Balancing Work with a Complicated Pregnancy
Episode 460 | Host: Emilie Aries | Guest: Dr. Nathan Fox
How do you manage a complex pregnancy while continuing to manage your career?
Pregnancy is complex, and people who experienced complications in the past often anxiously wonder just how similar their next pregnancy journey might be. When these stressors are piled on top of our day-to-day work challenges and the possibility of an unsupportive workplace, things get even more complicated.
This is a topic near to my heart, as I am currently 23 weeks into pregnancy myself, after dealing with recurrent miscarriage last year, and pondering many of these very concepts.
This was the perfect time, then, to talk with Dr. Nathan Fox about the premise of his new book, which he co-authored with Brown University economist Emily Oster, to learn how to manage pregnancy expectations and assertively communicate - with both physicians and superiors in the workplace during this time.
Nathan co-authored The Unexpected: Navigating Pregnancy During and After Complications, with Emily Oster, the author of the 2014 sensation Expecting Better and a previous guest on this very podcast. Nathan is an obstetrician/gynecologist who specializes in maternal-fetal medicine. In addition to his practice in New York City, he’s the host of the Healthful Woman Podcast, which delivers highly informative, engaging women’s health and wellness content.
Pregnancy care from a joint decision-making perspective
Joint or shared decision-making is the predominant philosophy in The Unexpected, and Nathan explains the premise behind this important but sometimes problematic concept. Back in the day, the doctor–patient relationship was a highly paternalistic one. The patient went to the doctor to ask a question or share a symptom, and the doctor told that person what to do.
Not surprisingly, people began to push back against this doctor-knows-best approach, arguing for bodily autonomy and more of a say in their medical care. While a pivot to patient-centered medical practice prompted more thoughtful and individualized care, it also caused a lot of frustration on both sides. Doctors were frustrated when their expertise was questioned or overlooked by patients who wanted a say in their treatment, and patients were frustrated that doctors either continued to be too paternalistic or ceased to offer a clear direction at all.
Nathan acknowledges that finding a middle ground is essential and difficult. Asking the patient what they want to do about their issue bypasses the expertise the patient came for in the first place. If, however, a doctor presents some options and the objective pros and cons of each, they can provide their expected expertise, and the patient can provide their own: a singular, in-depth knowledge of their own body. Only they know their risk tolerance, values, and past experiences, all of which will inform the eventual treatment decision.
Navigating pregnancy disclosures at work
Centering your expertise on the topic of your own body is important in the workplace, too. Though The Unexpected focuses on navigating pregnancy after past difficulties regardless of employment or career type, I wanted to get Nathan’s perspective on another often-arduous navigation: communicating pregnancy needs in the workplace. In addition to being the topic of a former episode—How To Talk About Marital Status, Parental Status, and Pregnancy in the Interview—this has been on my mind lately since my previous pregnancy experiences all took place while I was exclusively self-employed (which is no longer the case!). Bing a worker with a boss can significantly change, and challenge, the situation.
Though recent improvements such as the Pregnant Workers Fairness Act highlight how the landscape is continuing to improve, misconceptions and complexities are still common.
Nathan acknowledges that while standard large companies with robust HR tend to have clear-cut regulations that make the process, if not easy, then at least transparent, pregnant workers at smaller companies can face a lot of uncertainty.
Informing a superior of a chronic illness diagnosis, for instance, might be met with sympathy and encouragement to seek all necessary medical treatment. Reactions to pregnancy announcements, though, are often focused on congratulatory remarks, and comparisons made only through their own personal (even if limited) experience with pregnancy themselves. Many superiors assume the pregnant person’s only needs will be a missed hour once a month for appointments and parental leave after baby’s arrival, and sharing other modifications you may need can be stressful.
At the end of the day, it’s important to remember that you can’t legally be fired for getting pregnant, and you may have the right to reasonable accommodations, too. Listen to my recent episode with Sarah Brafman all about the new Pregnant Worker’s Fairness Act to learn more.
Risk of recurrence: experience and expectation
Our ability to focus on work alongside pregnancy isn’t helped by ruminating on whether or how the pregnancy issues we faced last time are going to resurface this time around. Countless concerns can make a person nervous about their subsequent pregnancy or hesitant to take the leap once more. Understanding which complications are likely to happen again and which tend to be one-offs goes a long way to easing our minds and rebalancing our focus on all aspects of our lives while we’re pregnant.
The Unexpected does a fantastic job of laying out the risks of recurrence of various pregnancy issues, and this was particularly helpful to me as someone navigating a second pregnancy after past complications.
As Nathan puts it, it’s important to know what to expect because, regardless of whether the outcome is positive or negative, matching experience to expectation is usually far preferable in the end than being caught completely off guard.
How does my conversation with Nathan resonate with you? I’d love to hear your thoughts and experiences on this complex topic and welcome you to share and engage on our Courage Community on Facebook or our group on LinkedIn.
Related Links from today’s episode:
Episode 438, The Impact of Stress Reduction on Infertility
Episode 414, New Rights for Pregnant Workers
Episode 346, How to Advocate for a Better Work-Life Balance as a Working Parent
Episode 311, How To Talk About Marital Status, Parental Status, And Pregnancy In The Interview
Discover more about Nathan’s Podcast
Learn more about Nathan’s practice
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[INTRO MUSIC IN]
EMILIE: Hey, and welcome to the Bossed Up podcast, episode 460. I'm your host, Emilie Aries, the founder and CEO of Bossed Up. And when I saw that Emily Oster was out with a brand new book as a former guest on this very podcast,
[INTRO MUSIC ENDS]
back when I was doing my motherhood and work series leading up to my son Max's birth, back in 2021, I immediately reached out to her and said, we've got to get you back on the podcast. This is such an interesting take for a second book, a sequel, really, to her first hit, Expecting Better. And she very kindly deferred and said, no, I'm too busy. To which I replied, well, how about your co-author? Because unlike her previous books, Emilie Oster, the economist, co-authored this book with a maternal fetal medicine specialist, Dr. Nathan Fox, who brought a very interesting lens to the medical risk calculations involved with being someone who is navigating a complicated pregnancy.
And just about a year ago, I had just done an episode with Sarah Brafman, a policymaker on the new Pregnant Workers Fairness Act, new workplace rights for pregnant workers, that I thought this episode absolutely needed to happen because my first entire series on motherhood at work was shared and recorded from the very naive but adorable position of being someone who was going through a very simple pregnancy.
As many of you know, I've been very candid with you, as listeners over the past year, I've been navigating recurrent miscarriages that I've talked about and kind of processed in a variety of ways on this very podcast. One episode that comes to mind in particular was with Dr. Alice Domar, whose research studied the impact of stress reduction on infertility. And so I feel like this is a journey we've been on together. And I have some exciting and good news that we'll get into in this interview, because things here are looking up, which is my way of saying this book on navigating pregnancy during or after complications is particularly relevant for me right now.
And joining me to break that topic down is the expert, the co-author, the maternal fetal medicine specialist himself, who already partnered with one amazing Emily on this amazing book with Emily Oster.
And now he's here with me, another Emilie, to talk through how to navigate pregnancy complications and advocate for yourself both when it comes to your medical team and in navigating this in your workplace. Dr. Nathan Fox is an obstetrician and maternal fetal medicine specialist practicing in New York City. He's also the host of the Healthful Woman podcast and recently co authored a book with Emily Oster called The Unexpected: Navigating Pregnancy During and After Complications. I am so excited to have you on, Dr. Nathan Fox, welcome to the Bossed Up podcast.
DR. FOX: Thank you for having me. It's a pleasure to be here. Nice to meet you.
EMILIE: I'm so delighted to be chatting with you on so many fronts. I'm holding in my hands right now The Unexpected: Navigating Pregnancy During and After Complications. Congratulations again on this feet. I'm now currently navigating a pregnancy that has not been so simple.
This is news to my listeners, too, but I am 23 weeks pregnant, as of this week, week and last year, I was really candid with folks on this podcast about losing two babies, right? Two miscarriages in the first trimester, possibly three, actually, now that I, like, go back and collect all the data. And so it's like a personal and professional interest of me to have you, a maternal fetal medicine specialist, a podcaster, and now a co-author on this podcast to really talk about what I know so many women listening have navigated or are navigating or might navigate.
So my first question for you is, just, like, what inspired this book that even in the opening pages you write? I hope no one has to read. So why write this book?
DR. FOX: Yeah. First of all, uh, that is the big reveal about your pregnancy. You look terrific. I hope you're feeling well.
EMILIE: Thank you. I'm feeling great.
DR. FOX: Good. My career is not writing books, right? I'm a doctor. I see patients. That's what I do. And I started the podcast, right, a few years ago, which is mostly just sort of for sport. Like, it was something I thought was cool. Like, I started listening to podcasts, and I'm like, you know, there aren't, I don't think there's any really good podcasts for pregnancy and women's health because, you know, either they're sort of run by laypeople, which is, which is great. So they're more, like, interesting and they're talented, but they're not really deep. They're not really, like, the information one needs, or they're run by doctors, which are horrifically boring. So I felt there was space to do that.
So I had this podcast, and it's going well, and who am I gonna have as my first guest on the podcast? And I had, over the years, developed a close relationship with Emily Oster, mostly just because I read her first book, and I loved it. This is really cool. Like, she's an economist, and she wrote this book on pregnancy, and, like, that's so strange. But she did such a great job, and the book is amazing, and the one I recommend to patients, I literally, I cold called her.
I just reached out to her and said, hey, I'm a doctor in New York, and I like your book, and, you know, thanks for doing it, and if you're ever in New York, let's have lunch. And so she answered, and she's, you know, she's really delightful. And we met, and then we started collaborating. And so I called her. I said, hey, would you come onto my podcast? And again, she graciously said yes. And we've been sort of collaborating for a few years, sort of, you know, um, like unofficially collaborating.
You know, she would email me when she got questions from listeners that need help with, and I would sort of, you know, have her on my podcast. And then she said, you know, I'm thinking of writing, I guess, a sequel to, you know, expecting better related, complicated, uh, pregnancies. And she said, you know, this isn't really my wheelhouse. I need to partner with an OB or an MFM, would you do it? And I'm the kind of guy who just says yes. I'm like, yeah, great, like, let's do it, you know? And again listen, I just, that's just sort of how I live my life. I, you know, I think adventures are great, and I think trying to do things is great, and occasionally you fall on your face, but, you know, it's what life is about, you know, carpe diem, you know, I'm a big, like, just seize the day, do what you can.
So I said, let's do it. And we spent about a year back and forth writing and collaborating, and, you know, which is amazing. It was a great process, and I'm really proud of what we, you know, what we turned out. It's really, I think, a very, if I say so myself, it's a good book, but I think it's really meant to be very, helpful to a lot of people. And, yes, you would hope that no one, you know, needs to read this book because it's about what to do in a pregnancy after your first one went awry in some way or another.
But that's naive because so many people have complications in pregnancy, ranging from, you know, what someone might call small, which doesn't. What does that mean? A small complication to something like life altering, devastating, and everything in between. And what do you do the next time around and how do you literally, how do you navigate that? And so I think this hopefully will be very helpful to a lot of people, which is really the. That's the part that's meaningful to me.
EMILIE: Yeah, absolutely. I just love the idea. It almost sounds like the setup of a joke that, like an Economist and an MFM walk into a bar, and you're like, that is the bar I'd like to hang out in, because I, for full disclosure, love Emily Oster. Because I studied at Brown University as an undergrad, I studied Political Science. We never overlapped there.
But when I found out that this economist was becoming quite, quite notorious for her work in prenatal care, I was like, yes, that is the decision making power I really think that I crave as a pregnant person, as a woman, that I think so many people listening want to have as well. Which is one of the things I loved most about this approach that you've taken in the book is, how can we partner with our experts, our medical care team, who know a lot more about medical risk and, you know, choice in that regard, without losing our sense of agency over our own bodies and our own choices, right?
DR. FOX: 100%.
EMILIE: And so I was really fascinated by your philosophy around joint decision making. And we could get into a million different examples, because your book goes, like, chapter by chapter on many very different kinds of complications. But overall, tell me about that philosophy of, how someone who is navigating a complex pregnancy or even thinking about giving it another shot after the first one or last few, did not go well. Like, how do you partner with a care team without saying, I'm gonna make all the decisions or succumbing to 100% of them making all the decisions.
DR. FOX: Right. So there's a lot to unpack there. The first is, I don't know which one of us is going to comment on the fact that the person from Colorado said, joint in decision making. That's fine. Okay. [LAUGHTER] You know? Haha. All right.
No, so seriously, though, I think that there is this concept in medicine now either called joint decision making or shared decision making. And the idea is that historically in medicine, doctors were very. It, uh, was a paternalistic field, meaning someone would come to a doctor, like, I'm a patient. I'm in trouble. I have a question. You're the expert. You tell me what to do. And that was sort of the relationship. The doctor is, you know, is the expert, and, you know, the high and mighty, and we would. Not necessarily a bad way, but, like, all right, here's what you should do. And people just say, like, all right, like, that's what I'm gonna do.
And then there was this pushback against that, appropriately, that, you know, it's not all about someone telling you what to do, but helping you make a choice what to do. Cause sometimes, you know, like, if you're having a heart attack, we don't say, like, hey, would you like CPR? That's not the situation. But, you know, it's, there's a lot of things in medicine that are not clear cut, they're not cut and dry, that there's options or there's risks and benefits each way. And the idea was to shift it from a paternalistic view to some people called patient centered. Some people used autonomy, like the idea that the patient, the person who's sitting there as agency over their own body and own decisions, and they're going to make decisions. Great. That's an amazing concept.
And so medical training and medical sort of philosophy changed, or we're going to try to shift it, that we are there to guide and to help and make recommendations, but ultimately, the patient chooses. Now, it's a delightful concept, but the problem is it frequently breaks down, and it breaks down on both ends, meaning frequently, the doctor might feel like, what is going on here? Like, why does this person think that they know better than I do? I went to medical school. I trained as my expertise. And you hear things like, would you tell your plumber how to do things? Would you tell your electrician?
And so there's frustration sometimes on the doctor side, the provider side of this relationship isn't working because this person is telling me how to do my job. And on the other side, the patients sometimes get very frustrated because either they feel the doctor is still being too paternalistic, or they feel, why is a doctor asking me what I want to do? I don't know what to do. I'm here to ask you what to do. And so it often breaks down into frustration.
And I think the reason is, and this is the long answer to your question, I think the reason is, the approach to shared decision making is not that everybody comes in as equal partners, and you whiteboard it and make a decision. The doctor, it doesn't have to be a doctor. It could be, obviously, a nurse, a nurse practitioner, whoever, the provider. The doctor comes to the table with certain expertise and experience about medicine, and then the patient, the person on the other end of the table, comes with certain expertise about themselves. What are their values? What are their fears? What is it they're looking for? What are their goals? What are their experiences?
EMILIE: And also like, risk tolerance. Right?
DR. FOX: Everything. All this stuff so, and I tell people this all the time. I said, you know yourself better than I know you. And so we need to sort out what to do. Like, are you the type of person who would rather, you know, try something more experimental, knowing that there might be some risk? Or are you the type of person who is a little bit more conservative and would rather just do tried and true, even if it may not necessarily work? And these are things that, again, that's how shared decision making is supposed to work. Or I say, listen, there's two options. There's A, there's B. I think they're both reasonable. Here's the upside to A, the upside to B. The downside to A, the downside to B. What do you feel about that?
Like, going back to the plumber example, if my plumber said to me, what kind of pipes would you like me to use for your toilet? I'd be like, I don't know. Like, I don't, what are the options? I have no idea what you're talking about. But if he or she said to me, all right, listen, we can use this kind of pipe, which is going to last longer, but it's twice as expensive, whereas this one, which is going to save you some money, but you may have to replace them in five years.
All right, I can make a decision. Do I have cash upfront? Do I want to wait for, am I moving in three years? And I'll leave it for the next person. I know that about me. And so that's shared decision making, and we're trying to bring that to medicine and also giving the patients the background knowledge to have that conversation without feeling left out, not understanding what's happening.
EMILIE: Absolutely. And it feels to me like society writ large gives pregnant people a lot of unsolicited advice. That's very black and white, right?...
DR. FOX: Oh, yes.
EMILIE: …it's like, you shouldn't do this. You have to stop doing that. You have to do this, and you have to do that. And it's just what I loved about Expecting Better was Emily's approach to looking at the data. Like, how confident are we in any of this advice?
And unfortunately, it's not perfect. Oftentimes, we don't have huge data sets, and some things, like complex pregnancies are really hard to study. You can't do a double blind study on some of these things. And so kind of knowing that you have a care team who you respect, but also who you feel respected by in helping you to make those decisions for yourself is, is so key. And also kind of hard to figure out.
So what advice would you have for folks who are wondering, like, how do I go about preparing? In the book, you say preparing myself, preparing my materials, and preparing my script to figure out, do I have that care team?
DR. FOX: Yeah, that's a golden question. And I think that. I mean, I'm a doctor. My father's a doctor. My brother's a doctor. My wife's father was a doctor. Like, I'm around doctors all the time, and when I go to a doctor, I have that same question. How do you know if this person is any good or if they're right for me, it is very, very hard to know this.
So, like, for everyone out here who's like, god, I have no idea. You are like everybody else. This. It's very hard to know, because what could you possibly glean? Like, all right, you're going to know if their office is clean. You're going to know if the person who greets you on the phone at the front desk smiles at you. You're going to know if they run on time. You can take a glance at the diplomas on the wall. Like, ooh, you know, she went to Brown, she's smart. Like, you know, you can get a little bit of that. You can get a little bit of that. But ultimately, it's nice to have all those things, but it's not what you care about. You want to know is, is this person going to take care of me? Is this person going to help me?
And I think some of it depends on the context of what you're looking for. So, for example, if I have something in my body that needs to be surgically removed, right? You don't need a long term relationship with that person. You're like, I want to find the person who has the best hands, who is the best surgeon, who's gonna open me up, take this out, and close me up in the fastest way possible. That won't kill me, right? And I'll recover quickly.
And whether that person is kind to me and listens to me, it's nice, but ultimately, you'd much rather have a very, very competent surgeon who's a jerk than a really, really lousy surgeon who's delightful, right? Because your goal is not to have this person care for you for 50 years. It's literally, like, one and done. Take out my appendix, and I'll never see you again the rest of my life.
And so in a situation like that, you're like, okay, what do I need to look for? I want to look for experience. I want to look for training. I want to look for, if there are new ways to do the procedure that are less invasive, are they skilled in that? Are they not skilled in that? You know, things like that? Much more so than, oh this doctor wasn't nice to me, or their office was annoying because you'll never need to see their office again.
On the other side, if you just got diagnosed with diabetes and you're 22 years old, this person's going to be in your life until one of you drops dead. Right? I mean, you're talking for 50 years, right? You're talking about. And so that person probably, you're going to have to say, all right, listen, I assume that this person went to medical school. They're probably bright, right? And, you know, diabetes is not such an uncommon diagnosis. They probably know something about, about diabetes. What do I care about? This person needs to be a good listener. They need to be available. They need to be someone I get an appointment with. They need to be someone who I can talk to, who I trust, who I think values what's going on in my life. And that's much more important than the degree on the wall. And so I think a lot of it is people. It's different based on what your goal is going into it.
EMILIE: And pregnancy is, like, in between, right? Yeah.
DR. FOX: Yeah. Yeah. So I would say it's much more the latter than the former, because in pregnancy, even though it is a limited relationship, it's a year, and for many people it's multiple times, it's, you know, it's, you have one kid, you have two kids, you have three kids, you have four kids each time it's that. And frequently they're going to end up being your gynecologist afterwards.
So if you're like a typical in terms of, like, healthy, no big issues in your life, and you're looking for an OB/GYN, you're looking much more so for the relationship aspect, because also things come up in pregnancy, things that are very emotional, things that are very private, things that are very personal and potentially hurtful, and it matters. The stakes are very high if the person can't have a good relationship with you.
Again, in a very high risk pregnancy, and it might be less so. It might be. Listen, I've got a real straight, like, a very significant one time problem right now with this baby, with this pregnancy. Maybe it's much more so, the expertise. And again, you'd love to have both, but you have to sort of think about that in terms of what you're looking for. And then how do you evaluate that is then the next thing. How do you assess if someone is a good person, is a good listener? And I would say word of mouth from people you know is helpful. Online reviews are pretty much useless because they're always the people who love you the most or hate you the most.
EMILIE: Yeah. I've never thought about reviewing my doctor online, ever, so I can imagine.
DR. FOX: Exactly. But if you know someone or can talk to someone who went and ask questions, like, does he or she listen? Like, does he or she value your opinion? Does he or she talk to you like a human being? Right?
And these are things if you can't figure out, meet with them once. It's no different from dating. You sit across a table from someone, you talk to them for ten minutes, you get a pretty good feel what they're like, personality wise, and is it a good match for me? And different people want different things. Some people want funny. Some people want intellectual. Some people want quiet. Some people want loud. You have to sort of see what you want to see if that person's a good match for you.
EMILIE: Yeah. And how they make you feel. Right. Like, just like that self reflection afterwards, you know? It's so interesting. As I was going through multiple miscarriages, I'm such a data hungry person. I'm like, give me all the information I can get. And after the first loss, everyone said, there's not much to be found out here, which is reinforced in your book. Right? Because these are so common, basically, it's probably a genetic abnormality. It's your body basically saying, this pregnancy is not going to be viable anyway. Move on. Right? And…
DR. FOX: We don't say it quite like that. But yeah.
EMILIE: … yeah, nobody said it quite like that to me. But that's how I felt. I was like, dang, okay, there's nothing to be done here. I'm such a fixer and a doer and a, uh, logic-oriented, like, evidence-based person. I was like, what can I do? And just the surrender involved in pregnancy has been so humbling. It was already humbling last time around, but this time around, especially. And so the second time it happened, I said, all right, f*** this. I'm getting as many opinions as I can. I want as much information as I can.
And it was funny reading your chapter on miscarriage, where you described sort of like, the frustrating senselessness of it all, oftentimes, because that's exactly how I felt, which was. There's really. There was nothing to see here. I got all the blood work I could get done. I consulted with an MFM. Beyond my midwife practice. I found myself an OB, a proper OB/GYN. And, like, I just made appointments basically, and talked it out with as many providers as I could. I saw a Nutritionist, I got hormone testing, and there was nothing to be found, which is good news, but also very frustrating.
DR. FOX: But that's the right thing to do. Cause you have this inner. It's like a void. You're like, you're trying to figure out what the hell happened to me, and you're seeking answers, and those are good places to go. It's not like you went into some, like, you know, wacko things to figure it out. You're doing the right things. And I frequently tell people that, you know, especially with the miscarriage, it's very nihilistic in a sense. Like, we have no control, almost always, over this process. And some people find that very disconcerting to feel like, wait, I don't have control over this. Like, I can't make this pregnancy better. I can't make it worse. It is what it is, and we're going to just have to wait and see how it finds out.
Other people find that very comforting. Other people say, oh, well, it is what it is, and it'll play out the way it plays out. And if something good happens, that's great, and something bad happens, at least I know it's not my fault. And different. And it's amazing that I say the same thing to two different people. One person is like, that is the worst news I've ever heard. And the other one's like, wow, thank you. I'm so happy that it's not in my control. And, you know, humans are different, uh, across the board, which is fascinating.
EMILIE: That's such a good point.
DR. FOX: But it's true, there are situations when miscarriages are due to underlying reasons that can be identified and can be addressed. That happens. And so, absolutely, you have to go through the due diligence, but it's really the exception, not the rule, unfortunately.
EMILIE: Right. Yeah. And what I loved about the book is that you go chapter by chapter talking about risk of recurrence, so that when you're even thinking about trying again, which takes some time to kind of wrap your head around, depending on what you've been through. I have a girlfriend who went through some significant birth trauma, who's like, I'm going to need a minute before I can even conceptualize having another child that I want, but I have some trauma to resolve. And it's like knowing the risk of recurrence, because some things have nothing to do with future pregnancies, and some things predict what will happen in future pregnancies just breaks it down in such an empowering way, in the book.
I will confess, I got to the chapter that said, and I'm newly in my second trimester, that was like second and third trimester complications. And I'm reading this in bed, and I turn to my husband, I show him the chapter title, and I'm like, do you think I should be reading this right now? And he was like, absolutely not. And I was like, me neither. I'm going to just skip to the end here. So I'm going to read the middle part of your book only if and when I have to because I'm living through it right now and I run a little anxious.
But then I skipped to the end and read the last couple chapters, and it's just like I had some breastfeeding challenges. Also with my first that I was reading about when we were talking about last night and talking about recurrence and, like, this is probably going to happen again in some capacity. It could happen again. What would we do differently? Kind of having that discussion up front is so empowering. It's giving the information that patients need to really make those best choices for themselves in a very uncertain process.
DR. FOX: Yeah. And, you know, you know, it's interesting. I agree with everything you said, and I agree that having an understanding of what to expect, you know, expectations have a lot to do with sort of the experience. If, if the experience matches expectations, it tends to be more positive experience or a less traumatic experience, even if it's not a positive experience, than if it doesn't match expectations. So understanding what your risk is, what can be done to mitigate that risk, what can't be done to mitigate that risk, sort of putting it in context is very, very helpful for people. I agree that it's not always helpful to read about all the terrible things that could happen to you.
But you know what's really interesting? The other group of people for whom it's really helpful is not just the person who went through it or is about to go through it again, but for their family and friends to understand. Oh, oh, now I understand, like, what she means when she said, I had this, and I had this, and I had this, and I get a better sense of what that means and what she's going through. So you can really, like, for people who've gone through, let's say, like, some complication, say, like, please read this, like, like, mom, dad, friends read this and then talk to me.
EMILIE: I mean, when I read the chapter on Hyperemesis Gravidarum. Gravidarum, whatever it's called, basically like extreme throwing up and he hearing the women's stories who were so dismissed, saying it's just morning sickness, what's the problem? And hearing how life altering that is. And like, I cannot imagine the courage of going back into pregnancy for a round two on that one, if your likelihood of it happening again is so high.
And actually brings me to one of my final questions I wanted to ask you, which brings this back to the workplace context, which is this January, February, actually. Before I knew I was pregnant, I accepted a full time job in house, for the first time in eleven years. I'm now an employee. In addition to what I do at Bossed Up and the last pregnancy and all the miscarriages happened when I was my own boss.
Now I'm navigating early pregnancy after loss in a workplace with a boss. And it just makes me empathize so much more with most of my listeners who are full time working women. It's like, if you have some of this stuff come up, I feel like the workplace has barely wrapped its head around parental leave as a concept, which is still not a right for everyone in this country. Right?
But it's like, how do your patients navigate not only of the conversations with their family members and their providers, but with their workplace? Cause I'll tell you what, I didn't disclose this pregnancy for a long time because I was holding my breath and basically riddled with anxiety, wondering if it was going to last. And so I'm just, like, wondering if you have any thoughts or advice or experiences on that front, because navigating complex pregnancies in the workplace feels especially daunting.
DR. FOX: Yeah, it's very, very challenging. I think it's obviously very challenging for pregnant women going through complicated or uncomplicated pregnancies. Also because you don't always even have a diagnosis. Like, what if someone, like, they had a very traumatic pregnancy the first time around and now they're in their second pregnancy and it's going fine, but they have expected anxiety, so they have many, many visits. And this, and how do you even explain that to someone? Number one, that's number one. Number two, there's so much, like privacy. You don't want everyone knowing your business, obviously.
And I would say it's very common because many people get pregnant, obviously, and now everyone's working. Right. [LAUGHTER] So it's, you know, I mean, everyone's working, so it's. It's very, very common. And it's also challenging for people who, with, let's say, chronic medical conditions, they have Cancer, they have Diabetes, this. But the difference is if you go to someone in your workplace and you say, I've got Cancer, they're like, oh, my god, go see the doctor. Get like, whatever you need, whatever you need, whatever you need.
But the problem is, if you say, I'm pregnant, like you said before with the Hyperemesis, all they know about pregnancy is either their own experience, their spouse, their family member. They're like, well, pregnancy is not a big deal. Like, why would you need to be the doctor more than once a month for 15 minutes? Like, suck it up. But that's not what it's like for a lot of people. Some people's pregnancies are a disaster, and I'm seeing them twice a week for an hour, and it's, it’s so hard to sort of do that.
What I would say, though, is most places of work that have proper HR departments, so, you know, middle to bigger size companies, they get it. You could go to the HR person and just tell them, I have a pregnancy. I have this. I got this. I got this. They're going to tell you, here are the rules. Here are your benefits. Here's what you get paid for. Here's what you don't get paid for. We can't fire you. You know, and it's very, very ordered.
Again, whether the laws about how much you get paid for what you don't get paid for, it differs based on the job, based on this, but you're not getting fired. They can't fire you, and they'll get it. I would say the hardest time people have is not with that. It's either with just people who work on a team, their team members being respectful of them and understanding what's going on, or people who work in much smaller environments with don't have HR, they just have a boss, or they have some person that they work for, and then it's just, you know, it's total randomness how, how helpful or open they're going to be to that. So I think that that is. But that is notoriously challenging. It's very, very difficult.
EMILIE: And I'll link to some former episodes we did about workplace rights. The Pregnant Workers Fairness Act, which just went into law last summer, gives women the right to reasonable accommodations during pregnancy that wasn't actually afforded across the board historically.
And so I think there's like, there's so much patient advocacy required in pregnancy. There's also workplace advocacy required in pregnancy. And while you're already multitasking all the time, while you're constructing a human with your own body, it's just a lot. So I think, you know, however, we can make this easier for women and empathize and not assume what someone's pregnancy experience is like is just so, so key.
This has been such a joyful conversation. I could talk to you forever. There's so much more to your book than we even had time to get into and your podcast. But let's leave our listeners with knowing where they can catch up with you and keep tabs on you and tune into your Healthful Woman Podcast. So tell us, where can we learn more and where can we get our hands on this book?
DR. FOX: Well, if they're walking around the Upper East Side of Manhattan and see me, they can come and say hello to me and we'll take a selfie. So that's number one in terms of my practice. Our practice is in New York City on 90th and Madison. And, you know, we're at Mount Sinai Hospital in New York City.
If you're not local and you want to hear from me otherwise, or if you are local and you do. So I do have this podcast. It's called Healthful Woman. It's very hard to say that podcast name. It's a terrible name. We should have called it, like, something else.
EMILIE: Same thing with Bossed Up. Everyone just hears, boss and up. So I feel you there. Yeah.
DR. FOX: Yeah. So, so. But it's, like, helpful. But the word health woman, in the singular, it's everywhere you get podcasts. We drop once a week. It's topics related to pregnancy, women's health, wellness. We have birth stories. It's sort of, you know, we have a wide scope. We have a great audience in terms of, like, engagement and, um, then it's obviously the book. And we have websites, healthfulwoman.com. There's a lot of good information there. The podcasts are there. You can google, I'm around. I'm up and about. You can find me.
EMILIE: I will drop links to all those resources in the show notes to make it easy. And by the way, I'm from Connecticut originally, and I married a Jersey boy, so I'm really. I'm loving the New York vibes that I got in this whole conversation, because I'm really just an East Coast transplant here in Denver.
DR. FOX: No, but I'm the opposite. I'm a nice person who moved to New York. [LAUGHTER]
Right? So that's my pleasant disposition. Is the Midwest in me. It's uh, you know.
EMILIE: That makes sense. That makes so much sense. Well, this has been so delightful. Thank you Dr. Nathan Fox, for joining us today.
DR. FOX: Thank you for having me.
EMILIE: For links to everything Dr. Fox and I just discussed. Head to bossedup.org/episode460. That's bossedup.org/episode460. We've got the full transcript available and a blog post summarizing the key points that we discussed as well. So it's an easy thing to share. And I've got links to all the great things that Dr. Nate Fox is up to.
And thank you for being with me on this journey. It's a very exciting time around here and I'm so delighted to be navigating even a complex situation. Although after reading Emily and Nate's book, I'm feeling like my complex pregnancy is far from the most kinds of complex pregnancies that are out there. And so I'm just full of gratitude right now.
Things are crazy, things are wild. I'm overwhelmed by a lot. And, you know, navigating all this with a full time job now is very different in my perspective than as an entrepreneur full time. And so I just appreciate you being along for the ride with me. I'd love to hear from you. As always,
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let's keep the conversation going in the Bossed Up Courage Community on Facebook or in the Bossed Up group on LinkedIn. My inbox is always open at emily@bossedup.org. And until next time, let's keep bossin’ pursuit of our purpose. And together let's lift as we climb.
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