on the baby. We can never give that complete confidence and say that all the time.

15:26                                Nicole: That's a really good point. I mean we've come a long way in technology but there is a lot that we cannot say with certainty about pregnancy.

15:34                                Keisha: Right! And there's things we see that we're not sure if it has clinical significance because technology has gotten so much better. There's things we are seeing now that we didn't see before. So I think the first thing that I would ask is, you know, getting specifics in terms of numbers. And I talk a lot in numbers with patients because I think that paints a bigger picture. So if I say, you know, you had a genetic test and it showed that your risk for having down syndrome is low. I could say that, but I'll say, you know what, it shows that in like 10,000 people, only one person will be affected. That's a very, very low risk. So I think patients need to be clear about, well, what are the specific chances of what? Based off of your ultrasound, Dr. Reddick, and based off of the testing, what kind of risk factors do I have at this point?

16:20                                Keisha: I think for moms who have medical complications, you know, I think that they need to be detailed about the specifics about their medical complication in respect to pregnancy. Will this cause me to have an earlier baby? Will I be able to get to full term? Should I have kids again? Is it risky for me to have any future pregnancies? I think those are all valid things for patients to ask. And I guess I'll say, you know, you mentioned that sometimes when patients leave a high risk or they don't recall a lot, and that's, I think often happens, especially when we have a patient that may have a more complicated ultrasound finding where even I feel like, wow, I just hit this patient with a ton of bricks. I wonder if they processed some of this. So a lot of times what we will do, and I will say our genetic counselors do a great job with this is calling patients back and checking in with them and saying, hey, you know, I know there was a lot that we discussed the other day. We just want to check in with you and see if you have any questions now that you've had some time to think about everything or would you like to come back sooner than your next appointment that we can sit down and talk about it all over again?

17:27                                Nicole: Well, that's really good to hear because for sure you may get hit with just even if it's just something that's not that complicated a lot of information at once. So the opportunity to go back even sooner than you anticipated and kind of refresh things is really, really, really important.

17:42                                Keisha: I mean it, it's overwhelming. It's overwhelming. I mean, you know, you come in getting an ultrasound, thinking you know, I'm just getting this ultrasound and then you walk out with devastating news or for some patients who have certain medical complications is managed differently during pregnancy. For example, diabetes. And so, you know, if you found out you have diabetes in pregnancy, sometimes that's devastating for women and because you know, hey, they're pregnant and they want to be able to enjoy their pregnancy, they want to be able to eat what they want to eat, they want to go to their shower and eat cake and now we're saying, no, you can't do any of these things. And so what I've found to do is, you know, one call to patients and just checking in with them and I just, I mean, it's a simple phone call and saying, you know, we talked about a lot, let's just kind of rehash it or let me just make sure you're okay. Or, yeah, I want to make sure you understood everything I said. Those are just simple things to help our patients out.

18:33                                Nicole: Yeah, for sure. For sure. Now, if a woman sees an MFM doctor during her pregnancy, does that mean that the MFM doctor is going to be the one who delivers her baby?

18:44                                Keisha: Not necessarily. Most of our practice is what we call co-management. So I will see you as the high risk doctor, but you will still maintain your prenatal visits and your delivery with your Ob Gyn. An example would be if someone has high blood pressure, I will maybe manage your blood pressure. I will keep an eye on your baby and do your ultrasound. But your doctor will ultimately deliver you. There are a few circumstances where we take over the care, or where the doctor will refer you or transfer your care to us. And those will be, you know, let's say that we're anticipating a preterm delivery and the hospital you deliver at, it doesn't have pediatricians to take care of babies that young. So in that case that patient will become our patient. Or if it is a baby that has certain complications or birth defects that need to have surgical repair after delivery or need to have a neonatologist involved. Those patients will become our patient. But for the majority of the patients we like for you to stay with your doctor, your doctor wants to stay with you, you want to stay with your doctor. So we respect that and there's only a few, a smaller population of women that we need to take over their care.

19:55                                Nicole: Okay. So that's good to know. Women should, will be able to stay with their own doctor the vast majority of time. And it's like you said, a co-management situation.

20:04                                Keisha: Right.

20:05                                Nicole: Now. The next question, and this one is kind of a pet peeve of mine. I'll let you respond to that. I may add my two cents afterwards, but are all high risk pregnancies the same? We use that term pretty much for anybody who sees an MFM doctor but are all high risk pregnancies the same?

20:20                                Keisha: No and it's just like I said at the beginning, I consider there's high risk and then there's high risk. So I have like the smaller high risk bubble in my head which is, you know, maybe the patient who is 36 years old, she doesn't have any medical complications, you know, she's fine. She doesn't have any significant history of surgical issues. You know, those patients are probably going to have an uneventful pregnancy. But then we have those who are in a different category of high risk where it's concerning for them to even have any future pregnancies. So, you know, if I have a patient that has a very complicated cardiac history, you know, that is a totally different patient, that's a totally different management during their whole pregnancy. So I think that, you know, a lot of times when patients come in and they're like, oh my gosh, I'm going to see the high risk doctor. I'm like, yeah, but you're only high risk because of your age and you're otherwise a healthy person. So I don't really consider you super high risk. But certainly there are people who meet that category and oftentimes those are people who need to see an MFM for the rest of their pregnancy. And for any future pregnancy should they decide to have babies in the future.

21:26                                Nicole: Okay. Yeah. So that's one thing. I mean you touched on both of the things that I see. I see a woman who may be considered high risk because she has like say diabetes during pregnancy. That's very well controlled. She's doing fine with just diet changes, but she's kind of like adopted this, I'm high risk and high risk and high risk, and I want to say like, just step back from that like, yes, you have a little bit. I don't want you to get wrapped up in that term because most likely you are going to be fine. And, but then on the other night, I mean like, like very, very fine, normal, uncomplicated delivery. And then on the other side you have some women who don't necessarily appreciate that they are really high risk. And you, you know, you're, you're trying to impress that you had diabetes before you were pregnant and high blood pressure before you were pregnant and you are very overweight. These things can really increase your risk. So, what are ways or strategies that you try to help women understand their individual risk?

22:35                                Keisha: I think you just said it right there. You have to take them as the individual. What I've learned, you know, in practicing is one of the things that I try to do is I just try to figure out the patient who's in front of me. I try not to generalize all of them together. You know, I try to think about how can I make a difference for this person sitting in front of me, how can I, you know, make sure that they are comfortable with me and understand everything that's going on. And a lot of that is being patient with them, you know, and sometimes it means you're spending a lot more time. And I give the example of the patients with diabetes because again, I think that is extremely overwhelming. I mean, you're okay now you got to stick yourself four times a day and check your blood sugar and oh, by the way, you can't have this. So a lot of times I'll say, you know, tell me what your day is, tell me what your start of the day is. Tell me. I want to know what your life is like and let's see how we can implement things a little bit of things at a time as opposed to overwhelming you with all of this at once.

23:38                                Keisha: And so I think that tends to work better than me just trying to beat down on a patient, you need to do this, you need to do that, you know, that doesn't work, you know, they're not my children. And so I have to kind of see things from their, you know, viewpoint and that way that I can have a little bit better understanding of how I should approach them and how I can make them more comfortable and clearly understanding what's going on. I usually, like I said, I just really am a lot more patient with them now, and, and try to really think about their day to day life and how I can help them have control over their current situation.

24:16                                Nicole: So it's obviously important to you to connect with each woman as an individual and really to try to provide her the best information and optimism or realistic picture of what's going on. You're not grouping women all together. You're really taken an individualized approach, which is key.

24:40                                Keisha: Right. Right. Otherwise, you'll start to generalize and stereotype all of them and you can't. I mean, that's, that's wrong. That's not good care, you know, or you'll get frustrated, you know, some people get frustrated with patients. Oh my gosh, why didn't you do this? Well, let's step back for a second. Okay, let's think about what her life is like right now. You know, I want you to imagine what her day to day life is. Because we, in our practice, we, we teach residents. So, you know, a lot of my teaching is, you know, very much clinical work and academic work, but some of it is also me teaching you how to be a good doctor, how to be a good emotional doctor. And looking at the patient, not just from what you see on a piece of paper, but rather their entire life, you know, hey, she has, she's working two jobs. Let's see if we need to write a note for her job to tell her she needs to take breaks. Let's figure out what we can do to implement, you know, she's in school right now. Does she have to do this at this time? You know, really trying to figure out helping the patient figure it out because they can't. Sometimes they can't. It's too much. It's too much for them to handle.

25:40                                Nicole: Right, right. That warms my heart to hear that you are teaching other doctors to be that way because that's a critical skill that we all need as physicians for sure. What does being high risk in one pregnancy mean for being high risk in a future pregnancy?

25:57                                Keisha: I think, you know, what made your high risk, you know, if it is, you know, starting off with a baby, a baby that had a birth defect, if it is something that's genetic that may make you somewhat high risk the next time because you may have a risk for that occurring again, which is why we like to get some genetic testing on patients because we like to be able to have a conversation about what's the chances of this happening again. If it's certain medical complications, you know, things like high blood pressure or diabetes as we get older, those risks increase. Okay, so you know, for patients who are otherwise well controlled, that's great, but as our bodies get older, as women get older, their risk can increase. So you may not be as high, may not be severely high risk, I guess, if that's a word, but there's gonna be some aspects of your pregnancy that might be a little bit different. So you know, if a patient has seen a high risk doctor before in the past, you know, oftentimes they'll see us for a consult again, which I think is completely reasonable. You know, like if a patient's had a prior preterm birth, they don't necessarily need to have me as their doctor, but we need to have a discussion about things we need to monitor in this current pregnancy to make sure you don't have another preterm birth or if we can decrease those risks for you having a preterm birth.

27:16                                Nicole: So again, the individualized approach, it's very possible that you, depending on what it is, you may not necessarily be high risk in the future again, or you may be or there may be some in between where you just have a conversation about things. So again, that goes back to that individualized approach, but it doesn't necessarily mean that once high risk, always high risk.

27:41                                Keisha: No, no, but I think it really does depend on what has happened in the prior pregnancy, you know, and often times again, the majority of them are patients who we will see for a consult and we'll give recommendations and they don't necessarily have to come back.

27:55                                Nicole: Okay. Okay, good. Now what are things that women can do to decrease their chances of having a high risk pregnancy?

28:05                                Keisha: Well, I will say before you're even getting pregnant, you know, being healthy going into pregnancy is key. So crucial and some things we can't fix or change. So, you know, for people who have things like high blood pressure, optimize blood pressures beforehand, is key, or patients who have diabetes optimizing your blood sugars before getting pregnant is key. So I think, you know, if you're having certain medical complications going into the pregnancy, making sure before you conceive, that you are in a healthier state is, is important. Um, I'm a big proponent of working out so, you know, when I have patients who come in and like, I want to start working out Dr. and I'm like, well, you can't start crossfit now at 16 weeks pregnant.

28:50                                Nicole: Like I'm with you. We can work out, but we can't do crossfit.

28:55                                Keisha: But I think if patients, you know, implement something, you know, if it just starts with just walking, you know, if you're just not even tell patients you know, it's hot, it's hot in Georgia, it's real hot in the summertime, go to the mall, just go to the mall and walk up and down the hall.

29:10                                Keisha: Just once, that's all you have to do. Just something simplistic. Something that you can put into your day to day life. Like eating healthy, you know. I think we're all a victim of running around being busy, you know, kids or no kids, work, you know we don't get the best things in our bodies. So I think trying to implement that. In terms of things with genetics, there's nothing you can do about that. You know, you just, we are who we are, you know, when things form they form, there's nothing we could do about that part. Making sure women who are anticipating pregnancy are taking prenatal vitamins or vitamin that has some type of folate supplement which most standard vitamins do. So I think that's key because you know, there's a risk for spinal defects with low folic acid. And aside from that really is optimizing your health if you can before you're pregnant.

30:04                                Nicole: Yeah, just doing the best you can. And I have to say I know that we, this is an ongoing discussion. We in Ob Gyn do not necessarily do the best job that we can have taking care of women in between pregnancies. You know, we kind of do a six week checkup and then, you know, bye. See you later until next year. So we have some work to do on our side about supporting women so that they can take care of themselves better. But it, I can't like overstate how important, what Dr. Reddick is saying, what Keisha is saying is that we just got to take care of ourselves in general and that taking care of yourself between pregnancies before you get pregnant is so crucial because a lot of things happen in the very beginning of pregnancy.

30:55                                Keisha: There's a lot of, you know, the baby, all of the organs develop in the first trimester. Really after 13, 14 weeks, you're just talking about a baby that's just growing, just getting bigger. Lungs are developing. But all of those major organs have developed in that first trimester. So, you know, for women who, you know, have certain medical complications it's imperative that those medical complications are optimized. Diabetes is a critical one. It's imperative that your sugars are under good control before you even are pregnant. Plus it also helps the overall outcome of your pregnancy, not just your baby being developed, you know? Okay. But also, did you do well during your entire pregnancy?

31:39                                Nicole: And so the first step to healthy pregnancy is a healthy mom. And we're not just talking about physical health, but also your emotional and mental health as well.

31:51                                Keisha: Right. I would, you know, say that I think a lot of people don't realize how stress does a number on your body. And so, you know, some of my job is me tackling that for patients. You know, if I have a patient that has a very challenging social life, you know, if I have a patient and I walk in the room and I see they've been crying, you know, I'm not going to sit there and start saying, Hey, let me see your blood sugar log. I'm gonna say, well, what's going on? What's happening in your life? You know, is there something that I can help you with? Is there something that I can try to help fix or find a solution for. Because that, you know, people know that stress causes heart attacks. What do you think it does to your blood pressure and everything when you're pregnant? You know, I just don't think that it's good to have those, that type of energy if you can avoid it. So if you know things that help you, you know, prior to pregnancy, whether it's meditation, whether it is taking a run, whether it's taking a long walk, you know what, whatever it is, you need to continue those things while you're pregnant because pregnancy can be stressful. And so I think starting that off with the pregnancy, you know, you can be in a good state. That's always key.

33:07                                Nicole: Absolutely, for sure. Taking a holistic approach to your health is really, really, really important. So now the next set of questions are to help listeners get a sense for who you are and not necessarily just as a doctor but who you are as a person. So what is the most rewarding part of your work?

33:31                                Keisha: You know, I love it when I can see a patient through a very difficult pregnancy and they come back and we can get them further than where they are before. There is a patient who I've been seeing recently. I took her her and delivered her baby a year ago and she was sick, very sick during her pregnancy and had to get delivered and she was getting very ill and her baby's doing fine. It's literally, her baby is a miracle. It really is. And I've seen her again and it just warms my heart to have thought about things and have some insight about things to help prevent in the future. So I, I get very, I mean, that's very rewarding. Or if I see a patient and, you know, I love a good vaginal deliery. Yeah, I do. I do. I mean, I know I do, you know, a good portion of c-sections just because of the nature of what I do, but I always say I love a good vaginal delivery.

34:31                                Keisha: So there was one I had a couple of years ago ndt this patient had a VBAC and I think she had had two c sections and I mean, you know, we were tossing and turning her all over the bed. We had the birthing ball. I mean, we were doing everything and this kid ended up being really big and she says to this day, she said, I saw your eyebrows raise when the baby came out. But she had a great delivery. It was amazing. And so before I walk out of the room, because I was coming off a call and my partner was taking over the next day, I said, I'll see you back in two years. And sure enough, two years later she had another baby. She had another successful VBAC.

35:10                                Keisha: It was great. It was so wonderful. She had such a beautiful delivery. I mean, I don't know. I feel like when I do a c section, I'm fine doing them. And I talked to patients about the whole time I play music if they want to, if not, they listen to Beyonce because that's my favorite.

35:25                                Nicole: Let me tell you what, I'm going to just throw this. Dr. Reddick is like, top of the beat the beat. Wait, what am I saying it right? The Bay they have. Okay. She is like at the top.

35:40                                Keisha: So then I'll tell you know, ask patients, is there music you want to listen to you or you know, can we drop the drape, you know, I'll tell dads, come on, I want you to get your camera ready, like, I really try to make it as inclusive as they want me to be. You know, I have some patients who like don't say nothing the whole time they're like I don't want to see anything you're doing. But a vaginal delivery. I don't know. I like, you know, I like to be there holding the patient's hand and helping them and you know, oftentimes I'll tell moms, I'll say, listen, you're so much stronger than you imagine. And you know, a lot of times when moms are in it, they're in the thick of it and they're like closing their eyes. I'm like, no, open your eyes. You're about to see this miracle right now. Like, this is your one time seeing it. So yeah, I really do love it.

36:24                                Nicole: Yeah, yeah, yeah. Now on the flip side, is there anything that's frustrating? What's the most frustrating part of your work?

36:32                                Keisha: I think one of them would be the misconception about what we do as maternal fetal medicine doctors. I think patients or sometimes society thinks that we're here to tell you to not continue your pregnancy. And so sometimes patients come in thinking that that's what they're going to hear from me and that's not what you're here for, that's not what I'm here to do. That's not what my job is. What can be saddening is when you know, I have to tell someone some bad news about their baby. You know, when someone comes in, because we also just do, we do ultrasounds for doctors who have patients who are low risk and you know, here this couple was coming in here for their ultrasound and they're excited and they can't wait to see the gender. And here I am throwing them a ton of bricks and that really, it sucks. It is really. This is terrible.

37:26                                Nicole: And it never, it never gets easy.

37:28                                Keisha: No, it never gets easy.

37:30                                Nicole: Yeah. I know. Sometimes society gives this impression that doctors are like, you know, we're uptight or you know, with our white coats on or whatever, but I can tell you the good ones and most, we get personally involved and you can't help it. It's just kind of the nature of the work and it, it never gets easy in this field to have to deliver bad news. On a higher a higher note. What are you especially passionate about when it comes to pregnant women?

38:05                                Keisha: Well, as of late, I've been really trying to hone in on disparities with women are black women in particular. A couple years ago I did a talk on maternal mortality rates and it was rather astonishing, astonishing to me because I had just moved to Georgia and Georgia has the highest rates in the entire United States. And I was just baffled by that and...

38:40                                Nicole: And to be clear that that's women dying during your, or after pregnancy.

38:48                                Keisha: And so, you know, I was shocked. I couldn't understand like, how is this happening, you know? Yeah. And there's been programs that are being implemented to, to change these outcomes, but, you know, I thought, okay, it's not just because somebody black or you know, that they are a woman of color. There's something more to this, there's something more to why these women are getting sicker. And I'll use myself as an example. I had my last pregnancy when I was 37 and a half years old and so I was advanced maternal age. My other two pregnancies were otherwise on complicated. Got Pregnant. First one was a vaginal delivery. The second one was a c section because I stopped dilating and my baby was like nearly two pounds bigger. But we have tried to labor and anyways, I had a c section with that one.

39:42                                Keisha: So this one I thought whatever. We're having another kid and actually got very sick during my pregnancy. I had developed preeclampsia and the severe form of it. And my baby was extremely small because the preeclampsia had affected my placenta. Now I had worked out during my pregnancy, I actually ran a 5k during pregnancy. I was working during the pregnancy, but what was the difference in this whole thing? I was a bit older and it was scary for me to know that I started off this pregnancy healthier than I have any other ones physically healthy, I'll put it like that. And yet somehow or another I got very sick and delivered a two pound baby, 10 weeks early. And so in my mind I'm like, there is something else there, there is something going on with maternal mortality it's not just delays in care that may be part of it or you know, near misses, but there's something that's happening to women of color that's causing them to be at a higher risk as they get older and start having children.

40:46                                Nicole: And how to, how to improve that. I mean, there's so much that goes into it, like you said, access to care, there's stress. There's implicit bias or racism in our healthcare system. Again, a whole another podcast episode. Right, right, right. Now you talked about, you just mentioned your personal experiences with pregnancy and childbirth, including having a preemie baby 10 weeks early who was in the NICU. That is something that we, I don't want to say unfortunately shared, but how has that experience, because I know that experience certainly influences me. How has that experience influenced you in your work?

41:29                                Keisha: Oh, it totally. It changed a lot of things. You know, I don't think as a maternal fetal medicine doctor, you know, I had a grasp on some stuff with the NICU, but never to this point. until I had Giuliana. It's changed a lot of things. I think, you know, I tell people I have my rounds with residents throughout the week and when they have their didactics, which is where they do their educational section and they have lectures. I'll do what my, what I call my personal rounds. And those are the rounds where I sit down a lot longer with patients and talk to them a little bit about my own experience of having a baby in the NICU, which has to be at the top two most difficult things that I have ever gone through. You can't explain.

42:23                                Nicole: Ladies, we're not trying to like bring you down or anything like that because we have come through the other side of it and we have beautiful children as a result, but there is, it's very difficult to explain how challenging, how hard it is when you have a baby in this situation.

42:42                                Keisha: And the crazy thing with my situation was I was on call. I was the on call doctor when I got sick. And I was, I'm about to go into the hospital and it just so happened my Ob Gyn, she was a general Ob Gyn. She, you know, just happened to be at the hospital on call and I called her and I told her what was going on and so I came in and I was terrified. I mean, that's another thing, I don't, I realized I knew too much and I realized how my patients felt like when you're sitting in the hospital waiting for something to happen. You know, it's just like you're waiting for the foot to drop. When is it going to happen? Is gonna happen today? Is going to happen tomorrow? Like your mind just can't rest. And so, you know, when I got to the point of delivery and I have this, I mean two pounds of small.

43:32                                Keisha: I don't know if people realize, I mean it's, a two pound human is really tiny. But to see your own child, that's two pounds. I was like, oh my gosh, this is my kid? You know, this has been, did thisreally just happen? But I think one of the things that I've been able to do is really kind of bond with my patients a bit differently than I had in the past. And even my residents say, wow, you counsel about this so great. You talk about this so differently than your partners do. Not in a bad way, but since I've had the experience of it, I mean, I breastfed all my kids and for moms who have babies in the NICU, breast milk is critical and, you know, that was the one thing I can control. So I was just breastfeeding like all the time.

44:16                                Keisha: I don't even know how I did it. I don't know when I slept, but I breastfed all the time and so, I'm able to really explain to patients my own experience of what I did and I'll have patients who call me back now and say, you know, I remember you told me about these emotions you had. And I sometimes get jealous of other women who are still pregnant or I sometimes miss having a baby shower. And I'm like, I know, I know you do. I know I can relate to you. It's the things that you wish you had. And so I think, I'll tell you, I'll be honest, when I was going through it and I heard people saying you will be a better doctor. And I remember thinking I'm not a bad doctor now, I'm a great doctor! But it has allowed me to have conversations with patients and give them hope. And, and, and also be just very honest, you know, I'll say, listen, it's not going to be an easy road. I'm just being honest with you. You can call me personally at my office and I'll talk to you. I'll meet you at the hospital if you want me to.

45:24                                Nicole: I cried every single day.

45:29                                Keisha: Because it's hard to see the end in sight and, and, and you just never know. You never know how you're gonna do it. They're so tiny. They're so helpless and it's unnatural, you know, you're leaving a baby at the hospital, while you go home and for us we had two other children who were in school. So, you know, I think the nice thing that has come out of that, one of the blessings that's come out of it, is me being able to communicate with my patients and talk with them and they can see Keisha Reddick, right? They don't just see Dr. Reddick, they see Keisha Reddick, who has had a preemie baby, that one who's had preeclampsia early, you know, the one who's, you know, I tell them like, hey, I was scared. I mean for real. I was.

46:14                                Nicole: Yeah. I don't want to remember some of those texts and being on the receiving end and how um, that was a stressful time for you.

46:28                                Keisha: So I think it's been good for me to help my patients out who are going through a similar situation.

46:38                                Nicole: Just to end, what is one piece of advice, the one most important piece of advice that you would give to expectant moms?

46:46                                Keisha: You know, I think number one would be I want you to enjoy your pregnancy. Despite the discomfort, despite your fears, I want you to try to enjoy your pregnancy. This is the closest you and that baby will be.

47:04                                Nicole: I've never thought about that.

47:05                                Keisha: This is the closest you'll ever be. This is it. And so you know, when I've had patients who've had complications or losses from before, it breaks my heart because they are on eggshells during their pregnancy. They're scared and I'll tell them, I'm like, okay, here's your homework. You're 28 weeks now. I want you to go and buy something for this baby. Just one item. Just go buy it. I want you to have some faith. Just go buy something and have faith that it's going to be okay. I want you to try to just take one step at a time. Enjoy your pregnancy. This is the closest you and your baby will ever be.

47:45                                Nicole: I like that. I like that a lot. Well, thank you again for being here. This was great and I know it will be super helpful information to the women listening. So where can people find you if they're interested in seeing you as a provider or I don't know if you do any social media or anything like that?

48:04                                Keisha: I don't. But I am located in Savannah, Georgia. I'm a physician here at Memorial Hospital. So anyone in the Savannah area who has any concerns about high risk complications, or if they want preconceptual counseling, we also do that. People who may have a history of certain medical issues or family history, we talk to patients and give them information, things to get prepared for, for a future pregnancy.

48:35                                Nicole: Okay. Perfect. Well that's it. Thank you again and I will talk to you later. Wasn't that great. Tons of useful information there. Now, when I have a guest on the show, whether it's an expert guest or someone sharing their birth story, I like to give something that I call Nicole's notes and it's just my top three or four takeaways from the show.

49:02                                Nicole: So my first takeaway from today's show is you will most likely have a normal pregnancy. The risk of you having any issues is low. Number two, a maternal fetal medicine doctor is there to help you get the best outcome during a pregnancy that has some concerns. They're not there to scare you. They're not there to make you feel bad. They are there to help you have the best possible outcome for you and your baby during your pregnancy. Number three, if you have to go to a maternal fetal medicine doctor, you deserve an MFM who treats you with respect, who treats you with kindness, who appreciates you as an individual and not a condition, and also takes a holistic approach to your care. So do not be afraid to switch if you're not happy with the MFM doctor that you have. And then the last thing is, remember to take care of yourself. That is so important for having good outcomes for your pregnancy. Take care of yourself both during your pregnancy and in between pregnancies to have healthy pregnancies and a healthy life.

50:18                                Nicole: So what did you take away from the episode? Let me know on Instagram. I'm on instagram at Dr. Nicole Rankins. You can comment on the post for this episode or send me a DM. Now, be sure to subscribe to the podcast in iTunes or wherever you listen to podcasts and if you feel so inclined, I'd really appreciate you leaving an honest review on iTunes. It helps other women find the show and don't forget about the discount or The Birth Preparation Course. For a limited time, you can get 20 percent off the regular price of the course. I don't discount the course often, so don't miss out. There's a 30 day money back guarantee, so if you're not happy, you can get a full refund within 30 days. Go to www.ncrcoaching.com/enroll and use the code CELEBRATE to claim your discount. All right. I will see you next week. And until then, I wish you a healthy and happy pregnancy and birth.

51:13                                Today's episode is brought to you by Women's Wellness Coaching by Dr. Nicole Calloway Rankins. Head to www.ncrcoaching.com to check out my free one hour mini course on how to make your birth plan as well as my comprehensive online childbirth education class, The Birth Preparation Course with over eight hours of content, and the private course community. The Birth Preparation Course will leave you knowledgeable, prepared, confident, and empowered going into your birth. Head to www.ncrcoaching.com to learn more.

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