It’s the most excited you’ll ever be. And it’s the most scared you’ve ever been. Myra J. Wick, M.D., Ph.D., Mayo Clinic obstetrician, gynecologist, and medical geneticist, joins co-hosts Angela Mattke, M.D., and Nipunie Rajapakse M.D., to discuss the often-conflicted feelings of expectant parents. Questions tackled include: * What factors make a pregnancy “high risk?” How much does age matter? What can I do to lower that risk? * What can I do during pregnancy to give my baby her best chance at being born healthy, and staying that way? * Should we consider genetic testing? * How should we plan our lives — work, relationships — with a needy new addition joining our ranks?
Dr. Angela Mattke:
Welcome to the Mayo Clinic Moms podcast. We're having candid conversations and answering difficult questions about pregnancy, raising kids, and everything mom-related. I'm Dr. Angela Mattke, and I'm a mom of two and a pediatrician at Mayo Clinic Children's Center in Rochester, Minnesota. And my co-host is Dr. Nipunie Rajapakse, who's a pediatric infectious disease doctor also at Mayo Clinic and is also pregnant.
Dr. Angela Mattke:
So first off, if you're listening to this podcast, it means you're probably pregnant or you know someone who's pregnant. So congratulations, whether this was a planned pregnancy or a really pleasant surprise. You might be having some questions or maybe even starting to have some worries about is your baby healthy and how do you keep yourself healthy during this pregnancy over the coming months? So during this episode, along with my co-host Dr. Nipunie Rajapakse, who's pregnant, and as we follow her journey, we are going to be joined by special guest, Dr. Myra Wick, an obstetrician gynecologist and medical geneticist at Mayo Clinic. She is also the medical editor of Mayo Clinic's "Guide to a Healthy Pregnancy." So she has some serious street cred when it comes to answering these questions. So we're gonna be asking her questions today, including things like what might put you at higher risk for complications during pregnancy, and does your age really matter?
Dr. Angela Mattke:
And what about your infant? Are they at risk for maybe some special medical challenges during pregnancy or problems? And what about genetic testing? Dr. Wickick is a geneticist as well, so she's the perfect person to answer these questions. And what about that little thing you've got going on right now, you know, called your life, or maybe your career and your job and how are you gonna make a baby work in all of this? So let's dive right in today. First of all, I wanna introduce to you my co-host Dr. Nipunie Rajapakse. She's a pediatric infectious disease physician at Mayo Clinic Children's Center, and she's also pregnant, and this is going to be the person and the main guide of our show today. So congratulations, Dr. Rajapakse, on your pregnancy.
Dr. Nipunie Rajapakse:
Great. Thank you, Angie. We're super excited.
Dr. Myra Wick:
Yeah. So how far along are you?
Dr. Nipunie Rajapakse:
So we're 31 weeks along now. So partway through the third trimester things are starting to get real as we get closer to the end here.
Dr. Angela Mattke:
Yeah, definitely getting real. And as a pediatrician, I'm sure you're really excited that you're 31 weeks; we always think one extra week is a little bit better for the baby and for you as well. So congrats.
Dr. Nipunie Rajapakse:
Every week makes a difference at this point, for sure.
Dr. Myra Wick:
Yeah. How are you feeling?
Dr. Nipunie Rajapakse:
So I've been feeling pretty good starting to feel some of the fatigue and definitely getting bigger and harder to move around. But I think mostly the usual pregnancy kind of discomforts and things, so yeah. Things are going pretty well so far.
Dr. Angela Mattke:
Yeah. Have you gotten to the point where you're never sleeping?
Dr. Nipunie Rajapakse:
Yes. Yeah. That's already started, which was a bit of a surprise to me. Honestly, I knew after baby came that the sleep deprivation would be a big thing. But I was hoping I might get a few weeks of good sleep leading up to it, and that definitely is not the case. So working through that for sure.
Dr. Myra Wick:
Yeah. Definitely. Okay. One of my favorite things to hear about is like the pregnancy story. What's your journey been like so far?
Dr. Nipunie Rajapakse:
Yeah, so my partner Thomas and I, we knew we wanted to start a family. Like many women with professional careers who have long training, we kind of put things off for a while. The time never quite seemed perfect and wanted to get through the training part and kind of getting established in a career. And so we started on this journey pretty late, so I'm 37 and he is turning 40 in a month. And so a bit later than maybe most people might think about starting a family, and being in medicine had a lot of kind of conversations with friends and colleagues who had kind of similar paths and struggled in, in many ways either getting pregnant or with recurrent pregnancy losses. And so that was kind of really at the forefront of my mind going into this journey and knowing that there were certain things that were going to be kind of outside of my direct control.
Dr. Nipunie Rajapakse:
And so we kind of went into it with the mindset of if this happens for us. That's great. If not, then we might need to look at other options. But we were really excited back in the spring to find out that we were pregnant. I was four days late, had pretty regular periods before, so it was notable to be a few days late; it was a super busy time at work. And I actually was only notified by my watch that was kind of tracking my cycles that I was late. And so ended up taking and it was positive and we were very excited for that. But I think also a little bit nervous knowing some of the risks related with having a baby at my age, both for myself and for the baby.
Dr. Nipunie Rajapakse:
And so it's been kind of quite a journey so far for us in learning and going through this. And in that first month, before we knew, I think I managed to do kind of a lot of things off that list of things that we know probably shouldn't be done during pregnancy. That was a time that we decided to get a bike. So Thomas is a big road biker. And so he encouraged me to get a bike, and I ended up riding the bike and falling off twice. During that first time, we had sushi, we had rare steak, all sorts of different things. Thankfully, I think things will end up being fine, but you, in retrospect, kind of think back through all of those things and wonder whether they will have an impact or not. So the first trimester, I think, went reasonably smoothly, definitely had some morning sickness, which is really a misnomer, because I mostly had it in the evening.
Dr. Angela Mattke:
All day sickness.
Dr. Nipunie Rajapakse:
Yeah, yeah, exactly. That has thankfully passed now. And then second trimester was feeling pretty good. And then third trimester now has been quite well. Just some of the usual discomforts and things associated with a growing belly and not being able to sleep as well, but we've been pretty fortunate to have no major complications or issues thus far. A couple of minor things that I think we'll talk about through this, but yeah, we're now getting ready for the next step.
Dr. Angela Mattke:
You know, you mentioned like some of the things that you did before you knew you were pregnant. I think like every pregnant woman can relate to that. Right? But you mentioned, you know, you're a little bit older and so I wanna talk about maybe some of the challenges that come along with pregnancy. And to do that, I wanna bring in our special guest, Dr. Myra Wick, as we mentioned, in the introduction of today's episode, so she's an obstetrician gynecologist and medical geneticist. So she is literally the perfect person for us to talk to about challenges during pregnancy. And I mentioned she has some serious street credibility, right? She has been the medical editor for Mayo Clinic's "Guide to a Healthy Pregnancy," but she's also a mom of four. So she's done this once or twice. Right? So hopefully she can give us some words of wisdom. Dr. Wick, thank you for joining us today.
Dr. Myra Wick:
Thank you for inviting me. It's a pleasure to be here.
Dr. Angela Mattke:
Yeah. So mom of four. And your kids are mostly grown at this age, is that right?
Dr. Myra Wick:
Yeah. Yep. The oldest one's actually an orthopedic surgery resident out in California. And then the second one is in his mid-twenties, he's been back home with us quite a bit during the pandemic. And then our older daughter is working out in DC, and we just sent our baby off to college, which was a little traumatic for Mom, and she's out in Maine, which seems like a really long ways away from Minnesota.
Dr. Angela Mattke:
It is a really long ways away from Minnesota. So you're an empty nester almost for the first time, it sounds like!
Dr. Myra Wick:
Yeah, we have one that's home most of the time, and then we have two fur babies, so.
Dr. Angela Mattke:
Oh yes, absolutely. So Nipunie mentioned, you know, she's 37; she's in her thirties. So let's talk a little bit about like, what does this mean for her pregnancy, for the health of her pregnancy, for the health of the infant compared to maybe somebody who's in their twenties or even in their teens. Are there different challenges? Would you approach like Nipunie's pregnancy a little bit different if you were seeing her in the office?
Dr. Myra Wick:
Well, fortunately, most moms do well, even moms that are older and it's always hard to know what exactly that definition is. Some people use 35. But one of the things that we think about is the increasing risk for chromosome problems or chromosome aneuploidy as moms age. And probably the most familiar chromosome aneuploidy is Down syndrome or trisomy 21, which is an extra copy of chromosome 21. There are a couple of other chromosome conditions that we can see; one's called trisomy 13, which is an extra copy of chromosome 13, and trisomy 18 extra copy of chromosome 18. So there are different screening tests that we can use to screen for the chance that the pregnancy might be affected by one of those conditions. And those tests have really evolved over the years.
Dr. Myra Wick:
Back when I was pregnant, there was a screen that had only a blood test that looked at three different protein markers in the mom's blood. And that test is still around. We can still use it. It's now called the quad screen because we use four different markers. And we use that test usually in the second trimester. But the test that most moms, or the screening that most moms have heard about, is something called cell-free fetal DNA screening or some people call it noninvasive prenatal screening. And that test allows us to screen for those three chromosome conditions but also will let us know about the gender of your baby. And we can do that as early as 10 weeks. So that's one of the things that we talk about with all moms but especially for moms who are a little bit older. And a lot of women are interested in the test because they can learn the gender of their baby early, early on,
Dr. Angela Mattke:
Really early on. Yeah.
Dr. Myra Wick:
Yeah. But the test was really designed to screen for trisomy 21 or Down syndrome. So we think as geneticists, that's really important – and obstetricians – really important that moms understand what they're doing when they have that screening test done that it's not just the gender test. So that you might get some other information from the testing, and maybe you, you know, weren't anticipating that information or you didn't want that information. And then what do you do once you have that information?
Dr. Nipunie Rajapakse:
Yeah. So this was one of the things that was kind of new to me, because from when I went through med school, that test wasn't available. So that was something I learned about kind of early on when we went for our first prenatal visit. And I had assumed that we'd have to wait till the 20 week ultrasound to find out the sex of the baby, and so that was kind of interesting information to learn early on for us. We wanted to find out and so we know that we're having a girl. And the other thing was, yeah, kind of understanding the difference between the types of testing offered. So I know there's kind of screening tests that can be done. And then there's diagnostic tests. Maybe, Dr. Wick, can you talk a bit about what the difference between a screening test is and a diagnostic test when it comes to these genetic tests?
Dr. Myra Wick:
Sure. so screening tests are tests that tell us about the risk. They don't give a definitive answer as to whether or not the baby has a chromosome problem. The screening tests are really accurate. So, for example, the detection rate for the cell-free DNA screening for Down syndrome is about 99%. And the false positive rate is low. It's about 2–4%. So they're great screening tests, but if the test comes back abnormal, it doesn't mean for certain that the baby has that condition. And so, in order to determine whether or not the baby actually has that condition, we'll recommend additional, what we call invasive testing like a CVS, which is a chorionic villus sampling or an amniocentesis. And both of those tests involve a long, skinny needle and ultrasound guidance.
Dr. Myra Wick:
So with a CVS, that's a test that we typically do between about 11 and 14 weeks. Long skinny needle. We take a little tiny sample of the placenta that's forming, and the placenta almost always represents the genetics of the baby. So we can send the cells from the CVS to our cytogenetics laboratory across the street. And they can do some different studies, like what we call a karyotype, where they look at all the chromosomes or a chromosome microarray where they look at the chromosomes in even finer detail than a karyotype. And so, again, we do that at about 11 to 14 weeks. So depending on when the test results or the screening results come back, if you're in that window and the results are abnormal, then we can offer you the CVS.
Dr. Myra Wick:
If a patient is after 14 weeks and we need to do invasive testing, then we'll do an amniocentesis. And that involves taking a little sample of the amniotic fluid the baby sheds cells into that fluid, and we can send those cells to the cytogenetics laboratory, and they can do the same kinds of studies. So that's definitive testing and it also gives us more information. It gives us information about all the baby's chromosome, not just 13, 18, 21, X, and Y. So it gives us a lot more information. Traditionally we've talked about the risk of invasive testing. We've traditionally quoted that there may be a risk of loss from CVS on the order of about one in 300 to one in 500. That risk is a little bit lower with amnio; about one in 900 pregnancies could be lost by the procedure.
Dr. Myra Wick:
There are some more recent papers that have shown that those risks may not really be there. And the procedures are very, very safe. Here in our practice, we have very experienced providers that are doing the procedures. So things usually go extremely well without complication. Yeah. It's always important to remember too that the invasive tests are available to everybody. So every once in a while, I'll have, you know, a 23-year-old low-risk patient come in and say, "I want everything. I wanna know everything there is to know about my baby's chromosomes." And if that's the case, then maybe the right test for her is an invasive test from the get-go, rather than using it in a stepwise manner where you would use the invasive test only if there was an abnormality with the screening test.
Dr. Nipunie Rajapakse:
Great. So that kind of maybe answers my next question, which was: does the testing offered kind of vary by how old you are at all, or would most of these tests kind of be an option for anyone?
Dr. Myra Wick:
Yeah. Most of the tests are an option for anybody and we should really be offering them and describing the testing to all patients. And then we're supposed to give non-directive counseling, right? So we tell the patients about all of their options and then help to guide them in their decision-making process.
Dr. Angela Mattke:
Are you thinking about getting pregnant or maybe your current mom-to-be, or you're like myself and you're in the midst of raising kids, and you're looking for practical evidence-based advice from Mayo Clinic experts? Mayo Clinic Press has got you covered. We have a series of four books, starting from "Fertility and Conception" to "Guide to a Healthy Pregnancy," "Guide to Your Baby's First Years," and the last book in this series, the one I was the medical editor of, Guide to Raising a Healthy Child." You can find these amazing books from Mayo Clinic Press wherever books are sold or on the Mayo Clinic Press website.
Dr. Nipunie Rajapakse:
Angie, I'm curious, did you have any testing done during your pregnancies?
Dr. Angela Mattke:
I was gonna ask you the same question, because I'm curious. You know, I didn't have any testing done because I think testing has changed so much, and, you know, my kids are a little bit older. And so some of the testing, you know, was just kind of coming about then, but also, my husband's a radiologist, and we did a lot of ultrasounds because he was in training, and they were encouraged to do lots of ultrasounds, you know, on friends or on themselves to just practice. And so what a perfect person to practice on than your wife to practice your OB ultrasound. And so we were constantly checking on the baby, and I have to say, like, we found out the sex of our baby at like 13 weeks by our ultrasound. And most of the time, you can't really tell definitively that early. We thought that's what it was. And we obviously confirmed it with our repeat ultrasounds that were, you know, done on a ridiculously frequent basis. So how about you; did you have any genetic testing done?
Dr. Nipunie Rajapakse:
So we decided after hearing kind of about some of the different options. I think I have gone into this pregnancy kind of wanting to have as much information as I could. I thought that that would kind of help with my nervousness or anxiety about things, just to at least know what to prepare for. And so we did decide to do the fetal cell-free DNA testing. And we had that done around 10 weeks along, and thankfully showed that we were low-risk for all of the different chromosomal abnormalities that it tests for. And then that was also how we were able to find out that we were having a girl that early as well. But I will say you don't have to find out the sex. There is, I think, when they send you the result, there's a version that has the sex on it and one without. And so you can just open the one without if you want it to be a surprise.
Dr. Angela Mattke:
Awesome. Yeah. I didn't really want it to be a surprise. I wanted to know because I am like the world's most Type A biggest planner. And so it helps me kind of just prepare mentally for the arrival of my little bundle of joy. So yeah. How about you guys? Was that a question about finding out the sex of the baby or not?
Dr. Nipunie Rajapakse:
No, we hadn't talked about it before. And so we both knew that we wanted to find out, I thought we'd have to wait until a bit later. So it was a surprise for me that we could find out early as 10 weeks.
Dr. Angela Mattke:
Yeah. Is that, Dr. Wick, is that as early as you can do that blood test?
Dr. Myra Wick:
Yeah.
Dr. Angela Mattke:
Okay. And what's the range on that? Like between what weeks can you get that test done?
Dr. Myra Wick:
Yeah. really anytime after 10 weeks, sometimes after 36 weeks, you'll get some strange results back. I think it's just because if you look on the report, it gives you the answer that everything's normal or not. It tells you the gender. And then when I'm thinking about Nipunie's result, way on the right hand side, it gives you a fetal fraction. And I think when I saw your report, it said, like, 11%, and that's an important part of the report. So when we take the blood sample from the mom to do the testing, there's a mixture of DNA from the mom and from the baby. And so that fetal fraction has to be at least 3% in order for the laboratory to reliably give us a test result.
Dr. Myra Wick:
And so if we do it before 10 weeks, that fraction of fetal DNA might be too low for the laboratory to give you a report back. And so we call that a no-call result, and that always makes people a little bit anxious because you can see a low fetal fraction when there's a chromosome problem as well. So so when you see that back then, you know, we need to counsel the patient about "what are your options." Usually, we'll wait another two weeks because that fetal fraction should go up as the pregnancy goes on. But so we try to get that testing done at 10 weeks so that we're sure that we're gonna have an adequate fetal fraction. One of the other reasons why we might see a low fetal fraction is if a mom has a really high BMI or if she has a high weight; there seems to be a dilutional effect. So for a mom with a BMI of 40 or 50, you might actually wanna wait a couple of weeks beyond 10 weeks, just so that you're sure that that fetal fraction is is high enough to get a result back. That was probably more technical information than you wanted.
Dr. Angela Mattke:
No, I think that's helpful. Yeah.
Dr. Myra Wick:
And you know, why would we use that test at 30 weeks or 31 weeks? I think probably the most common reason is if the baby's growth has fallen off, and we just wanna make sure that it's not a chromosome problem. That's causing the growth to be decreased or to be lower than we would've expected. And I just wanted to point out, Angie, you brought up a good point. That ultrasound is also a genetic screening tool. Sometimes we forget about that, but we probably pick up at least 90% of trisomy 13 and trisomy 18 with the anatomy ultrasound. We see findings that are characteristic. Down syndrome can be a little bit trickier. We pick up maybe 50% of Down syndrome cases. And it's primarily the babies that have a cardiac condition, congenital cardiac condition that we would pick up. But yeah, ultrasound is another great genetic screening tool.
Dr. Angela Mattke:
Yeah, yeah. It is. Especially if you're getting it at ridiculous frequencies like I did. And then my babies, I was always measuring really small. So there was always concerns that, you know, my babies weren't growing well, and then they do ultrasounds, and my kids were like way huge. Unfortunately for me at time of delivery, but still there's a lot of testing, you know, that's done during pregnancy. So let's talk a little bit more. So we've talked about genetic testing; we've talked about, you know, the anatomy ultrasound that you just mentioned. What other things would you be watching as an OBGYN during the pregnancy to monitor the health of the mom and monitor the health of the baby?
Dr. Myra Wick:
Yeah. So another set of tests that we do somewhere between about 24 and 28 weeks is testing for gestational diabetes. So we have the mom drink a sugar solution and we all remember how horrible that is! And then you get to sit in the laboratory for an hour and the lab draws a blood sample to see how your body is handling that sugar load, if you will. And in our practice, we use a cutoff of 140. So if the mom's blood sugar is 140 or higher after that one hour, then she gets to do another test, a three-hour test, where she comes in fasting, and they do four blood draws. One's a fasting blood draw, and then the mom gets to drink another sugar solution.
Dr. Angela Mattke:
Oh, goodie!
Dr. Myra Wick:
And then we do a one-hour, two-hour, and three-hour blood draw. And if two of the four of those blood draws are elevated, then we diagnose the mom with gestational diabetes. And first step is to try to manage with diet and exercise and a lot of moms do just fine with that. And we don't need to think about any medications, but if we're still having trouble, the mom's monitoring her blood sugars, and we're seeing about 15–20% of those blood sugars are elevated, then we're gonna talk about starting insulin or another oral medication called Metformin to help control the the sugar levels. And there are a couple of reasons why we wanna do that. The first is that we don't want you to have a huge baby. So if blood sugar levels are out of control, the baby might grow really big and you might end up with an 11-pound baby. That could be really–
Dr. Angela Mattke:
Who struggles with their sugars after birth, you know,
Dr. Myra Wick:
Exactly.
Dr. Angela Mattke:
That's what I take care of in the hospital. So.
Dr. Myra Wick:
Yep. And we worry about difficulties with birth when there's a large baby; oftentimes when mom has diabetes that's uncontrolled, the babies will have a larger abdominal circumference and that can cause trouble during labor. Something called a shoulder dystocia where the baby's shoulder gets stuck under mom's pubic bone, and that can an obstetrical emergency. So that can be a scary thing that we don't wanna see happen. So anyway, we look for blood sugar levels at 24 to 28 weeks. We are also checking the mom's hemoglobin again just to make sure that the mom doesn't become anemic. It's really common for the hemoglobin to drop a little bit. It's just part of the physiology of pregnancy. But if it drops below a certain value, I usually use about 10.5.
Dr. Myra Wick:
Then we might recommend that mom take an iron supplement if she can tolerate it, just to make sure that that her hemoglobin and her iron are in good shape going into labor because labor and delivery is a time when we often see a lot of bleeding and it's really common to lose blood during labor and delivery. We're also testing at 24 to 28 weeks for syphilis. So our patients are being tested twice for syphilis in pregnancy – once at the new OB visit, and then again at the 24 to 28 weeks. And that's a recommendation of the Minnesota Department of Public Health. We're seeing more syphilis cases apparently in our state. It's kind of taken a backseat to other infectious diseases right now, but that's another thing that we're testing for.
Dr. Myra Wick:
And then kind of the the last benchmark, if you will, is testing for group beta strep, which is a bacteria that is present in about 25–30% of women in the rectal vaginal area. It's part of the normal bacteria. Doesn't usually cause any trouble for the mom. But there's a small chance that during delivery, the baby could contract the group beta strep and become really sick, as both of you know, you care for those babies, take care of those babies. And so if mom is positive, then we treat her prophylactically with antibiotics – usually penicillin, if she's not penicillin allergic – during labor. So those are kind of the main tests that we think about. For some women, if they have thyroid disease, we wanna make sure that that they're taking appropriate thyroid medication replacement. So we might be following TSH levels, thyroid stimulating hormone levels, during pregnancy as well.
Dr. Nipunie Rajapakse:
So many of those things, Dr. Wick, that you mentioned like gestational diabetes, I believe the risk is higher for women of advanced maternal age. But obviously that's not a factor that I can change. I can't change my age at this point. Are there things that you recommend women can do if they are older and going into a pregnancy to reduce their risk of some of these types of complications?
Dr. Myra Wick:
Yeah, I think some of the same things that we recommend for all of our patients, really. If you can go into pregnancy with a healthy weight, if you happen to have diabetes, we have some patients with type one or type two diabetes to make sure that's well-controlled going into pregnancy. If you have blood pressure issues – most of our patients don't have blood pressure issues; they're young and healthy and have nice low blood pressures. But we do have a few patients that have blood pressure issues. So that can complicate things in pregnancy like worsening hypertension at the end of pregnancy or something called preeclampsia, which can be serious. So if we can get those kinds of things managed before you even get pregnant, that's awesome and helps to reduce risks during pregnancy. Exercise, diet, trying to have all those things under control – which I'm sure we all did, right? – before going into pregnancy. Yeah, so, but you're right. Older moms do have slightly increased risk for some of those common complications, like gestational diabetes, gestational hypertension during pregnancy.
Dr. Angela Mattke:
You know, the last thing that I really wanna pick your brain about, Dr. Wick, and I also have some nuggets to share, but I mentioned in our intro that you think you know that your life is gonna change when you have a baby, but I feel like you don't really understand until you have a kid. And I don't know if we can really prepare because everyone's gonna have their own journey and everyone's gonna have their own experience, but, like, life really changes. And then especially if you're trying to have a career with it and that, you know, all three of us are physicians. And so, you know, we have busy careers, trying to take care of patients and then, you know, you have four kids. I have two; so far they're still alive, and I think they're mostly healthy. So I'm managing okay. And they're happy, and they know they're loved, but what kind of tips would you give to her or knowledge about things that, like, you didn't realize, or you wish you would've known about just trying to balance your new life after the baby?
Dr. Myra Wick:
Boy, I wish I had some magic answers. I'm a planner, but yet my husband and I are kind of go-with-the-flow. So we weren't great about planning. We just kind of had kids. And I think a support system is so important. My husband works in the medical field, but he's not a medical professional, and his schedule was always a lot more flexible than mine. So it was nice to know that, you know, I couldn't get home until six o'clock, so he was gonna be there. We also had huge support from my parents. They live in the area, and they really were second parents to my kids. And that was a huge support. I don't know, honestly, what we would've done without them.
Dr. Myra Wick:
And I know that not everybody has that luxury. But I think building a good support system was key for me and for our family. I don't know how, how helpful that is, but it does change. And, you know, there are periods in your life where you feel like all you're doing is going to work and then going home and doing a second job. But yeah, it can be very tiring sometimes and hard to remember to do things for yourself. It's important to, you know, get out and get a walk or just take a little time to take an hour to go shopping or get your hair cut. Yeah.
Dr. Angela Mattke:
Nipunie, I think my biggest advice for you is try to let the mommy guilt go, and I'm still working on this. I am not good at it, but after, I think, having kids, my standards for myself definitely changed. And they had to because it wasn't sustainable to keep kind of practicing at the level that I was and giving as much as I was to, like, my clinical practice and stuff because there wouldn't have been anything left to give to my family and my kids and stuff. And so, I had to let the guilt go about not being able to do everything like I exactly wanted it to be. And just being like satisfied with "good enough" that, you know, everyone's alive, everyone's known that they're loved. And you know, at the end of the day, you know, everything's getting taken care of eventually. So.
Dr. Nipunie Rajapakse:
Great. Thank you both for that advice. I know, I think it's hard. I feel like I should know as a pediatrician kind of what I'm in for, but everything that I've heard from colleagues and friends is that until you kind of go through it yourself, you have no idea what it truly is like, so I appreciate it.
Dr. Angela Mattke:
Well, I, I mean, even now my kids are older and it's still like, I feel like I still don't know what to expect. Like every age is different and, you know, everyone's just trying their best. I think one other piece of advice is like, you will become a lot less judgmental of other people, and, as much as possible, to let that go and not become one of the "Judgy McJudgy" people that are judging everyone for their kids, like, you know, how their kid's acting at Target or, you know, the meltdowns they have in the office. I feel like parents are always like apologizing to me, and I'm like, oh my gosh, like, this is life. Like, this is what my kids do, too. Like, we're people, too. So I think we're experiencing the exact same things that everyone else is going through. So, Dr. Wick, thank you so much for joining us. And I look forward to you joining us on our future episode. Thanks everyone for joining today. Make sure you don't miss any of our upcoming episodes by subscribing and following along on either Apple Podcasts or Spotify. If you enjoyed this episode, and you want other moms out there to hear this valuable information, make sure that you leave a review wherever you listen. Thanks for joining us. We'll see you next time.