Dr. Stephanie Waggel: From Career to Cancer to Motherhood

0:01 Hello, today I have with me Dr Stephanie Waggle. Dr Waggle is the mother of two and a psychiatrist specializing in perinatal mental health. Dr Waggle, thank you so much for coming. Hi, well, thank you for having me. I'm really excited to hear all about your birth stories. I got to hear a lot about medications and pregnancy last time. It was so interesting. Now I get to hear the personal side, so I'm going to have you go ahead and tell your birth story All right, I suppose we would begin once upon a time. I guess let's talk about the first child first. Let's go in order. I have a three-year-old daughter who's almost four, so this was just before the pandemic.

0:47 I have a boy and a girl, so I suppose I was a little bit older than the usual, which I think is actually a good thing. I know that there's so much negatives about the geriatric pregnancy, but I think having an established life and career and stability and being fully mature and knowing what it is that you're doing is actually pretty helpful. So I think it was good that I was like 32 when I had my first kid, so I think that's a good age. So let's see, conceiving was interesting because I actually had kidney cancer and so I had to sort of plan it around my follow-up testing, because you can't really go and get a CT, an MRI, because of the contrast with the MRI there's some radiation with the CT too.

1:36 So if you can avoid getting those tests while pregnant, I think that you should. So I had to kind of time it around that. So I was supposed to get this test done every six months. So basically I would just start trying the day after my CT or whatever scans that I was getting. I had been on continuous birth control for several years and that is when you skip the placebo week so that you do not have a period. The reason for this is I have endometriosis, so my periods were horrific and so it's actually sort of I'm just going to try not to get like too medical, because I know that I'm supposed to be telling my birth story and not giving a grand round, but suffice it to say that it's sort of like the American way to have your period.

2:22 A lot of European women just stick with the continuous birth control and don't have a period. But here in America it just seems like everybody wants to have their period, which is helpful to know that you're not pregnant and that sort of thing. But I won't go into all that. So I was obviously going to have to start having a period again, because so I would have to stop the continuous birth control and endure a few horrific periods, because you obviously have to stop birth control in order to get pregnant. So I had got my scan, so then I immediately started trying and then I had to obviously like regulate, get back on my cycle again, and it was just, it was a little bit difficult, but I actually discovered, instead of going to your chain pharmacy to buy ovulation tests, which are like $50 for two, you can buy 100 of them on Amazon for like 20 bucks.

3:16 I found this out and then that was very, very helpful. But by the time I really started figuring out my cycle again and that sort of thing, it was time for another scan. So then I had to stop trying to get pregnant, get my scan done and then jump aboard back on again. So it was a tricky timing. But after about eight months I took a pregnancy test and it didn't. It was basically negative. But then later on I look you know you're supposed to only read it within a certain window, but later on I looked and there was like the tiniest little line and so that's obviously pregnant and so, like I said, this was in 2019.

3:58 So this was before the pandemic, so I guess the world was a little bit normal back then, and so I own a busy private practice and so I understand, especially like when it comes to birth plans. I understand that things probably aren't going to go to plan, but it's at least nice to have a plan in mind so that you know it's not just utter chaos Now. Being a physician myself and having delivered 12 babies, I know that a lot of practitioners kind of have a negative not all, but some have a negative view about birth plans and they're like kind of roll their eyes and they're like you know it's not going to go this way and you might as well toss it out the window now.

4:45 But I feel it's at least nice to have my preferences written down somewhere for documentation purposes and I didn't get right a novel or anything and I made sure everybody understood. Like you know, I know that statistically it's not going to happen exactly this way, but I did schedule things just just in case I could get them to work out the way I wanted to. So I actually scheduled an induction and planned my caseload around that being how it actually happened, and so I stopped booking patients for that week that I scheduled my induction and I came up with plans about some patients that required more monitoring than others, like what to do if I went into labor early and that sort of thing.

5:31 So I had a plan, but I was also understanding that if it didn't go that way, then you know that's, that's okay, we can change some things and actually I went and had my induction. So I did deliver exactly when I thought I was going to and so as far as my birth plan was concerned, so I put the name of the doctor and I understand that you go into labor, it could be at any time, so that doctor may not be working, but it was an induction and it worked out that way that the doctor that I wanted was the doctor that was there. And then I actually went ahead and I picked out a pediatrician. You know they have you do that ahead of time.

6:13 And then of course, you want to put your past history. So I put about my kidney cancer and then during labor I said like try different things, different positions. And then I picked an epidural and brought the first door year classes in soldier and deaf people and of course I needed a. I didn't realize until I had my son that I really didn't have much of an epidural during the birth of my daughter because by comparison I was like, oh, I think what happened is it all pulled to one side of my body? And so it was only kind of a half epidural. Because when I had the full, real epidural with my son, I was like, oh, this is a lot better. I actually got the birth plan from I think it was like Huggies or some diaper website.

6:57 It was just a really quick two page fill in the blank, multiple choice kind of thing, and it said like special preferences. So I put that I'm a medical doctor, I teach pre-med students, so I wanted to take some pictures or photos, like, of the epidural and stuff like that. And I said, oh, that's fine. Oh, there was like squatting, standing, all sorts of different positions you know. And then I wanted to avoid a C-section if possible. But then not completely lose my mind if they said that that is what needed to happen, because the ultimate goal is really safety. Oh, and then I said I wanted to have a mirror because I've delivered babies before, I'm not really queasy. And then there was.

7:39 I had to do like all this research about this delayed clamping one to three minutes after delivery. There's like a lot of mixed literature, but one to three minutes is the time period that I came up with and then have my husband cut the cord. And then I now, speaking of mixed literature, the cord blood registry. There's some people that say like it really never comes in handy and some people were like, yeah, I actually used it and I said, you know, it's a piece of mind, I think I'll get it. But I guess I was really nervous because they say that like sometimes they aren't able to get enough of it to be able to store it. So I was like, oh, make sure you get enough of it. And then there is a small part for after delivery.

8:21 So I said that I wanted to hold my baby's skin to scent immediately after. I wanted my baby to kept with me at all times, and then I chose breastfeeding, which that could be like a whole other topic. So basically, for my daughter it was scheduled induction. I just went in and I was in labor, actually called in a prescription while I was in labor because I had a patient that had a panic attack, but I was just chilling. I think that because I have been present for so many deliveries that it wasn't like the shocking new experience for me. So I was able to like be well aware of what was going on.

9:03 I think it could be pretty scary if you've never been in that environment, because there's a lot of mysterious things going on that you might wonder about and there's like not good explanations for a lot of things that are going on, but having had the experience I knew what was happening, so it wasn't really that scary. So it was pretty smooth with my daughter. I didn't know at the time, but I guess it was not a real epidural, at least on half of the side. But I didn't have a kid before, so I didn't know how much it was supposed to hurt or not. So when you say that your epidural was not working on one side, was it just not. It was like numb on one side and then did it take some of the edge off on the other side, or you just were like straight up in pain on the other side.

9:50 Oh, it was like straight up pain. It was like a natural birth on one side and epidural on the other. Yeah, that doesn't count as an epidural I mean it was a half and half. Yeah Well, what's the point of that? You know like it's so funny because they'll be like oh well, it works on one side, okay. But if you come in and you have a broken leg on one side, people don't say, oh well, it doesn't count because you're. Only one leg is broken. You know it's like okay. So then in, like in my book, you didn't have an epidural and I don't know why there's some sort of disconnect and like difference in judgment when it's a woman having a baby versus somebody that's coming in with a broken leg.

10:32 But, pain on one side of the body is still pain. I'm just saying. Yeah, and I didn't have anything to compare it to and I'm like and I actually did, I could tell you know, it really hurts on one side. And they were like oh, it's because you've been laying on that one side, like let's flip you over. But I think it was too late, I think the distribution had already taken place and I was like, well, it's not like I'm going to go get another epidural or something. I don't know. Right, yeah, they didn't have me flip over, but I think it was too late. Yeah, sometimes that's an option. Sometimes it's just like get a bolus and turn you over. But if that doesn't work, well, and then I was I figured. You know I'm already committed. Let's just keep going.

11:13 So then, how was pushing for you with with the half epidural? You know it was, it was fine. I actually I do a lot of ab work and core work and so the pushing, I think, wasn't really a problem, they said. They said I was a good pusher. Yeah, I didn't have any issues with pushing. My husband was very helpful. Oh yay, he was very encouraging. He was, I think, pushing too. Yeah, probably that's the problem. We all do so. How long do you think you? Do you remember how long you pushed? I want to stay three hours. Wow, that is a marathon, but you do marathons too, right? So no problem, yeah, I do. They kept warning me that my pelvic outlet was small and that the baby might not fit, and all this stuff, and I'm like, no, no, we're, we're going to try our best here.

12:02 She made it work. She decided to help out and come out. Well, she's tiny, six pounds. So I mean she helped me out there. Yeah, so, and then, as far as your birth plan, like the rest of your birth plan, the after delivery birth plan, did that go the way that you preferred? After delivery yeah, I mean, they got. They got enough sample for the cord blood. My husband cut the cord. I suppose that they did the clamping somewhere between one and three minutes. I had a mirror, I got skin to skin, I got the breastfeed. Everything went very smoothly and the pregnancy itself went smoothly. I think at this point I thought, oh, like I could have like five kids.

12:43 But things changed with my son. Yeah, so then, just to comment on the birth plan I like that you talked about the birth preferences because, again, it's great to know what people want, but what's so interesting to me is, most of the time with people want is what we already do, because we're adopting a lot of the stuff that's on the birth plan is just best practices, so we're adopting a lot of that. Most of the places I work they're doing the cord clamping at least one minute. They'll do a little bit longer, but then they don't recommend longer than five minutes because of the potential for jaundice and they will explain that. The cord blood it's good to do the cord blood banking If it's something that is affordable for you, then that's perfect.

13:29 There's all sorts of things that are now normalized that I think that part of the reason that people do the birth plan is because of this culture in obstetrics that it's still, it's lingering, but women felt like they had to come in with their dukes up trying to ask for best practices, and while that may be still the same thing in certain areas and with certain providers, most of the time the preferences that people come in with are what we're already doing. It's still great to have them Right and we all are working towards, most of the time working towards that same goal. And then you know when things start to go awry. That's when we have a conversation and that's when things get kind of. You know, it's like you go into the hospital for a procedure and somebody says you're gonna have this procedure and then suddenly you're not having that procedure, and so if things do go awry that's where it does get stressful.

14:20 But if it's straightforward, most of the time everything in the birth plan can be accommodated for, unless it's something kind of wacky. You know that is against hospital policy, like eating your placenta in the room. That would ever be part of the birth plan. But that was not on my birth plan. But I did watch a movie about that one. Yeah, in the room they ate it in the room. Oh, I don't know if they did it in the room. Yeah, some people take it home and eat it. Apparently. You know it's right, right. Hey, you know people got their preferences. Look it's me, it's me yeah. Let's move on to your second birth story. So then, how is that pregnancy? When did you decide to get pregnant? All of that fun stuff?

15:00 How old was your daughter? Oh, so actually so my daughter was one, she was almost two, so it wasn't like we were trying to get pregnant. We were watching it was the wire or something, and where they kept saying let the chips fall where they may, which I guess is like a gambling. It's like if we do, then we do, if we don't, then we don't. So we were just saying let the babies fall where they may. So we were not neither trying nor not trying, and so I was. We were actually in Disney with my daughter, who was not quite two, and my period was late, and so we instacarded pregnancy tests to the hotel room and they kept just like not saying yes or no, like nothing was showing up, and I'm like this is just weird.

15:46 And so I was like, oh, then finally there was one that said yes and I was like, oh, okay, well, this is a fun surprise and let's see. So I actually, like I said earlier, with my daughter I could have had five more kids, because the pregnancy was fine. There were really no issues a little nausea, some swelling, and then the delivery went pretty well, no issues. But with my son I was like vomiting every day I was. It was really bad. I was sick. All the time, I felt miserable and that actually, towards the end of my pregnancy I had to be on crutches because I had this left adductor muscle pain that I assume was from the relaxin.

16:33 My muscles were just kind of turning the jelly and I actually was not able to draw my leg in towards my body, unable to lock. Basically that was not fun and it was just really painful and I couldn't sleep, and so that it's all relative. So, compared to my first, I was like Whoa, this is, this is not going anywhere Like the first one. So, yeah, pretty sick, Lots of pain, couldn't walk, oh my gosh. I was so swollen, like you could write your name in my leg and it was like the pitting edema, like plus three, like you could. Just it was sunken, oh my goodness. And then, like I couldn't wear any shoes, I had to buy extra wide shoes.

17:17 It was really something. And so I had an induction scheduled for my stand. He came, you know, when he felt like it, because he, he's just a different matter all together, and so I actually my water broke at home, and I know that a lot of times when you go in, like they might send you home. So I took photos to show them how much water broke, which was good, because when I went in they were like not going to admit me and I was like, no, I have pictures. And then they're like, oh, okay, let me see. And they're like, whoa, okay. And then they immediately got me into a room. So I was like, okay, good. And so they had the heart monitor on and they were saying, oh, it seems like the umbilical cords wrapped around his neck.

18:04 And I'm like, oh, this kid, I'm telling you what. So, basically, my daughter, everything went smooth and the whole birth plan went exactly the way that I had it. But my birth plan for my son, I mean honestly, like overall it wasn't that bad. But it was pretty scary for a second when they were saying about the umbilical cord and the doctor who was delivering him said that if he doesn't come out like within the next few minutes, they would have to take me for a C section. And I was like no, and I pushed so hard 15 seconds after she said that he came out. Because they were. They were actually talking about vacuums and clams and I heard them chattering in the background about getting these devices out.

18:49 And I'm like Nope, and I was like and then like so fast he came out. So some of the stuff on my plan was skin to skin immediately. We did get to do that. I don't know if it was one or three minutes for the cord clamping. I was too busy freaking out about the word vacuum. We were able to get his cord blood banked. I suppose that they were able to get enough. Oh, I had an epidural with him and I was like, oh, this is an epidural. Yeah, so definitely had an epidural with him because I didn't really feel anything at all and obviously I was able to push. Well, I think the motivation with all this talk about C sections and vacuums and what you know, all these different things that were not on my plan really is what got me to push.

19:35 It was really quick, like super fast, a little bit scary, but not scary for that long, because he came out and he was crying and he was pretty good and I was able to breastfeed and do skin to skin and we didn't have to go get a C section and I actually had a real epidural. So it wasn't. It wasn't that bad, it was only scary for like that 15 seconds 15 seconds of abject terror. Did you have? I forgot to ask you about this for the last. Did you have any kind of repair that needed to take place after Either delivery? How I sure did.

20:16 Wait, it's like they told me about my small pelvic outlet and all this, and then my both of my kids are like six pounds. It's not like they're huge, but I actually had a preference on this. So where it said a Pseotomy, I said, rather than risk of potential tear, I would have one. Yeah, because the other option was only as a last resort. And then another option was like don't do it at all. Yeah, for the intended reason. Yeah, yeah so there was tearing, for sure, both kids, but it is what it is. I've actually had to do those before, so and it's, it's like I'm picturing the other side and I'm like, oh, I don't want.

20:57 That's when I was like, I don't want to think about it, or no right, oh my gosh, I actually had somebody. I don't even I don't want to get off on a tangent, but there's that husband stitch which is like so, like I don't know that's illegal, like what now? Like that's terrible. Not even. It doesn't even work. Are they like? Throw an extra one in, then it. I don't know, I guess, if that's what you want, but don't, I don't know. No, so I don't think I got that. No, it's not standard. Well, cuz like some people get their general practice to do in a Pseotomy that used to be the thing, and some of the old school Doctors will still do that but it's just not really, and you know if you're gonna tear to afford right that was my selection.

21:38 I was like, if it's, you know, there's a tear, or it looks like a potential tear or something. Yeah but don't do it just for fun, right. And then so how is the recovery? Do you remember, like, what they ended up doing and how the recovery was for you, and did you have any pelvic floor issues? Oh, pelvic floor issues. So, part for the course for my daughter, everything went pretty well. I recovered quick again, no issues that stand out, but, like I said from my son, I could not walk, and so I was hoping, by some miracle, that delivering him would be what allows me to be able to walk again, but alas, that was not the case, and so I obviously needed physical therapy, and then, specifically, pelvic floor, because the Left adductor muscle that wasn't working was it towards the pelvic region, and so I was Specifically looking for pelvic floor physical therapist.

22:33 So today, in 2023, I know plenty of pelvic floor physical therapists. However, back when this was happening, I couldn't find any, and I made the mistake of asking my insurance. My insurance company sent me a list of they're like we don't know any pelvic floor physical therapist, but here's a list of physical therapists. I'm like well, I guess I got to start somewhere, but here. But I called the first one was like this is a family practice. And I'm like, oh, okay. And I called another one and they're like this is a dermatology office. And I'm like, okay, and I called another one and they're like, yeah, this is a physical therapy office, but we don't take your insurance.

23:17 And I'm like, what is this lift they gave me, because not a single number on it was beneficial in any way. Wow, and so my OBGYN said that maybe I should just wait a little bit and see if it gets better. And so that's what I did. And it did get better. I would. I was able to walk a little bit, like about a month out. And then I'm, I'm crazy and started training for a marathon. Yeah, I was like, oh, I could finally walk. I might as well train for a marathon, that's, that makes a lot of sense. But I was running. I noticed that the left adductor pain, which I wasn't able to find a physical therapist for at the time, was most prevalent when carrying Either child on my left hip, because I think I default to carrying my kids on the left side so that I can use my dominant right hand to do you know the cooking and the cleaning on that sort of thing.

24:14 I definitely wanted on the record that I'm in physical therapy now, but I called every single physical therapist on the list my insurance gave me and none of them were either Physical therapist or took my insurance, which was so silly. Anyway, currently, almost two years later, yeah, I found one. But I was like, okay, well, I love running and you know I did sign up for this marathon. So I started training for the marathon and I realized that if I was to hold one of my children, it's always on the left side, like I'd have them on my left hip, because my dominant hand is the right hand and I would need my dominant hands. Do you know, cooking and cleaning and Whatever else.

24:56 So I Realized that that was a huge contributor to the left adductor muscle pain. So then I started Lipping them and holding them on the other side. So that actually helps substantially. So, and then I started running and it would only hurt after maybe 10 or 12 miles and I it's 26.2, so I got it. I had to build that up a little bit. So what I actually did was I found this like Helvic girdle online and I put it on and then the strap that went around my left leg actually helped too. So the two things that helped the most were switching the hit that I was carrying my kids on and then wearing the pelvic floor stability apparatus if I was going to go on a really long run, and so I was able to sort of get back to normal.

25:50 However, whenever I was doing the marathon around mile 16, again the pelvic floor, the left side adductor muscle like turned to gelatin, and I actually had to text my husband in the middle of the race like Look at my location and somehow try to find me and hand me this girdle, because I'm like dragging my leg. It was really bad, and so I, I actually I did pretty well for the first 16 miles of the marathon, but then, like my pace was like I don't know, like nine or ten minute miles and then after 16 are really really slowed down like 15 minute miles.

26:30 But I finished, which is great. I was proud of myself for that, considering a few months prior I wasn't able to walk. So this time I'm training for another marathon and I'm in physical therapy and I have a better plan. But I guess what I'm most worried about is if we get back to my daughter. When I the pregnancy Smooth, just a little bit nauseous and swelling, no big deal Delivery except for the fact that the epidural didn't work on one side with the delivery was smooth I was like, oh, I could have five kids, but then, with my son throwing up every day, not being able to walk, and then that I was like, oh, I don't know how many more times I could do this at all.

27:11 So my fear is that if I were to have another child, this inability to walk would return, and it's especially. Everybody wants to be able to walk, but it's especially detrimental to me because I'm a long distance runner and so it's like my passion. So I guess I'm going to have really intense physical therapy. So now I'm going twice a week and I have almost an hours worth of physical therapy exercises that I have to do every day, but it's a preventative measure. So I would say that the adductor pain and having to be on crutches was probably the most difficult part, even more difficult than throwing up every day.

27:54 Yeah, I didn't like the throwing up every day. Did you have any issues, like with the actual pelvic floor? Did you have any? Yeah? so the pelvic floor physical therapist which I found out later whenever I got into the perinatal psychopharmacology. I'm not getting specific pelvic floor physical therapy now, it's more about the leg, but they said what was going on was part of the pelvic floor. But you didn't have like necessarily the classic pelvic floor symptoms, you just had pain Right right. Like I mean. I was. I was about to say if I sneeze IP, but that actually is not the case anymore. OK, so the therapy is helping. And then you mentioned that there was some.

28:36 You said that breastfeeding was a whole other issue. Was that something that you desired and then had some trouble with? Like we could do like an entire episode about that. So with my daughter, and here's the thing is that I don't want to sound like, oh, I was so dedicated to it, I'm so hardcore, I wasn't going to give up, because if you formula feed, that's fine. I don't want to shame anybody, but I really was like this is excruciating, but I'm going to do it anyway. But I don't want to say that to sound like I'm so cool or whatever you know, but it was really painful and every time I breastfed I like started crying. My nipples were bleeding. I couldn't even get in the shower because droplets of water, they were so sensitive. I eventually did figure out what to do with my second, but with my daughter it was excruciating.

29:22 I got, I got like nipple shields. I got that lanzen oil, lanolin, lan, lanolin. I tried that. I read everything that you could try to do and it was just so painful and so horrible and just so excruciating. I kept doing it. I don't know, I have a glutton for punishment. I think I see that as kind of you know. You seem to have like this funness for suffering, for pain. Yes, pain and suffering. It did eventually get better after a while with my daughter. Now I wised up and I figured out the trick with my son, because I was like I can't. No, this is so horrible, I was so scared. What I figured out to do that was, I believe me, I tried everything.

30:06 I tried creams, and I went to lactation consultants and I tried the frozen cabbage, all sorts of things with my daughter. But the solution was actually quite simple, unfortunately took until my son. The thing that helped was like a gradual increase in stimulation. So instead of just no kid on my nipple and then kid on my nipple, which isn't abrupt change I actually would take a towel and put a towel over my nipple, okay, and just leave it there for like 30 seconds and then I would start rubbing the towel and so it was the gradual, subtle increase in friction and stimulation and then put the baby on, instead of just no baby and then baby.

31:00 It was okay. A towel and then a moving towel and then a little bit pinching of the towel and then baby, and it was the gradual transition that finally made breastfeeding bearable. But was it still painful or was it bearable? No, no, Well, I mean like, was it enjoyable or was it just? bearable. It was much better, and I mean it wasn't excruciatingly painful it was. Yeah, yeah, I wish I would have figured, no I didn't cry every time I breastfed with my son. I wish I would have figured it out. I don't know. It seems like such an obvious thing, like an gradual desensitization, if you will.

31:42 I was surprised I didn't figure it out. But, I'm also surprised it wasn't in any of the millions of suggestions or forums or spreadsheets or literature that I read. Yeah, that's so interesting. The only thing that I've heard of that is similar. That people have tried to do is to do a little bit of light pumping beforehand. I tried that too yeah, it did not work. Mm-mm no, when are the kids just super aggressive on the breast? Yeah they're gnawing Because they're supposed to like the normal latch is a little bit of stimulation at first and then it kind of picks up and then it starts to have that like deep. I just have like really ravenous children. I think. I mean, I went to like three different lactation consultants and nothing worked until I figured out the whole towel.

32:26 Gradual, how desensitization thing, that was the ticket. That should be a method that you should share. You should do an online course and a full sensitivity. I know right, stimulation, right, slowly increase it's amazing. And then, so how long did you, how long were you on maternity leave for? Okay? So how did you? Okay, how did you balance career and motherhood? That's a great question. Wonderful yeah, in that immediate postpartum period. Well, I will tell you, I don't know how any of my colleagues that are still in the hospital have kids and can do that, because the hours that I was working when I worked in the hospital were atrocious.

33:06 You couldn't even keep one person alive, let alone two kids. So I own my own private practice so I can make my own hours, and it's not like I purposely like made myself suffer, but at the same time I have patients that really depend on me and I couldn't just be like I'm not returning me by. So it was a lot of meticulous planning. Like I said, I scheduled the induction, I scheduled no patients, I stopped accepting new patients, and then my patients that require higher levels of care and more periodic check-ins. I would have on the schedule for like Thursday, let's say so. Then people that could go a few months without seeing me I just didn't schedule them for like the first three months after I delivered and then people that really did need to see me.

33:53 I'd have them on like Thursdays. So I think I would say I took a month off of no work, but of course, like people would need prescriptions or pharmacies, would you know, call with some kind of the insurance the buckle, so it's not like I wasn't working at all, but I stopped seeing new patients and then about a month later, like I started seeing patients on, for example, thursdays that would need to check in, which was honestly like fine when I was doable. And then my husband had paternity leave, so that was helpful too. And then COVID actually kind of helped, because it was like then you could do hella medicine, which really wasn't such a thing before COVID, and so you know, I could check in with my patients virtually while, you know, my daughter was here and then with my son, covid was really going on.

34:45 So like everything was virtual. So it's not like I overworked myself, but it's just like I had to prioritize, you know, certain patients. So there were weeks where I'd like work like two days a week or something. It wasn't overwhelming, but it really required a lot of logistics, a lot of planning, a lot of scheduling, a lot of okay, this person can go three months, so I just won't see them for like three months, but this person needs to be like a Thursday person, that sort of thing. And I love that you allow yourself to have that prioritization. I think a lot of moms there's this feeling that we have to please everyone or be there for everyone and I know we talked about this last time.

35:31 You can't beat everything to everyone Right? So that you're able to just sit down and prioritize that and make that clear and establish your boundaries. I think that's amazing. Did you have an assistant at that time, or an office? manager. I did not a full-time assistant Like I do now. Like now I have a full-time office manager, mariam. But I had some interns which are like med or pre-med students. It's not like they would work a set number of hours each week, usually during summer and spring break and winter break, like I have a lot of them doing a lot of work. So it really depends because obviously, like, if they're away at school they're not going to be able to do but virtual things were like really good, they could help with if a patient you know couldn't find a certain vitamin somewhere, they'd be.

36:23 Like, for example, a lot of people have hard time swallowing fish oil pills because they're so humongous, so they would help be like oh, here's a fish oil pill, look smaller things like that which were really helpful so that I wouldn't have to fool around finding like small fish oil pills when I have a baby that I need to feed and take care of. But nobody that was full-time on the schedule like all day, just periodic help here and there and then, when did that come about and what was that? I know this isn't necessarily birth related, but just I just think it's important for moms to kind of figure out when and how and learn to kind of balance their careers, and a lot of the people that I've had on have had their own business. Having an assistant is like chef's kiss man Mwah, like that's, you got it.

37:05 That assistant is great. Well, ever since I started, I did teaching and you have physical exam skills and suturing workshops and things like that, and so a lot of the students wanted extra hours because I have hour logs that can log how much time they spend shadowing and stuff like that, and I'm like, oh well, if you need more hours, then you can help this person find vitamin or things like that, and so that's, they started volunteering to help. Obviously, they can't do anything medical, but they can do things like here are the hours of the Walgreens down the street or stuff like that. Yeah, and then when you, how old were your kids when you transitioned to be able to having a full-time assistant?

37:49 Well, I guess it would have been about six months ago. So, oh, wow, yeah, so the assistant's helpful. I mean I had, I had a nanny too. Let's not play games, yeah, no, but I mean that's the thing. We need a village, we need help, we need yeah, yeah, exactly. And I just want to really normalize that. You know, and not everybody always has the resources Right. No, oh my gosh, childcare is so expensive. I really had no idea. It's like for a lot of people, all the money that you make having a job is the money that you want. Like it goes exactly to somebody taking care of your kid. It's crazy yeah it is yeah, and the thing is, if you're going to work, it's such a balance.

38:29 But also, you know, I want moms maybe potentially moms that are listening to this, that haven't had their kids yet to really start thinking about reaching out and finding that village, because it's so hard to just do this whole motherhood thing alone. Find moms that are in the same stage of motherhood and spend time together, or maybe one takes the kids for a little bit, then trade off that kind of thing, because I just, I mean, I didn't really feel like I did that until COVID, which I think a lot of us did. Fine, we're all home and now we have to figure out how to safely interact with people. So what we did was go outside and meet our neighbors. But I think, you know, just maybe thinking about that beforehand would have probably been a little bit better for me and for some other moms that are just not thinking along those lines.

39:14 Because there's this whole what we talked about last time, that toxic independence. You don't have to be all of the things and so just have moms kind of wrap their heads around that going into it. There's no reward for doing it all by yourself. You have to be supported and it's important to teach your kids to have them watch you be supported as well, because you don't want to teach them to go through life alone either. So just as a reformed, toxic, independent person, formally. Formally Well, it's reformed. Still working on that, I think it's important to give people the permission and the space to be able to recognize that it's not expected that you do this alone and that the village used to be there for a reason and that maybe it needs to be more purposeful when we become mothers and intentional in building that village.

40:08 So just that kind of encouragement. Something that I ask everybody at the end is if you could go back and talk to yourselves before all of this experience having kids, pregnancy, all of the things is there anything that you wish that you could tell yourself or wish that you had known? Well, I guess I'm glad that I waited until later on. I was nervous waiting until later on, but I think the more stability was actually better that way. But that's something that I did anyway, so I guess it wouldn't if it was like a thing that I could change. I guess it would be more persistent in calling the physical therapist than not just using the stupid list that my insurance gave. There's so many things that are different once you become a parent.

40:52 I don't think that you realize a lot of the stuff that you say makes absolutely no sense once you're actually living that life. For example, before I had kids, I always was like, oh, my kids are just going to eat whatever I give them, and if they don't like it, then too bad. And now I can't. That just doesn't make any sense. So I'm like wait a minute, I want to feed my kids. Wait, now they're actually not eating because they will literally only eat pizza. You know just things like that. Or like if I saw like a kid screaming in public before I had kids, I was like, oh, they can't keep their kids calm. And now I'm like, well, no one can. They're little moms, you can't just keep them quiet.

41:35 Yeah, so I mean, it's not like anything big, it's just like kind of some of the little things like that that I thought that now that I have kids I realized made absolutely no sense at all, like I can't believe. I thought like that, that's so silly. Yeah, maybe have different expectations. Right yeah. And is there anything that we didn't go over, that you wanted to talk about? I think we covered it pretty much. I just, I guess I don't want two things I want to clarify is I definitely got physical therapy eventually, and the other thing is it's not good, or it shouldn't be glorified, to force yourself to go through excruciatingly painful breastfeeding because I don't want anybody to be like, oh well, like you know, it hurt.

42:20 And then I stop like that's fine, You're probably, that was probably a better idea than I thought I knew baby, and that's important. And it doesn't matter how, as long as it's an approved pediatrician, approved method. Right, exactly. Well, dr Waggle, thank you so much for telling your birth story and sharing all that with us. Always great hearing from you, and we need to sit down and come up with other enlightening things to talk about. Oh, yeah, yeah. I have so many good ideas, just find them my way, let's do it.