Episode 17 SN: On Both Sides of the Line, An OBs Story: Dr. Shieva Ghofrany

Paulette: Hi, thanks so much for coming on the show, can you introduce yourself and tell us where you live.

Dr.Ghofrany: Yes, thank you for having me. I’m Shieva ghofrany I live in Connecticut, and I’m an OB GYN for 20 years,

P: amazing so that’s the also interesting facet of your story is that in some ways you know too much. Which will be interesting to hear. So before you got pregnant. I’m wondering what your ideas were about pregnancy, and how far you’re training you were or your experience.

Dr. G: Do you know how many times I’ve talked about this, no one’s actually ever asked me that question, kudos already i What were my thoughts about pregnancy well I had had endometriosis. That was diagnosed when I was 28, so I’d had a long history of really bad painful periods that literally led me to at age 27,28 I remember saying, in medical school. I’m never going to have a baby, because it sounds, it’s just so painful, I would like a hysterectomy because I was in so much pain from my endometriosis, so that was my like what were my thoughts about having a baby. That was my thought.

P: So what’s endometriosis. It’s a condition where the tissue that normally lines the inside of your uterus, the endometrium grows outside your uterus. Endometrial-like tissue outside the uterus, acts like it does inside the uterus. It thickens breaks down and bleeds with each menstrual cycle, but this tissue has no way to exit your body surrounding tissue can become irritated, eventually developing scar tissue and adhesions. The main symptom is painful periods, it may affect more than 11% of American women between the ages of 15 and 44. It’s especially found by women in their 30s and 40s, and may make it harder to get pregnant.

Dr. G:  I always assumed I’d have children because I come from a more kind of traditional household, but my pain was so bad that if you asked me in the childbearing years when I was of age, I didn’t want to have babies because it was too painful. Then I did get married when I was 29, and started getting pregnant, and miscarrying when I was 32, and had my first child at 34, and I was a resident at the time.

P:  Okay, so let’s go back over here. So, did you get pregnant easily.

Dr. G: So I was 32 went off the pill, I was a resident, didn’t want to necessarily get pregnant, because I thought let me just go off the pill, let my cycle get back to normal. We’ll try in a year got pregnant quickly. Oh, right, which was great, in retrospect because then I didn’t have to worry about it, except that that ended up being a miscarriage. It was what’s called a blighted ovum, which is where it’s a gestational sack meaning the sack was inside my uterus, but it was empty, so the egg and the sperm had gotten together created the pregnancy but that pregnancy never would have gone on to have a heartbeat or anything so it, so it didn’t.

P: It didn’t develop

Dr. G: it was an empty sack and it passed on its own, except that I had to have some of the SAC removed, like in a little office procedure because not everything came out on its own so I was a resident and bleeding and cramping and running out from like the hospital to the doctor’s office and back to the hospital. So that was my first experience with like women tough it out. We go through things, and we kind of compartmentalize, right,

P: that sounds really hard. Good Lord, I’m sorry to hear that you did you because you were a resident like you knew exactly what was going on and scientifically or

Dr.G: I knew exactly what was going on, scientifically, which made it easier and the good news was I could look at it kind of pragmatically as Oh well, at least I can get pregnant, and I’m still young enough at 32, and I didn’t start to kind of delve into the like, I was very overweight, I was very overworked, did that have an effect, you know, we were still in the mindset, this was back in 2002 of, well, people who are stressed and overweight get pregnant all the time so it can’t be any of that effect, and I would still say that’s somewhat true but it’s, you know, I think we know more nuances now. But yeah so that was the first miscarriage. And then pretty quickly. A couple months later I got pregnant, a second time and got a bit farther, and almost saw a heartbeat, that was kind of lagging in the measurements and had started bleeding pretty quickly after the positive pregnancy test, and that one miscarried. That one unfortunately miscarried didn’t go away altogether on its own meaning I didn’t pass all the tissue so I needed a D&C the dilation and curretage the procedure to remove everything. And because my uterus is tilted very kind of aggressively like at an acute angle. I had to go back a second time for a second DNC

P: Good Lord and are you as, kind of, are you as kind of pragmatic about the second miscarriage or  this is upsetting

Dr. G: this time I’m upset because  sort of upset because I didn’t even know if I wanted to be pregnant, you know, with my first pregnancy that quickly. But then, as you probably know like once you get pregnant once like your appetite you like your you get your appetite so you want to be pregnant again. So now I’m more upset, but I’m still telling myself, what we what we used to say clinically, you’re, we’re not worried until you’ve had three miscarriages in a row. Now we kind of actually have altered it to about two in a row if you haven’t had a child at the time was three. So I kept trying to be pragmatic and not let myself be too upset. And the truth is, you know, I’m a workhorse so I kept working. I did start to get really frustrated with my husband whose a wonderful soul, but just didn’t know how to deal with this, you know, the emotional toll of having a husband who is great, but has zero idea how to cope with pregnancy with miscarriage, and with a wife who happens to work a lot in the field so she’s somewhat obnoxious about like pushing you away as it is.

P: Yeah,

Dr. G: the extra layer of challenge there, you know.

P: Yeah, that sounds hard.

Dr. G: Yeah. So did you were you trying again or where are we and the luck was that despite me having endometriosis, that was bad enough that I had had surgery again back when I was 28 I got pregnant quickly, each time I’d get pregnant, so I got pregnant, and that one, I spotted and bled, but turned out to be a good pregnancy, meaning that is, who is now my almost 17 year old son.

P: Oh my god.

Dr. G: That said, that pregnancy was really fraught with challenges by that point I had gotten up to 250 pounds and I’m only five foot three so that’s not healthy anyway you cut it, I was mildly hypertensive so my blood pressure was always a little bit elevated, and from the beginning, the tests that we had done for him were during the pregnancy showed that his placenta probably wasn’t that healthy, meaning at the time the tests we did for Down syndrome. When they were abnormal, but didn’t show Down syndrome, really meant that there was probably something placental going on and in my case, what happened was throughout the pregnancy, his growth started to lag, the fluid around him was really low. And so we ended up having to induce me for growth restriction. And that was like a very challenging labor. In fact, your friend Sarah was at that delivery. It was a 30 hour labor with three hours of pushing and within eight hours after the delivery, he ended up having some seizures and went to the NICU where we found out he had had an intra uterine stroke in the previous week, At some point the MRI could time when the stroke occurred in a general scheme

P: let’s go slower here one second here, where are you in your pregnancy when you get induced

Dr. G: 39 weeks.

P: Okay so late

Dr. G:  Yeah, working all the time, watch the baby, he’s starting to lag in his growth. Probably I should have agreed to be induced at 37 ish weeks but I was like, wait I’m working, I’m working. Finally,

P: do they give you a scale in terms of growth restriction like he’s, you know,

Dr. G: right, like he was when we worry about growth restriction we worry about two things really we worry about a deceleration and growth like where are the babies falling off their growth curve we call it, or once they get below 10th percentile, and he was falling off his growth curve sticking around 10th ish percentile with the fluid, being not as much as we’d like. And that’s a secondary part that we look at, Because if the fluid is less that really shows the placenta is not giving the baby all the nutrients, and then finally by 39 weeks he was like just below the 10th percentile. His head circumference was not growing, that’s something else we look at and his fluid was low, so I got induced.

P: And that sounds, the induction nobody talks about induction with like loving terms right.

Dr. G: Well, I mean, you know I have a catch 20 I will have a love hate for deductions on one hand deductions nowadays we realize that if you do, most women 39 weeks. This new trial that’s coming out called the ARRIVE trial really shows that you can have lower rates of really dramatically bad things that we don’t like like God forbid fetal death and higher rates of vaginal deliveries, but it does mean you’re there at the hospital for a longer period of time potentially if your body doesn’t want to go into labor, mine did not want to go into labor, nor was I in great shape from a stamina perspective like pushing was really challenging, but you know listen when he came out, I kind of naively was like, Finally he’s out. That’s it. Forgetting that things can happen afterwards. And the truth is, he is a very healthy, almost 17 year old now, with some learning disabilities and other, you know, side effects later but overall I’m, I feel very fortunate that it was not as bad as it could have been.

P: Yeah, no kidding. Wow, so was the labor what you thought it would be because you probably had seen Labor’s, are you.

Dr. G: Yeah, at that point. So at this point by the way I had finished residency I had found out I was pregnant with this pregnancy, right, right when I basically started my practice, so I joined my office at the time this is now 2003 I’m a new attending, I’m working crazy hours we delivered a lot of babies, it was three of us I was on call every third night. And so I ended up, then getting induced like close to the end of my first year of being in private practice and I’ve been a doctor for five years I’d seen, You know, 1000s of deliveries that point, and my delivery was kind of like what I expected it was long, it was challenging. I had an epidural early, you know, there was points throughout the entire labor were touch and go. Should we do a C section should we not the heart rate tracing which is what we look at as a reflection of oxygen status during labor was never terrible but never perfect, so it was kind of a challenge the entire time, and then the pushing was also three hours with my mother, my sister, my husband, my best friend who’s your friend in the room, three nurses, two doctors at time for the delivery, and like I said then eight hours later he was a little bit like pale and blue. And it turns out his oxygen level was dropping. And so we sent him to the nursery to get checked out, and they realized he was having seizures. So, that kind of turned into a 10 day, NICU stay, me trying to recover from three hours of pushing which is not pleasant or fun, and actually what’s interesting that I learned a lot about then was just that the whole notion that everyone should deliver vaginally, that’s when I really cemented my ideology that that is just not true. Some women deliver vaginally and it’s an amazing process and some women do not deliver vaginally, Nor should they and my delivery was really not a great delivery and it was no one’s fault. It wasn’t my doctor’s fault I trust him and he did everything that he can and should have done, but it made me realize that this push to really force women or shame women into thinking they should deliver vaginally is very damaging and I actually say this a lot. I think it’s, I think it happens at the hands of other women as well I think it’s very anti feminist, and it’s women who are perpetuating it in my case my catheter in my bladder stayed in for 48 hours after my delivery because I was so swollen from pushing, whereas after a C section it comes out after 12 hours right so again, I’ve really tried to encourage women to understand that when it’s a great delivery it’s great and when it’s a challenging delivery is challenging, regardless of whether it’s vaginal or C section. And the more we can really discuss that both deliveries can be wonderful in different ways, and each can be challenging in different ways. I think will really get parity and equity, with regard to respecting either delivery.

P: Do you think vaginal deliveries become not the right choice when there’s some physiological issue like you said your uterus is tilted in a certain way, like that.

Dr. G: Yeah I mean I think that it depends on so many different factors right the patient the her, her anatomy, her emotions, the baby’s position everything and I don’t think her emotions should be discounted and I think they are, in my case the baby was sunny side up. Have you heard that term where we’re what we call occiput posterior it’s actually very common. If you have friends who are like I pushed for three hours and the baby came out with a cone head and I had back labor. Those were all whether or not the patient knows it their baby was most likely what we call sunny side up, meaning the head is down where it should be. But instead of the face looking towards mom’s spine, the face is turned up, looking towards the front, and that means that the diameter of the head that’s trying to come out of the pelvis is a bigger diameter than if the head was the other way. And so my six pound baby. We three hours to push him out and came out with the craziest conehead. And so my sacrum I had like my, my cocksix was fractured so my sacrum really hurt

P: Oh my God.

Dr. G: I was so swollen from again pushing for three hours that my bladder needed the catheter in for 48 hours, so I think no one could have predicted that and I have other women who were also 250 pounds and small babies and they come out easily, or skinny with big babies who come out easily, so that I think that the really important thing is that every patient, every situation and every baby is so different in the OB world we call it power passenger pelvis. So the power being how big your how good your contractions are the passenger being the baby and the baby’s position and your pelvis, meaning what shape is your pelvis and your uterus and are those going to allow the baby to be in the right position to come out and any of those varying factors can alter how easy or how difficult it is for the baby to come out. And I think unfortunately what we see nowadays is this big push, no pun intended for women to deliver vaginally, and because of women’s backlash at wanting to deliver vaginally to take back. You know what they deem is something natural from the medical community, the medical community’s response has been to say okay well we’ll look at things and you’re right we can we can allow you to push even longer than we thought and we will get more vaginal deliveries out of this and that will be satisfactory for moms because moms want vaginal deliveries, they get more epigenetic changes and all these things that are evidence based, but in reality I think what we’re ignoring is the physical physiologic and psychological toll on those very difficult deliveries that either don’t end up bad you know and have harder C sections or do end up vaginal and have really challenging recoveries, or, you know, babies that end up not being as healthy as they could be. So I think there’s a lot of aspects with that are really complicated and it’s become oversimplified into vaginal delivery good section is like, you know, we just, you know, step cousin, kind of thing

P: can you use those three metrics that you talked about the power the psychology and I forgot what the third one was

Dr. G: power,passenger pelvis,

P: can you use those three to predict, like who will have a good birth and who won’t to to say to them ahead of time, it’s likely that you’ll do X or Y, right…

Dr. G: Yes to a degree right like if you’ve been doing this long enough, just like any field, you’ve seen enough to know like when I’ve seen, you know this mom with this psyche, with this pelvis, with this passenger in this position, blah blah blah. Here’s what I think. Now, even the best of doctors who’ve done this for a long time we’ll be wrong sometimes. Not a lot. In other words, when I if I think before at the beginning of every delivery or even a week before the delivery, what do I think is going to happen. I’m not always right for sure I’ve been wrong sometimes. But I’m often right. And the hard part is that sometimes, if you know the answer is the doctor is not an easy thing to inform the patient of right like let’s say I knew the baby is sunny side up at 39 weeks when I’m going to induce you. But if I say to you, Paulette you know baby sunny side up so I think this is what’s going to happen anyway. It sounds good, like you as a rational, reasonable person sound like you might be like well I wish you would have told me because then I would have done things differently, But it’s not that easy because you have had not only nine months of your pregnancy 10 months really of your pregnancy of reading things and researching, but then also being told that the medical community just wants to induce babies or just wants to do C sections because they get paid more, which by the way is not true, or that they just want to be home by five o’clock, which is a joke is never true like no OB is home by five o’clock, or that like, of course you have to deliver vaginally because it’s natural and because it is better for the epigenetic changes so you can’t hear that information and really digest it that

way, some women can but many women don’t want to hear it.

P: Yeah, yeah

Dr. G: and it sounds negative to them and they’d rather just kind of go into it in a more positive way which I actually love manifesting and I love positivity, but I think it has to be metered with some realism in order to actually achieve better outcomes and I, I’ve said, frequently, patients who come into it realistically but optimistically saying, I’m gonna try this gradually. I hope that’s what it is, I fully realized that I might need a C section and that’s okay too. They do great meaning anecdotally, they have a higher rate of vaginal deliveries, I think, and those who end up needing a C section, have had a very good experience and felt very validated and felt very heard by their doctor. And so either way it’s a win win, whereas those go into a dogmatically saying it has to be this way, has to be vaginal, with no epidural or whatever it is that they think it has to be, then no matter what happens, they’re really, they’re unhappy, and sometimes maybe even have more complications because they are trying to control a not controllable situation that we can respond well to, if we have a partner in it who kind of has faith and trust in what we’re doing.

P: Yeah, this is an important narrative to publicize because this is contra to the cultural pressure to do otherwise right and this is, I’ve already talked to so many women who said I had to be natural I you know I had pictures in my head and have to look exactly this way, and that’s, I think our diet of what birth looks like is so unrealistic and so thin and so like it’s in the movies or whatever

Dr. G: and honestly it’s, it’s not just in the fiction movies, it’s in the very present population of documentaries and things that are, and I listen I did an integrative health and healing, fellowship, right, like a Masters of sorts, so I love things that are Eastern an alternative, but the unfortunately the Eastern alternative or even just like Instagram world of things should be natural, really glorify the ability of nature to always do the right thing. The irony being and I say this a lot when people say things like the women have been delivering bad generally in nature for millennia, women have been dying,

P: I was just gonna say what’s the death rate right now

Dr. G: currently die in other countries. Right, yeah, or have other side effects so which I say to patients like if you are willing to accept those consequences that I’m, God bless you. That’s okay. I don’t mind. But to go against nature by women being older than we used to be heavier than we used to be, reproductive techniques like IVF been in or, you know, women who are having, having babies through IVF with a donor sperm donor egg with their female partner, all things that I support, as I always joke like we have not set the table for nature, and then we expect nature to show up to our party ready and willing to like do the right thing, and it’s obscene and absurd and it leads to a lot of problems and the problems end up being for those very women that want this to work the way they want it to work. Like the men, it doesn’t affect the patriarchy.

P: Yeah, yeah, yeah. So wait, let’s get back to your story although this is totally fascinating, your sons of the NICU for ten days, sounds stressful and as a doctor does it feel. I mean, not that you have another frame of reference, but are you panicked like the rest of us or do you think like,

Dr. G: Oh no, I think I was like, in a weirdly surreal state of denial, and I’m not joking when I say that so I, in fact, so he has the seizures eight hours after delivery, he ends up being in the NICU and for about 24 to 30 hours, we couldn’t touch him because he was on a continuous EEG machine to find out what was happening with his brainwaves. The MRI shows ischemia ischemia is the medical term for loss of oxygen, so ischemia to two parts of his brain. Now, in our vernacular ischemia or loss of oxygen kind of mean stroke, but in my mind I don’t. I do not equate that word, I just keep saying ischemia Yeah, because in my mind it’s so medical but like, oh, he lost the oxygen and he had seizures and then he’s going to be better the seizures are going to be done and that’s it, until three years later, when a patient of mine who I delivered her son, he had an intrauterine in stroke, and she and I were talking about it, she’s in the nick you at another hospital to transfer the baby, and she says something and I all of a sudden said, Oh my god, I never even thought that my son had a stroke, and I remember her saying Shieva, of course you know that your son had a stroke, I’m like you I kept using the word ischemia, but that’s like in this situation, he had a stroke. So I think that power of denial was actually very, very beneficial for me, and very protective, because I was really able to be in the mode of like, okay I’m trying to nurse, I’m not great at nursing my milk is not coming in, I’m going to nurture who do what I can. I had really excellent NICU doctors who kept reminding me that babies do very well because of the neural plasticity and our ability of their brain to really respond to stimulation. And, you know, I’d say the challenges during that time, or probably more managing my husband and I and how much again he did not know how to deal with this well, and he’s a wonderful person, but really did not show his best side at that point and it was that was emotionally really hard. I think that was the hardest thing for me at the time. And again,

P: he was upset or he was distant?

Dr. G: he was distant, he was like at the time unfortunate he was like interviewing for a job so I was in the nick you like I always had someone with me like between my friends and my family and my parents are both positions and I was never alone but I didn’t feel like he was a partner in the whole thing. And I think again the narrative is very much like the partners, The man man is like the most supportive person and I’m so glad and blessed to have a husband who does these things and again, my husband is an amazing person, but this was not where he shined and so that felt very lonely to me, and certainly nothing that people talked about because everyone like acts like their husband is amazing and like wiping their butt, after the delivery.

P: Yeah, yeah,

Dr. G: and I know that that’s not true, but that’s how I felt at the time. Now I know that,

P:  but also that may have been his way of dealing with it right? It was too painful…

Dr. G: maybe… it was like taking our baby. Yeah, but, but, even if that is the case, it’s still

not a, a, that is not a wonderful way to deal with something when the other person is then left taking over.

P: Oh, it doesn’t help you at all. I totally agree. I’m just saying like, you never know what’s gonna look like on someone else and  we also had distress in my pregnancies and stuff and it was, you know, I’ve never seen my partner in that context before so I didn’t know what to expect and hey, like right now. Yeah. So you brought him home and how is that?

Dr. G: so I brought him home. I will never forget the drive home it was 10 days later, all of a sudden you’re like, I don’t want to be in the NICU and you find out you’re in the nick you and then you get used to all the alarms and bells and whistles and the nurses and then 10 days later, you’re like, you’re not going to come home with me I got to go home and our drive home I hope we get our drive home being like, I literally thought we were in a game of Frogger, I remember we were like in the car and I felt like, so vulnerable at any moment, a car was gonna hit us or something was gonna happen we got home, you know, our 12 minute drive home and I remember being like, Thank God we got home like it just felt like we had battled to get home when in reality it was just like a drive home from the hospital, and he was a challenging baby he was not a delightful easy baby until eight months he did not sleep well. He did not nurse well so he got formula right away. I really felt like I couldn’t sit for about six weeks because of my fractured tailbone. And I was swollen…I had so much edema meaning swelling in my hands and feet imperative and everywhere because I was so overweight and so hypertensive and retaining fluid, and then went back to work at I think seven weeks, and frankly, I can’t say like I was miserable, like I look back, when you’re a physician and you’re training and you’re a resident, like working 120 hours a week you’re kind of like prepared to do all this stuff. So I did it all, and I didn’t have postpartum depression, but I would never go back to the first year of any of my three children’s lives like and I say that, openly and happily to people, not because I want to act like it’s the worst for everyone, but I want women who don’t love that first year of their baby’s lives to not feel bad about it, I am not one of those people who’s like I go back to infancy and want to snuggle I’ve zero desire to go back to their infant lives and when I hear babies cry I actually still get a little chill down my spine. And I’m, I’m not embarrassed to say that I’d rather us talk about it some people love the infants, my mother still loves and adores infants. I do not, you know,

P:  infants are very very challenging. That is for sure. I remember when we left the hospital and I was like how are they just letting us leave,

Dr. G: like, with no infection or manual or anything. Right, well good I’m glad that worked out. What about the next pregnancy was that, no, no, no, because then I had so he was a year. I had him in April 2004 By July of 2005 I was pregnant again. Great, I got pregnant again. Bleeding like stink. Having to go see my, my husband’s family abroad, in the middle of a miscarriage.

P: Oh my god,

Dr. G: and I thought okay well okay I’ve already had, you know, now I have a baby, now the miscarriage isn’t as upsetting because I know I already have a baby. And if I never have another baby, at least I have one and I know my body can always do it, I’ll probably have another baby. And so I ended up having three more miscarriages after that so four miscarriages after the first baby, some of which needed a D&C, some of which didn’t and the interesting part is at the time if you asked me I would remember exactly like how many leads how many days in D&C, the D&C you know for the miscarriage only thing I know I’m like six miscarriages for DNC is, I cannot remember which ones have D&C is or not and I say that again happily because in the moment that any of us are going through anything. It feels so dire and like just like the details are ingrained in your brain, and I really want all of us to remind ourselves whenever we get through something and actually forget some of the details how good that is that like, it’ll, it’ll always feel better. Like, not necessarily soon after and it doesn’t mean you forget I don’t forget those six miscarriages I actually very much feel attached to those these materials in what have turned out for me to be good ways, because I’ve learned a lot from them, but I’m so glad that it’s reminded me time and time again that all the details that you thought you’d never forget because also, why’d you do. So then I got pregnant with my now second son and that pregnancy, I got antsy, because I wanted to be pregnant I was tired of miscarrying I took the medication to help you ovulate more so just because of timing, I had an agenda, I had to be pregnant. And I got pregnant, bled a lot at seven weeks thinking I was having another miscarriage and as it turns out that was a twin pregnancy and so one of the twins went away before I even knew it, so when I went in to get my ultrasound. I said okay I’m having another miscarriage just like, let’s get through this and I have like one more in me before I’m like done trying, and the doctor said oh actually you know what, there’s a great heartbeat, but the other one. It looks like there was another one that is no longer going to continue, which was not sad to me because I was just happy to have one heartbeat that baby boy is now almost 13 He had a clubfoot, which is where the foot is literally turned up and inward completely deformed, that we knew of, during the pregnancy, and it had to be repaired when he was born so he had casts every week for six weeks, and then these special boots for four years, but compared to a child with a stroke like you know a clubfoot was nothing.

P:Yeah, yeah, yeah

Dr. G: it was cumbersome and annoying. We had to go to the city like once a week every week for six weeks after his delivery, but like, it was fixable, so it’s fine. And then I was done, then I thought, I’m done, and I did not want to go through vaginal delivery again and I planned a C section, and my partner’s at the time, who had not delivered my first baby though I loved the doctor who delivered my first baby, but my medical partners who were still my partners, said, Do you want to go through that again. I laughed, I did what do I want to torture myself my partners are men, by the way and I submit a hell no, sign me up for a C section we’ll all show up in the right time and place and get this done. And I was so happy to do that it was so comforting for me to know that I knew the time and the date and the place and how he was going to come out, which is not to say that a C section is easy, are always the right choice, as I say to everyone. There’s no one right answer.

P:Yeah,

Dr. G: For me the right answer was the C section, it might not be for other people, maybe my second delivery would have been easier, but I did not want to take that chance for my recovery and what my first one had gone through so the C section I learned a lot from that too I learned a lot of little things that I say to patients during C section that I’ve kind of altered since then, I learned what to tell patients to like eat and not to eat before the C section. So I looked at it as, you know, street it was like me learning on the street, how to do things, and I really thought I was done after that I was never going to have another baby. Yes, I was that I didn’t have a girl but it didn’t matter I was blessed to have two boys I’m done this body is done. And then I did weight loss surgery when I was 40. So my first son ended up being 34 My second son was at 3840 I did weight loss surgery, I was done, never gonna have another baby, lo and behold for four months after that surgery I got knocked up by surprise. My surgeon said, I thought I’ve heard you a really great gynecologist what happened I said I know God I relied on my husband. And that was my surprise baby girl who’s now 10 And that was the healthiest pregnancy because I have lost, about 80 pounds. So despite being almost 41 When she was born. It was healthy, and she’s healthy and I had another C section and I had my tubes cut finally at that point, I think, like, each time you go through these things, they, they suck and they’re amazing, right, like I’ve learned great things and terrible things through all of these experiences, and I would not go back and undo any of those miscarriages because now I have my three babies. Right,

P: yeah, yeah,

Dr. G: I think, I what I say to a lot of patients whenever they’re going through miscarriages is that there is a very small segment of the population who will never or can never have a baby but that’s relatively small. So as long as women we are willing to go through either help getting pregnant or help staying pregnant or donor egg or donor sperm or whatever it ends up being. I can pretty much guarantee every woman will have a baby and if we remind ourselves of that almost before we even gotten pregnant, it would be so common because then, Each miscarriage wouldn’t feel so desperate. Yeah, for me, the desperation initially felt like this might be a sign that I’m never gonna have a baby. Right, but I knew I would be maybe I just wasn’t in the mindset of telling myself that and now I’ve learned that that’s really powerful to tell ourselves the fact it’s not snowing yourself it’s telling yourself the truth, you know,

P: yeah, that would be super calming I had trouble getting pregnant, so I know the weight of that, like, this may never work out right which now I have two kids, so we’ll obviously do work out but that that is very common to have that out there.

Dr. G: Yeah, and I think it’s something we should reiterate, and make it a really, like, make it a, a fact for people to remind themselves.

P: Yeah, totally. Do you think the miscarriages are attributable to endometriosis or we don’t know what,

Dr. G: no, I don’t  think there was revealed endometriosis because at the time I didn’t you know I endometrioma which was the 17 centimeter growth of endometriosis that I had was removed and I had no other obvious sign of it. I really do think and I don’t say this to be inflammatory to any woman out there who has weight issues I have many many many extremely overweight patients who have very healthy pregnancies. I think in my case, I had a lot of inflammation, and I don’t use that in the kind of Whoo, you know, Eastern like just general sense I had inflammatory markers that were measured on blood tests that dramatically dropped after I lost weight, and I really do think that that was a lot of it because my placenta was not healthy. The miscarriages we had reviewed by a pathologist and each of them that she could look at she really saw some vascular insufficiencies meaning the blood vessels that had formed between my uterus and the placenta weren’t that healthy, and in fact this is something I glossed over. I forgot that in my second and third pregnancies. I used Lovenox which is, if you know what that is but it is a form of heparin so heparin is a blood thinner. Yeah, there are like women who have antiphospholipid antibody syndrome women who have had other blood clotting issues will use heparin during pregnancy because it’s such a high likelihood of a clot or other pregnancy issues like miscarriages, or abruption where the placenta comes off early. And so I did not necessarily need to use the Lovenox my blood test markers at the time didn’t necessarily support it from an academic perspective, or an evidence based perspective but enough people that I respect felt like it might work, and my eighth pregnancy, ended up being my second child. So to me, it’s not a coincidence and he was healthier the clubfoot was probably a coincidence, he was healthy, he was seven pounds he was well grown, and then with my daughter, I probably didn’t need it because I’d already lost weight and my inflammatory markers were already dramatically lower, but I felt superstitious at that point. And so I continued to do the Lovenox which is a daily shot of a blood thinner,

P:  that makes sense and that inflammatory markers are an issue because your immune system is so keenly involved in the development of the placenta in the early part of your pregnancy

right and how it’s attached to the uterus and

Dr. G: when that embryo implants into the sidewall, that’s the inception of what is creating the placenta and and the placenta is the interface right where you’re getting your nutrients so a faulty placentation is really what can give rise to preeclampsia diabetes growth restriction, God forbid worse things right, nowadays we’re giving so many women baby aspirin low dose aspirin, starting by ideally, you know 12 To 16 weeks because we know that can improve their likelihood of not getting preeclampsia, and that’s because that comes from how the placenta has invaded into the wall of the uterus. So yeah, decreasing those inflammatory markers just created a healthier environment for the third one, you know to do better.

P: That’s awesome. So it knowing what you know now because you’ve been a doctor for many years after those births, is there something that you would have told young Shiva earlier, maybe that she didn’t know

Dr. G: well here so hard right, if I put on like my coaching mindset I would say, well I could have told her, but she only did what she could have done at the time, right, so at the time, I was working like crazy as a resident, I’m still I would say very food addicted I have a lot of like food issues right like I love food, I use it as a comfort it’s, I haven’t cracked that code yet so what I have said she admits unhealthy to be 250 pounds and you probably should try to be less stressed at work, and you should exercise. I guess they would have told me that but I knew that right like I definitely regardless of being a doctor, we all know that, could I have done anything differently. The fact is, it would have had to take a lot of work, mental health and emotional work right I was a very mentally healthy person I’m happy I’m engaged I’m, you know I don’t tend to go become depressed and things like that but, but I also like, I just I’m going to do what I’m going to do and at the time I had to work I was a resident I worked a lot, there was no way around it then I was an attending, I liked working I like involving myself with my patients so yes I would tell myself that but I don’t know that it would have changed anything. I will say that I think that and this is why I always joke about my street cred right because of everything I’ve been through and my weight issues I feel like I can talk more openly to patients, and most of the time, at least I think they don’t think that I’m like shaming them or blaming them or you know acting like you should do better. I really can emote with them because I’ve been through it, but I still find the weight issue to be so hard, not because I’m reticent to talk about it openly, but I think that many women understand and know what we need to do to be healthier as far as weight and exercise, but it’s hard to do it for a million, like purely academic reasons like time and for a million emotional reasons right. So I don’t know how much us telling patients that is going to help right, I think there’s a small group of women who have I say, by the way, do you know if you exercise more, and eat less carbs for example you’re gonna be healthier in your pregnancy. I think there’s a small group that’ll benefit, I think the rest of them already know that, and then in fact maybe hearing it over and over from the medical community just leads them to feel more like shame and avoidance and feel like this is paternalistic group of people telling them that they shouldn’t be doing these things so, so I actually, I talked about it but I don’t talk about it as much as like I should, according to the medical professionals, But I think I try not to talk about it too much because I think it shames women and I don’t think it’s beneficial.

P: Yeah, yeah, I can see that pregnancy I found really stressful, I’m just not even like putting aside my issues before I’ve had any issues. It’s just, it’s so much uncertainty, and it is for me and probably for a lot of women, the first time where you really are confronted with the fact that you have no control over this, like wildly important and powerful process going on inside you. It’s such a weird dissonance between kind of your outside life where you feel like you’re in control of everything and kind of what’s going on. So…

Dr. G: and the world keeps telling you, I mean the world as it stands right now, where they get social media and this entire other world of like pregnancy, telling you like, you should take control, you should empower yourself against the medical professionals, don’t let them try to tell you what to do. And I think that’s equally confusing right because then you have this the medical professionals are clearly trying to harm me, which is just not true. Like, there’s plenty other ways I can harm people, not this, and it means that women like you and I who are very type A and work really hard and are used to being able to control things. We’re going to try and, damn it, we’re going to do it. But the fact is we’re not going to do it because it’s undoable, you cannot control it, and then it just leads to more and more that cognitive dissonance, you feel self doubt, you feel doubt in your practitioners, which just creates more and more angst, and I really feel like it is like the demise of the doctor patient relationship and what leads to, again, an anti feminist potentially really dangerous situation for women. I think it’s what’s driving a lot of people to feel like they should deliver in in their home for example, and some women will do very well but we know the data stands that there is a higher rate of postpartum hemorrhage and other problems when they’re delivering at home. So it’s it’s a challenge, and I do think like you’re to your point, you’re used to controlling things you can’t control things, but yet no one’s actually explaining to you like it’s okay that you can’t control it and here’s why it’s okay that you can’t control it because not controllable but together we can still give you a great outcome and that’s really what you want, and the is you don’t want to control it but you’re being told that you should.

P: Yeah, yeah, yeah, I think that’s true, you’re doing a lot of amazing things in the world of data ecology and medicine. Do you want to tell us a little bit about your path forward or your hope for the future.

Dr. G: Well, I’m trying, I mean I’m as you can tell I’m like really really aggressively and obsessively wanting women to like just understand their psyche, a little bit more and you know I really I want women to trust their intuition, but when I say intuition. I think women supplant thinking their intuition is actually like listening to someone on Instagram and I keep saying like that’s not your intuition. That’s someone else’s intuition telling you. So yeah, my business partner I built this platform called tribe called V and it’s initially, the two products that we’re now, one has launched one is launching are pregnancy products but then the third is going to be a gynecology product and when I say product, a platform where we’re really trying to encourage women to have a lot of pre emptive information. So our my OB and new pregnancy program gives them an ebook, and then two to four lives every month where I talk about pregnancy issues and we do q&a My whole purpose being if I give you pre emptive information and explained to you. Hey, you’re gonna go for your ultrasound next week, here’s what might happen. Don’t be alarmed if you hear, you know, XYZ, like cysts in the baby’s brain, or a spot in the baby’s heart because those things are common and don’t freak out, the more preemptive information I can give you but in a calm way that educate you without freaking out, the better you’ll be because then when you hear those things because they’re common your brain did not devolve to like death and destruction or in the gynecology platform side, I want to really educate people about HPV and herpes and menopause and perimenopause and birth control and, you know, bleeding and endometriosis and all of the things that, because we don’t hear about them, We only then hear again on the internet or from our mother or from our aunt or from our sister or from that woman who almost died and then it becomes horribly anxiety and inflammatory provoking. So if instead we all talk about it more, and you hear it from someone who’s like not only teaches about it but has been through all these things, then hopefully it won’t. I’m not saying that any of the things are not easy like endometriosis still sucks anyway you cut it miscarriages are terrible anyway you cut it but they are less terrible when you understand them, when you understand how common they are when you understand what can be done to help them, then you’re not blindsided by it, and again if you hear about it ahead of time, you’re just not as worried.

P: Yeah, I agree. That’s amazing. So, I’m gonna sign up for the perimenopause thing because that seems like a black hole in my limited experience. So how do we how do we find these things.

Dr. G: Well, so the gynecology platform part will be out enrolling hopefully in the next like I’m going to say three to six months so people can go to tribe called v.com and just get on our mailing list for now. If they’re pregnant or trying to conceive, they can enroll in our pregnancy program, because then they get immediate that the PDF or the ebook, and they get to be part of our lives every month, so we do literally two to four zoom lives where we talk about all this stuff and the community of women is already starting to kind of bond with each other and everything, and then our pregnancy course will be coming out, but again the GYN platform will come out in the next couple months where all this stuff will be discussed, really, like, in detail in detail by like the woman who has you know I’ve been through menopause because I had my ovaries removed four years ago and I deal with it every day with my patients, and most of it is not complicated. When someone explains it to you but no one ever had the time to explain it to you.

P: Yeah, yeah, that’s right.

Dr. G: Yeah, and I think if we can do this, not only for women our age but for our young girls if we can talk to them about their period or about masturbation or about what it’s like you know when we if you decide to have a baby or if you decide not to have a baby or what if you have pain during your period or what if you find out you have HPV, I mean, literally, that the number of things we do not talk to them about is so endless that they all end up being so freaked out when they hear about it, even educated women don’t hear about this.

P: Yeah, that sounds awesome. Thank you so much for sharing your story and for sharing this new platform I’m excited to check it out.

Dr. G: Thank you for being here and thank you for sharing, millions of women’s stories because we need to get it out there.

P: Yeah, Totally. Thanks.

Dr. G:  Thanks, Paulette.

P: Thanks so much for listening to this episode, and thanks so much to Dr. Ghofrany for coming on the show. She was best friend from high school was my college roommate, which is how we know each other, which is lucky for me because she is an amazing person and a force for good and gynecology, you can check her out on Instagram at Big Love fierce Juju or tribe called V. For more in depth information about women’s health issues. If you’d like to share your story on the podcast, go to war stories from the womb, calm, and sign up. We’ll be back soon with another story of a person who’s overcome the many challenges that pregnancy and Birth invite.