Special Edition: Prenatal Care with Jen Hamilton – S4E4

Jessica Stewart-Gonzalez: Welcome to The Parenting Brief. I’m your host, Jessica Stewart Gonzalez, an Arizona working mom and chief of the Office of Children’s Health at the Arizona Department of Health Services. If you’re a parent or expect to be one soon, this show is for you. From pregnancy to toddlerhood, we’ve got you covered with expert advice and helpful solutions.

Jessica Stewart-Gonzalez: Thank you for joining me today on The Parenting Brief. Whether you’re a first time parent or have been through the process before, there’s no denying that pregnancy and labor is a journey like no other. It can be both exciting and daunting, and that’s why it’s so important to have access to the right information and support throughout the process.

Jessica Stewart-Gonzalez: Today we’re talking about prenatal care and why it’s essential to a healthy pregnancy.

Jessica Stewart-Gonzalez: With us today is Jen Hamilton. Jen is a board certified labor and delivery nurse, founder of the nonprofit Hot Mess Express, and an influential advocate with a dedicated audience of more than three million TikTok followers. Jen, I cannot thank you enough for being so generous with your time to have this conversation with me today.

Jessica Stewart-Gonzalez: Your content has not only helped me personally in healing parts of my own birth trauma journey, but you have absolutely influenced me professionally in addressing public health related to maternal and child health as well. Thank you so much for being here.

Jen Hamilton: You are so sweet.

Jessica Stewart-Gonzalez: Like seriously, you’re amazing.

Jen Hamilton: Oh, thank you so much.

Jessica Stewart-Gonzalez: So let’s just start with the basics. What is prenatal care? What are the components of prenatal care? And when should it start?

Jen Hamilton: Yeah, so that’s a great question and a lot of people really don’t know until they have to figure it out for themselves. So prenatal care will start when you find out that you’re pregnant and if you’re trying to conceive, it also can begin before that. Prenatal care during the pregnancy is going to largely depend on your risk factors and what your life was like prior to getting pregnant, your family history of things, so that they can make sure that they’re giving you the care that you need. A lot of people think that prenatal care is just a bunch of ultrasounds, and I think that sometimes it can be surprising to people to see that you really only get like, a couple maybe ultrasounds unless they’re worried about something.

Jen Hamilton: So it’s more than just going in and seeing the baby. It’s making sure that you’re taking the proper precautions as far as avoiding certain things that could be harmful in pregnancy, making sure that the medications that you’re on are appropriate for pregnancy. And there may be medications that you’re on where the risk of going off of those medications outweighs the benefit of not taking those during pregnancy.

Jen Hamilton: So for instance, if you have like a seizure disorder or something, you know, if you googled, they would say don’t take seizure medications during pregnancy, but if you’re somebody who is likely to have a seizure, that’s more harmful than, uh, keep continuing with the medication. Sometimes you’ve got to take things that are harmful in pregnancy if the benefit outweighs the risk of stopping it.

Jen Hamilton: So, you know, you’re making sure that you are taking those prenatal tests that are, that are recommended, if that is something that you have been given informed consent about and are comfortable with. Some of those tests would include things like a gestational diabetes test, which is done, towards the kind of middle of your pregnancy and there’s some reasons why they don’t do it right away. But if you do come back positive for things like gestational diabetes or other risk factors, they will help you modify your lifestyle and your care to be able to have the healthiest pregnancy possible and then that will continue all the way up until you deliver and one of my big beefs with our prenatal and postpartum care is that we have all of these appointments leading up to the baby being born, and then once the baby is born, we have like one shmeasely little appointment at the six week mark.

Jen Hamilton: But what I really want to drive home is that if you are concerned about anything, even though there’s only that one little shmeasely appointment, you are absolutely able to and should reach out to your provider. So things like having, you know, headache, blurred vision, seeing spots, not feeling right, or things like feeling really depressed or overwhelmed, all of those things are things that you should talk to your provider about even after that baby is born.

Jessica Stewart-Gonzalez: How do you navigate the difference between, like, just not feeling right and maybe something is wrong with, I just had a baby and nothing feels right, or I’m pregnant and nothing feels right. How do you really navigate when you should be worried versus when this is just part of the weirdness of pregnancy and giving birth?

Jen Hamilton: Yeah, there’s a lot of people who take that, you know, thought like maybe everything’s fine because everything feels terrible and that can kind of keep them from getting the care that they need when something is wrong. So what I always tell people is it is better to be safe than sorry. Like if there’s anything that you’re concerned about, even if maybe you’re hearing it from family members like, Hey, I’m noticing that you’re really down or, you know, kind of leaning into your own intuition and feeling like, you know, I just don’t feel right. Sometimes people go into the office and they don’t really have, you know, a tangible thing that feels wrong, like they can’t really put their finger on it, but just going in allows us to be able to look a little bit further and see that maybe their blood pressure is really high and they just feel off.

Jen Hamilton: So sometimes the warning signs that we may have after birth is just trusting our own intuition when something feels off.

Jessica Stewart-Gonzalez: What would you say are some of the biggest misconceptions about prenatal care that you’ve encountered in your work?

Jen Hamilton: What I’m seeing a lot recently is, uh, the misconception that prenatal care is not necessary.

Jen Hamilton: I’m hearing a lot of people come in saying, you know, oh, we’ve been, you know, birthing babies for, you know, Millennia and our bodies know exactly what to do and everything’s going to work out perfect all the time and prenatal care can help us to be able to get to that goal of making sure that everybody is healthy and safe I know that sometimes things feel like superfluous like it’s just too much or you know We’re going to the office too many times and maybe this isn’t necessary.

Jen Hamilton: But the things that we can accomplish during a prenatal care visit can identify risk factors that can put you at higher risk of things that can have really catastrophic outcomes. And as a labor and delivery nurse, I have seen people forego prenatal care and come in with really catastrophic outcomes because they just assumed that like, oh, I’ve had a baby before maybe, and everything was fine.

Jen Hamilton: So this time I’m just going to go it alone. But it’s so important that We have prenatal care because those are the things that can help us to be able to make sure that everybody’s healthy.

Jessica Stewart-Gonzalez: You had mentioned and you talk a lot about informed consent. What does that look like in that prenatal care setting?

Jen Hamilton: I think that one of the biggest problems that we have within the obstetrical community is assuming that everyone wants everything done that we recommend. And I think the biggest part about that is having our patients understand the why behind things, the risks, the benefits, and like I mentioned the why I think is the biggest part of that because each patient has the ability to make their own informed decisions even if I don’t agree with that decision.

Jen Hamilton: So my job as a nurse and a provider’s job in that prenatal space would be to make sure that they have all of the information that they need to make a decision and that information needs to be evidence based. And a lot of times with, you know, the social media stuff, there’s a lot of misinformation that’s swirling around on the internet.

Jen Hamilton: So it’s just important that our patients understand why the benefits, the risks, the alternatives, and be able to make that decision for themselves.

Jessica Stewart-Gonzalez: And if somebody doesn’t feel like they’re getting that information, they should ask why. Right?

Jen Hamilton: Absolutely. Absolutely. Because within the obstetrical community, there are providers who just say, this is what we’re gonna do, or this is what we need to do, without any information on the back end of saying like, hey this is exactly why I think this is important. This is how it works. And so, you know, I don’t believe that people should just inherently trust us all the time just because we are, you know, licensed or credentialed or whatever. I think that we have to be able to educate our patients so that they feel comfortable with the decisions that they’re making.

Jessica Stewart-Gonzalez: How can expectant fathers and partners be involved in the prenatal care process?

Jen Hamilton: Yeah, so I’m so glad that now that COVID is kind of over that partners are being more included in what’s going on, because man, there for a little bit, oh, it was rough. Basically, basically, the partner didn’t get to be involved in any of it till the baby was born.

Jen Hamilton: And some places weren’t even letting them do that. So I think that One of the most important things that partners can do to be involved is just be there. I know that sometimes, you know, schedules don’t allow for that or whatever, but man, having a partner be involved and just being present is so, so wonderful.

Jen Hamilton: It can also help the birthing person to remember questions that they may not remember to ask or to, you know, understand or hear things that the provider is saying later on because sometimes when you’re in an appointment your anxiety is high and you may not remember everything that was being said. So I think just being present is, you know, an easy way that partners can show up.

Jessica Stewart-Gonzalez: When is it ideal for parents to start birth planning or should they even have a birth plan? How does that help or hinder those expectations in the labor and delivery journey?

Jen Hamilton: Yeah, so I think that understanding the things that can happen or the choices that you may be faced with when you go into labor and delivery is so important to learn about during pregnancy.

Jen Hamilton: But one of my things is that I believe in something called birth vibes more than a birth plan, because there are lots of patients that I have that Spend their whole pregnancy planning exactly how they want things to go and then something at the end kind of throws a monkey wrench in that and it can begin birth trauma before the baby is even born.

Jen Hamilton: For instance, I had a patient not too long ago who spent her entire pregnancy planning for the birth that she wanted and not any thought to maybe a birth that she didn’t want. And I think that it’s important to plan for both. so that you have the ability to pivot when pivoting is inevitable. So this particular patient came in and had spent her entire pregnancy planning for a water birth.

Jen Hamilton: It was her first baby. Her water had broken and had heavy, heavy meconium, which kind of risked her out of being able to have a water birth. And when she came into the hospital and learned that that was no longer an option, she had no other coping techniques other than the one that she had planned for which was the water birth and now she was devastated and so it took a long time to kind of pivot from that and understand that we can still have like a beautiful vaginal delivery. Even though that choice is no longer an option. So, you know, it was really tough for her.

Jen Hamilton: It was a very tough few days to kind of grieve what she thought was going to happen to make room for what her reality was. So when I say birth vibes, I want you to plan for how you want to be communicated with when you come into the hospital. What are the things that your care team needs to know about you in order to take the best care of you?

Jen Hamilton: So things like, you know, man, I really wish that my mom was here and she’s not able to. I have been through something really traumatic, so this is very hard for me. Maybe you’ve experienced loss before. How much information do you feel like you will need in order to make a decision that you feel good about?

Jen Hamilton: How much time will you need to make that decision? What do you want your environment to look like? What kind of people do you want to be on your support team? Because all of these things are things that can be almost for sure about rather than planning for the, you know, unexpected things that can happen.

Jen Hamilton: So I love it when patients come in knowing what’s available to them, knowing the information behind the things that you, they may be deciding on. But I love when they also give themselves the freedom and the grace to be able to make those game day decisions when things don’t maybe go the way that they thought they might.

Jessica Stewart-Gonzalez: What advice can you give or share for families who are looking for an OB GYN? What should they look for?

Jen Hamilton: I love it when people ask around about OB GYN care. Sometimes we just Google, you know, like that’s what I did. That’s how I found my OB GYN, but there’s more to that relationship between yourself and your provider than just who looks good on a Google search.

Jen Hamilton: So some really good resources that you can reach out to are like going into your local moms groups on Facebook. Everybody’s got opinions. But the secret sauce is that if you can find a labor and delivery nurse who works with these people, talk to them. Okay, because they are the ones who can see all of the OB GYNs in that area and see how they act or react, you know, maybe in an emergency, maybe when a patient is deciding something differently than what the provider thinks, because there’s so much more to, you know, that relationship between patient and provider than you know, just the nitty gritty medical stuff.

Jen Hamilton: It’s about their communication, their compassion, uh, their responsiveness to your, your needs. And a labor and delivery nurse is going to have the tea, the down low of the situations with your providers.

Jessica Stewart-Gonzalez: You often use and have coined and spread across the universe the phrase, it’s okay to be scared because I’m not.

Jessica Stewart-Gonzalez: How does that mindset help families?

Jen Hamilton: Because there’s so much about labor and birth that is normal to me, because I see it every day, that is brand new to you. And I have heard thousands of birth stories. Of, you know, these people explaining their birth trauma, and I’m waiting for, you know, the emergency c section, I’m waiting for the cord prolapse, the shoulder dystocia, I’m waiting for those things where I’m anticipating there to be, like, significant, like, medical birth trauma.

Jen Hamilton: But the birth trauma that they have is just that their labor was not communicated to them in a compassionate and empathetic way. So things that may seem really normal to me, for instance, you know, oh, I got an epidural and my blood pressure dropped. That’s very, very common, but to a patient who’s never experienced that before, that can feel like, oh my gosh, I must be dying, you know?

Jen Hamilton: And so also the pain associated with I had somebody talk about one time that after their water broke, that their pain increased tenfold, and they didn’t anticipate that. And so they thought that something was wrong. They were really caught off guard when the labor nurses were like, yeah, whatever, you know, they didn’t really seem responsive to their concern with their pain When you know, yes that can happen because whenever your water breaks there’s these hormones that are released that kind of ramp things up. But because they weren’t anticipating it and it wasn’t communicated very normal things that are not scary to us can be so scary to the patient.

Jen Hamilton: So, I love to tell my patients that it’s, you know, it’s okay for them to be scared because I’m not scared and I see this every day and I’m here to help you and I’ve got you.

Jessica Stewart-Gonzalez: Thank you to our listeners for tuning in. We hope you found this episode informative and helpful in your journey towards parenthood. Also, be sure to check out the show notes for links to more useful information and to follow Jen Hamilton on her social media platforms. If you enjoyed our show today, please share it with expecting parents in your life.

Jessica Stewart-Gonzalez: Together, we can help them feel confident and prepared for their parenting journey. Until next time, this is Jessica. You’ve got this.