A Doctor Delivers Podcast with Shannon M. Clark, MD

Dr. Shannon M. Clark discusses the following with genetic counselor, Liz Sheehan @agirlsnameisbizbiz:
•what are fetal chromosomal aneuploidies
•different types of antenatal screening tests
•cell-free DNA screening
•NT measurement plus serum screening in first trimester
•quad screen in second trimester
•screening PGT tested embryos
•ultrasound soft markers: choroid plexus cysts, echogenic intracardiac focus, echogenic bowel, pylectasis, single umbilical artery

Sen. Bill Cassidy of LA, who is also an MD specializing in GI or liver disease, had an interview with POLITICO for the Harvard Chan School of Public Health series Public Health on the Brink on May 19.

He has claimed to be unapologetically “prolife”, but said in this interview when asked what needs to be done about LAs high maternal mortality rate, “About a third of our population is African American; African Americans have a higher incidence of maternal mortality. So, if you correct our population for race, we’re not as much of an outlier as it’d otherwise appear. Now, I say that not to minimize the issue but to focus the issue as to where it would be. For whatever reason, people of color have a higher incidence of maternal mortality.”

I discuss these statements with Charles Johnson who founded of 4Kira4moms on 2017 after losing his wife Kira Dixon Johnson during a routine cesarean at Cedar Sinai hospital in Los Angeles. He is a voice for families facing unnecessary maternal loss and ending the maternal mortality crisis in this country.

Recently, he worked with congress to pass the preventing maternal death act which is the first ever to combat the maternal mortality crisis in the US. The bill was signed into law on 12/21/2018 and dedicated to the memory of Kira Dixon Johnson.

Dr. Shannon M. Clark discusses the following with ObGyn, Dr. Erica Montes @the.modern.mujer!

•pregnancy monitoring after COVID infection
•second COVID booster in pregnancy
•interpregnancy and interdelivery intervals
•exercise and activities with a short cervix
•progesterone for short cervix
•tubal ligation during a cesarean delivery
•reasons for IUGR and recurrence risk
•different ways to push
•safety of tylenol in pregnancy
•fetal kick counts
•antiphospholipid antibody syndrome
•adhesions during surgery
•uterine atony
•fetal hiccups
•elective hysterectomy

This is National Infertility Awareness Week! Dr. Shannon M. Clark discusses the following with REI, Dr. Lucky Sekhon @lucky.sekhon:

•IVF ad-ons: acupuncture, different forms of PGT, endometrial scratching, growth hormone, assisted hatching, steroids, embryo glue, aspirin
•chromosomally abnormal versus mosaic embryos and embryo transfers
•preparing your body for an embryo transfer
•unexplained infertility
•recurrent pregnancy loss
•low or no sperm and biopsy
•biochemical pregnancies
•fresh versus frozen embryo transfer
•following progesterone levels in early pregnancy

Dr. Shannon M. Clark discusses the following with MFM, Dr. Jasmine Johnson @mrsmommymd:
-assessing fertility and future family planning at annual exams
-health disparities and provider decisions about sterilization, treatment for ectopic pregnancy, fibroid management and more
-disparities in fertility awareness
-addressing preexisting medical conditions and medications
-racial and ethnic disparities in severe maternal morbidities and mortality
-maternal mortality data from 2020 and age groups
-IVF pregnancy over age 40 and adverse pregnancy outcomes and multiple gestations
-racial and socioeconomic disparities in those seeking fertility care
-barriers to seeking fertility care
-special considerations for first, second and third trimester care in those over 40
-special considerations for delivery planning in those over 40

Dr. Shannon M. Clark discusses gynecologic office procedures (EMB, IUD placement, colposcopy) and lack of pain control with ObGyn, Dr. Mary Claire Haver @thegalvestondiet and I discuss the following: 

-How we were trained

-Our personal experiences with these procedures

-Myths about innervation of cervix

-Why patients are not being heard

-Options for pain control

-What needs to be done to change things!

Dr. Shannon M. Clark discusses the following with Sierra Richard, PharmD @happypharmlife: 

-Old and new pregnancy category labeling systems for medications in pregnancy 

-How research on medications in pregnancy is done •Roadblocks to studying medications in pregnancy and lactation 

-How to sign up for a pregnancy registry for a medication you are on 

-Post-market and off-label use of medications in pregnancy and lactation 

-What to do if your pharmacist refuses to fill a prescription for you because of pregnancy

Recommend resources:
@mothertobabyotis
@postpartumsupportinternational
InfantRisk for providers and MommyMeds for patients (apps)
Perinatology.com, Drugs in Pregnancy and Breastfeeding
@centerforwmh
FDA Pregnancy Exposure Registries
Drugs and Lactation Database (LactMed)
For pharmacists: Brigg's Drugs in Pregnancy and Lactation that is built into Lexicomp

Dr. Shannon m. Clark discusses the following with REI specialist, Dr. Lucky Sekhon @lucky.sekhon:   

-The role of progesterone and/or progesterone supplementation and ovulation, conception, corpus luteum , IVF, luteal phase defect, early pregnancy: threatened miscarriage and recurrent pregnancy loss

-Prophylactic use during implantation window  

-Preterm birth: 17OHPC, vaginal progesterone, cervical length 

-Short cervix: vaginal progesterone, cerclage and 17OHPC 

-We also discuss bioidentical progesterone supplementation and if 17OHPC still being used!

Dr. Shannon M. Clark discusses the following with ObGyn Dr. Tamika Cross @tcross_md:

-monitoring the uterine scar in someone with a prior cesarean for risk of uterine rupture and counseling for TOLAC 

-uterine rupture 

-pap smears and HPV 

-subchorionic hemorrhage 

-abruption and chronic abruption 

-hiatal hernia in pregnancy 

-ARRIVE trial and IOL at 39 weeks for AMA 

-postpartum care and pelvic floor PT, behavioral health therapy, nutritional counseling 

-what is a D&C 

-cephalopelvic disproportion

Dr. Shannon M. Clark discusses the following with Dr. Kristin Lasseter, @the.reproductive.psychiatrist: 

-Impact of maternal psychiatric illness Consequences of lack of treatment or undertreatment on pregnancy outcomes 

-General treatment concepts 

-Specific meds for treatment of depression, bipolar disorder, anxiety, schizophrenia, and ADHD 

-Recommendations from MFM and psychiatry 

-Resources: MCH Center or Women's Health, Mother To Baby, Postpartum Support International

Dr. Shannon M. Clark discusses the following with Kayleigh Summers @thebirthtrauma_mama: 

-Kayleigh’s story of surviving AFE 

-AFE and clinical presentation, diagnosis, risk factors, survivability, long-term effects on survivors, infant outcomes, recurrence 

-The @afefoundation 

-The AFE biorepository 

-Birth trauma and how to get help 

Dr. Shannon M. Clark discusses the following with cardiologist Dr. Rachel M. Bond @drrachelmbond: •preconception cardiovascular health amd evaluation 

-acquired versus congenital heart disease 

-cardiovascular health in pregnancy 

-cardiovascular physiologic changes in pregnancy why some people find out they have heart disease for first time during pregnancy 

-postpartum cardiovascular health and disease 

-peripartum cardiomyopathy 

-risk factors for maternal cardiovascular disease •symptoms of heart disease in pregnancy 

-cardiovascular disease and cardiomyopathy as leading cause of maternal mortality 

-race/ethnicity as a risk factor for cardiovascular-related maternal mortality -

how to advocate for yourself •social determinants of disparities in maternal cardiovascular disease 

-how to protect your heart health

Dr. Shannon M. Clark and Dr. Temeka Zore @temekazoremd discuss the following: ✔️the myth that the COVID vaccine causes fem ale (egg-producing individual) infertility ✔️fever after vaccination/booster and affect on female and male (sperm producing individual) fertility ✔️COVID vaccine and male fertility ✔️COVID vaccine and menstrual cycle disturbances ✔️ASRM recommendation regarding vaccination/booster while TTC ✔️recommended waiting period to start fertility treatments after having COVID infection or receiving a vaccine/booster ✔️partners and vaccination/booster ✔️COVID infection and fertility ✔️COVID infection and erectile dysfunction ✔️best time in pregnancy to get vaccinated ✔️surgical procedures during fertility treatments

Dr. Shannon M. Clark and Dr. Marta Perez @dr.martaperez discuss the following: ✔️requesting vaccinated nurses in labor and delivery ✔️what to do if you get COVID ✔️monoclonal antibodies ✔️what we know about Omicron variant ✔️adverse pregnancy and maternal outcomes of COVID+ and unvaccinated ✔️adverse pregnancy and maternal outcomes of COVID+ and vaccinated/boosted ✔️asymptomatic COVID infection and adverse pregnancy and maternal outcomes in unvaccinated and vaccinated ✔️getting COVID after vaccination or booster ✔️safety of COVID vaccine and booster ✔️vaccination/booster during lactation ✔️antibodies in neonate after vaccination in pregnancy or lactation ✔️best time in pregnancy to get vaccinated ✔️low dose aspirin and being COVID+

 Dr. Shannon M. Clark discusses the following with REI specialist, Dr. Lucky Sekhon @lucky.sekhon:

•diagnosis of PCOS
•irregular cycles and ovulatory dysfunction
•biochemical and clinical hyperandrogenism
•role of pelvic ultrasound in PCOS
•workup for infertility in someone with PCOS
•role of letrozole, clomid, metformin, gonadotropins and IVF in a fertility treatment plan for someone with PCOS
•adverse pregnancy outcomes in those with PCOS
•does getting pregnant fix PCOS
•PCOS in those over age 35
•role of OCPs in PCOS
•dietary recommendations
•supplements and PCOS
•beware of the influencers who are selling fertility and supplement products for PCOS!

Dr. Shannon M. Clark discusses all things bladder (overactive bladder, urinary incontinence, interstitial cystitis and more) with Pelvic Floor Physical Therapist, Dr. Alicia Jeffrey-Thomas of @thepelvichealthladies.

Dr. Shannon M. Clark discusses the importance of a healthy couple relationship while parenting little ones with Dr. Steven & Erin Mitchell @couples.counseling.for.parents.

I discuss the following with @saramucowskimd of @dallasivf!
•fertility care for lesbians, couples with 2 egg providers, and single parent by choice: choosing a sperm donor, fertility treatment options, using an egg donor and gestational carrier, Invocell as an alternative to IVF
•importance of a reproductive attorney
•fertility care for gay male couples, two sperm providers and single parent by choice: fertility treatments options, choosing an egg donor and gestational carrier
•transgender family building: trans people with eggs who are taking testosterone, trans people with sperm who are taking estrogen, those not taking hormones and have not had bottom surgery
•fertility preservation for transgender individuals
•how to pick the right fertility center

I discuss the following with pelvic floor physical therapist, Dr. Jenni Gabelsberg of @empoweredmamasthrive!

Pelvic floor PT and:
•pregnancy
•preparing for a vaginal delivery
•postpartum period
•urinary incontinence
•pelvic organ prolapse
•diastasis recti
•load transfer
•cesarean scar pain
•pain with sex
•vaginal exam
•history of trauma
•and more!

Dr. Shannon M. Clark discusses all things IUI with REI specialist, Dr. Kenan Omurtag @drkenanomurtagmd.

Dr. Shannon M. Clark discusses the following with neonatologist, Dr. Prem Fort @thenicudoc!

•RSV, flu and COVID: what is it, what are the symptoms, signs that your baby needs to be seen or go to ER, infants at risk for more severe disease
•vaccine recommendations for adults, infants, toddlers and other siblings
•how to protect infants and children under 2 from infection
•having vaccinated and unvaccinated visitors

Dr. Shannon M. Clark discusses the following with pediatrician, Dr. Nkeiru Orajiaka @dr_norajiaka! 

Newborn: bathing, when to call the doc, false menses, urate crystals, constipation, lactation, umbilical cord stump care, safe sleeping, and more! Baby Proofing: anchoring furniture, teething necklaces, batteries, magnets, kitchen safety, and more!

Dr. Shannon M. Clark discusses the following with REI Specialist, Dr. Allison Rodgers @dr.allison.rodgers! • Male/sperm producing individual factor infertility: causes, risk factors, medical causes, role of lifestyle habits, diagnosis, semen analysis • Secondary infertility: what is it, how common, causes in sperm and egg producing partners • How to vet supplements for fertility and infertility

Dr. Shannon M. Clark discusses PTSD and birth trauma with Reproductive Psychiatrist, Dr. Kristin Lasseter @the.reproductive.psychiatrist.

October is Breast Cancer Awareness Month! I discuss the following with Dr. Anjali Malik @anjalimalikmd! •breast cancer stats •risk factors •early detection •self versus clinical breast exams •signs and symptoms of breast cancer •breast pain •dense breast tissue and fibrocystic breasts •mammograms •facts and myths

I talk with OBGYN Dr. Heather Irobunda @drheatherirobundamdabout about how to advocate for yourself during pregnancy, delivery and the postpartum period. We discuss the following:
•plan as much as you can
•get your medical and family history together
•research your obstetrical care provider
•take notes
•have a support person
•ask for a second opinion
•change providers
•stay vigilant in the postpartum period
•ask questions
•how to advocate for yourself in an acute situation
•is having a black or brown provider necessary to receive quality care

I discuss the following with @thepostpartumpharmacist Jenny Han, PharmD, BCACP:
•purpose of taking a PNV
•avoiding the “designer prenatal vitamin”
•what vitamins and minerals are important specifically for pregnancy
•choline
•omega 3 fatty acids and DHA
•fish to eat and avoid
•vitamin D
•folate
•5-MTHF vs folic acid
•folic acid and the nutrition label
•MTHFR gene variants and folic acid
•USP verification
•gummy PNV
•postpartum supplementation

Dr. Shannon M. Clark discusses why sex might be painful after delivery, and things to consider and when to seek help with pelvic floor physical therapist, Dr. Juan Michelle Martin @thepelvicperspective.

I discuss the story of Kira Dixon Johnson with her husband and founder of @4kira4moms, Charles Johnson. We also talk about the Preventing Maternal Deaths Act, the Maternal Momnibus Act and the Kira Johnson Act.

DR. Shannon M. Clark discusses early and recurrent pregnancy loss with ObGyn, Dr. Erica Montes @the.modern.mujer.

Dr. Shannon M. Clark discusses commonly asked questions about IVF with REI Specialist, Dr. Aimee Eyvazzadeh @eggwhisperer.

Dr. Shannon M. Clark discusses minimally invasive gynecologic surgery for ovarian cysts and endometriosis with MIGS Surgeon, Dr. Brooke Winner @dr.brookewinner.

Dr. Shannon M. Clark discusses the following with Pediatric ER physician, Dr. Natasha Collia @dr.tash.official.
•head, facial and long bone injuries
•the different types of drowning
•sunburns and heat-related illness
•trampoline and bike injuries
•bug bites and urgent care vs ER vs pediatric ER and what to expect!