Read. Talk. Grow.

67. Finding community on the complicated path to motherhood

Episode Summary

Today's conversation explores the emotional and medical complexities of motherhood, particularly for professional women. Dr. Denise Millstine hosts Dr. Rebecca Thompson, author of Held Together: A Shared Memoir of Motherhood, Medicine, and Imperfect Love, and Mayo Clinic expert Dr. Molly Kraus. We discuss the diversity of paths to motherhood — including adoption, surrogacy, pregnancy and fertility challenges. Dr. Kraus reflects on her own experiences and advocacy for reproductive planning among women physicians. Together, they emphasize the importance of storytelling, listening and community in navigating grief, resilience, and the unpredictable nature of family-building.

Episode Notes

Today's conversation explores the emotional and medical complexities of motherhood, particularly for professional women. Dr. Denise Millstine hosts Dr. Rebecca Thompson, author of Held Together: A Shared Memoir of Motherhood, Medicine, and Imperfect Love, and Mayo Clinic expert Dr. Molly Kraus. We discuss the diversity of paths to motherhood — including adoption, surrogacy, pregnancy and fertility challenges. Dr. Kraus reflects on her own experiences and advocacy for reproductive planning among women physicians. Together, they emphasize the importance of storytelling, listening and community in navigating grief, resilience, and the unpredictable nature of family-building.

This episode was made possible through the generous support of Ken Stevens.

We talked with:

Purchase a copy of Held Together with a portion of the proceeds going to benefit Postpartum Support International and their work in maternal and family mental health:

Purchase a signed copy of Held Together for shipping anywhere in the US (please specify SIGNED on checkout page notes):

Visit Dr. Thompson's website, where you can explore in-person gathering opportunities and recorded media, find reviews and endorsements, read the full introduction and other excerpts from Held Together, and get in touch if you'd like to talk about ideas for collaboration: www.rebeccanthompson.com

 

Got feedback?

Episode Transcription

Dr. Denise Millstine:

Welcome to the “Read. Talk. Grow.” podcast, where we explore women’s health topics through books. Our topic today is motherhood, particularly struggles faced by modern professional women, including physicians. Our book is “Held Together: A Shared Memoir of Motherhood, Medicine, and Imperfect Love” by Rebecca Thompson, MD. I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine.

 

And my guests today are Dr. Rebecca Thompson, who is a family medicine and public health physician specializing in women's and children's health. She trained at Harvard, Stanford, and Oregon Health and Science University. She lives in Portland, Oregon, where she spends her free time wandering through green spaces, reading in cozy nooks, and accompanying her husband and children on all-weather adventures near and far. “Held Together” is her first book. Becca, welcome to the show.

 

Dr. Rebecca Thompson:

Thank you so much for this opportunity. Great to be here.

 

Dr. Denise Millstine:

Our second guest is Dr. Molly Kraus, who's an associate professor of anesthesiology at Mayo Clinic in Arizona. And while being incredibly accomplished in that aspect of her career, has also been a staunch advocate for women in medicine, particularly around fertility, pregnancy and support of mothers. Molly, welcome to the show.

 

Dr. Molly Kraus:

Thanks for having me.

 

Dr. Denise Millstine:

“Held Together” is a braided narrative of many women's stories, including Rebecca's own of her pregnancies and experiences with some terrifying and often rare medical conditions, alongside stories of her friends, colleagues and other women Rebecca connected with to create this book. 

 

Okay, you both know how “Read. Talk. Grow.” works; we discuss books that portray health topics in an effort to better understand health experiences through story. In this case, we'll discuss motherhood and many of its complications, particularly how that affects busy and professional women. Becca, tell us how you came to fully put together this beautiful book.

 

Dr. Rebecca Thompson:

Thank you. So the origin story of this book is really in our family's origin story. When I was just starting out as a new physician, finishing up my training, about to start on my first attending level job, my husband and I decided that's a pretty good time to think about starting a family, and from there, everything just did not go as planned. Almost nothing about it went as we had hoped it would go. And at first I just didn't feel like I could share any of those details. 

 

As physicians, we are. We're supposed to be there for our patients. We are strong and capable, and we get things done. We're successful. That's what led us to the path that we're following. When we suddenly find ourselves off that path, it's confusing. It can be really intimidating. And frankly, it can feel a little embarrassing. 

 

Like we can't even do the things we're trying to help our own patients do and support our colleagues in. So I was hesitant to talk about the struggles that we were having, the repeated losses, the medical complications and everything that just we couldn't make right. 

 

But over time, there was some kind of a shift where I felt like, well, holding this in has become harder than starting to let it go. And as I started to share glimmers of our story, first with close friends and family members, I found that every person around me had a story they wanted to share and where I had felt completely alone in these struggles, even if I knew others were going through struggles, they felt like everything was different in ours. I just I couldn't connect with my friends who are having different struggles. But once I started letting them in, the way that we were able to support each other was just incredible. And so I realized that I wanted to find a way to preserve all of these stories. I was starting to hear and that we could work together to let those stories help others and offer something back.

 

Dr. Denise Millstine:

I think that's really beautiful and so important that you said about the embarrassing component of it, because telling these stories is really vulnerable, and it's so brave that you not only told your own story, but pulled together these women to give them a platform to tell them and be honest about their own really vulnerable and intimate stories as well. So thank you for that.

 

 

Dr. Rebecca Thompson:

Thank you. Thanks for saying that. It was challenging, but the most rewarding thing I've done professionally by far.

 

Dr. Denise Millstine:

Until you were on “Read. Talk. Grow.”

 

Dr. Rebecca Thompson:

I do love talking about it with so many different people. You all, everyone I've talked to with it for an interview brings out a new angle on things and makes me see the work in a different way, and I am really grateful for that too.

 

Dr. Denise Millstine:

And we're looking forward to the conversation. So, Molly, tell us your reaction to the book and also if you're open to sharing your inspiration for supporting women in medicine through your career as it pertains to their reproductive lives.

 

Dr. Molly Kraus:

Well, Becca, I really enjoyed the book, just as a reader. There is such diversity in the book of different stories, different backgrounds of women, different religious backgrounds, and really how these women became mothers and grew their family, their stories, you know, of women who went through fertility journeys, losses, complications, adoption, surrogacy. I mean, there are so many different ways that we become mothers and become family units. And it was really moving and eye opening to read all these different accounts. So I really enjoyed the stories.

 

Dr. Rebecca Thompson:

Thanks.

 

Dr. Molly Kraus:

And I personally became interested in motherhood and medicine. First, I would say as a medical student, because I got married in medical school and really knew that I was going to be ready to start a family during residency. But at that time, you know, this was 15 years ago, so it wasn't as common for residents to have babies during training. And, you know, that comes with a lot of challenges. And I didn't know that many women who had babies during medical school or residency. 

 

And I just wanted to make sure that all women in medicine felt empowered to start their family when they felt that they were ready for it. And then also, you know, for the trainees to start thinking about their family planning. Because sometimes we were so focused on training and medical school and then residency that you may not even really think about it until you get done with training, which, you know, I think it's fine to wait until you're done with training, and many women do, but it's good to start thinking about it when you're younger and knowing what your options are. And if there's anything that you might want to do during training.

 

Dr. Rebecca Thompson:

Definitely. That’s wise. 

 

Dr. Denise Millstine:

I think this idea of not deciding is deciding. So if you're so focused on, whether it's school or training or getting your feet underneath you in your career, you may just assume that when I'm ready, it will be there and available to me to become pregnant and to have a family. Whatever you're thinking that's going to look like for you. 

 

And as is depicted and “Held Together,” we see that for many people that is not an automatic and often I think we don't hear those stories. So, Becca, maybe you'll talk to our listeners about your first pregnancy. So this is how the book kicks off. You're doing a pregnancy test. You can't believe your luck. It's immediately positive. It felt like, could it really be this simple?

 

You go for a walk with your husband, Ian, you guys are giddy, like, do you want to be a parent? You're laughing and quickly you learn just how challenging, heartbreaking, and abruptly pregnancy can change. Will you share with our listeners who haven't yet read the book?

 

Dr. Rebecca Thompson:

You'd portrayed that really well, really accurately, and captured the sentiment of it. We didn't assume things would be easy for us because we did know people, in spite of the whole experience, making us feel isolated and alone. We did know people who had some struggles in our family. Even each of our parents had had a not super straightforward path.

 

It ended up being more straightforward than our path turned out to be. But at the time we thought, well, this won't happen right away. Like we don't make assumptions about it. So we thought we were guarding ourselves against some of that pain. But yeah, we were quite shocked when it happened so easily and even more shocked when it ended so quickly within, you know, days after that, everything was unraveling.

 

And now I can say with the retrospective view, I have, that was the easy one. That first pregnancy loss. So simple, so straightforward in some ways the most emotionally challenging because everything happened so fast. But then we were pregnant again the very next month, and that one got a lot more complicated and led to the surgery. That is kind of the opening scene of the book that I'm recovering from.

 

And the third pregnancy, in some ways even more complicated. I mean, every one was a little bit different, but as everyone knows, just from the intro that you gave in my bio, like we do have children, so I can tell you that the book, if I want to put it this is not as sad, but it's got challenging stories in it for sure.

 

But it really is fiercely optimistic. Never simplistic, but you know, you watch our path and as complicated as it gets, you know that in the end we make something happen that is akin to what we had hoped for. 

 

So, you know, I think that the optimism, too comes in. We'll talk as we talk more about some of the different stories, I'm sure. But the optimism comes in watching people struggle and then grow from it and change and make meaning out of all of these incredibly difficult situations.

 

Dr. Molly Kraus:

I agree with you. It's a very optimistic book. It's also a very moving book. I cried at times in the book. I was so moved by the stories, and you're right there with the person as they're experiencing this, and I think it brings up your own experiences as a mother and a woman. If you've gone through anything like that, it's just a really touching, moving book.

 

Dr. Rebecca Thompson:

Thank you. And I want to say I love it that you cried, but I'm touched that you were so touched. Right? And I have to tell you, when I reread these stories and I've read them so many, I mean, dozens of times, I can't stop reading them. I still find them so compelling, even as close as I am to the stories and the writing.

 

They move me every time. I find myself teared up through them all the time when I reread them or talk about them. And I think that's partly because. So, as you all know, that and those of you who've read it know this is a shared memoir. It's not just my own story. It does hold the stories of 21 other women as well. And what's unusual, I think about it, why I've called it a shared memoir, is that it really was a collaborative process. 

 

So each of the women's chapters, this is not an anthology. I didn't just reach out to people and say, I'm looking for a story about surrogacy. I'm looking for a story about foster care, about divorce, about infidelity, about IVF. These are just people that I know organically in my life and a lot of each other. And with each of them, I already had a relationship, and that ranged from friends of 30 plus years to patients that I'd only worked with in the past few years and had been getting to know, and colleagues I'd met throughout different stages of my training. And I approached each woman to invite her to collaborate. 

 

So each of these chapters essentially, for the most part, like some people, contributed more of their own writing and journal notes and things than others, and some people contributed quite a bit of their own writing. But each of the chapters was really the foundation with oral history and working with the women, talking with them, recording everything and going back and forth over many iterations, over several years for each chapter.

 

But the whole book took just over a decade to write, but each chapter had many iterations where I would take the recorded histories that we had, transcribe them, try to write the chapter in her words, using her, trying to channel her voice, use her voice, and present it back to her and say, what did I get wrong? How about in this part? Could you tell me more about that? What were you feeling? What details did I miss? And so while I'm presented as the author and yes, I sort of wrote these stories, I really feel like I'm shepherding them for these women. And I still feel just as moved when I read them, as if I'm hearing them for the first time.

 

Dr. Denise Millstine:

Yeah, they are really such powerful stories, and I liked what you said about them being fiercely optimistic, because I do think that when we think about pregnancy, we often see these highly romanticized narratives and images. So many women come into the process just having that as their expectation and are in fact shocked that within the joy there are challenges and unexpected events.

 

And I don't know if you had a chance to listen, but in Episode 34, we talked with Danielle Valentine, who wrote the book “Delicate Condition,” which is actually pregnancy horror, because she was so disillusioned by what she navigated with her pregnancy. The only way she knew how to make sense of it was to write it into her genre, which is fiction but horror fiction. And what an interesting approach to really see some of these things that she was so shocked by. 

 

Okay, Molly, I have a question for you. So Becca shared about several pregnancy losses. So miscarriage or pregnancy loss is so, so difficult, so hard and so common. The topic was actually even an inspiration for creating “Read. Talk. Grow.”at the very beginning. Why do you think we don't talk about miscarriage and pregnancy loss?

 

Dr. Molly Kraus:

You know, it's painful and so personal. And sometimes I think as women, we don't know when to share the news that we're pregnant. And, you know, you have this struggle. Do I wait until I know that, you know, this will be a successful pregnancy and share my news, because I don't want to have to go around and tell everybody if I did miscarry. 

 

Or do you tell people earlier in case you do miscarry, you can have that support and let people in? I think it's a little taboo, maybe in our culture to speak about miscarriages. But, you know, in my own experience, I feel that same way that the more you share your experiences, the more you heal and the better it is. And you find, you know, friends and colleagues and other women who have had similar experiences and it helps you get through it. It helps lift you up. 

 

And you know that theme was in many of the stories, not all the stories, but there was pregnancy loss in multiple stories. And there is something once you've had a miscarriage. I did experience a miscarriage myself, personally. 

 

It's the second you know you're pregnant. You can't help but think about the future, you know, and you're already thinking about the due date and how old's the baby going to be at Christmas. And, you know, your mind just goes there. Even though, you know, miscarriage is common. You're early in your pregnancy, perhaps. You know you should be a little guarded, but you just can't help. You already love that baby. You know all those things in your mind. And so when you miscarry, even if you are pregnant a short time, it is emotional to work through.

 

Dr. Rebecca Thompson:

Because it's not just about the loss of that pregnancy, that particular person who would have been. It's about the loss of this imagined future. It's the potential, right? 

 

Like you say, even though several of the stories include pregnancy loss and early stories, this book covers such a wide arc of family life. You know, the oldest collaborator is in her mid-70s now, and her daughter has adult children. And so, I mean, there's a huge range. 

 

And I think about how what you've said thinking about the potential, the future that we lose when we lose something in life, whether a pregnancy or something else. Right? It's the possibility and the potential that we really lose. 

 

And even stories where there's, you know, there's one story talking about the loss of a spouse, and I won't name it intentionally so that I don't give a spoiler per se, but I will say that that person talks about when her husband died, one of her biggest sources of grief was that they would never have a sibling for their other child, and it was the loss of the potential; the travel they wouldn't do together, the other children they would never have. It was certainly about the loss of him as well, but there was so much more to it than that. And it was all about her hopes that she hadn't even thought to realize were so fragile.

 

Dr. Denise Millstine:

Yeah, I think grief is so complicated, and we often think of it in terms of death, but I think maybe we don't often think of miscarriage or pregnancy loss as a death, but it's clearly a grief that most people will have to navigate after and will look different for each person and each couple. 

 

Becca, I wanted you to comment about when you've had a pregnancy loss and then you have another pregnancy. So you've just shared with our listeners that in your earliest pregnancies, you had three pregnancy losses before you had your first child, Zach. And terribly sorry for all that loss that you went through.

 

Dr. Rebecca Thompson:

Thank you.

 

Dr. Denise Millstine:

But in that second and third pregnancy, you can't help but have your radar up for symptoms you're experiencing and trying to navigate, is this just normal, or is this something that I really need to raise the alarm about. Can you help women who might be listening on how to distinguish with those subsequent pregnancies, like when do you pick up the phone or send the portal message or however you communicate with your team?

 

Dr. Rebecca Thompson:

It's the trickiest question, right? It's even more complicated when you know a little medicine. So yes, for us, after the first loss and like you say, our suspicions are kind of heightened for problems that can arise. It's always such a fine line. You don't want to doubt your intuitions, but you also don't want to overflow them or panic at every little thing, because even miscarriage, it's as you mentioned, Molly, it's so common, right? 

 

It's considered almost a normal event in reproductive life. That doesn't mean it's not really difficult to go through individually, but at a population level doesn't usually mean anything is wrong with you. That one wasn't going to work out genetically or for whatever reason, right? So thinking about it at that personal level, I felt like I was balancing well, I know that I'm more concerned than I might have been because something went wrong last time, but I also know that I'm not feeling anxious.

 

And when someone, another medical professional is telling me it's just because you're anxious about this pregnancy, look into yourself and figure out, is that true? Is that it's easy for people to label, especially women. But a lot of our patients, we label things as anxiety. Look inside and say, do I really feel anxious or is this some kind of intuition coming from some other reason or some other? Is there science? Is there evidence behind why I'm worried? Because I felt like that was the biggest way that I was dismissed when I was dismissed. 

 

And this is even more of an issue. It came up during the second complication, the second pregnancy loss, when I went to the emergency room and I was worried that I was having internal bleeding, and I was completely dismissed and told I was being anxious, and I was just worried because I had lost the last pregnancy.

 

And, you know, to the point where I heard the attending kind of talking about this with the residents and teaching them that I was just being anxious. Meanwhile, like, if you look at my vital signs, I was clearly kind of slightly, just fighting off, being in shock. I wasn't it wasn't nothing dramatic, but my vital signs were slightly abnormal. Everything pointed to, this was not just because I was worried, gave me fluids and said, you're just dehydrated. Like, no, I'm not dehydrated and I don't feel any better after fluids. I still feel this abdominal pain and shoulder tip pain and all these, you know, whatever. 

 

So I guess what I'm getting at for anyone going through this in that moment is to reassure you. It's really hard to sort out what is your worry, because you're going to be worried and that's appropriate, and what is the reason for your worry. So don't let people tell you it's just because of something. Just it's usually a red flag. They're saying it's just this thing. They're being dismissive. So please listen to what your body is telling you and at least talk to someone to think through why you're worried, whether that leads to other testing or not. It'll help you understand and help your clinician understand if there's some, you know, scientific medical reason that's likely to be behind it that you should really explore for your safety.

 

Dr. Denise Millstine:

I think that's really phenomenal advice. Thank you so much for that.

 

Hey listeners, we hope you're enjoying this episode of “Read. Talk. Grow.” If you find our discussions helpful and insightful, please take a moment to subscribe to and rate “Read. Talk. Grow.” on your preferred podcast platform and don't forget to tell your friends to listen. Your support will help us reach more readers and those eager to learn about health through books. As always, feel free to drop us a line at readtalkgrow@mayo.edu with suggestions for books, topics or any comments. Thanks for listening.

 

Molly, I want to highlight someone who played a really important role in Becca's pregnancy. And that's the physician named Devorah, who Becca met when Devorah was a resident. So for our listeners who aren't in medicine, that's a young physician in training being supervised by attending physicians. Devorah made Becca feel heard and supported, seen and cared for. Were you equally struck by the wisdom and compassion of this young physician, as well as thrilled to see her story later in the book?

 

Dr. Molly Kraus:

Yes, I really loved how Devorah was really a character throughout the book. She came in and out of the book, and I loved how you weave that throughout the book and your relationship and how it grew as she moved on, graduated from training, set up her own practice, and you followed her as a patient. And it was really moving to read about your relationship, even when she was a resident, and what she meant to you, even though she had a supervising physician, you really felt that she listened to you. You connected with her. She was looking out for you. You could trust her. And that really came across as the stronger relationship there. You didn't really talk about her attending physician, and that can happen.

 

And I think it's a powerful relationship for residents to experience connecting with their patients, and also for our patients to have these residents, physicians who really take the time, get to know the background, the history, our training in a way that they listen to their patients and take time with their patients and can really make an impact, even though they're still in training.

 

Dr. Rebecca Thompson:

Yeah, listening is absolutely the core. It was the core of our relationship when it started. It was the core of so much of medicine and the good care that we can provide. And she and I still are really good friends, Now we live a bit far apart in town, so we don't get to get together as often as I'd like, but we really that relationship has endured and gone through many, many other things. Even since the book ended that we've been able to support each other in. And I feel like the core of our relationship has always been listening to each other. 

 

Also, thank you for pointing out the structure of the book and how that brings her into it. You know, as a character in my story. But then at the end, you see her story and how she became this compassionate physician who was able to provide me the care that was exactly what she would have wanted if our roles had been reversed.

 

And, you know, I'll say also, she and I have been doing some live, in-person book events together. We just scheduled another one for the Fall, and it's been really great to talk in conversation with her, too, with groups of people about those relationships and how being physicians, how we take care of each other and how it changes our own perspective on our own medical care.

 

Dr. Denise Millstine:

Yeah, she seems like a really remarkable human being.

 

Dr. Rebecca Thompson:

She is.

 

Dr. Denise Millstine:

I love the idea that, you know, we often think we want the most expert, the most knowledgeable, the most highly polished health care professional on your team, and often not what you need the most is somebody, like you said, who sees you and who listens. 

 

Talking about listening, Becca, several of the women, I guess you've said now all are somehow connected to you and your personal life. But several of them are actually dear friends of yours. And one thing that struck me in their stories is that everybody, at least everybody included in the book, navigated some challenge. But even as a close friend, you didn't know that you might make an assumption that, well, this person had a successful pregnancy on their first try and carried the baby to term. And as far as you know, talking, of course, about your best friend and as far as you know, everything's going well. And yet then she's navigating this really severe and difficult colic with her young child. Can you talk about that idea of being so close to people and yet truly not actually knowing their struggles, particularly as it pertains to motherhood?

 

Dr. Rebecca Thompson:

Absolutely. That oh, that's such a fantastic point to bring up. And I think that really gets the motivation of writing this book as well. That you truly never know other people's stories, and it even ties back into something you were saying a few minutes ago. While some of these stories, the loss is a death or loss of a pregnancy or loss of a living person. They're not all about death, by a long shot. 

 

And even these loss of the imagined future that we thought, you know, we were walking toward even when there's no dramatic, visible loss to the outside world, they can bring just as much grief that we're not having the experience that we had hoped for and envisioned and tried to build for our families. And when it's not in our control, especially. 

 

Right. So for you're talking about Tessa's chapter and she's been one of my closest friends for let's see. So since we started med school more than 25 years now, and when we were both going through such different experiences of becoming parents, we wanted to trade places with each other. We didn't understand how difficult the other person's experience was. And because of that, we just couldn't connect, even if we'd wanted to. We just were not able to be there for each other. And I think that is one of the things I really hope people get from this book, whether you are a clinician, I think you might get that in a special angle.

 

But even just being a person with a body, hearing these stories and realizing you never really know what people are going through that and having curiosity, I want this book to bring out people's curiosity about what others are experiencing and make fewer assumptions so that they have that foundation for compassion. 

 

And I hope that having these kinds of stories out in the world, it helps people feel more patient with each other, and it counters some of that quick judgment that we think either that person we know what they're going through in a negative way, or that we think their life is easier than ours. We just really never know.

 

Dr. Molly Kraus:

Becca, in one of the stories, one of your collaborators at the end of her story really reflects on her current family and what others may see. And I remember her pointing out, you know when medical students come and see my office and see, you know, my children, they may have no idea what I've gone through. 

 

And that really struck me as just exactly as you said, like we really are just seeing from the outside and you make assumptions like they're so lucky they have a beautiful family and you think it's one way, but you really don't know. And that story really highlighted ultimately had two beautiful children, but it was a very difficult journey to get through that.

 

Dr. Rebecca Thompson:

Yeah, that story really epitomizes all of these things. That's Eriko's chapter. And another thing about that chapter and what people looking at that picture of her two beautiful children at her office desk don't understand, is she is the quintessential example of what you said earlier, thinking about how your training might impact your family planning timeline, and she feels like she waited too long and her career really impacted in a very I mean, she's grateful for all that she has in her career is going well now. Like it all kind of came together, but it made things really, really difficult for a lot of years. 

 

And she very much now advises younger trainees to think proactively about the timing, especially if they want to have children through pregnancy, which is not an assumption. Many people choose other paths, so not to imply that's the only way, but if they want to be pregnant, to think about biologically how to balance those realities. As you said, Denise, you can't just assume it will be there when you're ready. She's an advocate for that now, too. 

 

Dr. Denise Millstine:

Well and Molly, this might be a good point to talk about some of the work that you've done with AMWA, which is the American Medical Women's Association, and really encouraging young female health professionals to think about their reproductive life plan.

 

Dr. Molly Kraus:

Yes. So I'm the vice president of Ignite Medicine, which is a nonprofit organization started by Dr. Julia Files several years ago when she recognized that there is this hidden curriculum for women physicians that we could do better educating these women medical students about certain struggles or challenges they may face as women physicians, such as burnout affecting women more than men, family planning and imposter syndrome, for example, among other things. And so she started this nonprofit organization known to work with medical students, particularly women medical students, to discuss this curriculum, to work on coaching, to give the perspective of older women physicians, what we wish we would have known when we went through training.

 

Dr. Denise Millstine:

And what a great name for it Ignite, because it really is just trying to bring attention to it as you said earlier. Many women professionals just put their head down and think, I'll deal with that when I come up for air and are surprised to find out how long it takes to feel like you have space to come up for air.

 

I want to talk about testing in pregnancy, because this too is something that we see in many of the stories in the book, and I'm hoping you'll both comment on this. Molly, maybe you first thought about some of the struggles around decisions to test, or findings that may or may not be clinically significant. How do you help people who are seeing these, who knows if they're clinically important findings on testing during pregnancy or really at any point.

 

Dr. Molly Kraus:

That was highlighted in a few stories in the book about if they were going to go for more testing. A couple instances where there was indeterminate finding and struggling with that, not knowing and waiting for a final test, or even the birth of another child at times on the story. 

 

And I think we talk about the mixed emotions of pregnancy and growing your family. And I think a thing that comes across is fear also. It's a normal emotion to experience during pregnancy and labor and delivery. Of course, I think it's a personal decision for the patient to decide how much testing they would like to do when they're pregnant, and what level to pursue the testing, but I think their obstetrician would be the best person to talk them through what tests there are.

And what's the chance that the test is correct or could miss the diagnosis? Or what's the chance that the test signals that diagnosis and it may not actually be true. So patients should have a good understanding of the test and how reliable the test is before they make that decision to pursue the test.

 

 

Dr. Denise Millstine:

I just want to double down on that before Becca answers this question. Which is for our listeners who aren't in health care, you may be surprised to learn that almost all of our tests are not perfect, even if they're 99% accurate. There is always some level of error that could happen with any test, and many of the tests that are done are an interpretation, an opinion by an expert. So an expert opinion, but have to be taken in that light. 

 

So I love what you said, Molly, about recognizing what is the accuracy of this test. What is it actually predicting? Could it be wrong? All of these are complicated but important questions to ask. Okay, Becca, talk about the testing in some of these stories.

 

Dr. Rebecca Thompson:

Yeah. So I will speak then to the literary side of some of the tests and how we explore them in the book. I think one of the things that's really fascinating about seeing different people's experiences with these kinds of tests is you get this sense of a moment when things could have pivoted so differently, these sliding door moments, what if my life had gone this way, but instead it went that way?

And that's part of why, you know, these chapters are organized in a very intentional way, in which stories are next to each other and which ones are at which points intersecting with my own, because they have common threads. 

 

And the reader then can see one example of when a test goes a certain way, what a family does with that information, and one test goes the other way, how it affects the family going forward. So another really interesting thing this isn't delved into in the book, but overall, I hope that we've conveyed a little bit of sort of medical history and you see how different tests and different technologies change over time with and even just adoption laws and things like different technologies and regulations. Right. 

 

But in this case, you know, you see, when I'm pregnant for the fifth time, getting a test, a certain test with kind of early pregnancy testing, ultrasound, it's kind of a soft marker finding abnormality in ultrasound and saying, well, let do these other tests and see a more invasive test to see what we think is probably the truth. Again, knowing it's not perfect. 

 

And turned out to be my daughter. My daughter and I were actually part of a study developing blood testing, maternal blood testing based on the CVS, the chorionic villus sampling invasive tests that we had during pregnancy with her. To correlate, can you just look at mom's blood rather than doing an invasive test to figure out chromosomal differences, right. We were in the study for that test. 

 

And then later, you know, in that section of the book, you see a couple of different women getting that test. One of them is Leah, and she has an invasive test, but also blood work, initially saying, we have this worry about a chromosomal difference. That blood test was the one that my daughter and I had been part of the scientific study for. So it was really rewarding to me that being at a university medical center, I went through the pregnancies at the place that I had trained, as well as a resident. We were able to contribute to some knowledge that helped people and not just people in abstract, but someone I knew then ended up being able to use that kind of a study years later to learn something that changed how she made decisions for her family, and that was really a full circle moment.

 

Dr. Denise Millstine:

Yeah, and I love how the stories include people who have the test and those who decide they don't want to know the test results. And there's lots of variations, whether it's with a genetic abnormality like Huntington's disease or hemophilia, a blood clotting disorder, or like you mentioned, a chromosomal abnormalities, severely complex topics, and not all the same answer because, again, every pregnancy is unique. Every partnership has its own unique dynamics as well. 

 

I can't believe how fast our time together has gone. So I really want you both to end with giving listeners who are thinking about motherhood are in the middle of motherhood and finding some challenges or complications. What do you want them to walk away with from this conversation and from reading the book? Molly, do you want to go first and then we'll close with Becca.

 

Dr. Molly Kraus:

What I really took from the book, and that I hope listeners take from this podcast is, you know, really my opening comments about the diversity of this book and these experiences of women and how they grew their families, became a mom. That there are all sorts of ways we make our families and it's a wonderful thing that we share as women becoming mothers and having a community of women that you can connect with, because it really does help us through our own journey by sharing our own story and listening to other stories and experiences. 

 

It helps us connect. It helped us as an individual heal our own kind of wounds and traumas and experiences, and it gives us time to reflect ourselves as well in our own experiences. So I really enjoyed the book and being here on this podcast. Thank you.

 

Dr. Denise Millstine:

Becca.

 

Dr. Rebecca Thompson:

I think the thing that I would most like people to know about the book is that I see it as an example of the universal in the specific. So in every story you see just ordinary women going about their lives, making decisions for themselves and their family, and you witnessed them confronting these extraordinary moments. 

 

So this is a book that really is about any person, any family. It's all these stories, I hope have kind of an everywoman quality. We tried to keep them feeling very approachable and very universal in a lot of ways. Even if you've never been through the thing the person describing, you can see it and feel that you see yourself in it. 

 

So I hope that when readers explore these stories, they will realize they are these women. They can get through whatever it is they're dealing with and reflecting on that they've dealt with in the past. We got through this. So you can too, because you are one of us.

 

Dr. Denise Millstine:

How incredibly beautiful. Thank you both for being here with me to talk about motherhood and to talk about the beautiful book held together, a shared memoir of motherhood, medicine, and imperfect love. We hope you'll go out and read the book. Thank you.

 

Dr. Rebecca Thompson:

Thank you so much.

 

Dr. Molly Kraus:

Thank you.

 

Dr. Denise Millstine:

Listeners interested in related topics should check out Episode #1 “Sugar and Salt,” where we talk about reproductive rights, as well as Episode #24 “The Women with the Cure,” which is another historical look at women's roles. 

 

“Read. Talk. Grow.”is a product of the Women's Health Center at Mayo Clinic. This episode was made possible by the generous support of Ken Stevens. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen. 

 

Visit our show notes to see the books discussed today and for links to other health education materials. Follow us on social media like Instagram and Facebook, or reach out directly to our email readtalkgrow@mayo.edu with suggestions for books or topic ideas. We'd love to hear from you. 

 

This podcast is for informational purposes only and is not designed to replace a physician's medical assessment and judgment. Information presented should not be relied on as medical advice. Please contact a health care professional for medical assistance if needed for questions pertaining to your own health. Keep reading everyone!