Birthing A Bad Dream

Summary

The Dream — “Birthing A Bad Dream”

Host: Jane Marie
Guests: Alicia (Jane’s friend), Dr. Sarah Toogood (OB-GYN at Cedars Sinai, LA)
Air Date: January 15, 2026

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Episode Overview

In this reimagined episode of The Dream, host Jane Marie returns with a deeply personal and incisive look at the “cult of wellness” as it infiltrates the most intimate and anxiety-ridden experience: pregnancy and birth. Shifting the show’s format toward candid, wide-ranging interviews, Jane Marie explores how expectations, cultural pressure, and an abundance of conflicting advice converge to create what can only be described as a “bad dream” for many women at their most vulnerable.

Through honest storytelling (her own and her friend Alicia's), Jane dissects the roles of science, wellness culture, healthcare providers, and personal agency in shaping experiences of pregnancy and birth. OB-GYN Dr. Sarah Toogood joins the conversation, shining a light on the chasm between medical outcomes and emotional journeys, and why no amount of information can ever guarantee control or peace of mind in the birthing process.

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Key Discussion Points & Insights

The Cult of Wellness Targets Pregnant Women

• Jane Marie opens with a critical observation: while wellness culture is usually easy to avoid, pregnancy makes women lightning rods for unsolicited advice, judgment, and “the right way” messaging from every direction.
  • “Once a woman becomes pregnant, her body is no longer her own... the whole world suddenly feels ownership. This comes at us with unwanted questions and unwanted touching, unsolicited advice about the right way and the righteous way to be pregnant, to give birth and to mother.” (04:59)

Medical Uncertainty & the Myth of Control

• Jane shares a deeply personal moment: a scary pap smear result at five weeks and a doctor’s advice that vaginal birth might “flush out” potential cancer.
  • “I'd never related to friends on the hippier end... but here I was, unwillingly thrust into their world... spending 35 weeks thinking, maybe you're growing a cancerous tumor right next to a baby is... well, it was fucked up.” (05:36)
• Her approach: “I basically just wanted the baby to come out however it needed to... But then reality intervened.” (05:44)

Comparing Approaches: Jane vs. Alicia

• Alicia, a close friend, shares her high-information, Type-A approach to pregnancy, shaped by both medical necessity (Ehlers-Danlos made hers high-risk) and personality. She attends natural birth classes mostly to learn, not to eschew medicine.
  • “I have like a joint disorder called Ehlers Danlos syndrome. So I was told I had a high-risk pregnancy... So I was constantly asked, six or seven times a day: What kind of birth are you going to have? Are you going to do delayed cord clamping?...I remember getting into a thing about delayed cord clamping...” (07:00–09:03)
• She hoards information out of fear, not fascination.
  • “It was not that I am so interested in birth actually...it was that I was completely terrified that I was going to make the wrong decision and something bad was going to happen. In fact, I was sure that something bad was going to happen.” (10:21)

The Information Deluge & Decision Fatigue

• “Because all these decisions are available... I want to be responsible and have answers to these questions and really think it through.” — Alicia, on the overwhelming array of “choices” offered to pregnant women (09:16)
• Jane’s coping mechanism was the opposite: “A point at which information overload convinced me that there wasn’t an answer. I shut down.” (10:08)

The Reality of Birth: When Agency Meets Biology

• Alicia’s labor story — induction at 41 weeks, expectations shaped by documentaries and doulas.
  • “Every drug I got, I had the most painful, least productive possible reaction... I was having a panic attack. I think, like, I can't breathe and I can't stop crying.” (19:38)
  • The hospital process was lengthy, confusing, and emotionally exhausting, ultimately making her feel like any pain or unexpected outcome was her own fault:
  • “This pain is my fault. And the baby's going to die for sure. And that's definitely going to be my fault.” (22:35)

The Medical Perspective: Dr. Sarah Toogood

• Dr. Toogood highlights the divide between “complementary” and “alternative” medicine and how a well-resourced patient population leans heavily on additional “wellness” information.
  • “I like the word wellness. It implies you're trying to be well, and that means something different for different people...I like it when patients use it as a compliment to our treatment, not as an alternative.” (28:07)
• She acknowledges the “small stuff” women obsess over (coffee, wine, beauty products), but confirms it's rational to care:
  • “Pregnancy is not a disease state... There are things that are safe that you did before pregnancy that you can continue... but in certain amounts, caffeine can be dangerous.” (30:33)
• She warns against confirmation bias and apophenia – finding patterns and causation where none exists:
  • “We seek out info to confirm stuff we believed before... It's not scientific... But it feels good to distill reality down like this.” — Jane (31:34)
  • “Apophenia is the tendency to make connections between things that have nothing to do with each other and then to instill meaning where there is none... like thinking you landed a dream job because you started drinking moon juice.” — Jane (32:16)

The Myth of the “Right” Birth Experience

• Dr. Toogood on the conflict between outcome and experience:
  • “As your doctor, I want a good outcome for you and your baby. Just because you're having a good experience does not mean you're going to have a good outcome. Everyone wants a good experience and outcome. For some women, they can have that, for others, they can’t...” (38:47–39:21)
• Empowerment messaging in birth classes can backfire:
  • “For women who have that mindset going into labor and have a vaginal delivery... of course they feel empowered because everything they told themselves was correct. When those women have to come to the hospital... they're disempowered... they feel like they did something wrong... but statistically that's just not true.” (42:15)

The Elusive Nature of Certainty

• “No amount of information—or virtue—can guarantee a smooth or natural birth. So much is out of your hands, and taking on the burden of every decision is a sure path to self-blame.” (Paraphrased throughout)

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Notable Quotes & Memorable Moments

• On the Uncertainty of Advice:
  • “There are the decisions that we make based in feelings. Some people choose home births because they feel more comfortable there... who are we to judge?” (22:49)
• On Self-Blame and Birth Experience:
  • “It was like my job to try to stay on the cliff... This pain is my fault. And the baby's going to die for sure. And that's definitely going to be my fault.” — Alicia (22:35)
• On Confirmation Bias:
  • “Like, I think if I don't get induced, I'll have a vaginal birth. Oh, look, I didn't get induced and I had a vaginal birth. So I was right. It's not scientific.” — Jane (31:34)
• On Medical vs. Experiential Values:
  • “If you want to trump your experience at the expense of your outcome, that's really difficult for a doctor to help guide you through... I, as your doctor, want a good outcome.” — Dr. Toogood (39:00)
• On Blame and Trauma:
  • “...they dissect every minute of every day for the weeks leading up to their birth and think if they had done one thing differently, it would have changed the outcome. And it's just not. Statistically, that's just not true.” — Dr. Toogood (42:15)

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Important Segment Timestamps

• [04:59] — Jane introduces the episode’s core theme: the “cult of wellness” during pregnancy
• [06:44–10:51] — Alicia describes her hyper-preparedness and anxiety in childbirth classes and decision-making
• [16:03–19:38] — Alicia and Jane recount their birth stories with frank confusion, fear, and systemic critique
• [27:35–30:33] — Dr. Sarah Toogood joins, reframing the patient-provider relationship and wellness questions
• [31:34–32:16] — Jane covers psychological phenomena: confirmation bias & apophenia
• [36:03–37:46] — Discussion on clean beauty, phthalates, and the limits of risk avoidance
• [38:43–43:50] — Deep dive on outcome vs. experience, empowerment, and the emotional aftermath of difficult labors

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Takeaways

• Pregnancy and birth are inherently chaotic and uncertain. The modern wellness industry, consumer culture, and even the medical establishment offer both overwhelming choice and little actual control.
• Self-blame and “perfect outcomes” are dangerous myths. No matter the preparation or the information, many aspects of birth are out of moms' hands; self-flagellation for imperfect experiences is both unnecessary and common.
• Medical evidence and empowerment narratives can clash. Having “the right mindset” or “trusting your body” does not guarantee a desired result; outcomes often depend on unpredictable biology, not planning.
• The wellness industry’s promise of control is seductive but illusory. The best anyone can do is make informed decisions, accept uncertainty, and avoid internalizing blame for the uncontrollable.

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Conclusion

Birthing a Bad Dream is a refreshingly honest, relatable, and deeply thoughtful deconstruction of what it means to navigate the choices, judgments, and uncertainties of pregnancy and birth. Jane Marie’s frank storytelling, Alicia’s vivid anxiety, and Dr. Toogood’s medical candor combine to create a powerful meditation on control, empowerment, and self-compassion during life’s most vulnerable moments.

Transcript

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[Raj]

Hey, it's Raj and Noah, and we're back with a new season of Am I Doing It Wrong? The show that explores the all too human anxieties we have about trying to get our lives right.

[Noah]

Because we're still doing a lot of stuff wrong.

[Raj]

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[Noah]

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[Raj]

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[Noah]

And for the first time ever, we're going to have full video episodes on YouTube. Because as long as there are things to get wrong, we're going to be right here to help you do them better.

[Jane Marie]

Love y'. All. I'm Jane Marie, and this is the Dream. Today we're bringing you one of our favorite episodes from season two. Enjoy. Most of the time, unless you opt in to thinking about wellness, you can pretty much avoid it. But there are a few moments in life where, try as you might to avoid it, you're inundated by the messaging of the cult of wellness. And one of those is during pregnancy and birth. It's well known that once a woman becomes pregnant, her body is no longer her own and I'm not just talking about the body being taken over by the new, more important, more precious being inside of it, but the whole world suddenly feels ownership. This comes at us with unwanted questions and unwanted touching, unsolicited advice about the right way and the righteous way to be pregnant, to give birth and to mother. And a lot of that has to do with wellness, eating well, exercising well, sleeping well, taking the right pills and tinctures, and choosing the correct caregivers for this special time. Often on this show we're talking about the people and businesses that take advantage of these vulnerable moments to profit from our uncertainty or our attempts to be healthier. But it's hard to say that there's a specific villain in the birthing industry. Sure, there are a slew of teas and supplements and crystals that promise to support fertility and pregnancy, but it's not like there's widespread policies or cases of evil doing healthcare providers hell bent on screwing women over at this time. It's more the culture around birth is broken and often the damage comes from inside our own heads. So today we're just going to talk about what it feels like to be in one of those vulnerable moments, to be overwhelmed with advice and information, and to be forced to question everything you're hearing. Because when it's just you alone, you have a right to pick and choose how well you'd like to be. But introduce a new human, whose existence you are completely responsible for, into the mix, one who cannot yet voice their opinion on the subject, and things get complicated. I grew up being told that birth was easy by a mother who'd had three successful natural births and who also claimed, until she saw me in labor, that mothers who had epidurals experienced less pain, and that pain was necessary to create the maximum amount of love women like her had for their children. Basically, until a few years ago, her thinking was that you had to pay a great price, sacrifice as much as humanly possible to earn true love. She was also, I might add, 20 years old when she had me, so her bones and joints were supremely bendy and she had super short labors. But enough about my mom. I love you, mom. Despite this attempt to indoctrinate me, when I found out I was pregnant at 34 years old, I didn't have super strong feelings about the type of pregnancy or birth I wanted. I basically just wanted the baby to come out however it needed to from pretty much the day it went in. But then I got a bad pap smear at five weeks. Something showed up called atypical glandular cells. And my doctor called me. She said it could maybe be cancer, maybe not, but that A, they couldn't do any more tests on me while I was pregnant, so, B, our best bet was to try for a vaginal birth because that process has the potential to flush out whatever was creating those cells. That's what she said. Spoiler alert. I'm fine. I just had HPV like half the planet. But spending 35 weeks thinking, maybe you're growing a cancerous tumor right next to a baby is. Well, it was fucked up. I'd never related to friends on the hippier end of the spectrum who, like my mom, had really strong feelings about natural birth. But here I was, unwillingly thrust into their world in la, of all places. And I found myself having many conversations with women like my friend Alicia, who had a baby a few years after I did and who couldn't have been more different than me in terms of how she looked at her pregnancy. Did you always want a baby?

[Skyrizi Safety Information Speaker]

I always wanted a baby. What I almost did. What I would say is, I want to read that chapter in the book of life. I want to know what it says in the chapter of having a kid and being a mother to somebody.

[Jane Marie]

I helped write the chapter right before that one in Alicia's book by introducing her to the man who would eventually become her husband and the father of her baby. Ever since she told me she was pregnant, I've had this kind of pride around it, like, I did it. That's my baby. And as you'll hear, Alicia and I are a lot alike. That's why we're friends. We're both producers, type A, et cetera. But when it comes to the baby stuff, there are some pretty stark differences. When did you start thinking about what kind of pregnancy and birth you wanted?

[Skyrizi Safety Information Speaker]

Well, I went to a birth class at a natural birth center, which is a midwife run. You go have birth there at this birth center.

[Jane Marie]

Why did you decide on that?

[Skyrizi Safety Information Speaker]

So I have like a joint disorder called Ehlers Danlos syndrome. So I'm just like very hypermobility. So I was told that I had a high risk pregnancy. So they were like, you have to give birth in a hospital. Which I would have done anyway. I don't think. I had watched the Business of Being Born. And I have friends that have trained to be doulas, but I'm not. I wasn't afraid of medicine.

[Jane Marie]

Yeah.

[Skyrizi Safety Information Speaker]

So the avoidance of it. I didn't think that I would need to protect myself from a medical Experience. Nor was I so interested in the experience of birth that I felt like I needed to control it. Yeah, I went to a birth class because I wanted to learn all about it. The birth class was about 10 couples. I'd say half the people there were gonna have hospital births, half the people were gonna have home births. Tracy flicked it completely, was taking notes the whole time.

[Jane Marie]

Doesn't surprise me.

[Skyrizi Safety Information Speaker]

Constantly raising my hand, dominating the conversation. Barely would let anyone else talk, had researched everything, would hold myself back from saying what the teacher was about to say.

[Jane Marie]

I would've talked so much shit about you if you were in my class.

[Skyrizi Safety Information Speaker]

Annotating, clarifying for the group, that I think what you might mean. What might I. What I've read is maybe something my husband was like, every time you're gonna ask a question, you inhale like this. Because I am holding myself back from, like, raising my hand, like, high in the air, I mean. And at the end of the class, she goes, I think what you need to think through in terms of having an ideal birth experience is what makes you feel safe for some people, what makes them feel safe. And then she looks right at me and she goes, might be information. That might be the thing that you feel you really need to calm you down. And what I thought was, okay, if I arm myself with information, if I know everything about this process, then I will be able to make really healthy decisions. I don't. I'm not mistrustful of the hospital experience, but I also feel like there's a lot of credible things I've heard that make me not want to just do whatever they tell me to do.

[Jane Marie]

This is exhausting me. Even to think about how much you cared, like, I. To think of the amount of information you sought out that comforted you at the time is, like, overwhelming me right now.

[Skyrizi Safety Information Speaker]

What's complicated about it is that because all these decisions are available, right? Which I think has all been generated to give women agency in their birth. I was constantly asked, like, six or seven times a day, what kind of birth are you going to have? Where are you going to deliver? Are you going to do delayed cord clamping or not? Are you going to do the vitamin K? Are you going to labor at home? Are you going to have a doula or a midwife? Are you going to have a doula at all? Are you going to have your friend there? Who's going to be there? Do you guys have a playlist? How are you going to get there? What hospital are you delivering at? Are you going to induce So I kind of felt like, well, I want to be responsible and have answers to these questions and really think it through. I remember getting into a thing about delayed cord clamping where I read about it, there's a risk of jaundice. It seemed like a good idea to have all the cord blood in to the baby, right?

[Jane Marie]

I don't know what you're talking about. Even. See, this is what I'm saying. I shut down. Like there was a point at which information overload convinced me that there wasn't an answer. How did you continue to be interested?

[Skyrizi Safety Information Speaker]

I was terrified. It wasn't interest. It's not like I actually, it was not that I am so interested in birth actually, or really wanted to know the answers or. Actually, I don't think I even thought that there was a right answer. It was that I was completely terrified that I was going to make the wrong decision and something bad was going to happen. In fact, I was sure that something bad was going to happen.

[Jane Marie]

Why?

[Skyrizi Safety Information Speaker]

Because that's how I go through life, is planning for a variety of contingencies of what to do when something very bad happens. And that led me.

[Jane Marie]

But you're not a doctor, so that.

[Skyrizi Safety Information Speaker]

Led me to a very difficult birth.

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[Skyrizi Patient]

My perfect day has sand, salt water and friends, but my moderate to severe plaque psoriasis can take me out of the moment. Now I'm all in with clearer skin thanks to Skyrizi Rizankizumab RZA, a prescription only 150mg injection for adults who are candidates for systemic or phototherapy with Skyrizi. Most people saw 90% clearer skin and many were even 100% plaque free at four months. Skyrizi is just four doses a year. After two starter doses.

[Skyrizi Safety Information Speaker]

Don't use if allergic to Skyrizi. Serious allergic reactions, increased infections or lower ability to fight them may occur before treatment. Get checked for infections and tuberculosis. Tell your doctor about any flu like symptoms or vaccines.

[Skyrizi Patient]

Thanks to Skyrizi, there's nothing on my skin and that means everything is everything. Ask your doctor about Skyrizi, the number one dermatologist prescribed biologic in psoriasis. Visit skyrizi.com or call 1-866-Skyrizi to learn more.

[Jane Marie]

The first mistake Alicia made is the same one I made watching the Business of Being Born, which is a documentary by Ricki Lake about home births versus the medical industrial complex that, according to Lake and her doula, has made birthing more dangerous and less healthy for everyone involved.

[Skyrizi Safety Information Speaker]

It wasn't an illness.

[Jane Marie]

It wasn't something that needed to be numbed.

[Skyrizi Safety Information Speaker]

It needed to be experienced.

[Dr. Sarah Toogood]

It was the most eventful day I've.

[Skyrizi Safety Information Speaker]

Ever had in my life.

[Jane Marie]

There's this explainer scene in the middle of the movie that anyone who's seen it definitely remembers. It's an intense and terrifying cascade of what could go wrong. If you make the biggest wrong decision after the decision to have a hospital birth and that's the decision to get induced. You get this feeling at the hospital where there's like a limit to how long you can be in labor. Like, oh, it's been 12 hours, so now you need Pitocin.

[Skyrizi Safety Information Speaker]

I did know the pressure was on. You know, as we got into like 20 hours, 21 hours at the hospital.

[Jane Marie]

I had Pitocin and then that made me itchy. So they give you something else for your itching.

[Skyrizi Safety Information Speaker]

I knew once they gave you that Pitocin, you need the epidural. Feel better now that you have your epidural?

[Jane Marie]

Oh, my God, yes. And then things come on really strong. So then you get an epidural.

[Dr. Sarah Toogood]

And if you're uncomfortable, we can always give you more.

[Jane Marie]

It was very easy for them to.

[Skyrizi Safety Information Speaker]

Start doing things that we hadn't really.

[Jane Marie]

Wanted them to do, like Pitocin and whatnot, because. Cause I already had the IV in my arm.

[Skyrizi Safety Information Speaker]

They don't really give you the option, you know.

[Jane Marie]

And then another epidural. Cause nothing was happening. You're having a contraction right now. I don't feel the pain.

[Skyrizi Safety Information Speaker]

They gave me another drug called Statol.

[Jane Marie]

17 hours of Pitocin, they gave me that.

[Skyrizi Safety Information Speaker]

And I remember that made me. I was like, what's going on? What's going on?

[Dr. Sarah Toogood]

There's something wrong.

[Jane Marie]

Cerbidil is the end.

[Skyrizi Safety Information Speaker]

I hated that drug. You know, it seemed to me that once they started an intervention, they all just kind of. It was a domino effect.

[Jane Marie]

If you're pregnant and you feel strongly about having a drug free vaginal birth, or like me, your doctor is telling you that's what you need to aim for. Watching that scene in the movie really pushes you over the edge. So imagine Alicia's frustration when she's faced with this exact worst case scenario.

[Skyrizi Safety Information Speaker]

So I ended up getting induced. I'll tell the story. So, like, I got to 41 weeks. Tons of people I know had wanted to have home births, ended up going to 42 weeks, went into the hospital, had had an emergency C section. And I said to the doctor, why is that? She said, well, what I would argue is we're getting new Data that at 41 weeks, the earlier you induce. If you're going over, the earlier you induce, the baby's smaller, your placenta is younger, and you have a better chance for a vaginal birth. What I also had internalized is that a C section is very bad. An epidural will lead to a C section. If I get in an epidural, then I won't be able to move, which then will interfere with pushing in some way where I won't. They will then eventually that will lead to a C section. I want to avoid that for a variety of reasons. The doula sent me a video, the gist of which was, babies are a ripening fruit on the vine. And some cherries become ripe later than other cherries. And 42 weeks versus 40 weeks, they never really know anyway, when the baby was conceived. And I was like, that doesn't sound like science. The thing the other lady said sounded like science. Plus, my husband has to leave town next week. It would be cool if he was there. There's three doctors in the practice and they had said like, well, do you want to deliver on a Monday or Tuesday or Wednesday? If you induce, it's about a 12 hour process. So which. Which doctor do you want? Which morning do you want? And I was like, Monday, let's get.

[Jane Marie]

It over, get the week going.

[Skyrizi Safety Information Speaker]

Yeah. My doula had texted me, just so you know, as you go into this. Induction can be kind of a mind fuck because it can take a lot longer than you think. And I had kind of absorbed that and thought like, okay, whatever. It was 55 hours from the second it started, and every, Every drug I got, I had the most painful, least productive possible reaction. So they gave me cervidil and they were like, you'll sleep through this. And about an hour later, I was having like one continuous level 10 contraction that lasted for 12 hours and nothing happened. I wasn't dilated. And because I was so scared of getting a C section, I asked for laughing gas, which also confused them because they were like, I guess they had to go find this machine. They offered it, which did absolutely nothing. My whole body was like shaking uncontrollably. I was in so much pain. And the nurse came in at one point in the middle of the night in the first night, and she was like, how are you doing? And tears were just streaming down my face, but I was trying to be quiet because my husband was finally asleep. And I was like, I'm having a panic attack. I think, like, I can't breathe and I can't stop crying. And she was like, okay, well, okay, that's burst. Baby looks fine. Yeah, I mean. So then the doula came and she said, you look like someone who is at about. You look like you're in the kind of pain that someone who's about to give birth is in. And you're not dilated at all. So this isn't doing anything. I think you should get the epidural. So my doula went home because I wasn't in labor. Every next thing that happened, when they were going to break my bag of water, when they were going to give me a different drug, when they were talking about a C section, the doctor would come in and say, It. And I would say, give me a minute. And I would call the doula and she would tell me different and new information. Okay, they want to break your bag of water. Just so you know, once you start that you're on a 12 hour clock, they're not going to let you labor more than 12 hours because your bag of water has been broken and it's a chance for infection. So if you do not deliver in 12 hours, you will have a C section a day later or whatever. When they're like, I'm going to break your bag of water, I was like, stop. No. If you do that, I can't go home. I'd been there for 48 hours in labor. I'm not going anywhere. I can't even. I can't walk. I can't barely talk. Like, I'm mumbling. And it's like, you think you're gonna leave, but it's because I had all these ideas in my head. Like, oh, I was so afraid. Like, well, then I can't go home and then I'm gonna lose my. I was just so, like, it was like clawing. It felt like I was like being pulled off of a cliff. And it was like my job to try to stay on the cliff. What was in my head was I decided to do this and this is my fault. So every single thing, I was so mad that I had been surprised at all. Like, you should have told me I couldn't move around. You should have. Why didn't you tell me that this could take so long? The doula had to tell me. So I don't trust you because you told me this was going to be 12 hours and I don't trust the doula because, like, she said something about cherries, but, like, this is all my fault. This pain is my fault. And the baby's going to die for sure. And that's definitely going to be my fault.

[Jane Marie]

The baby's fine, but what happened to Alicia is the perfect example of the uncertainty and uncontrollable nature of pregnancy and birth. We make most of our decisions during pregnancy with the best of intentions based on evidence we gather from anywhere we can find it. Some of those decisions are based in science. Like, we can all agree that it's a bad idea to. I don't know. I don't want to finish this sentence because there's an exception to every rule. When you're pregnant, there are always people who are like, my mom drank and smoked during her whole pregnancy, and look at me now, and you're like yeah, anyway, there are the decisions that we make based in feelings. Some people choose home births because they feel more comfortable there, while others feel more comfortable in a hospital. Some want a scheduled C section a few weeks early, while others will go weeks beyond their due date. And who are we to judge? That mushy space provides us with plenty of choice, which can be a great thing, but it also provides an opportunity for all kinds of messages based in science or religion or emotions or folklore or first hand experience to come in.

[Skyrizi Safety Information Speaker]

It's the New Year and Instacart is here for whatever your new routine looks like. Maybe it's committing to the after work.

[Jane Marie]

Workout or trying plant based recipes or just having fresh ingredients in the fridge.

[Skyrizi Safety Information Speaker]

Because with Instacart you get time back. You can filter shopping by dietary preferences.

[Jane Marie]

And never run out of what you need.

[Skyrizi Safety Information Speaker]

So whatever your new year plan is, Instacart is here to make it just a little more possible. Download the Instacart app today. Actual dietary information may vary.

[Jane Marie]

Always check product packaging.

[Skyrizi Patient]

My perfect day has sand, salt, water and friends, but my moderate to severe plaque psoriasis can take me out of the moment. Now I'm all in with clearer skin thanks to Skyrizi Risankizumab RZA, a prescription only 150mg injection for adults who are candidates for systemic or phototherapy. With Skyrizi. Most people saw 90% clearer skin and many were even 100% plaque free at four months. Skyrizi is just four doses a year after two starter doses.

[Skyrizi Safety Information Speaker]

Don't use if allergic to Skyrizi. Serious allergic reactions, increased infections or lower ability to fight them may occur before treatment. Get checked for infections and tuberculosis. Tell your doctor about any flu like symptoms or vaccines.

[Skyrizi Patient]

Thanks to Skyrizi, there's nothing on my skin and that means everything is everything. Ask your doctor about Skyrizi, the number one dermatologist prescribed biologic in psoriasis. Visit skyrizi.com or call 1-866-Skyrizi to learn more.

[Raj]

Hey, it's Raj and Noah and we're back with a new season of Am I Doing It Wrong? The show that explores the all too human anxieties we have about trying to get our lives right.

[Noah]

Because we're still doing a lot of stuff wrong.

[Raj]

But who isn't? That's why each week we're talking about the topics that we could all use a little helping hit with. Whether it's making new friends as an adult, managing our emotions, or even dreaming.

[Noah]

We'Ll be talking to experts in their fields who are definitely doing things right. So the rest of us can be bit wiser and a lot better equipped to handle whatever life throws at us.

[Raj]

Subscribe now and listen to new episodes of Am I Doing It Wrong? Dropping every Thursday starting January 1st, wherever you get your podcasts.

[Noah]

And for the first time ever, we're going to have full video episodes on YouTube because as long as there are things to get wrong, we're going to be right here to help you do them better.

[Jane Marie]

Love you. This is an ad by BetterHelp. Did I talk too much? Can't I just let it go? Take a breath.

[Skyrizi Safety Information Speaker]

You're not alone.

[Jane Marie]

Let's talk about what's going on. Counseling helps you sort through the noise with qualified professionals and online therapy makes it convenient.

[Skyrizi Safety Information Speaker]

See if it's for you.

[Jane Marie]

Visit betterhelp.com randompodcast for 10% off your first month of online therapy and let life feel better. After hearing Alicia's story, we really wanted her to have the chance to shake off once and for all any feeling that she actually had control over the outcome in the first place or that any mistakes were made by trusting her doctor versus her doula versus everyone else in the room, that the baby just comes out however it comes out, and that aiming for natural versus saying yes to medical interventions in the end really didn't matter. It doesn't say anything about Alicia or about motherhood. So Alicia invited her doctor in to talk.

[Dr. Sarah Toogood]

I AM Sarah Toogood, MD. I'm an obstetrician gynecologist with Cedars Sinai Medical Group in Los Angeles.

[Skyrizi Safety Information Speaker]

The thing I've always been the most fascinated about your job is being a doctor in la in the neighborhoods of LA that I think those hospital service. Do you get people coming in with non medical or alternative or like people getting outside information and like I don't know exactly what to call that kind of a thing.

[Dr. Sarah Toogood]

Yeah, I like the word wellness. It implies that you're trying to be well and that means something different for different people. I think using the words complementary or adjunctive treatments, I like using those words as well because it's not the word. Alternative medicine used to be pretty traditionally used and I don't think people are or should be using it as an alternative to traditional medicine, Western medicine treatment. I like it when my patients use it as a compliment to what our treatment course is.

[Skyrizi Safety Information Speaker]

Do you remember when you started practicing like sort of having to contend with patients coming in with questions about it or telling you about complementary treatments they were doing?

[Dr. Sarah Toogood]

Like yeah, in Residency, the focus is so much on evidence based medicine and knowing the most current literature and staying up to date on the journals and, and there's not room for a lot more than that because you're learning so much every single day. We would be in the clinic or on labor and delivery and it's a patient who had a history of a heart transplant, who's pregnant and is trying to deliver a baby. How acute that medical situation is, is very different than a young healthy woman with her first pregnancy who drinks a cup of coffee every single day and wants to know if she can continue it. When I became an attending, my patient population changed. Where it was, you know, predominantly ppo, well insured, good access to healthcare population. And that's when I found myself dealing with patients questions about these complementary techniques. I guess I would say.

[Skyrizi Safety Information Speaker]

My memory of pregnancy is almost like kind of looking for things to worry about to a certain extent. And having the caffeine thing comes up where it's like, it didn't occur to me till you just said that that like, oh yeah, that's a slightly ridiculous thing to worry about. But like, it came up constantly in my life with people saying like, are you gonna keep drinking coffee? Oh my God, you're so brave for continuing to drink coffee. Have the glass of wine. Waiters pushing me to have a glass of wine. Should I have a glass of wine? Reading studies about it, talking about it, I can't imagine how little stuff like that comes up.

[Dr. Sarah Toogood]

But it's, I mean, the thing is, it's not ridiculous. It was part of your life before pregnancy. Pregnancy is not a disease state. There are things that are safe that you did before pregnancy that you can continue to do during pregnancy. But in certain amounts, caffeine can be dangerous. There is an association with an increased risk for miscarriage in very high quantities. So that's why I say it's not ridiculous. Those are questions women should be asking. It's the women who are really sick and have a lot of complex medical problems, almost don't even have the space to think about that since pregnancy is such a common experience. A lot of women think that because something happened to them during pregnancy or they did something specific during their pregnancy and it helped them, or they had a, you know, a nice delivery and they think this one thing helped them achieve that. They spread that around like it's fact and it's just not.

[Jane Marie]

Let's pause here for a second and talk about a few psychological things that go on not only with our thinking about pregnancy and birth. But with the idea of wellness in general. What Dr. Toogood is talking about here is confirmation bias. It's a totally normal human thing that we all do where we seek out info to confirm stuff we believed before we sought the information. Like, I think if I don't get induced, I'll have a vaginal birth. Oh, look, I didn't get induced and I had a vaginal birth. So I was right. It's not scientific. There's no telling what would have happened in the scenario that didn't happen. But it feels good to distill reality down like this. We also take it too far sometimes and engage in a thing called apophenia. I was so happy when I learned that there was a word for this, because you see it everywhere in the wellness world. Apophenia is the tendency to make connections between things that have nothing to do with each other and then to instill meaning in something where there is none. The most common example is seeing Jesus in a piece of toast. But it could also be thinking that you landed a dream job because you started drinking moon juice. These mental tricks we play on ourselves are a shortcut to feeling in control of situations like birth that are often so far out of our control that making sense of them would be impossible.

[Dr. Sarah Toogood]

And also that people comment on pregnant women's bodies. It's obvious when you're pregnant for most people. And I mean, you know, you get on the elevator when you're pregnant and someone looks at you and says, oh, you must be having a girl.

[Jane Marie]

Based.

[Dr. Sarah Toogood]

On what they think a woman carrying a girl looks like. Which has been studied and has not been shown to be accurate. I mean, it's. Is it like.

[Skyrizi Safety Information Speaker]

What I heard was, like, if you have a linea negra, that means you have a girl, and if you're carrying low, that means you have a girl.

[Dr. Sarah Toogood]

Yeah. I mean, in some studies, I would say some groups say if you're carrying low, it means you're having a girl. Some groups say if you're carrying high, it means you.

[Jane Marie]

You're having a girl.

[Dr. Sarah Toogood]

And it's just. That's just not true. I mean, there's just so many factors.

[Jane Marie]

About why women carry low or high.

[Dr. Sarah Toogood]

And it's different from pregnancy to pregnancy and woman to woman. But people. People take their own experience and they apply it to everyone who's going through a similar experience. And by definition, your experience is unique because it's just you on that specific pregnancy.

[Skyrizi Safety Information Speaker]

The flip side of this feeling that there's, like, a huge amount of information everywhere is that there's no information everywhere. And I got an enormous amount of it off of Google.

[Dr. Sarah Toogood]

Yeah.

[Skyrizi Safety Information Speaker]

So I was constantly on Google researching things and then leading me into stuff I had never heard of or worried about. And then when you start asking questions about it, one of my experiences, I would come in, ask a question about a thing I had heard on the Internet, and a lack of feedback or information about that would then make me suspicious and make me think that it was on me to, like, truly learn more about it versus being calmed down by a lack of information.

[Dr. Sarah Toogood]

Absolutely. You know, I get asked a lot about the cord blood, the delayed cord blood clamping.

[Skyrizi Safety Information Speaker]

I did that to you?

[Jane Marie]

Yeah.

[Dr. Sarah Toogood]

And I mean, and you're not alone. We get that question, you know, with probably 75% of our patients. Patients were asking those questions you might.

[Jane Marie]

Be asking as well. So here's what delayed cord clamping is. It's a prolonging of the time between delivery and clamping the umbilical cord, which usually happens within seconds. Delayed cord clamping lets more blood flow from the placenta to the baby. And on the positive side, it's said to increase blood volume and iron in the baby's blood, which has been shown to benefit preterm babies. But on the negative side, it can also increase bilirubin, which causes jaundice.

[Dr. Sarah Toogood]

It's not an easy answer. And I don't have the. The answer. I have information, but that's information. Especially with pregnancy. People can't perform really well controlled, tight studies on pregnant women, because if we don't know if something's safe in pregnancy, we're not going to, you know, expose one group of pregnant women to something that we don't know is safe and the other group not. And so it's hard to find really solid information in the exact kind of, you know, clinical trials that are considered the gold standard. Those aren't available for pregnant women.

[Skyrizi Safety Information Speaker]

Do you get asked about makeup?

[Dr. Sarah Toogood]

Yes. The clean beauty industry is booming right now, especially in Los Angeles, and it's based on having certain chemicals and preservatives not in the product. You know, I think that the phthalates with. In perfume, that's a commonly asked questions, and I did a deep dive into that, too. And they're. They might cause some harm, but people concentrate so much on the phthalates in perfume, but they're everywhere. The most common exposure of phthalates is from receipts. And no one talks about that. Everyone talks about, you know, perfume and how you should have a phthalate free perfume. But when they go to the store, they don't think about not having a receipt, not grabbing a receipt and exposing themselves to that.

[Jane Marie]

Phthalates spelled P H T H A L A T E S. Yes. Are a man made chemical that binds polymers. They make things malleable and sticky and they're in everything from plastics to flooring to hairspray and perfume so it sticks to you. And they're blamed for everything from developmental delays to autism to adhd. But most comprehensive studies show they only have a negative effect in super high industrial doses and that average people who don't work in a phthalate factory don't need to worry. But then again, we can't do studies on babies in pregnant people, so maybe we should reduce our reliance on them just to be safe.

[Dr. Sarah Toogood]

How important important is that and what is the decrease that we should use to be quote unquote safe?

[Skyrizi Safety Information Speaker]

There was this split in the two different kinds of advice I was getting. And one was from the medical side. It was totally outcome based, which is all I can look at is information. All I can do is look at empirical information and all I can really judge and all I can count is outcomes. So. And then on the other side was experience, which was sort of believing as an article of faith that if you have a good experience, if you feel right about it, if it feels good to you, if your instinct says, if your body says, if you feel comfortable, then that is what will determine a good outcome. If I feel safe during my labor, if I feel, if I feel safe for the stuff I was told, if I feel safe and comfortable during my labor, then my labor will continue to progress normally. If I feel scared or uncomfortable, whatever it is, I don't like the look of someone's face. I don't like the smell of their perfume. That's going to stall my labor.

[Dr. Sarah Toogood]

It's a mindset. You have to be in the right mindset to do it.

[Skyrizi Safety Information Speaker]

Trust the baby.

[Dr. Sarah Toogood]

Yeah, trust the baby knows what it's doing. Trust the baby. Just because you're having a good experience does not mean you're going to have a good outcome. Everyone wants a good experience and everyone wants a good outcome. And for some women, they can absolutely have that, for others, they can't. And if you want to trump your experience at the expense of your outcome, that's really difficult for a doctor to help guide you through. I, as your doctor, want a good outcome for you and your baby.

[Skyrizi Safety Information Speaker]

Pain level, I remember being kind of specific to that, where it was like during My birth, the doula came in and was sort of saying, like, you are in the amount of pain, I would qualify as like, a level 10, and you're not even dilated at all, so you should get an epidural. But pain level. When I was describing all this pain I was in to a nurse or a doctor, the look I would get is kind of like a bummer, but I can't do anything about that. But I do remember feeling like, okay, you don't care about that, because it's not. It's nothing you can measure, therefore it's kind of immaterial to you. So therefore, I have to be the defender of my own pain. And it's me versus you about that decision, which is very complicated. I don't think you wanted me to be in pain. Not you specifically, but you were one of many people that came into my incredibly long labor. I don't think that you wanted me to be in pain. But also, pain didn't seem to determine outcome. Where do you see the most tension between those things of people favoring their experience at the expense of their outcomes?

[Dr. Sarah Toogood]

Yeah, I talk about this a lot because we worked so closely with one of the birthing centers who I loved working with, and I trusted the midwives, and I thought they took excellent care of patients, and we would be their doctors if the patient disqualified for a birth at the birthing center because she developed some complication or, you know, an induction was indicated or if something happened during labor. And by the time they come to the hospital, I mean, they're. They have a 50% chance of having a C section because they've already veered off of a normal labor course. And that's why the women who were already in labor being transferred, that's why they had to come to the hospital as they veered off course. All of their kind of education and childbirth classes were geared towards giving birth unmedicated in a birthing center with limited interventions and really no options for pain control except for nitrous oxide. All of their birthing classes were centered around empowerment and empowering themselves. And if you feel empowered, you will have a better outcome, and you're in control. Your body's made to do this. And so for women who have that mindset going into their labor and delivery, and they have a vaginal delivery in a birthing center, as expected, of course, they feel so empowered because everything that they told themselves was correct, that they trusted their body and their body could do this, and they did it. When those women have to come to the hospital because their labor course is not going the way that they thought. They're disempowered, and more so than women who are expecting to give birth in a hospital, but they feel like they did something wrong, that it was on them, that they, you know, they surrounded themselves with the wrong person or they weren't in the right mindset, or they what. Whatever it is they could think of, they. They go through and dissect every minute of every day for the weeks leading up to their birth and think if they had done one thing differently, it would have changed the outcome. And it's just not. Statistically, that's just not true. A lot of them feel devastated, and the outcome was good, right? But their experience was not good for them. And it's partly because they blame themselves for it, because they were always told, this is how you empower yourself. So then if you fail that you've disempowered yourself. I had a patient stuck with me who had a C section for arrest of descent, which means that you're 100% dilated and you've pushed, and the baby is not going to come out of the vagina. So this woman had a C section. And the next day, she was still questioning the decision to have the C section. And she asked me, well, what would have happened 100 years ago if I was in this situation? And I looked at her and I said, you and the baby both would have died. And I 100% believe that. And she said, oh, well, that's dramatic.

[Jane Marie]

Doctor Toogood is a real doctor, and trained doulas and midwives are real health professionals whose presence during birth has been shown in multiple studies to lead to more positive outcomes for mother and child. And we're going to come back to that later in the season. The statistics are truly remarkable. Especially in underserved communities, prenatal care of any sort is shown to have positive effects on pregnancy, the birth experience, and the newborn phase. But what that care looks like exactly can vary so greatly as to nullify the feeling that any one particular choice is better than another. At the beginning of my pregnancy, a few studies came out saying that drinking moderately during pregnancy had zero effect on the baby's intelligence. And then I found some articles that said even one drink could cause birth defects. I got acupuncture on the advice of my midwives because they said it could increase the likelihood of going into labor on my due date, which would decrease the likelihood of getting induced. But during one session, I asked the practitioner if I had to believe in acupuncture for it to work and she replied, well, yeah, it helps. I never went back, but I did go into labor on my exact due date and the baby was born two days later. The Dream is a production of Little Everywhere and Stitcher, written and reported by me, Jane Marie and Dan Gallucci, editing by Peter Clowney and Tracy Samuelson with production by Stephanie Kirayuki and Lyra Smith. The Dream is executive produced by me, Dan Gallucci, Peter Clowney and Chris Bannon. Our mixing engineers are Casey Holford and Brendan Burns. Please rate, review and subscribe wherever you get your podcasts and thanks for listening.

[Skyrizi Patient]

My perfect day has sand, salt water and friends, but my moderate to severe plaque psoriasis can take me out of the moment. Now I'm all in with clearer skin thanks to Skyrizi Risankizumab RZA, a prescription only 150mg injection for adults who are candidates for systemic or phototherapy with Skyrizi. Most people saw 90% clearer skin and many were even 100% plaque free at four months. Skyrizi is just four doses a year.

[Skyrizi Safety Information Speaker]

After two starter doses, don't use if allergic to Skyrizi. Serious allergic reactions, increased infections or lower ability to fight them may occur before treatment. Get checked for infections and tuberculosis. Tell your doctor about any flu like symptoms or vaccines.

[Skyrizi Patient]

Thanks to Skyrizi, there's nothing on my skin and that means everything.

[Skyrizi Safety Information Speaker]

Nothing is everything.

[Skyrizi Patient]

Ask your doctor about Skyrizi, the number one dermatologist prescribed biologic in psoriasis. Visit skyrizi.com or call 1-866-Skyrizi to learn more.

[Raj]

Hey, it's Raj and Noah and we're back with a new season of Am I Doing It Wrong? The show that explains or is the all too human anxieties we have about trying to get our lives right.

[Noah]

Because we're still doing a lot of stuff wrong.

[Raj]

But who isn't? That's why each week we're talking about the topics that we could all use a little helping hand with. Whether it's making new friends as an adult, managing our emotions, or even dreaming.

[Noah]

We'll be talking to experts in their fields who are definitely doing things right so the rest of us can be a bit wiser and a lot better equipped to handle whatever life throws at us.

[Raj]

Subscribe now and listen to new episodes of Am I Doing It Wrong? Dropping every Thursday starting January 1st, wherever you get your podcasts.

[Noah]

And for the first time ever, we're gonna have full video episodes on YouTube because as long as there are things to get wrong. We're gonna be right here to help you do em better.

[Dr. Sarah Toogood]

Lunch was great but this traffic is awful.

[Jane Marie]

Um, can we stop at a bathroom? Are you alright?

[Skyrizi Safety Information Speaker]

I keep having stomach issues after eating like diarrhea, gas and bloating, abdominal pain and sometimes oily stools.

[Jane Marie]

Sound familiar? Those stomach issues may actually be a pancreas issue called exocrine Pancreatic insufficiency or lipase may help manage epi. Creon is a prescription medicine used to treat people who can't digest food normally because their pancreas doesn't make enough enzymes.

[Skyrizi Patient]

Creon may increase your chance of fibrosing colonopathy, a rare bowel disorder. Tell your doctor if you have a history of intestinal blockage or scarring or thickening of your bowel wall, if you are allergic to pork or if you have gout, kidney problems or worsening of painful swollen joints. Call your doctor if you have any unusual or severe gastrointestinal symptoms or allergic reactions. Take Creon as directed by your doctor and always with food. Do not chew capsules as this may cause mouth irritation. Other side effects may include blood sugar changes, gas, dizziness, sore throat and cough. These are not all the side effects of Creon. Call 863-9110 or visit creoninfo.com to learn more. That's C R E O N info.

[Skyrizi Safety Information Speaker]

Com. I'm asking my doctor about EPI and if Creon could help.