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S3 E30 Who?! From OB-GYN to Intended Parent: Dr. Audrey Puentes on Surrogacy and Support
74 Plays21 days ago
In today’s episode, Whitney is joined by Dr. Audrey Puentes, a board-certified OB-GYN and intended parent who brings a rare and valuable perspective to the surrogacy conversation. As someone who has supported patients through pregnancy and delivery, and also walked the surrogacy journey herself, Audrey understands both sides in a way that few can.
This episode is packed with helpful, practical information specifically for intended parents. We will cover everything from prenatal testing and key pregnancy milestones to the transition from fertility clinic to OB care, how to navigate appointments with your surrogate, and what to expect on delivery day. Audrey also walks us through topics like C-sections, skin-to-skin, discharge planning, and postpartum expectations for surrogates.
Whether you're just starting the process or preparing for the birth of your baby, this conversation offers clear guidance, real-world insight, and reassurance from someone who truly gets it, both professionally and personally.
Takeaways
- Surrogacy can be a daunting process for intended parents.
- Medical professionals also experience emotional challenges during surrogacy.
- Choosing the right OB-GYN is crucial for a supportive experience.
- Intended parents should communicate openly with their surrogate and medical team.
- Understanding the timeline of appointments can alleviate anxiety.
- Routine screenings are essential for monitoring pregnancy health.
- Genetic testing provides valuable information about the fetus.
- Intended parents should feel empowered to ask questions during appointments.
- The transition from fertility clinic to OB care can feel overwhelming.
- Intended parents can choose appointments to attend based on their significance.
- Induction may be planned for convenience, especially for out-of-state parents
- The hospital setup and who can be present during delivery should be discussed beforehand.
- Every pregnancy and delivery experience is unique, requiring tailored communication.
- Discharge for surrogates can vary, but a 24-hour stay is ideal.
- Milk supply may take time to establish.
- It's important to prepare for the unique aspects of C-section deliveries.
- Every family's journey is unique, and there is no wrong way to build a family.
Links
Recommended
Transcript
Introduction and Guest Overview
00:00:00
Speaker
Hi everyone. Today's guest is someone I'm so excited to share with you. Dr. Audrey Quintus is not only board certified OB-GYN, but also an intended parent who has personally experienced the surrogacy journey.
00:00:14
Speaker
That dual perspective makes her voice incredibly unique and deeply valuable for anyone navigating this path. Audrey brings a calm, thoughtful approach to what can sometimes feel like an overwhelming process.
00:00:27
Speaker
In our conversation, she breaks down everything from prenatal testing and pregnancy milestones to what intended parents can expect as they move from the fertility clinic to OB care.
00:00:38
Speaker
We also talk about delivery day logistics, skin to skin, discharge planning, C-sections, and more. Basically all the things you may not even know to ask, but need to know.
00:00:48
Speaker
Whether you're just starting out or you're weeks away from welcoming your baby, Audrey's insight will leave you feeling more prepared, more empowered, and definitely more at ease. Enjoy.
00:01:01
Speaker
Me, you, and who? Who knew it would take more than two people to have a baby?
Guiding Listeners on Surrogacy Journey
00:01:07
Speaker
In a world where infertility is no longer a taboo topic, this podcast will take you through all of the different aspects of surrogacy and egg donation through the lens of many who walk this journey in different ways.
00:01:21
Speaker
My name is Whitney Hall, and I am a two-time surrogate now turned surrogacy coordinator for egg donor and surrogate solutions. the very agency I used when I chose to carry for two amazing families.
00:01:35
Speaker
With this podcast, it is our goal to help guide and support you as you learn about what it takes to grow a family in an alternative way, as well as hear inspiring and beautiful stories of how this path has changed lives forever. We can't wait for you to hear about just one more way happy families are created every day.
Audrey's Personal Surrogacy Experience
00:01:58
Speaker
audrey Thank you so much for being here. I am so, so excited that I get to chat with you from like this perspective. um Very exciting. Very different. Very different, but so funny. Yes. Okay. So for those who do not know, you are Dr. Audrey Quintus, a board certified OB-GYN in Texas, but You are also a recipient mom and are currently a intended parent who has walked this road personally, which is so amazing. And I got to be lucky enough to be your coordinator the first go round. But can you just share a little bit about your own family building journey and how, um you know, just how this has kind of shaped the way that, you know, you you do your work now.
00:02:45
Speaker
Yeah. we started our journey um in, let's see, so 2018, we got some news that I was not going to be able to carry my own baby.
00:02:59
Speaker
um We found out it was due to cervical, like an early cervical cancer kind of thing. So it was sort of an immediate process. It wasn't due to fertility concerns.
00:03:10
Speaker
um And so it was kind of an abrupt and abrupt diagnosis. So I ended up having a hysterectomy a couple months after that. um So we knew early on that surrogacy was going to be the way that we were going to need to build our family.
00:03:26
Speaker
um which was new and it was kind of daunting um and really just little overwhelming, I think. And being an OB-GYN and my husband's an anesthesiologist, so we kind of were familiar with how things kind of go.
00:03:42
Speaker
So, um, we were, we were aware and I'm not going to lie. I drug my feet a little bit. and we Um, but we did reach out to, um, the fertility clinic that we, um, that we were working with and, um, your, uh, your agency was who they recommended, um, one of two. And we definitely fell in love, um, just with, you know, speaking with you guys and everything. so and We did go there and um we actually were very, very, very lucky and were matched with a wonderful, a wonderful gestational
The Medical Perspective on Surrogacy
00:04:17
Speaker
carrier. And um we went through a very
00:04:20
Speaker
just Again, know not everybody's journey is gonna be as quick and as easy as it was, but we went through beautiful, beautiful- was pretty breezy. It was so breezy.
00:04:32
Speaker
As an OB-GYN, as an OB-GYN and medical professional, we always kind of have this, not saying, or but just this feeling that things just don't go right for us. Nurses, labor and delivery nurses, labor and delivery doctors, like we just know things aren't gonna go well.
00:04:49
Speaker
and I mean, you end up with all kinds of crazy things happening and ask any labor and delivery nurse and it's like, yep, this is going to happen. so Sure. Absolutely. like Waiting for everything, but everything just went beautifully. um I even got to deliver my son, which was really cool. And so it was beautiful. I was, it was such a great experience, but, um and so we, you know, we, we walked that whole path and everything. and We had a very supportive, you know, very supportive,
00:05:15
Speaker
um you know, work environment, very supportive, um you know, gestational carrier and her husband and her family. And so we really, really went through that. And, you know, the the agency was great. Our coordinator was awesome.
00:05:28
Speaker
And also, you know, out with us, you know, being a little like spacey just with our schedules and everything. So um But then, you know, we have a beautiful, a beautiful son and he's going to be three in a couple of months. I can't believe it.
00:05:41
Speaker
Yeah, I know. And he's a spitfire. So, um so that's kind of us in a nutshell. and i It's a long nutshell. Yeah. ah yeah But I mean, again, like I kind of, I kind of love even, know even the fact that like you and your husband are both like in the medical field, that there's just still that very humanness of like, sure, we know everything or we kind of know everything.
00:06:02
Speaker
medically kind of where we need to go next. But the very humanness of just and we're going to still drag our feet a little bit and we still need to adjust and, you know, just all of that. It was and I did. i felt like, you know, because you still have those emotions, you still have those feelings and, you know, and then because like starting a family you know, with using a surrogate and using a gestational carrier, this is process like it's not as organic as as, you know, the normal, you know, the the natural way, you know, basically where you have to make choices and those places are big choices. And it's um you have to decide, OK, today I'm going to go to the fertility clinic and talk about. Well, OK, now we're going to decide that we have to reach out to, you know, an agency.
00:06:51
Speaker
okay, now we need to make the profile. Okay, now we need to do this. And mean if you're any kind of nervous or not ready or anything, it it is going to put that block there.
Emotional and Logistical Considerations
00:07:01
Speaker
and And it's, it is a little bit, you know, daunting and stuff like, am I ready for this? And so it does. I mean, you, you know, you need to do it. It's just whether or not you're ready for it. So that was definitely something I think that we were kind of, i think, drag dark our feet out. Not that we didn't want it, but it is, that you know, it's a little nerve wracking.
00:07:19
Speaker
Absolutely. No, for sure. sure. And not for anything, but I mean, you're you're in a world of babies constantly. So, I mean, yeah yeah, there's so much, there's a lot that I feel like you're having to just navigate.
00:07:34
Speaker
Oh yeah, absolutely. 100%. Yeah, no, for sure. i think it's so um you know, i always i i always feel like when it comes to, you you know once you kind of dive into the world of third party, a lot of intended parents are, you know, they're pretty confident whenever with their surrogate, when they're they're in that fertility stage, because a lot of intended parents have done it you know themselves or, you know, they've had to, um you know, they've dealt with the clinic at least prior to the surrogate being there. So there's a lot of confidence with like the fertility stage. But once
00:08:05
Speaker
your surrogate becomes pregnant and they're released to obese care, a lot of intended parents aren't always sure what to expect. So i would um i guess kind of my first question to you when it comes to you know, just that part of you know your journey, what would maybe be some of those good questions that intended parents can ask at that like first OB appointment just to so they feel informed and included and connected?
00:08:33
Speaker
Yeah. So I think some of that actually comes before. So, you know, before you go to that first OB appointment, um I think it's going to be important to number one, um you want to make sure that that the doctor that you're, you know, that your carrier is seeing that she that that doctor is supportive.
00:08:54
Speaker
um And if there are if they have done or have taken care of surrogacy pregnancies? um And if not, is it something that they're willing to do? and if the hospital, and you guys are really good about kind of vetting, you know, the hospital and whether or not that's something that they're comfortable with doing.
00:09:12
Speaker
um Because the next step is are you going to be at that appointment? So are you, as the intended parent, going to show up to that first appointment?
Transition to OB Care
00:09:23
Speaker
um And the reason I say that is because a lot of times that first appointment isn't the, isn't the first time you've seen your baby. So you've seen your baby at your heartbeat check. Typically you've gone to that heartbeat check and you've been released.
00:09:37
Speaker
So that typically happens around nine to 10 weeks is when you're re when you're being released over to that OB b to your, your first visit. So, you know, some so I've, I've, so right now I'm taking care of two, um, separate, um, seriously pregnancies.
00:09:54
Speaker
Um, and neither of the intended parents have come to the very first appointment. Okay. So, and that's a personal choice. And so, um, the questions I asked, or I personally, as the physician said, you know, are they going to be coming?
00:10:11
Speaker
And so you need to talk to your carrier and say, listen, am I going to, do we want to come to that appointment? So number one, deciding whether or not you're going to And I think that's a good place to start. So when you are, can decide to come to that appointment, whether it's the first one or the third one, it's going to be, you know, asking, are you comfortable, you know, Dr. Smith, are you comfortable, um you know, with me calling or, um you know, calling and leaving messages to ask or or how how can I get information about the pregnancy if I want something
00:10:48
Speaker
you know, to ask if I want to ask a question, because sometimes um like I've done it where i I did, you know, but it's a little different for me because physician, but I advocated for something that my carrier was not really afraid to ask, but I felt like she wanted to ask it would make her life a little easier. um and And, you know, just kind of asking that, um what is my role here? Like how much, how is information going to be shared with me?
00:11:16
Speaker
Um, and so those are kind of, that's kind of the, one of the first things, um, finding out, you know, in the event of an emergency, how am I going to be notified if my, if my carrier can't talk? Like, what if, you know, something's going on Are you going to be okay and comfortable calling and talking to me?
00:11:37
Speaker
Um, and so, um, those are kind of the little things like, what is my role here? um and being able to feel like, am I going to be able to be included, that sort of thing? um I think just I think finding someone and making sure that that physician is the first thing is making sure your physician is going to be, you know, OK.
00:11:59
Speaker
having that relationship, I think, is the most important thing. No, I feel like that's huge. And not for anything, I mean, you know, we'll we'll cut to the, like, as far as illegality is concerned, you're going to have that HIPAA form and everything. But I do feel like when it comes to communication, there's kind of this,
00:12:17
Speaker
not everybody knows how to handle it, because now everything's a portal. And I'll just send you a portal message. And, and a lot of times, you know, you know that, oh, I need to talk to the intended parent. But once you know, maybe your nurse doesn't know, or your nurse does know, but they're not there that day, or, you know, however, you know, that works.
00:12:36
Speaker
Right. So in your situation, I guess with your two, how, how is it working right now with, you know, the community as a physician right now? How's that communication working? Just as an example. So a lot. So my the two that I have, they're actually the the gestational carrier is communicating with the intended parent.
00:12:57
Speaker
And in a couple of situations, the intended parent is sending like text messages to the the um carrier and then she's screenshotting it and sending it through through the portal.
00:13:09
Speaker
yeah oh And so that's been how it's kind of working. But I have said from the very beginning, if they want to call me and talk to me, just send me a message and say, Hey, you know, is there a time after clinic that we can call and discuss?
00:13:22
Speaker
I would be happy to do that because it's very different again, like you said, with the patient portals, like it's, it's going to be in the carrier's name, not the intended parent's name. And so any lab results are going to go through and they're going to go through the, to the carrier. There's going to, you know, the intended parent's name's not going to be on it anywhere.
00:13:40
Speaker
right um And even, um even like scan documents, I know with our, our system, like even scan documents, even if it did have the intended parent's name on it, it's going to get lost into space because,
00:13:52
Speaker
it won't have a place to go. Like there's, right you know, with ai and everything. So um basically making sure, hey, listen, like when lab results come through, um how am I going to get that information? Am I going to rely on my gestational carrier to take care of it?
00:14:10
Speaker
um should i Should I call and ask for that? Find a way and a way of communicating that you feel comfortable with. um because your doctor should feel comfortable with that and also should understand the type of pregnancy that this is. um And that you're not just, you're not being, and it sounds terrible to say, but you're not being overbearing. You're being, this is your, you know, this is your kiddo. This is your child. And it is hard because you don't necessarily have control of what's going on.
00:14:44
Speaker
um And you are expected to be asking these questions um and and and be a little nervous and that's okay. um So those are kind of, you know, basically knowing what their comfort level is taking care of it.
00:14:58
Speaker
And I think some of the, that's going to be the biggest thing. um Knowing how frequent the appointments are and then asking what appointments are the big things going to happen.
00:15:12
Speaker
when are we going to have ultrasounds um you know when are we going to do you know when would i expect lab work to come back you know when am i gonna when am i going to be getting information char those are going to be the big ones so kind of having a timeline of when to expect things would be helpful um finding out if you can be on facetime or record or on the phone call during those and if you can't be there because some offices don't allow that.
00:15:46
Speaker
um That's gonna be a big one. And also recording of ultrasounds. I will say that um even in our CRC pregnancies, our ultrasounds, you can't record them. Even mine, even when I went to my our ultrasound for the anatomy scan, they wouldn't allow me to record.
00:16:06
Speaker
Um, and I'm, I'm an OB gen. So, right yeah you know, I'm like, okay. So they wouldn't allow me to record. So, um, and it has to do with HIPAA violation and things like that in case somebody else's name popped up and stuff. So, um, making sure, you know, finding out what, what you can do, can your carrier call you during the appointment, um,
00:16:28
Speaker
Can you, can, if you're not able to be there, can you do voice, you know, can you do FaceTime? Would that be okay? Finding out for those appointments, because you're not going to need to come to all of them. I'm not going to lie. Like it's, if you want to come great, do it.
00:16:44
Speaker
But there are going to be some where it's, it's going to be heartbeat check, answering questions, checking in, and then that's it. And they're very short appointments. And if you live a distance away,
00:16:55
Speaker
then it might not be something that you you necessarily want to do. sure. sure i think, and ah sorry, i don't mean to interrupt you, but going back to you know just that, again, that communication level and and things like that, I feel like this is such great advice to ask the OB prior to that first appointment, because then I think it really gives,
00:17:20
Speaker
intended parent, surrogate, and their coordinator that opportunity to kind of figure out you know, what does feel, what does feel good as far as communication? Because I think a lot of intended parents really struggle with exactly what you said.
00:17:33
Speaker
I don't want to be considered, you know, quote, overbearing, but again, to your point, is your kiddo, that OB is your doctor too. And, you know, you do get to ask questions. It's not overbearing to want to know when you say labs, what does that mean? And and what are we looking for? And, you know, just, just things like that. That's not overbearing. That's just wanting knowledge.
00:17:55
Speaker
Oh, yeah, absolutely. and And, you know, when it's going to be a little bit different than you know, the person that is carrying the baby because it's a little like she's going to have sensations and things like that, that, you know, maybe she's experienced before. So she might not worry about the round ligament pain.
00:18:13
Speaker
um And so she might not ask about that. And so there's going to be things that she's experiencing that she's not going to ask about. And that's okay, yeah you know, to to, you know, you hear her say that, you're like, oh my gosh, like, is that okay?
00:18:28
Speaker
You know, and and that might be something to say, oh, is that, is that fine? um And it's, I almost, I almost kind of compare it to maybe i ah dad that doesn't really know much. You know, like, I'm sorry dads out there, you know, but it's true, you know, every now and then.
00:18:46
Speaker
It's true, sure. Like, is this okay? I'm like, yeah, man, that's fine. It's just, You know, and, and you know, just like, you know, he's all worried, you know, she she has a she burps and he's like, oh man, you know It's kind of same thing because you're nervous. Like you've never, you know, if you've never, if you're now, if you're, if you're an intended parent that has experienced pregnancy before, you may not be as, you know, little, you know, kind of nervous, but you are nervous because you don't, you don't know if that's a normal sensation or not. You just want to make sure that everything is just perfect.
00:19:19
Speaker
And I think going into it, again, being a physician, taking care of someone, you know, this you know, this group of, of patients basically you know, we expect that we expect a really nervous, potentially very nervous, very excited set of intended parents. And we also have, you know, possibly a nervous, you know, gestational carrier because she's, you know, carrying someone else's kiddo. And so we've kind of got this like very special little situation. And I think, again,
00:19:56
Speaker
before, that's a big thing that we talked about, like you mentioned, you know, really ahead of time, knowing that that physician that's going to be taking care of, of the carrier is in this pregnancy is going to feel comfortable with that and, and know, and spend the time, you know, spend the time with that family. And that's, I think that's going to be, that's almost like preemptively before you even get to the What do I need to know? Question? Sure, sure. Absolutely. No, I think that's so great when you know, again, kind of, you know, when you go back to the fertility process, right? Like there are so many appointments.
00:20:33
Speaker
There's lots of blood work. There's ultrasounds. There's constant updates. It feels like, you know, you're like 10 times a day. You're feeling you're hearing from someone and then suddenly, you know, the care transitions to an OB and that pace totally slows down.
00:20:46
Speaker
It does. It's like a huge it's like a huge break. um And it is it is. And that's even for and that's even for, you know, you know, patients who've gone through IVF um and we go. So, you know, that very first part of the pregnancy, you're going to be seeing your OB every four weeks.
00:21:08
Speaker
So you do every four weeks until you hit. And this varies a little bit, but every four weeks until you hit around that 28 week at 28 weeks. <unk> a twenty eight weeks that will then transition to every two weeks.
00:21:19
Speaker
And then at approximately 34 to 36 weeks, then you go weekly. So that first chunk of time, I mean, you're going every month and you're thinking, oh my gosh, like, are you sure? Like, I need be going sooner, but there's not, you know, and this is where it kind of comes the reality of pregnancy, right? At the beginning of the pregnancy, there's really not a lot that as an OB we can do to kind of change and you know, change how things are going. It's sure or, or it's not right. And so baby's growing, that's baby's growing, baby's developing. And, um, you know, a lot of times, you know, we're not starting to feel movement. Um, usually I start, we start thinking maybe around 16 weeks, um, and somebody who's really had a few kiddos, um, I don't start worrying, you know, even for like my first time mama's at like 22 weeks, I have some girls who don't feel anything. I'm like, it's fine.
00:22:15
Speaker
Um, but at the, yes. So at the beginning, you know, you're not seeing, you know, that, so that nerve, those nerves really do start building, especially for, you know, some intended parents are like, is everything okay? So then it really comes down to, I know for us, like, I felt like our, you know, our carrier, shes sweetheart, would tell us like, oh, I'm craving this.
00:22:36
Speaker
i'm I'm eating this. Then it becomes more of like the little stuff in between, like the non-medical stuff that you'll be getting. But that pace really, really does slow down. um I know for, and that'll come different. It'll be different for everybody, but I know every doctor is different. I know for us,
00:22:54
Speaker
um We were sent to high risk because of the way that the embryo is formed. um certain Certain doctors, um there is a little bit of an increase in cardiac defects sometimes with our ICSI babies.
00:23:08
Speaker
um And so some will take that little bit of an increased risk and go ahead and send you to high risk, which will then maybe increase the frequency of those appointments. Um, early on, um, and it just depends on the physician. I do just, I send my girls to the high risk doctor just because that was what was done for us. And I feel like, you know, I feel like it's, I would want that. So we, we still do that.
00:23:32
Speaker
Um, it gets them in make sure that, you know, we get that, get that checked out and everybody can kind of just say, okay, we're all good. Um, but it's, like I said, it's different for everyone. um But yeah, those early, those early appointments, it really does kind of slow down because again, because now we're, we're in the, the hard part is at the beginning.
00:23:51
Speaker
The hard part is getting pregnant and staying pregnant through that first trimester. And then after that, we're just looking at a nice, beautiful pregnancy, hopefully. Right. Yeah. And that's the part to swallow, you know, for sure, for sure. Because I think I was going to say, you know, I think, I think you, you kind of,
00:24:10
Speaker
As unfortunate as it is, you know, like you said, OB in that first little bit. There's not a lot you can change about, you know, what happens in those first, you know, little weeks and you can have as many ultrasounds as you want and it's not going to necessarily change an unfortunate outcome.
00:24:29
Speaker
yeah But there are things that you're monitoring. There are, you know, all of that's, it that's why there's, you know, hey how, you know, how are you feeling? Is there bleeding? You know, just like all of those things, there's blood work and, and, and all of that, but going every day or every week, isn't doing much. There's not much for you guys to do. Yeah, exactly. And and that's and that's such a hard thing. And that's even for just anyone who's not going through this process. That's a very hard pill to swallow. And, um,
00:25:02
Speaker
Because yeah, we there isn't, there isn't really a lot. And I always tell my patients, I was like, there's nothing you can physically do at this point to change, to make this not go well.
00:25:14
Speaker
Like just keep living your life, doing a really good job, eating really well, drinking lots of water and being happy and hopeful. And that's like the best thing that you can do. um And so, you know, me seeing, me doing an ultrasound, yeah, every two weeks, it's my,
00:25:28
Speaker
make you less worried, but it isn't going to fix what we're doing, what's going on. So, um, it does, it does, it's such a hard thing. Cause at the beginning, like you said, you know, those appointments, you know, boom, boom, boom, boom boom because we r we are you know, we're checking lining thickness. We're doing, right we're checking, you know, you're used to, you know, when you're doing the egg retrievals, you know, for like, you know, for IVF and stuff, you know, you're doing all of those things because there's a purpose to every single ultrasound. And as we get further, that purpose of that next ultrasound,
00:25:58
Speaker
is to make sure that everything is forming well, make sure we have good anatomy, make sure that heart is looking good, make sure that brain is looking good. and We don't see that really well until 18 to 20 weeks. Right. that It does take some time because you don't want to look too early because things look a little funny.
00:26:12
Speaker
Sure. Oh, gosh. Yeah, for sure. yeah So, okay. So with that said, you know, what are maybe kind of those routine screenings and check-ins that kind of happen in that first and second trimester that can be expected with a typical, you know, pregnancy?
00:26:25
Speaker
Yeah, yeah. So if everything's going nice and normal. um you know So you've had your carrier screening likely, like the intended parent. So they've had their carrier screening. So we likely are a carrier of any sort of genetic abnormalities.
00:26:35
Speaker
know And that's that NIPT test and all of that test. So the carrier screening is testing mom and dad. Oh, your genetic screening. Sure, sure. We're going way back.
00:26:47
Speaker
We're going way back. So that's typically what some parents will do. So that's already been done. Then we have the, depending on if the embryo has been tested genetically. So the PGT testing, um some parents opt to do that. Some parents don't.
00:27:02
Speaker
um It depends on the fertility clinic. Then comes the next step. Some OBs will still recommend the n NIPT testing, which is additional, like non-invasive prenatal testing. It basically pulls, um, fetal, fetal, um,
00:27:23
Speaker
genetic material from maternal blood. It's non-invasive. It's not like an amniocentesis, but it's a little like just a little blood test. And it tests for different multitude of different things. Um, kind of our big ones, like trisomy, the different trisomy. So extra chromosomes, 21, 18, 13, they test for Engelman's, uh, Prater-Willi. So just a big multitude of abnormalities.
00:27:46
Speaker
Um, and it is again, non and and non-invasive. Um, So that's an additional, um, there are some, I, like I said, I have a couple of, um, intended parents right now. One of them was talking about potentially more invasive.
00:28:04
Speaker
Um, but, um, we opted not to, they opted not to do that as as sure um, but again, and then, so that's kind of our one, that's the genetic, then the genetic, um, testing then, um,
00:28:18
Speaker
The next, around the 15-week mark, you can do an alpha feed an alpha feedto ala fetal protein, AFP. I can never say the whole thing. I'm like, well, an AFP. And that can test for um the presence of AFP in the maternal blood. If the if the value is elevated, then that can potentially um show the risk of a neural tube defect. So is there a neural tube defect, meaning an opening in the baby's, like,
00:28:45
Speaker
spine, like in the back of it in the back of the head. So like spina bifida or something with like the the back of the cranium. And so that is something that um some intended parents may choose to do because that isn't something that is necessarily found with NIPT testing. Typically, we do see that whenever we're doing a lot of those ultrasounds early on.
00:29:10
Speaker
um And so some parents will opt to do that. That is, again, around the 15-week mark. Not a lot of us are doing that as much anymore simply because we are seeing those bur thoses early ultrasounds.
00:29:21
Speaker
And they are looking pretty normal. Like, we're able to see those. um So there's typically that. um Again, if there is any abnormality with either of those, then we do, again, send a high-risk maybe a little bit earlier. And then we'll be doing like an amniocentesis to actually draw um, you know, some fluid around the, around the baby, which will then have skin cells, um, that have been slept off. And that'll actually test for actual genetic material from the baby.
00:29:49
Speaker
Whereas the other, all the other testing, even the PGT testing, it's like a placental type of, um, test. So it can have some different material in it that isn't necessarily could potentially not be from the actual baby itself. So got there there's a lot of science involved in that, but those are typically like NIPT testing, potential AFP testing. And then around the 20 week mark, between 18 to 20 weeks, you'll actually get an anatomy scan where then you're at- That's the fun one. That's picture day. That is fun one. And
00:30:20
Speaker
one. That is the one that everybody wants. Everybody wants that one. We all want the photo of the baby sucking her. the oh yeah We all want that. So cute. I'm not going to lie. Hopefully my, for, you know, my, uh, high risk doctors aren't looking, um, because I totally snuck a photo.
00:30:38
Speaker
Um, they love it. They left a roof. And I just took that profile. Um,
00:30:46
Speaker
best photo in the world. So, um but yeah, so that anatomy scan, so what that is looking for, um you know, everybody wants it because, oh, they want to see the gender and they want to see the cute face, right? Oh gosh, yeah, absolutely. That's the highlights. That's the good stuff.
00:30:59
Speaker
That's the good stuff. So the anatomy sono is basically for, you know it's for other stuff. So we're looking at, you know, um because even if all the genetic stuff is totally normal, you can still have a structural abnormality. Sure. You can still have, you know, an abnormal, you know, an abnormality in, you know, the kidneys or, you know, the heart structure, anything like that.
00:31:23
Speaker
And so we're looking at, you know, measurements inside the brain, you're looking at the measurements of the size of the head um to get like a weight of the baby. You're looking at the heart, the, you know, does the diaphragm, is it formed correctly? Is the stomach, we have a stomach bubble.
00:31:40
Speaker
um So we're looking at all of those different things, which, you know, again, we're all hoping that everything forms nice and beautifully and perfectly. But that's what that appointment is really for. In addition, the beautiful, cute little profile, as well as, as well as the parts to make sure that baby is a boy or a girl.
00:31:58
Speaker
So yeah. um But those are, that's kind of what that part is for. So those are the big screening tests at the very beginning of the pregnancy that kind of, and you know, to check the genetics. Now, again,
00:32:10
Speaker
We didn't do NIPT testing because we had done the PGT testing. So we felt like that was sufficient for us. yeah And that's just going to be a personal, a personal choice if that's something that you guys want to do Again, it's a blood test.
00:32:24
Speaker
So, you know, it's not like it's something super invasive, whether or not you want to do it. It's totally up to you and your station carrier. You know, more information is not bad information.
00:32:35
Speaker
and Sure. Absolutely. You mentioned earlier, sometimes there's appointments that intended parents really don't need to go to. Why? um Because I would say that first appointment is going to be probably around the 12 week mark.
00:32:50
Speaker
Yeah. Maybe 10, 12 week. That one's probably a good one to go to because, you know, he get to meet us. Um, but then, you know, around like 16 weeks, we're going to listen to the heartbeat and say, Hey, how are you feeling? You're good.
00:33:04
Speaker
Are you eating well? You're sleeping okay. And then, and then that's probably going to be, be it. Honestly, yeah um, they're very short appointments depending on the weight.
00:33:15
Speaker
Um, it might be a while. So some of those appointments, um, you know, you're going to do your 20 week ultrasound. That one's a good one to go to. 24 weeks again, not so much listening to baby.
00:33:27
Speaker
Hey, how are you doing? Are you eating? You know, that kind of stuff. You can go to those appointments, totally go to those if you want to, if you have questions, those are, you can still go, but as far as like anything interesting or anything being done, nothing really out of the ordinary, just kind of a check-in.
00:33:48
Speaker
yeah um and it's more for, um you know, checking on the physicality of how things are going. Um, and so, you know, those are, those are really kind of up to you. And again, it's whatever, it's whatever you want to go to, especially if you're out of, like for us, we were out of state. So for me, I had to kind of pick and choose what appointments I honestly, the only appointment I went to was the anatomy ultrasound.
00:34:15
Speaker
Um, And that way I could, you know, and then I met, you know, I get to spend the day with my carrier and stuff, which was really fun. yeah um But that was the only appointment that I, that I made it to because it was, you know, it was a, it's a, I was about a six hour drive.
00:34:29
Speaker
So to make it for it and and for our new carrier, it's going to be about an hour and a half or probably an hour drive. um So I'll have to probably miss some of those as well. So um you just kind of have to,
00:34:41
Speaker
you know, pick and choose what you're going to go to. And I think I think that's something to kind of discuss ahead of time, like, hey, is the next appointment going to be one like, what are we going to do with that one? And that may be one just to like phone in. Yeah. Well, and I was going to say, i think that's so great.
00:34:55
Speaker
i think that's, I think that's so helpful to hear because I think a lot of people really struggle with, oh my gosh, I i feel guilty. I can't be there. Or this is how I'm going to be included in this. And, you know, for all intents and purposes, exactly like you said, I think I, I remember telling, you know, my intended mom, yeah she felt so awful and we were living in the same city. And so she, know she really, she felt so awful. She was just like this meeting and I just can't get there. And I was like,
00:35:18
Speaker
I'm about to go pee in a cup. They're going to ask me how I am. I'm fine. It's going to take five seconds. Like it really is going to be okay. Yeah. And like, so what I'll, you know, I've done is do you want to record the heartbeat?
00:35:31
Speaker
And I do this, I do this for all the pregnancies that walk through and, and, you know, like, oh, my, you know, my husband had to leave to go to, you know, had to leave to go to, you know, work or whatever. Cause you know, the wait was kind of long.
00:35:44
Speaker
It's not like that. Sure. you hear Just you know record record the heartbeat. you know So ask, like can I record the heartbeat? you know um And then that's something because it's your kiddo. And I mean, I did, although I was terrible. i I'm not even going lie. I would literally forget that we had an appointment that day.
00:36:00
Speaker
would I'd have to run and tell my nurse. i'm like, we have an appointment. um can, okay, I have a patient in a room. If I have to, I may have to run out. and I was like, if my alarm goes off, come and grab me.
00:36:12
Speaker
i love it. I love it so much. Yeah. Those reminder texts were good. I'm like, oh God, I gotta hurry. can like run and sit out at my desk and I'm like, oh yeah, everything is great.
00:36:23
Speaker
Yeah. Oh God. Yeah.
00:36:28
Speaker
burger I was probably like the worst intended parent. I was like, oh, stop it. No, you were not. No, you had trust in your surrogate. You knew she was doing everything just fine. And that like, you know, hey, it's going to be great.
00:36:41
Speaker
i was like, just let me know how it went. yeah Yeah, it was. And that I think is is important again, because like, so don't feel bad if you can't make it to all the appointments, because it's not not every appointment is going to be groundbreaking. It is important to go to some. um But like like I said, out of the two I have, I think I'm I've met one set of intended parents.
00:37:07
Speaker
And then the other one, I don't think I'm going to meet until the delivery. that's okay like it it's totally fine and i said listen if you guys ever want to do a phone call before or after you know just let me know and like we'll do that and and and again that's again where that communication between that physician and you as the intended parents is going to be really important yeah and again like you're saying like having that trust in your carrier and being able to say listen like I know that you know to ask the questions or even say, listen, can you write these questions down? And I've had that before. Like, hey, so the parents want to know, you know, can I do that? You know, can I do this or what? And you're like, absolutely. And you answer those questions. So.
00:37:50
Speaker
No, it's perfect. And I think you kind of said this in the beginning, right? Like, you know, maybe as a pregnant individual, they're not going necessarily think to ask a certain question about a symptom that they've mentioned because they're used to having it.
00:38:01
Speaker
But, you know, it might be helpful for, you know, mom or dad to just maybe have, you know, well, would do you mind asking, you know, the doctor about X, Y, Z? And that's totally fine. And, you know, you keep going back to communication. I feel like that's kind of, that's just the name of the game, you know, just in general with any part of this, you know, journey. But I think again, intended parents, you have permission to ask these questions and, you know, and having that relationship with the o whether it's even if you don't see them until delivery day, asking beforehand, you know, hey can I call you? Or are you willing to call me? Or what's the best way to communicate is just so vital, you know, this process.
00:38:39
Speaker
You mentioned delivery day. I was going to say, what are kind of the, How can, how do you feel like you kind of prepare and, you know, support your patients and kind of how did you feel, I guess, as you were also approaching, you know, delivery day and, you know, you're you're getting down to those weekly appointments and now we're starting to, maybe we're asking about induction and what are signs of labor and, you know, we'll, or for our intended parents that are out of state, I know I always get the question, when should I go?
00:39:10
Speaker
um and I'm like, talk to your doctor. Yeah.
00:39:16
Speaker
So big thing is going to be finding out the history, the birth history of the, of your, of your carrier.
00:39:27
Speaker
And did she go early? Did she, did she live at 39 weeks? Did she have to get induced? Find out that information yeah because if you find, if it turns out that she kind of went around 39 weeks or she went a little early,
00:39:45
Speaker
you might start thinking about potentially maybe planning on going a little early too. Yeah. um, you know, I advocate for induction for our, for our, um, for our carriers, um, simply because it's hard to plan, um, unless, unless you live in the same city,
00:40:13
Speaker
If you live in this country and you're down the road and it's easy to get to or you know you can get there in a short period of time, then you may not need to. Or, you know, the job your job allows like, yeah, I can just have to leave. I'm good, you know. um Then that might be something that, yeah, you can you can do kind of spontaneous.
00:40:33
Speaker
um But and and and obviously, if you know if if you're you want, that's a kind of something you want to talk to, you know, you want to talk to the the carrier about say, listen, like, are you okay with induction? or Are we not okay with induction?
00:40:47
Speaker
Um, And so, you know, for us, again, like me and my husband, we're both physicians. Like I can't, like if he's on call, like he can't, like if he's on, you know, an OB b call, like he can't just be like, all right, well, yeah, I gotta go.
00:41:02
Speaker
know, two o'clock in the morning, like we have to we have to plan it for us. And so that was something that for us, we really needed to have planned out. And so, you know, we really were kind of saying, hey, would you mind being induced? Is that gonna be okay?
00:41:17
Speaker
So as a as a physician, you know, that's definitely something I asked, you know, are we are we OK? You know, hey, listen, you know, your carriers are out. I mean, your intended parents are out of state.
00:41:28
Speaker
right are you okay being induced um and then and then if the answer is yes then typically we get kind of like a 39 week induction um and then maybe talk about hey just in case if you want to come in a couple of days early ah week early you know then that's up to you guys just kind of get planned get the lay of the land um you know get a hotel room set up that sort of thing um and so that's you know if you're not going to be induced then i would say maybe you know, figure out kind of where timeline that last delivery was at.
00:42:02
Speaker
Like, did she deliver weeks, maybe come in a couple of days before that timeline. So really kind of play that out. And really, again, like, you know, ask your doctor, i think is, you know, talk to the doctor and say, listen, like, what are my chances? Should I should I come in a little early?
00:42:15
Speaker
um Yeah. Because you don't miss it. Right. You certainly don't want to miss it. And you don't want to be in a situation where, you know, you're having to drop everything and you just can't. You just can't do No.
00:42:27
Speaker
Yeah. um But yeah, I think. planning it. So say that we've planned it, say we've got that 39 week induction going, really talking about what is what's the hospital like, you know, um what are my options? Like, what are we like? That was one thing for us. Like,
00:42:46
Speaker
what is the setup going to be that day? Like, are we going to, are we just going to be, you know, hanging out together a team, just in the same room? Like what are we doing?
00:42:58
Speaker
So again, like, I know this will all be discussed usually prior to, finding out who's going to be in the room, talking to the OB b and finding out how many people are allowed in the room.
00:43:08
Speaker
Mm-hmm. I will say that as an OB, unless it's very strict hospital policy, which unusually this situation is kind of waived a little bit, um but he just a teeny bit,
00:43:21
Speaker
um What you know, who can I have in the room? Who's going to be in the room? Really kind of figuring that out. Like, you know, I think with our delivery, her husband like was like, hey, I'm good. Like not being there is cool. Like, you know. Yeah. If I remember right, I think she was like, it's really best that he not be. So she's like, it's fine. It's fine. He was going to be our photographer because we had a photographer then she got COVID.
00:43:51
Speaker
And then her mom, she wanted her mom. Like her mom was like the sole person that she wanted to there. And then she was fine with my husband being there and then me, but then her husband was going to be the photographer. And then he had to go to go pick up the kids cause she didn't deliver as quickly as she was like all upset cause she didn't deliver before three 30. And I'm like, you literally have been here for like no hours. like It's fastest delivery ever, but whatever.
00:44:18
Speaker
um But yeah, so kind of figuring out like what our ideal room plan would be like, right? And then building off of that because typically, or what we would like is, you know the you know, our carrier to have her, you know, her space with her support people. And then hopefully, how our intended parents have another separate space where they can kind of like go in and out and be there and go visit back and forth and stuff and be present for like big events, you know, things like that.
00:44:50
Speaker
um we did not get so lucky. um They didn't, they didn't have an extra space for us. So it was fine. Yeah. um No big deal. It was a little, little hospital. And um we, it didn't, it wasn't a big deal. Honestly, the hardest part was they didn't have enough chairs. So my poor husband had to sit in like a wooden rocking chair for, from like seven to five, actually later than that. Cause they didn't have a postpartum room for us until like 10. But um so that was fun.
00:45:18
Speaker
um But really kind of checking your out like, it was good. So you know, kind of looking and seeing like, okay, what is it going to look like? Are we going to have our own space? Like realistically, most hospitals do try to do that.
00:45:31
Speaker
um And like, again, like, the agencies are really, really good. You guys are good about getting in touch with, you know, the right I was gonna say a lot of this we usually like we got out beforehand, and we kind of let everybody know, here's your protocol. And right now, if you have extra questions, a lot of times you're able to talk to like a social worker type individual or the charge nurse and things like that.
00:45:55
Speaker
But I think to your point there, you know, A lot of times the hospital will defer, especially in the event of like a C-section, they'll kind of tell you, you know, oh, there can only be one person in the OR, but that might be deferred to, you know, the OB or the anesthesiologist or things like that. And so that's kind of where you can talk to your doctor in those events. And, you know, exactly like you said, you can kind of prep, you know, intended parents and the surrogate for that things like that.
00:46:22
Speaker
And I think, you know, for us, like, again, I've already kind of talked for my upcoming things. Hey, listen, like we've got this this coming up. What is that going to look like? um And so my my charge, I've already talked to a charge nurse and our nurse manager and this we're not even due for till the end of the year. but kind of saying like, this is how we do it. And they're like, okay, I really like it when, you know, for instance, if it is in a C-section, you know, the patient and, you know, their support person is at the bed and then the intended parent, one of the intended parents is by the warmer.
00:46:53
Speaker
And so, you know, they're both in the room, but they're separate. So it doesn't, you know, nothing's in the way, but she's like, you know, this is their baby. So they should be in the room. Yeah. And so there is that feeling in most hospitals, there is that feeling surrounding this type of a pregnancy because it's important, right? Like this is your baby. So I think just kind of knowing that. So having those things kind of figured out a little bit and just knowing overall really it's and at the end of the day, the hospital and the nurses, they're gonna figure it out and help you.
00:47:27
Speaker
But you knew as an intended parent it's gonna help you feel better having more of that information. um then just knowing more and you will have your own, you will have your own space after delivery because she will be her own patient and then the baby will be its own patient. And so that baby will have its own room. So the baby will be admitted to its own room and you will be rooming in with the baby.
00:47:57
Speaker
um Don't be surprised if you don't get a meal.
00:48:02
Speaker
um does that happen That happens. That happens. Yeah. It was cute. But, you know, it is what it is. But, you know, you'll have your own space. um And so I think just the fun part about that is, yeah, it's like preparing. Like, what's it going to look like? You know, what are we what are we going to feel like? And I think, you know, you're you know, this agency does such a good job making sure and matching the matching everybody so well and doing those sites.
00:48:33
Speaker
you know, there's those, those psych, um, you know, cons consults, I say consult, but you know what I mean? Like the, yeah, well, we have the psych evaluation, but then we do ask a lot of those, the questions prior to even matching and, you know, talking a lot about that.
00:48:48
Speaker
It's so nice because like, you already kind of know going in what you're getting. And so you're not going to have those weird situations and you know that you have that, And um it's it's a good thing to kind of go into so you know what you're going to feel like. Like, i already know, you know, where we stand and we're not even, you know, we're not even pregnant again for this. I i mean, like, i already know what it looks like yeah emotionally and as far as like us as as as a family and as a group.
00:49:19
Speaker
As far as the hospital and stuff, I have no idea, but I know that it's going to be okay. I know that it's going to work out. um So I think you know, it's going to be the little minutia that, you know, who's going to cut the cord. Is it okay if I, if my husband is here, is it okay if he's here and he stands at the, those are going to be like the little things you guys like kind of figure out.
00:49:39
Speaker
Um, but as far as like the medical stuff, you know, as long as your doctor, knows and communicates that with the staff outside of what the agency does is going to be really important. And so just to make sure that that stuff is known is going to be important.
00:49:56
Speaker
For sure. Absolutely. Talking about kind of some of the medical sides of things, I know we kind of we do our best to, you know, prepare um intended parents, but typically like for a vaginal delivery, what can, you know, intended parents expect?
00:50:12
Speaker
What's kind of maybe the best spot for you to, you know, stand or i know in some, you know, situations, maybe you need to go and sit down or, you know, that kind of thing. What does that usually typically look like with a vaginal delivery?
00:50:25
Speaker
Yeah, yeah. So, so with the vaginal delivery, most units, at least the ones that I worked on, I worked in several places. um And so most of the time, you know, you've got, you've got the bed and then a lot of times right off to the side of the bed, there's either a couch or recliner, something kind of along the side.
00:50:44
Speaker
um And there's like space. So typically that is where family is put that doesn't want to see anything.
00:50:55
Speaker
and And that's where every every shape, form of family, right? Sure, absolutely. like Grandpa that somehow got wrangled in to be in there, like everybody. You go sit on the couch. And the dad, whoever, and like they're all up there. So um usually the head of the bed typically is the best place.
00:51:15
Speaker
Even, you know, head of the bed and looking down. So typically in a normal vaginal delivery, you're in a position, as you see on TV all the time, you know, you know, on the back knees up, you can't really see the parts, you know, um a lot of times it's just, you've got a big old pregnant belly. I mean, you know, half the time pregnant women can't even see their own toes.
00:51:38
Speaker
So certainly from that angle, but you're not going to be able to see directly underneath that belly. So that's usually a good spot for, anyone to stand if they want, you know, privacy. So it does typically is a good area. And so there is that good kind of space up to the, to the head of the bed.
00:51:56
Speaker
um and so that's usually good. Now, if for some reason there isn't a good spot like that, there usually is an area in the room where there's like a curtain or something where, um, maybe, maybe the, you know, or you know, the carrier says, you know, I don't really want them there until the baby is a out.
00:52:14
Speaker
um and You know, there's always a little space where they can sit, you know, and I'm not, I'm not, no matter what is happening, um if they walk in and their baby is there, they are not even going to look.
00:52:28
Speaker
They're not even going look. It's so true. No, I mentioned before, like I delivered my son, and you know, my, our doctor had me do that. And I don't remember do Like I remember this and this and then I don't remember anything i like, you know, and I was so right. And so, you know, that so at the end of the day, even if, you know, they did walk in and they might get a glance at something, they're not going to.
00:52:59
Speaker
for it. They're not going to see it. So, um, but that's a good spot to stand. It's like the head of the bed and that's good for, you know, for anyone who's like, okay, well, I want the family there, but I don't want them to see anything. Right. We want to have, you know, modesty and respecting all that. Yeah. That's a good spot to hang out.
00:53:14
Speaker
And that would be a good thing too. You can even talk to the nurses because sometimes the nurses are pretty, they might put a little blanket up over the knees or something and stuff. And there's a good way to, there's always a good way to be, to, to help with modesty if needed.
00:53:25
Speaker
Yeah, for sure. So baby comes out and generally baby usually like, you know, GC, gestational carrier kind of becomes like a table almost and you know, baby kind of hangs out there for a little bit and about that time is whenever, depending on whether you're doing delayed cord clamping or things like that, that's whenever you start cutting the cord.
00:53:43
Speaker
Yes. like yeah And so that is also a question too. So depending on how the GC is feeling, you know, I did ask ours, are you okay if I put our baby on you?
00:53:57
Speaker
um Because you know, I don't know emotionally what's going to be felt at that moment. Sure. Something that she's going to be like, I don't want, you know, this child isn't my child. I don't want this baby. I don't want to experience what I maybe have experienced with my other kiddos.
00:54:12
Speaker
um She was totally fine with it, but you know, it might be different for everyone, you know? And so in that, if that's the case, that is again, something to kind of put in like, maybe even in words um or birth plan of some sort to say, listen, I don't want baby directly on me.
00:54:29
Speaker
um And then that's something that as an OB, you know, I know that I even have, you know, mamas who don't want their own baby on them. They go, no, can you hold the baby and cut the cord and then go clean it and bring it back to me? That happens.
00:54:41
Speaker
And so we know we can hold the baby and do our own thing and everything like that. So um just needs to be something that's communicated again, back with that communication. So, but yeah, a lot of times, yes, the GC does become a little bit of a table.
00:54:55
Speaker
Right. you know, it's the easiest place to put the baby. There you go. Usually that's where the, you know, the towel is and that's where they do like the stimulation and stuff simply because that cord is still attached and we're getting that good blood flow and.
00:55:09
Speaker
um getting that baby stimulated and everything. And that's a good spot. That's just a good spot for babies. yeah Yeah, absolutely. Random plastic bag, drape thing. For sure, for sure.
00:55:20
Speaker
So after that happens, you have a lot of intended parents who are trying to figure out, well, how quickly do I get to do skin to skin? But then like you mentioned, there's a warmer and there's kind of some of those checks and things like that. What can an intended parent expect usually kind of in that, in those moments?
00:55:36
Speaker
Yeah, so that's going to be again, I mentioned a birth plan. So that's something to kind of think about birth plan wise. If you want that baby literally to just kind of be like to cord cut, dried up a little bit and gone skin to skin, that is up to you.
00:55:53
Speaker
Um, so we, you know, we can either dry the baby off, take the baby over to the warmer, get vitals, do weight, wrap the baby up, swaddle, whatever you want, or we can literally just, you know, make sure baby's good. Make sure baby doesn't need to go to the warmer for resuscitation for any baby's looking good.
00:56:14
Speaker
Then, you know, put baby skin to skin. I mean, I put on a shirt that had, um, it was like a skin to skin shirt, so didn't have to like undress in front of people. Um, and I just put it right on in there. Um, but it just depends on when you want to do that.
00:56:29
Speaker
Um, typically we'll recommend, um, delayed cord clamping and anywhere between 60 seconds, um, to, I think it's 180. um is where we kind of recommend that just to get that extra blood volume to the baby to just make sure we get that. Now, if you're wanting additional, you know, delayed cord clamping, that's something to, again, to kind of put into a birth plan um to discuss that with the OB b and everything.
00:56:53
Speaker
um And that will be, but that that's usually the timeframe, but if you want to go skin to skin, especially, you know, you know, you're sitting there, you're, you're knowing you're nearing, you know, you're nearing the delivery and things like that, kind of preparing yourself, maybe wearing a shirt um as the intended mom or intended dad, wearing a shirt that's easy to either like break away or even putting on a hospital gown backwards that you could bring the baby in. So that kind of stuff to kind of prepare ahead of time. And usually the the nurses are pretty good kind of preparing you for that.
00:57:23
Speaker
yeah yeah yeah no that's perfect so you guys you know you i know generally skin to skin and then most of the time we'll say 99 of the time um intended parents kind of go off on you know to their room and now they're having you know that and now surrogate is hanging out um what is generally what does discharge usually look like for a surrogate what's kind of that postpartum care that can be expected yeah so um if everything is going really well um it couldn't be i mean as long as her bleeding is controlled um as long as her vitals are stable it really varies for everyone i think in an ideal world we love a good 24-hour stay um but if you know sarah gets like yeah my fundus is firm my bleeding is good i didn't tear
00:58:18
Speaker
you know, she didn't have any other comorbidities. I mean, I've seen moms go home anywhere between six to 12 hours. Because you think about these patients that deliver in birth centers and things like that, they're home six hours.
00:58:28
Speaker
yeah yeah So it really just depends on the status. um I think a good 24 hour stay is usually a good, you know, a good place to be at. But, you know, as long as a lot of times, you know,
00:58:42
Speaker
The healing process, you know, as long as that bleeding is under control, as long as we've, you know, we're not, you know, having a huge, you know, terrible tear and, you know, everything has been repaired well and you're feeling comfortable, you know, that could be, that's really just going to depend on you. But as long as everything is looking good, I would say a max of 24 hours for a nice clinical delivery.
00:59:03
Speaker
Love it. Love it. When can, you know, a lot of times you'll have surrogates who um are perfectly willing to pump for their intended parents or, you know, they want to definitely want, you know, that, that magic colostrum and all of that. What is that? What does that typically look like? When can an intended parent maybe expect milk to come in or is it, um my gosh, baby's here. We need to immediately feed baby. You're like, what, what does that look like?
00:59:27
Speaker
So that is another good question to ask the OB when you kind of during some of the visits, um whether the hospital does donor milk. Great question. So they'll be kind of depending on where you're at, they might they might kind of be iffy about it.
00:59:44
Speaker
But. Um, usually, you know, you're the, the carry will start, be able to collect colostrum within that, you know, that usually the early, that next morning, um even that, ah that evening might be able to kind of get you, it's not going to be a lot, it's going to be a tiny bit, but they're, you know, their little tummies are like this big.
01:00:01
Speaker
So you don't need much. Um, usually that milk is really going to start coming in within the next few days. I would say I'm really looking at like, you know, anything in a bag for at least three or four days for sure.
01:00:13
Speaker
sure Um, and so usually you're going to want, if they're going to start pumping for you, you're probably not going to get that for a week or so, if not, you know, enough to be able to send, um, because they're not, sure unless we're coming to your house, but, um, but usually, you know, you'll be able to during your stay at the hospital, knowing that you're going to be transitioning over to pumped breast milk, be able to do some donor milk while you're in the hospital.
01:00:41
Speaker
Some, Some hospitals will say, unless you're discharging and you're going straight to breast milk, they will want you to try formula just to make sure that that baby is able to tolerate that.
01:00:53
Speaker
So that will be something that you may want to consider. um you know, having some at home or having some ready um or having donated breast milk that you have at home also ready for you. If you only want to do exclusive breast milk, um because it may take some time for your carrier to be able to get enough of a supply to want to be to be able to fill up a box, as I'm not going to lie, it's a little pricey to get that but like the the, you know, obviously the cost of the pumping, that is what it is.
01:01:25
Speaker
But the box and the shipping and all that stuff to get that figured out. It takes time and it takes, it takes. Sure. You don't want to ship like just four bags. Like you want to really fill her up. You want to fill her up. You want to get that done. So, yeah for sure and um, so you really want to make sure that's good. So, you know, either have kind of a, have a plan in play.
01:01:47
Speaker
Um, and so if you think that you're going to want to do again, exclusively breast milk, then you may want to find, someone or somehow get some breast milk from ahead of time or, um, think about doing kind of some, some, brought you know, some, um, some form supplemental with the formula. Yeah. And kind of going back, I know that's what we did. Um, and then, you know, kind of, we mixed that in a little bit, um, while we were waiting for, for the breast milk to come in and and that worked out really, really well.
01:02:18
Speaker
yeah yeah for sure. So going back just a little bit, you know, we've kind of talked typical, you know, vaginal delivery. in the event, I am in the fun club of scheduled C-section. um So what is kind of, you know, I know generally speaking when it comes to C-section, right? Like that's surgery. So now we're we're in kind of a whole different ballgame as far as, ah you know, where you can stand and, you know, all of those things.
01:02:45
Speaker
Yeah. Yeah. So, you know, for a C-section either, you know, so kind of one of the things I think to ask, and, you know, we can get into it whether you want to, if you want to or not, but, you know, there are going to be reasons for a C-section not scheduled, um but in the event of a scheduled or say that, Hey, we just find ourselves in the OR.
01:03:06
Speaker
Okay. We just find ourselves in the OR. um Typically, you know, we have, we have the operating table. um You know, there's going to be a big blue drape. You're going to see a little round belly.
01:03:18
Speaker
with like nothing on it. And then this blue everything all around it. So much blue, so much bright and so much blue. You know, good thing is it's, you know, it's color coded, right? So they basically, as you're, as anybody walking in that is not part of the surgical team, they tell don't touch anything blue. So, you know, ding, ding, ding, we've got our check mark. We know what not to touch, right? There you go. so you know, they'll bring in usually after, you know, depending on the situation,
01:03:48
Speaker
you know, your carrier will get a spinal, um, or we'll get their epidural dose up to make sure that it's working really well. Um, and then we'll get laid back, cleaned up, um, positioned, draped and tested it You know, are you numb? Can you feel that you're good?
01:04:05
Speaker
Awesome. Then support person for, you know, for the patient we'll get, we'll be brought in. um And so, you know, gets brought in, don't touch anything blue and will then stand behind the tray at her head.
01:04:19
Speaker
And so that's to be support for the person being operated on. um Usually around that time, likely will be kind of a team more than likely everybody will be sort of in the same room together. So as they go to get her support person, the one of the intended parents or two, depending on the policy of the hospital or how things were going that day, will be brought in and the will likely go to be around the warmer.
01:04:46
Speaker
um Whether the warmer is in the operating room or short lake right outside, that just depends on the hospital. Ours are inside the rooms. When I was in training, they were outside the rooms. It just depends on the facility.
01:04:59
Speaker
Will likely go to the warmer. so um you know And everybody has to wear these really weird like white bunny suit things. Yeah. ah Yeah. Yeah. You're like head to toe covered. Like, yeah. a yeah hat Pro tip. Don't wear anything really heavy underneath because it's going to, like it's going to be hot.
01:05:22
Speaker
Yeah. You're going to get toasty. Even though you think you can see through it, it's going to be hot. So don't, you know, don't wear like a sweatshirt, take your sweatshirt off. And also carry your phone in your hand and not in your pocket. Cause at the last minute you have trying to zip and it'll break and you won't be able to.
01:05:38
Speaker
So those are don't, don't wear anything warm and don't worry your hand, you know, your phone in your pocket. Hold your phone. Yeah. Hold your phone. So, you know, the surgery will get underway. um And then once we start getting close to baby, the anesthesiologist is really good about saying, Hey, listen, we're getting close to baby.
01:05:54
Speaker
And so that'll be kind of like the notification to everyone, you know, Hey, this is about to happen. You know, Hey, you know, patient, you're about to feel some sensations. And then also, you know, baby team,
01:06:07
Speaker
things are about to come to you. We're about to get a baby over to you. What's that timeline usually? If it is a primary or first C-section, from skin to baby, usually less than five minutes for a repeat. Depending on scar tissue, it can be anywhere between, you know,
01:06:27
Speaker
You know, same thing five, like a primary from five to minutes to, you know, 10, depending on how, what the scar tissue is like. um Yeah. Usually it's a very short period of time. It's finishing things out, kind of putting everything back together. That takes some time.
01:06:41
Speaker
So not very long. It's a very short period of time. then the baby goes to the warmer, um just kind of an alert. C-section babies don't always come out screaming and crying.
01:06:53
Speaker
Sometimes they need a little help. um They were just, you know, removed. Sure, they were nice and cozy and now all of a sudden, They're not. Yes. And especially they were breached, you know, this was not their intended. ah mo You know, they were not planning this. um ah name um And so it does. They get a little shocked and they're not the criers. And so I always warn, you know, everybody, hey, listen, they may need to be worked on for a second. That's OK. We have our teams in here for a reason.
01:07:22
Speaker
And so then they'll go over and they're basically looked at usually by either a NICU team um that has to come to the OR or they're looked at by a labor and delivery nurse that kind of checks on baby.
01:07:34
Speaker
um And there are certain scores they're doing based on like how baby is, you know, doing checking vitals, that sort of stuff. And so that's usually all done at the warmer. um And then after, once the baby's nice and stable, then that baby, you know, the baby will be wrapped and everything. And then wherever the plan, whatever the plan is for baby will be, you know, done, like either goes with the intended parent um or if, you know, the the care would like to see the baby at that time, they can.
01:08:00
Speaker
um That'll also, again, be a plan for, you you know, you guys to discuss, you know, beforehand, or do you want to just see baby, you know, when you're in recovery or postpartum, like that sort thing. Right. And no, you cannot cut the umbilical cord because you're in a surgical zone. Yes. Just by the way.
01:08:16
Speaker
Yes. That will not happen. That will not happen under any circumstances. You don't get to just like reach in there. No, no, no, no. Somebody will slap your hand away.
01:08:27
Speaker
A hundred percent. A hundred percent. Oh my gosh. No, for sure. So what advice just, again, you know
01:08:36
Speaker
As someone who, you know, you've sat in, you sit in the seat now as, you know, just a medical professional in this field, but then you've also, you know, been the intended parent, what sort of maybe reassurance or like perspective would you want to give to, you know, maybe some IPs as they're maybe, you know, feeling anxious or they're wanting to figure out how to be connected, but they're not sure, or, you know, just as we kind of get to this part of, you know, the journey.
01:09:03
Speaker
So, yeah. We're done. The baby's born. You're going to be connected. um It happens. um That was something that I worried about. i really did. um You know, because you especially like my job. Right. So I see moms that baby comes out, goes straight onto her chest.
01:09:23
Speaker
She feels that immediate connection. I'm not a very emotional person. I've never been, um you know, especially again, especially with my job. you I can't be, I have to compartmentalize a lot. So sure um I learned how to turn it on and off.
01:09:37
Speaker
And so that, that emotional aspect, I'm just not. And I said, well, how am I going to do this? I'm not growing this baby inside of me. I've also missed so many appointments. Yeah. like i'm not feeling you know the baby move um you know so we yeah have this theoretical child out there right that i i know i'm bringing home you know almost felt like it sounds terrible to say but i almost felt like it was like a puppy like i'm bringing home a brand new puppy i was like no i think that's a great description i don't think it's terrible i think that's a great descriptor it can totally feel like that yeah don't bring this little puppy home yeah
01:10:12
Speaker
um It's like all theory. Yeah. i'm like, yeah, like and he's coming home or like, you know, is he going to like me? But it it is a different, um it is a different bond. and And you, you wonder, and you do worry as a parent because you think I have to grow this child inside of me for this child to feel like mine. And even then you feel that and you think that and you think, oh, it's the oxytocin that's going to make me love this child. And you get that.
01:10:39
Speaker
you hear that right um and and it's not true the moment my son came out i was a water waterworks oh my gosh it's like the most pure waterworks and and i don't know where it came from don't know was just it was pure emotion i mean it was so it was raw it was raw emotion like And I'm like, what in the heck? and that and and and it was it was
01:11:11
Speaker
And it was that moment. And he has never not felt like my child. Ever. From that moment. I mean, I have a picture of him as little embryo and I'm like, you know, but like,
01:11:26
Speaker
The moment he came out and I saw his little face, I saw his head, I got it. even Even when I saw his hair, you know, i was like, okay, he's got dark hair. He, he, he, you know.
01:11:37
Speaker
And then when he came out and he was in my hands, I was, this is my baby. And there was no question. And you don't think that even, you know, but even, even mothers that birth their own child sometimes don't feel that connection.
01:11:55
Speaker
yeah that's okay. Right. Even if that does happen to you and you don't feel it right away, that's also okay. Yeah. But I don't, I don't think that's going to be the case because so many of us that are going through this have had such a struggle to get to this point, whether it is a struggle of years of infertility of this huge desire to create a family, um, that just wasn't going the way that you thought it was going to, um you know, the way that, you know, our family was, you know, we just didn't have that chance.
01:12:32
Speaker
There's there's struggles, right? And, um or even, you know, say that, you know, you're the way that you have to build this family is just different. um It's a struggle to go through and then to put your child into someone else and to have this trust.
01:12:50
Speaker
that they're going to take care of your child and grow them and and they're going to be perfect. it It's hard, you know, yeah and then this baby comes out and you know, this is your baby. it It's, you're going to feel it.
01:13:07
Speaker
You're going to feel it. There's no way that you can't. And yeah you're going to bond. There's, it doesn't have, your baby doesn't have to grow inside of you to your baby. There's, It doesn't. They don't. They don't need to anxiety be your baby at all. And, you know, and then the other part is true, too, for our carriers. You know, our carrier, she was like, you know, I miss him, but like a nephew.
01:13:31
Speaker
Uh-huh. That is like the best descriptor. She's like, I love him, but he's not my baby.
Reflecting on the Surrogacy Journey
01:13:39
Speaker
Yeah. Like she knew, like she knew.
01:13:42
Speaker
And I was looking back at pictures today, actually. kind of in preparation and, and you know, she she had tears, but she had tears when she was hugging me. She have tears when she was holding him. she didn't have tears when she was like looking at him.
01:13:56
Speaker
She had tears when she was hugging me because of what that meant for us together and that moment of what that meant, because she didn't, it wasn't that that was her baby. It was that what she was doing for us. And so he wasn't hers and he knew, and she knew that.
01:14:13
Speaker
And, yeah because he was mine. you know he was mine he was my baby um and and you feel it it's crazy it's crazy yeah for sure i mean that moment was just like that's the why that's the why women choose to do this and you know that's that's that and and that moment is exactly you know i think to your point right like you have that instant connection and also if you if it's delayed a little that that's not bad either everybody has that unique story everybody has their unique way of building their family and
01:14:46
Speaker
And it just, there's no wrong. There's no wrong in it at all. Yeah. No. And it's, and then, you know, for us, it's so different. It was, you know, and coming from this perspective and I've had a lot of, you know, I had a lot of people, you know, ask me like, how are you with everything? Like that, you know, because being an OB gen, like i have a, I do have a unique perspective on how this is and stuff. And so, um,
01:15:14
Speaker
I think it's made me a better OB-GYN. I think it's made me be more understanding, um, in different ways, um, to women just in general, going through this, going through fertility, going through just normal, you know, delivery. And so it's just, it's just different. Um, and it, I don't think it's, I don't, I don't, I do not feel,
01:15:39
Speaker
anything negative to the way that i had to have my child. Like, this is exactly how it was supposed to happen. And I'm so thankful that we were able to do this because there There is no, you know, there's no other way that this could gone. Like he's yeah perfect. It's wonderful.
01:15:55
Speaker
You know, hopefully we're going to have a successful journey journey again and, you know, get to do this again, you know? Yeah, absolutely. No, i love that. I love that. Okay. I have two more questions for you. Absolutely.
01:16:06
Speaker
my um My second to last question. Yeah. If there was any advice, again, as just as an OB to intended parents and, you know, even to surrogates, what would that advice be?
01:16:19
Speaker
as you're kind of in this, in that pregnancy part of, of the journey. Communicate, communicate with each other, communicate with your OB and that goes for, you know, surrogate and that goes for the intended parents, you know, communicate with each other and communicate each with the OB and don't be afraid to, um, this is a unique situation. And, um, and, and,
01:16:45
Speaker
Be excited about it. and You know, communicate. This is your chance as an intended parent. This is your chance to ask questions that you didn't get to, you don't get to ask. um Yes. Communicate. I think communication is 100% the most important and it's the most important thing to do. And that goes from the day you meet the OB b to after the baby is born.
01:17:07
Speaker
You know, when you're in, you know, when you're in the, you know, postpartum and you're, you know, you're, with the, you know, with, you know, taking care of the baby, cause you'll have, you know, maybe the OB b will come and visit you. Usually they do. I know ours did.
01:17:19
Speaker
um You know, when you're in there taking care of your baby, your brand new baby, ask questions, communicate communicate with your carrier, you know, how is this gonna look, you know? that kind of stuff, but communication 100%. Yeah, no, perfect.
01:17:32
Speaker
That's perfect. Okay, my last question for you, and it's a fun one. um As you probably know from really just every phone call that we ever had, um I am always holding a cup of coffee, or I guess in this case, it is tea, I will say, I kind of, I diverted, but generally speaking, some sort of caffeinated beverage is in my hand.
01:17:51
Speaker
And so I always love to ask the question, what filled your cup today? literally or figuratively what has been the thing that has filled your cup so literally had a well right now it's water and good for you i know right it might matter my lvn sch my nurse did it you you know it's not by choice okay because i will tell you that i did have some coffee but I did make myself a London fog today, which was quite lovely.
01:18:25
Speaker
like bar call i had a love at London fog. um But no, what, what filled my cup, I think, um I think figuratively was just, I think looking back at preparing for this one, being able to do this because i forget how lucky I am to be in this position.
01:18:47
Speaker
I'm taking care of women and hopefully taking care of more women doing this. But getting back to looking at my pictures and seeing, you know, you know, you have to go back over the years, you know, to see years from before. and um just getting to see my son as over the years and growing and and he's turning into such a fun little guy. and getting to see those little snapshots today, I think just really, you know, um spend the day, you know, spending a few minutes, like looking at that beforehand, just really, really fill me up and realize like how lucky I am to have that little guy and, you know, hopefully, hopefully have another one.
01:19:25
Speaker
Yeah, for sure. Life doesn't stop. And it's so fun to be able to just get to like, take a pause and yeah and and not for anything, but he is like particularly adorable.
01:19:39
Speaker
He's a precious little guy. is. He is. and he is um He's a good one, man. He's ah well, he is a toddler. So I don't You know, we're doing that, but. Oh yeah, sure. You know, so there's those days, but yeah at least he's cute all the time.
01:19:53
Speaker
He is cute. yeah He little guy. He is a cute little one. ah You know, funny and he's got a personality. He definitely has a very big personality, which. I'm thankful for that he will, I think that will come in handy when he gets older. so oh for sure.
01:20:09
Speaker
It's hard now on occasion, but I think it's going to serve him very, very well as he does that. No, that's the good, that every mom needs that mantra, I feel like. just Or every parent really just needs that mantra of like, yeah, this will serve you well later.
01:20:24
Speaker
This is worth it. I need this. yes yes Yes, absolutely. I can suffer through this. This is going to serve you well. like This will serve you well. he is my little bear Oh my gosh. I love it.
01:20:39
Speaker
Well, Audrey, again, seriously, thank you so much for doing this. Thank you for just your education and your, you know, just beautiful perspective of getting to, to be able to look at this from all of the different, um, sides. And so again, I just really appreciate this and sending you all of the baby dust and all of the good vibes soon. Hopefully. Thank you. and Absolutely. My pleasure.
01:21:04
Speaker
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01:21:21
Speaker
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Speaker
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Speaker
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Speaker
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Speaker
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