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Congratulations, you’re pregnant! But now what?

©MFMER

Co-host Nipunie Rajapakse M.D. talks through the “biggest adventure of my life” — she’s pregnant!  She’s joined by co-host Angela Mattke, M.D. — and special guest Jay Homme, M.D., pediatrician at Mayo Clinic and father of six children. Tune in for a wide-ranging discussion of pregnancy in an age of social media and pandemic, with topics including:

*          When, and how, to announce your news? How can we be sensitive to others who’ve struggled with infertility?

*          What to expect when we’re older and expecting?  Dr. Rajapakse is 37, her partner Thomas is 40.

*          How do we maintain mindfulness and stay in the moment?

*          What are good ways to keep partners involved in the pregnancy journey?
*          How do we stay active and preserve “date nights?”

Listen: Congratulations, you’re pregnant! But now what?

Read the Transcript:

Dr. Angela Mattke:

Welcome to the Mayo Clinic Moms podcast. We’re having candid conversations and answering difficult questions about pregnancy, raising kids, and everything mom-related. I’m Dr. Angela Mattke; I’m a mom of two and a pediatrician at Mayo Clinic Children’s Center in Rochester, Minnesota. My co-host is Dr. Nipunie Rajapakse, who’s a pediatric infectious disease doctor, also at Mayo Clinic, and she’s also pregnant. So, congratulations, Nipunie. How are you feeling?

Dr. Nipunie Rajapakse:

Thanks, Angie. I’m feeling pretty good. We’re super excited about all the new adventures that are ahead. So yeah, really excited to go through this.

Dr. Angela Mattke:

Absolutely. And “adventures ahead” absolutely is the best way to put it, because it is literally the biggest adventure of my life — from having kids to every single different stage of their lives. And every day is something different and every day is really fun. And there’s different challenges I think with all the different stages as well. I’m going to bring on our special guest for this episode, who is the perfect person to help us go through all of these questions today. I want to introduce Dr. Jay Homme, a pediatrician and adolescent medicine physician at Mayo Clinic Children’s Center. Dr. Homme is also an extremely experienced father. So, Dr. Homme, thank you for joining us today. Can you give us a little bit about your background? And how many kids do you have?

Dr. Jay Homme:

Well, thanks for having me. My wife Becky and I are the proud parents of six children: five biological and our youngest is adopted. We’ve been married for over 26 years and I’ve found that we’ve had successes and we’ve had some challenges and some failures. Sometimes failures teach you a lot of things and you don’t do those things again. But it really is a challenge, honestly — going from none to one is a huge change. And after that you just sort of add them on.

Dr. Angela Mattke:

Yeah, that’s what everyone tells me. I only have two and I thought going from none to one was hard, but I thought going from one to two was even harder. Everyone says after you’ve got two, it’s no big deal. Was that true for you?

Dr. Jay Homme:

Well, you have to go from man-to-man to zone defense. But other than that, each of them is an individual. You have to take them that way. You get used to having one, and then you add another one; and one of the big things is, how will I possibly have enough love for two? But — there it is. After you get used to that, then here we go.

Dr. Angela Mattke:

Yeah. Your heart just gets bigger and bigger. There’s always room for more, right?

Dr. Jay Homme:

There’s always room.

Dr. Angela Mattke:

You’ve probably had a lot of experience with there being a lot of like excitement in wanting to tell people that you guys were expecting, but then also worries and fears about telling them too soon. What if something happens to the baby or what will other people’s responses be to your pregnancy? Tell us a little bit about what you went through during that experience. And then I want hear about Nipunie’s thoughts about her journey.

Dr. Jay Homme:

Yeah. I think the decision of when and how to tell is really individualized and a lot of it just stems from your own personality and the way you like to interact. In some ways I’m just an open book, and I just tell you anything that’s happening whenever; but my wife is a little bit more introverted and reserved. This was something she was really looking forward to though, so she was excited to tell others. And I felt, we, at least with our initial child, were very… ‘young and dumb’. But there is some benefit to that because we didn’t worry about a lot of things. We mostly just felt excited. And as the years went on and we knew more things, it became, oh when should we worry about this or that? Telling people is very individualized. Some people want to keep it private for awhile because of the concern about telling someone you’re pregnant and then something happening to the pregnancy. Then you have to tell that person about that. That’s really hard. That’s real, and people have dealt with that. Others are just so excited. Like they pee on the stick and they call someone and say, “there’s two lines,” you know? And, I think it’s okay. You just need to decide for yourself, what works for you. I’ve had times where people come up to me and say, “I need to tell you something. I’m pregnant”. And I always respond the same way: “That’s awesome”. But in my head, I’m like, yeah that was pretty obvious several months ago, but I’m glad you’re telling me now!

Dr. Angela Mattke:

What about you, Nipunie? I mean, did you guys start telling people right away? Did you wait? What are the thoughts that went through your head?

Dr. Nipunie Rajapakse:

We were obviously super excited when we got the positive test, but I was also cognizant of a few things. We’re starting on this journey later in life (I’m 37 years old), & my partner, Thomas, is turning 40 later this year. I knew that with that comes a higher risk of certain complications — for example, miscarriages or early pregnancy loss. So, we did end up waiting until we had passed that 12-week point. I know Thomas told one of his good friends and his sister the day of or the day after we found out. It was nice to be able to talk with them about the experience early on. But for most others we waited until after we got past that 12-week point. The other thing that weighed heavily on me was that I have a lot of friends and colleagues who have had trouble conceiving or have struggled with recurrent pregnancy losses, or who were going through complicated pregnancies even around the time that we became pregnant. I wanted to be sensitive to those experiences and how we announced it. There’s lots of different ways to make an announcement and different things will work for different people. But we chose to tell people. Obviously, the pandemic also added some additional challenges in that most of it had to be done virtually. We didn’t go down the big social media reveal path or anything like that. And we tried to kind of have one-on-one conversations, mostly virtually, to let our families know. Both of our families are outside of Rochester as well, so that added some additional complications, but we were really happy to share the news with them.

Dr. Jay Homme:

I was fortunate. Social media didn’t exist when we were dealing with this and social media is not really my thing…but there really is this idea that our business is everybody’s business. And it’s not. This is about you. And this is about how you want to experience this really neat transition in your life and the life of you and your partner. And it should be on your terms, not other people’s.

Dr. Nipunie Rajapakse:

Because of [the pandemic and] working remotely, via Zoom, etc.– there are limited people that you’re seeing in person still. And I feel like even after the baby is born, there’s probably going to be people that think, “I didn’t even know she was pregnant”. They’ll find out in due time.

Dr. Angela Mattke:

Absolutely.

Dr. Jay Homme:

I think most people want to be happy with you, but once in a while you feel some judgment. I think after our fourth child, my wife’s grandmother was like, “What are you doing?”. We’re just having more children because we want to, but again, it’s about what’s right for us and what we were wanting to do. And you have to tune down others sometimes.

Dr. Angela Mattke:

Right, focus on you and your family’s journey. I love that. Let’s talk about the journey actually with pregnancy and focusing on enjoying it, because there’s so much. Jay just talked about social media. As soon as you start talking about or searching online about pregnancy or babies, you start to get a lot of stuff marketed at you. And then you start worrying about all the things you need, and then you start worrying about your baby and your future and your life—and more things like that. Jay, you’ve been through this so many times — how do you still stay mindful and in the moment, and really just enjoy the journey and the pregnancy, because it’s an incredible experience?

Dr. Jay Homme:

Well, some of it just, again, comes down to your personality style. I’m the planner. I like to know what’s going to happen, when it’s going to happen, how it’s going to happen, and then I like to see a plan come through. But there’s only so many things you can plan. One of the nice things about most pregnancies is it’s going to take about nine months and then that baby’s going to show up. So we’ve got some time. We can dial it back a little bit and say — what’s important right now? Sometimes it’s just getting through that. Oh man, you know, my wife just feels crummy. She’s tired. How can I be helpful right now? Instead of, what kind of car seat do we need and what kind of crib, and all that? Those things are fun too. But what is the thing that’s up in front of us right now? And then having a mindset for where we’re going. There’s some of that being in the moment and mindful, but also finding things to celebrate, and being real about what the not-fun parts of this are.

Dr. Angela Mattke:

Nipunie, do you feel like it’s been hard to stay mindful and in the moment during the pregnancy and take moments to reflect on it, or has that been an easy thing for you?

Dr. Nipunie Rajapakse:

It’s definitely been a struggle. Obviously, there’s a lot going on now in the world and work-wise, and things have been really busy. So, in some ways, parts of the pregnancy seem to have just flown by so quickly. We’re 31 weeks now. Thinking back, I feel like some weeks, I didn’t even realize were going by. So yeah, that has been a bit of a challenge — but we have been trying to be as mindful as we can and try and enjoy some of the moments, especially things like ultrasounds and making sure that we’re going to visits together and sharing these experiences together. That has definitely been really nice. It’s been hard not having family here and not being able to share some of these moments with them as well. We, for example, decided not to do a baby shower because of the pandemic. We haven’t had a chance to enjoy some of those experiences, but we found other ways to share the news and celebrate with them.

Dr. Angela Mattke:

You mentioned getting Thomas involved with coming to visits and ultrasounds. Jay, you have obviously been in an incredibly involved father and husband throughout your journeys. What are some other ways that partners can stay involved and feel they’re part of this journey? I know that their body isn’t physically changing and they’re not growing the baby, but they’re definitely a really important part of it. And I think most partners want to have that role.

Dr. Jay Homme:

I think one of the ways to think about it is, how can we be helpful? How can we be supportive with the goal of continuing to work together, rather than feeling like we’re starting to separate in paths, where you’re doing your thing and I’m doing my thing. I appreciate you saying I’m an engaged father. I hope so, but I have missed lots of parts of my wife’s pregnancies, lots of parts of my kids’ lives because of work and other responsibilities. But thankfully, some of my kids have told me that ‘Dad might not be around a lot, but he still seems engaged — he knows what’s going on and we can count on him’. As partners we have that opportunity to be taking this journey with somebody else; just find ways to stay engaged with each other. And it’s very individualized for partner relationships. One thing that my wife might appreciate, somebody else might say, ‘I don’t want that or need that’. She’s told me things like, “You never went and bought me ice cream when I was craving ice cream”. And I’d say, ‘You craved ice cream when you weren’t pregnant. And I guess I didn’t recognize the difference’. Communication is really important too – asking, ‘how can I be serving you right now?’. And also recognizing that there’s a loss that comes with this process as well. Some of the things you’re used to with a partner that normally wants to be active and go do things is now not feeling well and just wants to sit on the couch, and that’s what they need. And you’re like, well, ‘what about me?’. It’s hard not to turn focus and say that. Communication can be really helpful in that case.

INTERMISSION

Dr. Angela Mattke:

Are you thinking about getting pregnant, or maybe you’re a current mom to be? Or you’re like myself and you’re in the midst of raising kids and you’re looking for practical evidence-based advice from Mayo Clinic experts? Mayo Clinic Press has got you covered. We have a series of four books starting from Fertility and Conception to Guide to a Healthy Pregnancy, Guide to Your Baby’s First Years, and the last book in this series, the one I was the medical editor of, Guide to Raising a Healthy Child. You can find these amazing books from Mayo Clinic Press, wherever books are sold, or on the Mayo Clinic Press website.

BACK TO THE SHOW

Dr. Angela Mattke:

I remember you talking to me in residency, because I’ve always been a fitness person, and that pretty much went away. And I remember you saying, “You’ve got to do that”. You have to take the time for yourself so that you’re taking care of yourself physically and emotionally, but that’s really hard to do. Do you have any advice for Nipunie for how to take those ten minutes to do that self-care?

Dr. Jay Homme:

One way to think about it is to consider what’s motivating you to do it. There are things that you enjoy, things that you want, but oftentimes we might let in guilt. If I’m doing this for myself, then I’m not doing this for my child or for my partner. But then think about if you go long enough without doing those things, how will you feel and how available will you be to your child or to your partner? We all get a pretty good sense when someone we care about is not feeling happy or well. And that’s not the time to go up and say, “Hey, why don’t we focus on me here?”. It’s just a more natural exchange when our tank is full. We have more that we can give away. We all have to be clear: there are times when there needs to be sacrifice. Maybe I don’t get to go for the hour-long bike ride. Maybe it’s going to be 20 minutes — but it needs to be 20 minutes and not never.

Dr. Angela Mattke:

So Nipunie, I know you’ve been so busy during the pandemic, with our hospital census being really high. Your hospital service, taking care of really sick kids, has been super intense. Where have you found the moments to still care for yourself?

Dr. Nipunie Rajapakse:

It’s definitely something that we’ve had to be quite intentional about, because with how busy work has been, there’s definitely no shortage of work. I could probably work for all of my waking hours at this point. I’ve tried to be intentional, especially around the time when I get home from work, to try and enjoy that time with Thomas, to try and make a meal together, sit down and eat together — and at least catch up on what’s gone on during the day. And then any opportunities that we’ve had on weekends off to try and get outside, enjoy some from fresh air and some nature, and work in as much exercise as we can. That’s been a bit of a struggle as I’ve gotten further into the pregnancy. And so those are some of the things we’ve been doing along with trying to enjoy some things that I know will be harder with a newborn and baby — like enjoying a meal out once in a while so that we can have some nice uninterrupted time. Because I know things like that will be a little bit harder to come by once the baby’s here.

Dr. Angela Mattke:

Well, I want to move on to our last topic. Probably from the moment that you found out you were pregnant, you started to envision what your baby’s life would be like. And you started to have hopes and dreams for their future, and maybe some worries and fears as well, because that’s normal — that’s part of being human. I want to hear your thoughts about this, I want to hear Jay’s thoughts on this as well. Because sometimes those hopes and dreams don’t end up being necessarily what we thought they were going to be, and they change over time.

Dr. Nipunie Rajapakse:

Yeah. That’s a great question. As soon as we found out [that we were expecting], we started thinking about this entire life that’s ahead of our child; and there’s very little to go off of, in those initial days, aside from those two lines on the pregnancy test. And so, I think initially my focus was on very short-term concerns or worries about — is the baby going to be healthy? I know I’m older going into this, I know there’s a higher associated risk: What does this mean? That’s in the short term, but as we’ve gone through and had some of the testing and the ultrasounds, and things seem to be going well, your mind definitely shifts to think more of those long-term things. What is she going to be like? I think Thomas and I have pretty different personalities. Will hers be a mix of the two of us? I think we, as all parents, want the best for her and want to do everything right. And we want to try and set her up for a healthy and successful life. There are so many unknowns. I think being in pediatrics, we also see some of the complications and difficulties that children and families can have. Those certainly weigh on you as well. Thinking about all the great things, but also some of the complications that can arise, has been a bit of a challenge in trying to stay positive, but also being realistic about the different paths things could go down. That has been where my thoughts have been so far.

Dr. Jay Homme:

I think that’s really a great approach. It’s natural to have all these goals or dreams or visions, but it’s important to be willing to deal with the reality. That baby is born and hopefully handed directly to you. Some people have different situations where there might be a medical issue, medical complication, or maybe the baby needs to spend some time in the neonatal intensive care unit. Just remember what that baby needs most is you — they need you. And however that comes, and however it turns out, that is one of the best predictors of children doing well long-term: that they have caregivers that love them and meet their needs. Their needs. Wants are a whole different thing; and as they go through different stages of life, what do they really need? And at first, it’s really simple. They need you – they need you to care for them. They need you to feed them. They need you to change them. And then it’ll get a little more complicated in time. You’ll be driving them to this and that — but just take each stage as it comes. We all have had the privilege of working with so many families with children with various healthcare needs, and I’m always so heartened to see what parents are willing to do for their children, no matter what the situation is. And we all get to be part of that.

Dr. Angela Mattke:

Well, thank you both so much for joining us today on our introductory episode of our “Podcast Pregnancy” series. We hope that everyone will join us for our next podcast as we go into a little bit more of the medical stuff — early pregnancy. We’ll start talking about genetic testing. Should you get it? When should you get it? And what does it mean? We’ll go on to talk about how to you take care of yourself in pregnancy, some potential complications that could happen, and some testing that you might be needing during your pregnancy. Thanks everyone for joining today. Make sure you don’t miss any of our upcoming episodes by subscribing and following along on either Apple Podcasts or Spotify. If you enjoyed this episode and you want other moms out there to hear this valuable information, make sure that you leave a review wherever you listen. Thanks for joining us. We’ll see you next time.

Angela Mattke

Angela C. Mattke, M.D.

Dr. Mattke is a general pediatrician in the Division of Community Pediatric and Adolescent Medicine at Mayo Clinic in Rochester. In addition to being Medical Editor of Mayo Clinic Guide to Raising a Healthy Child, She is host of Mayo Clinic’s interactive Facebook Live show and podcast called, “#AskTheMayoMom,” where she discusses and answers audience questions about common pediatric health topics. You can follow her on Twitter at @DrAngelaMattke. For more information about pediatric health topics, follow @mayoclinickids on Twitter.

Nipunie Rajapakse M.D.

Dr. Rajapakse is a pediatric infectious diseases physician at Mayo Clinic in Rochester, Minnesota. Her clinical focus includes management of pediatric infections. Her primary research interests include studying ways of optimizing antibiotic use in children (antimicrobial stewardship) to decrease antibiotic resistance and other harmful effects. She has worked for the World Health Organization and has an interest in global health and outbreaks of emerging infectious diseases.

Jason (Jay) H. Homme, M.D.

Dr. Homme is a pediatrician at Mayo Clinic in Rochester, Minnesota. His clinical and research interests include diagnosis and treatment of the common condition of group A streptococcal (GAS) pharyngitis (strep throat). Additionally, as program director for the Pediatric and Adolescent Medicine Residency at Mayo Clinic, Dr. Homme aspires to provide the highest quality training experience possible for the pediatricians of tomorrow.

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