Podcasts about AOG

What builds trust when you don't have a title or position of authority? SUMMARY According to Lt. Col. Joe Bledsoe '11, it's honesty, integrity, humility presence and action. Tune in as he shares practical leadership lessons learned from the Academy, combat aviation and years of mentoring others.   SHARE THIS EPISODE FACEBOOK  |  LINKEDIN   COL. BLEDSOE'S TOP 10 LEADERSHIP TAKEAWAYS 1. Leadership starts before the title. People follow your example, ideas, and presence long before you get formal authority. 2. Informal leadership is as real as formal leadership. Class president, wingman, or peer—your influence, credibility, and support role matter even without rank. 3. Be “clay to be molded.” Show eagerness, humility, and effort; people notice fresh attitude and willingness to embrace hard things. 4. You can't lead alone—build a trusted team. Time management and heavy responsibility force you to delegate to people you trust and empower them. 5. Trust has two layers: inherent and earned. Start with inherent trust (shared values, shared background) and deliberately grow earned trust through behavior. 6. Five traits that build credibility fast: Honesty, integrity, humility, presence (actually being there, engaged), and decisive action. 7. Debrief like a fighter pilot: brutally honest, never personal. Separate the person from the performance, do root‑cause analysis, fix errors, and then move on—no re‑litigating. 8. Own your mistakes out loud. Saying “I'm sorry,” “I was wrong,” or “I don't know, but I'll find out” accelerates trust and models humility. 9. Mentors and mentees are non‑negotiable. Continuously seek guidance from those ahead of you and invest in those behind you to sharpen your own thinking. 10. Prioritize relationships and pride in the mission. Treat family and friends well, cultivate the Long Blue Line, and remember you're on the A‑team—act like it.   CHAPTERS 00:00:00 — Opening & Guest Intro Show open, Naviere introduces Lt Col Joe “Paveway” Bledsoe and his career highlights. 00:01:13 — Voluntold to Lead: Becoming Class President Basic cadet training, being “voluntold,” interview gauntlet, and getting elected class president. 00:04:09 — What a Class President Actually Does Informal vs formal leadership, picking the class exemplar (Robin Olds), dining‑ins, spirit missions, and accountability. 00:08:38 — From Future Doctor to Fighter Pilot Arriving at USAFA wanting to be a physician, loving biology and medicine, and the first seeds of doubt. 00:10:03 — Ops Air Force, Powered Flight, and the Pivot Deployed Ops Air Force in CENTCOM, exposure to flying in theater, powered flight, and choosing pilot training over med school. 00:12:22 — Mentors, Family, and Making a Hard Call Mentorship from family, upperclassmen, and permanent party; emotional weight of changing paths and family's reaction. 00:14:08 — Leading Without Rank: Credibility and Trust Informal leadership as a young wingman, lessons from time management and delegation as class president, inherent vs earned trust, and key traits (honesty, integrity, humility, presence, action). 00:22:06 — Fighter Pilot Debriefs & Radical Feedback Culture Brutally honest debriefs, owning mistakes, root‑cause analysis, safety and mission focus, and how that mindset translates beyond the cockpit. 00:27:48 — Leadership at Home: Marriage, Parenting, and ‘Knock It Off' High‑school‑sweetheart marriage, parenting, using accountability and humility with kids, and balancing “fighter pilot” mode with being a husband and dad. 00:30:30 — Future Conflict, Growth, and Pride in the Long Blue Line Risk and future fight, Institute for Future Conflict, exposure to other AFSCs and logistics, daily growth habits (mentors, mentees, reading, writing, running), advice to younger self, and closing message on being proud of USAFA and the A‑team.   ABOUT COL. BLEDSOE BIO Lt. Col. Joseph “Paveway” Bledsoe '11 is a U.S. Air Force Academy graduate and recognized leader whose career has spanned combat operations, advanced airpower development and service to the Long Blue Line. A native of rural Pennsylvania, Bledsoe graduated from the Academy in 2011 with a degree in biology before earning a Master of Public Policy from the University of Maryland.  He is Currently assigned to the Institute for Future Conflict at the U.S. Air Force Academy where he studies the future of airpower, emerging technologies and the challenges of great-power competition. Prior to joining the Institute, he helped lead training and operational planning efforts at the 366th Fighter Wing, contributing to major exercises and the wing's first deployment to the Indo-Pacific region. His work bridges the gap between today's operational realities and tomorrow's strategic challenges. A recipient of the Association & Foundation's Young Alumni Excellence Award, Bledsoe is widely respected for his emphasis on faith, family and service. Throughout his career, he has remained deeply connected to the Academy community through mentorship, alumni leadership and a commitment to developing the next generation of leaders. On this episode of Long Blue Leadership, he shares lessons learned from leading peers, building influence before authority and navigating high-stakes decisions in both the cockpit and the profession of arms.   CONNECT WITH JOE LINKEDIN   CONNECT WITH THE LONG BLUE LINE PODCAST NETWORK TEAM Ted Robertson | Producer and Editor:  Ted.Robertson@USAFA.org Send your feedback or nominate a guest: socialmedia@usafa.org Please note: we are only considering USAFA graduates as guests at this time. Ryan Hall | Director:  Ryan.Hall@USAFA.org  Bryan Grossman | Copy Editor:  Bryan.Grossman@USAFA.org Wyatt Hornsby | Executive Producer:  Wyatt.Hornsby@USAFA.org     ALL PAST LBL EPISODES  |  ALL LBLPN PRODUCTIONS AVAILABLE AT USAFA.ORG/LONGBLUELEADERSHIP AND ON ALL MAJOR PODCAST PLATFORMS     FULL TRANSCRIPT Guest, Lt. Col. (Ret.) Joe "Paveway" Bledsoe" '11  |  Host, Lt. Col. (Ret.) Naviere Walkewicz '99    Lt. Col. (Ret.) Naviere Walkewicz 0:01 Sometimes leadership begins long before you've ever been put in charge. It starts when people trust you enough to follow your example, your ideas or your vision. I'm Naviere Walkewicz, Class of '99; Long Blue Leadership starts now. Well, Lt. Col. Joe “Paveway” Bledsoe the Third. Welcome to Long Blue Leadership. Lt. Col. Joe Bledsoe 0:20 Naviere, it's great to see you. Thank you for having me here today. I'm looking forward to the conversation. Col. Naviere Walkewicz 0:24 So, Joe, your career has been exciting so far, and you're still in it. You know, you have been operational leader, obviously an F-15E Strike Eagle pilot. You've been deployed, you have been a researcher, you're a Young Alumni Excellence Award winner for our Association & Foundation, you've been an AOG board director and a fellow for the Institute for Future Conflict. And that, that's just, you know, a short little list, because you're a student heading back into, over to, is it North Carolina, right? Seymour Johnson.   Col. Joe Bledsoe 0:53 That's correct. Seymour Johnson, yep.   Col. Naviere Walkewicz 0:54 In the cockpit, yeah. Col. Joe Bledsoe 0:56 Yeah, we're super excited. Col. Naviere Walkewicz 0:59 Yes. Well, we're going to touch on probably many of those places, but I want to dial it back to something that only one graduate in every class experiences, and for you it happened shortly after Basic Cadet Training. Your class selected you as your class president. How did that come about? Col. Joe Bledsoe 1:14 How did that all go down? That's a great question. So there we were, right after basic training. I was in Cadet Squadron 19 for my freshman year, and I got the opportunity — this is one of those voluntold moments, right — where the upperclassmen and BCT cadre said, “Joe,” or “Cadet Bledsoe, report to H-1 during transition week.” That's when everybody's coming back, and you're like, “Sure, yep, yes, sir, yes, ma'am. Here we go.” So I show up with 40, 50 other fourth-class cadets, and we come to find out it was for us, and we were going to go through who was going to be the class officers. So first off, as I look back on that experience, a lot of respect and no humility being asked to go like represent Squadron 19, right? Like, I didn't volunteer, they just kind of pointed me in that direction, so we show up and got to interview with the upperclassmen, class officers, and there's funny interview questions, real serious interview questions. You know, I was just honest, right? Like, I'm here. This is what I think about what being a leader looks like, and how I could help serve the class, not thinking I would ever be selected, right? And as the night is going on, and ACQ is right around the corner, they kind of whittle it down to four or five of us, and we get up in front of the rest of the cadets and classmates that were there, and it was an open forum, like you know, back in Rome times, like you're standing in the gauntlet, Yeah, like it was like Roman voting, right? And asked a bunch of questions, and I remember standing up there with, you know, preppies, prior enlisted, and then me, just like straight off the street, and there's a couple other of us up there, and just answer the questions honestly, and at the end of that, there was a vote, and you know, they read the results, and I was like, "Holy smokes, I'm class president. How did this, how did this happen,” right? And I think there's a lot that — it was daunting at first, right? And then also, like, “This is awesome, I don't know what I'm getting into,” right? I just found out about it. I remember walking back on the Tizo. This was the first time I can say this now, because you know, grad, and I didn't run the strips because the upperclassmen and class officers walked me back, and I distinctly remember to — back to my squadron to — Jordan Kraft and Forrest Underwood walked back and were given some mentorship to me, like here's how to succeed, here's things we would recommend, and it was just an awesome opportunity to like kind of learn what pure leadership looks like, what it means to be in this not org chart that is unique to the Academy, and that's where the, that's where the adventure started for class president. I'm still, I haven't been fired yet, and I still proudly serve the Class of 2011 — Robin Olds' class — as their class president, and it's one of the best jobs that I have the privilege of doing. Col. Naviere Walkewicz 4:10 My goodness. I mean, just to unpack that a little bit, obviously, in basic cadet training, you did enough to impress your cadre, I'm sure that there was probably some sort of cadre selection to bring however many of them forth first. Would you say that you would you agree with that, or is that — am I way off? Col. Joe Bledsoe 4:28 Yeah, I would say —I think when I look back my time at basic training, like I wanted to come to the Academy since I was in your school, right? So, like, I thrived — I'm not saying it was easy by any means, right? We all know that, but I thrived in like this new adventure, right? And I took everything, I embraced everything. I think that may have been something they saw, right? Like I was clay to be molded, right? And I had some prior opportunities in basic to show that to my BCT cadre, and they picked up on it. It wasn't that I was trying, but I think looking back on that experience, there was moments of like my freshness, my eagerness, my like pride in that I made it to basic training, that I wanted to just try as hard as I could, and I think some of that probably shown through, and ultimately may have been why I was selected to go try that interview process, right? Col. Naviere Walkewicz 5:20 So that interview process, at the end of the day, you were elected by your peers, and you know it — to your point — you said in that unusual, the not normal org chart, right, the one that doesn't exist, but yet you have leadership of your class. What did that look like? How did that translate? Because not many of us are class president, I'm certainly not my class president, and so I'm not sure what that leadership role looks like. Can you share a little bit more about some examples? Col. Joe Bledsoe 5:46 Yeah, I think that that leadership role was very different each year, right? As a freshman and a sophomore, as a four-degree and a three-degree, before any official academy leadership position starts to present themselves, that they do for two-degrees and firsties, it was a lot of helping the class stay as a collective whole, right? So one of the first big things as freshmen was selecting our class exemplar, right? And running like — how do, who do we select? How do we come together and figure that process out? How do we then, once we have a name, once we selected Robin Olds, how do we have a formal dining in? Things that I had never even heard of, right? As well as on the other side, the shenanigans, right? So, the spirit missions, right? There was many times I've had to go to the commandant's office and say, I don't know where the class crest is, like, out of pure honesty, right? But, like, that is, that was like a way, as an underclassman, that we kind of got that informal leadership, but also you're the leader by default here, so we're gonna, we're gonna make you accountable for your class. So I got to see both sides, that transitioning a little bit more to two-degree and first a year was now taking a little bit step back in writing in the informal leadership position, so I looked as myself as like a supporting agent, supporting member to our cadet leadership, and I always presented that like, “Hey, if you need our class to do something, I will do that, but if militarily you own that, like, I'm not ever going to step on your toes or push back,” right? The other thing we got, I was able to do is also help provide, like, morale inputs, right? Like you kind of had the pulse of morale, I think, more as the class president sometimes than in the official leadership, so could help provide some inputs along those ways, and there are some, say more shenanigans or morale events that we get to help put forth and present those to the cadet leadership for official approval later on as we firsties. Col. Naviere Walkewicz 8:04 Gosh, well, that was, I mean, it's really insightful for us to understand some of the roles that a class president and class cabinet plays, and so understanding that it's — I like how you put it as a supporting agent to the formal leadership. And we're gonna touch on this a lot more, because I think there's going to be times when you'll share how you build that trust and credibility throughout, both when you're a cadet and as an officer. But before we jump there, I happen to find out, Joe, that you weren't coming to the Air Force Academy to become a fighter pilot, but to become a physician. Can we talk about that for a moment? Col. Joe Bledsoe 8:37 Absolutely, that's absolutely a — I came to the Air Force Academy, wanted to be a doctor. I knew I wanted to be a biology major. I declared, I think, the first day I could declare and went through the gauntlet of getting ready for med school applications, and I loved every second of it. It was awesome. Even my fellow classmates would say he was a huge nerd and studying all the time, because that was my goal, right? I came into the Academy, and I wanted to be a doctor, and I knew the gauntlet that is, that that is required to do such a thing. And I still love medicine, right? I still love — I think medicine is fascinating. Every time my probably get there someday, or in the conversation, but anytime my kids have to go to the ER, like I'm like, “Can I scrub in,” right? All that kind of stuff. Yeah, put me in. I love medicine, and it wasn't till the summer between my two-degree and firstie year did I have that midlife crisis at the age of 21 and then firstie year is when that crisis kind of came to a head, and new doors opened, and here we are today, right? So that, yes, you're absolutely right. Always wanted to be a doctor. I was still fascinated by medicine, but now I'm just a pilot. So, there we go. Col. Naviere Walkewicz 9:57 So, can we, can you expand a bit more on it? So, was it a decision you wanted to make or a decision you had to make? Col. Joe Bledsoe 10:03 Yeah, yeah, that's great. It was a decision I had to make, ultimately, myself. Right? No one, no one said, “Joe, you can't be a doctor.” So, the summer — there's two key things that really happened that helped influence that decision. The first one was the summer between two-degree in firstie year, I had the opportunity to deploy to the Middle East, and we've heard of Ops Air Force. You know Ops Air Force. Well, at that time we had a deployed Ops Air Force, so they sent cadets overseas to deployed locations to see what was, you know, to get the full experience in a deployed location. Col. Naviere Walkewicz 10:40 Wow. Col. Joe Bledsoe 10:40 So I had the opportunity to do that. Spent the summer in CENTCOM and kind of opened my eyes to… Col. Naviere Walkewicz 10:47 Oh, Central Command. Col. Joe Bledsoe 10:47 Yeah, sorry, Central Command, and got to experience — I got attached to a C-130 unit, right, and I got to see what flying looked like in a deployed environment, and I kind of opened my eyes, where I've been hyper focused on medicine, right? Like, you know, so focused on this is what it takes to be a doctor. I kind of like put my blinders on to what the rest of the Air Force did, right? So I was like, “This is pretty, this is, these guys and gals are doing awesome stuff, like this is this is the pointy end of what was going on.” And that planted a seed, that planted a seed. So it came back, firstie year was doing the med school applications, going through, I had some free time in my academic calendar, and I got to go down to the airfield and do the powered flight program. So, I got to see flying over the summer, and then I was blessed enough to have the opportunity to go fly an airplane, and I was like, “OK, the seed was planted, let's see if I get air sick, like, let's see if there's anything else here that might make me not want to do this.” And I loved it. Right, I fell in love with flying down at the airfield. I came back, and I was like, I'm gonna pause the med school applications and put my name in the hat for pilot training, and the rest was history, right? So, doors open, doors close, right? But that was my story, and I loved getting to talk to cadets about that, because so many can be — so many times we see some that are hyper focused, and like there's always other options out there, and it's OK to have a crisis we can talk you through. Col. Naviere Walkewicz 12:23 I think that's a fantastic lesson that you actually learned early, because you know it's interesting — had you not been sent to Ops Air Force at a deployed location, you might not have taken Alex flight, and so you know when you think about leadership opportunities and lessons, this is one of those moments where it actually steered you in a new direction. So, as we think about that, I'm curious, how your family responded to that, because, you know, you had come to the Air Force Academy to be a doctor. Were they happy for you? Were they surprised, a little nervous? Col. Joe Bledsoe 12:57 Yeah, there was a ton of mentorship there, right? Not just from my family, but from upperclassmen peers, permanent party, like, “What are you doing? Like, you came here telling us this was your goal. Where did this new goal come from?” So, there was a lot of time talking that through, and I needed that myself. It wasn't, as you know, in any decision, like, it wasn't a snap decision. So, a lot of time walking through that decision process and leaning on mentors and kind of asking the questions, like I knew what four years of med school, and then residency, but I knew what that like, what does pilot training look like? How long does that take, right? So, a lot of questions to help answer, or to find answers through, and ultimately, my family was super supportive, super supportive, and they still joke, like, “Hey, how come you're not doctor.” Well, because I fly F-15s now, right? But all supportive all throughout the process, right? And that's where you lean on others, right? Lean on others, because it very much felt like a crisis, like I still have scar tissue over it. But looking back on it, it wasn't just me making — I ultimately made the decision, but they helped me through it. Col. Naviere Walkewicz 14:08 That's fantastic. You know, I think about you as an officer, as a fighter pilot, and obviously there's a lot of steps you took to get there on the road was certainly not easy. Often, though, I think that there can be some misconceptions, or maybe this is accurate, that earlier in your pilot life or your aviator life, there's probably not a lot of leadership lessons where you're leading others. Maybe, maybe that's a misperception, and we'd love to talk about that. You know, how do you find the leadership opportunities then when you are, you know, you're party of one, right? You don't necessarily have any direct reports. What does leadership look like there? Col. Joe Bledsoe 14:43 Yeah, can we take that back to like some lessons I learned at the Academy?   Col. Naviere Walkewicz 14:46 Oh, absolutely.   Col. Joe Bledsoe 14:47 Right, I think, I think that's where I've leaned most heavily in, like, not in there's this difference between formal leadership and informal, positional versus informal, and I was blessed enough at a pretty young age to learn the plus — the how to succeed and how to fail in informal leadership. I've tried to carry that throughout my career. So when you say like the younger days of being a wingman in the F-15 community, it's a lot about credibility. It's a lot about that peer leadership. How do you build the credibility? How do you build the trust to be someone that others look up to in that informal system, right, in that informal system. When they look down their phone, like, “Who do I call? Who do I have to call? Who do I want to call?” Right? and I think that's where you have to balance some of that stuff, and I spent time thinking about that, and trying to lean on lessons that I learned from the Academy, and while formal leadership positions were never handed to me, that doesn't mean you're not a leader, right? Like, you can't beat it, doesn't mean you don't just get to sit back and not lead. Col. Naviere Walkewicz 16:02 Can you share an example of a time when you learned that about yourself, or what that looked like?   Col. Joe Bledsoe 16:09 In the flying world? Col. Naviere Walkewicz 16:11 Or as a cadet?   Col. Joe Bledsoe 16:12 Yeah, as a cadet, I think the biggest one was — I'll take it back to, like, freshman, sophomore year, where I learned one of the key pillars that I'm convinced the Air Force Academy teaches all us grads about is time management, right? And I thought I was pretty good at time management, and then when you're now the president of 1,000 other cadets, your inbox fills up very quickly, right? Or you're like, “I thought I was good at time management.” And I learned very quickly that you can't do it alone, right? You can't do it alone, and I had to learn to surround myself with people that I trusted and that I could delegate or hand tasks off to, and just say, “I need this accomplished,” and I did that to my friends that I knew would get the mission done, right? And I had to have that level of trust, and I think that is translated throughout my career, where I inherently trust people with a project, right? I think there's two versions of trust, inherent trust and earned trust. When I look at the graduate network, whether that's the Air Force Academy, Navy, West Point, and I see a class ring, I'm like, “I inherently trust you,” and I can, I believe, or I see some other veterans have on — like, “I inherently trust you,” and then in other cases where I've had to learn and work with people, it's now, “I'm earning your trust, and I hope you're earning mine as well,” and that is this unique balance of I inherently trust you, I learned that at the Academy. Now let's build on that as a foundation and get this earned trust to as high as we can. Col. Naviere Walkewicz 17:54 What does some of that earned trust or becoming more credible look like when young leaders don't have the benefit of time? Right, so I, the more time I work with you, the more I learn about you. You build that credibility, etc. How does one accomplish that, maybe either shorten the gap or do that a little quicker or impactfully earlier? Col. Joe Bledsoe 18:18 Yeah, time is always — like we always need more time, right? How often do you say, like, “I only have 24 hours, but I need more time,” right? So, if we're always fighting time, like, and everybody's fighting time, then, like, that's a constant. So, let's not worry about time. So, I look at it as, like, what traits do people bring to the table, or what traits can we can we sharpen? Honesty, right? Honesty is huge. You have to be honest, and that's a pillar of trust. Integrity, right? Integrity first and showing people that you display integrity is really important. Humility, I think, is also really important. Humility is really important. I was listening to a podcast the other day, and it really struck home to me, a sense of humility is — if a leader is able to say three things, they're gonna — I know I could, I can build that trust, no matter what that time gap is. “I'm sorry,” “I was wrong,” or one of the seven basic responses: “I don't know, but I'll find out,” right? I think that's really important with humility. The other one is presence, not with a T, like we're not giving presents, but presence. Being present is really important character trait in my mind, and the fifth one that I try to reflect on a lot is action. Right? I think defaulting to not doing something is not what we want. That doesn't help build trust. Taking action with what knowledge you have and making a decision is really important, and I think those are the traits that help build that credibility, help build that trust in that time gap, whatever that looks like. If you can hit those, the five that I try to hit home. If you can do that, hopefully you're building that relationship that is going to foster — have great fruition out of it. Col. Naviere Walkewicz 20:06 That's outstanding, and that's really helpful, I think. I love how you took out the constant of time being an excuse, right? Like, we don't always have the benefit of time, whether it's time and getting more experience or just time in general, I think those are outstanding examples of how you can build credibility. So, thank you for sharing that. You know, one of the things that I also would love to kind of dig into a little bit of your experiences, Joe — because they've been really vast, right? So, I don't believe that everyone has the same kind of path. How have you grown as a leader in these different experiences that really, again, aren't positional leadership roles? I'm just curious, how your growth has been in that space. Col. Joe Bledsoe 20:47 Think a lot of it's been through failure. I think a lot of it's been through failure. These might not be huge, like we lost a million dollars, or like, not through those kind of failures, but relationship failures, or conversation failure at the micro level, and how I've tried to handle that is surround myself with people that will tell me that the emperor — I'm gonna go back to the, I'm gonna go back to the old fairy tale, or fable, right? If you surround yourself with people that are able to come up to you, and you trust them, and you trust their feedback, that is something I've tried, that was Cadet Bledsoe, advice given to me is Cadet Bledsoe. Surround yourself with people that you will listen to and take their feedback honestly. And sometimes that means if I don't have that person in the room and I know I fumbled a conversation or I made a poor decision, it's going to that individual and saying, “I messed up, I'm sorry, I was wrong,” or “I don't know,” right. And that's how I try to use that to present humility, I think, and that's important, because we're all fallible, we all make mistakes, and if I can't admit that, then, like, we're off to the wrong foot right away. Col. Naviere Walkewicz 22:06 Do you think some of that that skill that you've developed over time has been something that you've learned in, and forgive me, I don't know if it's a fighter pilot community, specifically, or you know, I think about when you do your sorties and you have some sort of debrief, right? I feel what I've heard, I've not actually sat in one, but they're very real. Like, there's no, it's not about making you feel good about it, like it's about the safety and the mission, and so I'm curious, if that skill of humility, and you know, calling a spade a spade, and calling it I'm wrong and I'm wrong, did that come from some of that experience, and maybe you can talk through what that's like, because not everyone, I think, practices at that level of transparency. Col. Joe Bledsoe 22:46 Yeah, the fighter pilot debrief. I learned some of the importance of that through mentorship as a cadet, and then that was sharpened as a fighter pilot. And I learned the importance of that through the form, my formal job, right, the mission, the lives at stake, aircraft, that kind of stuff. And I think I've tried, I've only honed that skill through Air Force training, right? The Air Force has trained me to think like that, and I've tried to translate that into my personal life and leadership positions, because I think there's tons of value to that. There is tons of value in being willing to find a mistake, own up to that mistake with the knowledge and hope that it doesn't happen again, right? And if that is like, if you, if that's your north star, we don't do this again, like, why wouldn't you want to be on that team? Why wouldn't, why don't you want to be? That's how we get better, right? And I think that seed again was planted as a cadet. Like, let's, I tell cadets all the time, like, you're joining the A-team, so put in A effort, right? Like, if you're going to join the A-team, I don't want B-players, and this is what we got to get, like, let's go, right? It's a motivating factor in my mind. Col. Naviere Walkewicz 24:08 What are some of the ways to approach that in a leadership conversation for someone who would be interested in taking on some of those, those learned lessons? Col. Joe Bledsoe 24:18 Yeah, I think the first thing is transparency and honesty right up front. Like this, Naviere, if we were flying together, right and you were my instructor, your job is not to degrade me as a human, but to prove to me that I made a mistake with the ultimate goal of making me better, right? Your job is to always, like — and the relationship you and I have as an instructor and a student is my — I'm gonna sit here in the debrief and go, and Naviere is here to make me better, right? Like, that's your, that's your job, right? Right. So, once you start that as the foundation, like, it can only get better if I know your job is to make me better, and your job is I'm supposed to make this guy better, right. And often we can, when feedback is provided, you're like, this could be a personal attack, or, like, that's all left out, that's all left outside the debrief room, right? Like, we're here to make everybody better, and I think that's where it starts: with that transparency and honesty up front of the expectation. Col. Naviere Walkewicz 25:15 So you'll actually say that. You would actually… Col. Joe Bledsoe 25:17 No, I think that's just a common, that's a common theme, right? That's the expectation in the community. And not just in the fighter community. I think it's throughout the Air Force, right? I think that's what makes us really, really unique. Col. Naviere Walkewicz 25:32 Because feedback is something that we, we do — although maybe some can do it better than others — I think that's a really fantastic way — before you're giving someone feedback, you're really clear on this is what we're hoping to accomplish by having this time together. And so, I think what you just said can make feedback so much more impactful, because it's not about the person, it's about what are we trying to accomplish and helping you, I guess. It is about you, but ultimately helping you. Col. Joe Bledsoe 25:59 Absolutely, right? Like the where every debrief starts is we had a mission objective and we had tactical objectives. Did we do them? If we didn't, let's figure out why, right? So translating to the business world or private sector, it's a root cause analysis, right? It's a root cause analysis, and we will get down to the nitty gritty of like, what type of error — did you make a decision error? Did you perceive the environment wrong? Did your actions cause the error, right? And we get down to that level, so that when the student, student Paveway walks away, Naviere, knows, Naviere, you gave me the exact, like, you decided wrong, because X, Y and Z; don't do that again. Col. Naviere Walkewicz 26:43 Right. Col. Joe Bledsoe 26:44 Here's your fix. You know, that debrief can take hours, and that's the beauty of it, right? “We're gonna sit there, and we're not gonna let anything not be uncovered, because we're gonna go do this again tomorrow, and we can't make the same mistake tomorrow,” right? “We can't make the same mistake.” Col. Naviere Walkewicz 27:01 No, that's, that's fantastic. I mean, to have it that clear, and to know it, like, OK, we're not gonna, we don't stay in that space. We've addressed it, we know we've identified a fix, and we move forward. Is that what you said? Col. Joe Bledsoe 27:12 Absolutely. Col. Naviere Walkewicz 27:13 There's no like, continue to revisit, like… Col. Joe Bledsoe 27:15 Yep, that's the point, right? Like, “I've learned something, I know, I've acknowledged my mistake. Let's move on. This wasn't personal, this was you making me better.” Iron sharpens iron, right? So, here we go, and then move on. And now that translates, as you asked kind of a couple minutes ago, right, that can translate to so many things in your life, right? And I try to do that sometimes, like my wife will tell me, I go too fighter pilot, but there's versions of that that translate as we are not in a fight or pilot debrief. Col. Naviere Walkewicz 27:50 You literally got in my head because I was gonna say, now I want to put you on the spot, because Joe, you are married to your high school sweetheart, you make a 2% club, right? Like, you actually started the Academy with a sweetheart and ended with the same sweetheart. And now you have three amazing, beautiful children. How do you translate that to, you know, feedback to your family or your personal life? And I love how your wife said too fighter pilot, but how about to your kids? Col. Joe Bledsoe 28:15 Yeah, married my high school sweetheart, Alicia. We started dating our sophomore year, and we've been together ever since. So she is not a grad, but she has a lot of Air Force in her blood, so that's great, and the kids, I would say there's a couple things when it comes to taking some things I've learned or been trained in the Air Force, translating on the home front. The first one goes to accountability, right? I think accountability is really important because in an aircraft, you have to be accountable for your actions, and I think that translates to being a parent, as well as trying to teach the kids some humility. Right, where to be humble, when to own up to your mistakes, and sometimes that works in the fighter pilot way, sometimes it doesn't, and I think that's leadership, right? You can have leadership skills and be consistent in some, in some ways, but other times adaptability is really important, especially with the kids, and each one of my kids is very unique, and we have to cater to each one of them and their unique skills. I will say about my wife, I love her with all my heart, but she knows the words “knock it off” as well, right, because that's a sacred word, not just in the military, but on our, in our homefront, and that usually means stop being a full fighter pilot, like go back to being Dad, right? So she knows, she knows the words and how to make that all go down. Col. Naviere Walkewicz 29:47 I love that it's another language, right? You have your, your fighter pilot language, and you have a home front language. I love that. Thank you for sharing that. You know, I'd like to switch gears a little bit to your time operationally, and maybe this translates into now your work at the Institute, or your most recent work at the Institute for Future Conflict and preparing cadets for the future fight. I'm curious, how all of these skills that you've learned, and these leadership traits that you've continued to develop in yourself, have translated in moments of, you know, like, real conflict, real distress, like when the stakes are high, and how you prepare cadets to think that way, even though maybe they've not experienced that. I'm just curious, what that looks like. Col. Joe Bledsoe 30:31 Yeah, it is hard to translate — like cadets love war stories, right? Like, “So there I was…” but it's hard to translate some of, like, the putting, having the cadets put themselves in the shoes of someone that has 15 years of flying under their belt, right? Like, that's hard for them to grasp, and I understand that, and that's not what I'm asking of them to do, but there are certain skills that I think are really important, and that I've got to experience and talk to cadets and research and spend time thinking about at the Institute for Future Conflict at the IFC. One is risk, right? How do we, how do we think about risk, right? Are we risk prone? We risk adverse? How do we think about risk, not just in this moment, but how does our decision today affect five days from now, a month, right? And, as you remember, because I know it happened to you as a cadet, like you're just in the, like, “What's my next problem,” right? What's my next — OK, how does, like, fixing this problem affect next week? Right. And I think that's what I've got had the opportunity to think a lot about the IFC, as well as try one thing I've learned being back here at the Academy was my experience as a cadet is not the same experience as the cadets now. And what do I mean by that is when I graduated, GWOT, Global War on Terror was the thing we knew what we were getting into. I very much knew flying, going to the Middle East. Now the cadets looked to me and other permanent party, and like, what's our fight going to look like? And right, the question mark is, I don't know, but let me tell you, think about this, and I could be wrong, and I think that is where I've had a lot of time to think about future conflict and what's problems, maybe not nations or adversaries, but like big meta level things they'll have to think about, information access, information sharing, trust, right? How do you, how do you help develop some of these skills in the cadets? And that's where I've spent a lot of time the last two years trying to think and spend, spend some brain bytes, like what does air power look like in this unknown environment? Col. Naviere Walkewicz 32:52 And as you're about to step back into it, I'm thoughtful of that, and so now you're taking what you've helped cadets start to hone in and think about. How are you different now as a leader going back into the cockpit than you were when you came to the Academy? Col. Joe Bledsoe 33:09 Yeah, let me get back to the cockpit, and everyone can tell me what, how I'm different. We'll use that as the test. But here's one thing I think — I've reflected on this recently, going back to the Strike Eagle community. One has been my exposure here in Colorado Springs and at the Air Force Academy, meaning I've learned a lot about what others do that I wasn't — I knew other jobs existed, I knew other AFSCs did things, but not being in a flying day-to-day ops tempo, I've had the opportunity to sit down and, like, “What do you say you do?” “Oh, that has some effects here, here, and here,” and I use a specific vignette would be, I've got to spend a lot of time in the management department and helped teach in the global logistics minor, and like, I knew there was logisticians in the Air Force, and like, that's yeah, right? That's how stuff got here, but like, understanding the importance of, like, that's how my bombs got here, this is how the b…, right, like, truly understanding their frustrations, I think will make me get less frustrated in my day to day, right, and I think that has been one thing that the Academy has given back to me the second time I've been here, is a little bit more exposure to the Air Force, as well as the Space Force, being here in Colorado Springs, like seeing what each team member, like each cog in the machine brings to the fight, right? And I think that's been a blessing here. Col. Naviere Walkewicz 34:42 So those that you will begin to get back working with — your men and women in your community — they won't have had that exposure, and so I'm now going back to our where we started with the sense of informal leadership. How do you help others gain that experience and thought, and maybe thought process informally, since they haven't really been exposed to that? How would you help them navigate it? Col. Joe Bledsoe 35:09 Naviere, I think the best way to do stuff like that is, like, you raised your hand when you said logistics officers, like Naviere, we're doing a podcast with my next squadron, you're coming to talk, right? Col. Naviere Walkewicz 35:19 Right, it's like that was like a long time ago, we need someone more recent. Col. Joe Bledsoe 35:24 But, OK, Naviere, it's not you, but you know people, that's how stuff gets done, right, that's how stuff gets done. And while I by no means want to stand up in front of everybody and say I'm the expert on logistics, but I, I'm not that person, but I trust Naviere, Naviere's contact here, and that's how, like, you create this network of knowledge and this network of trust and credibility. And to my, to the fighter pilots that I'll be flying with, it's somewhat like throwing mud at the wall sometimes, like we're gonna keep throwing mud and see what sticks, but at least they know it's there, right? Like, we're gonna, your job is still to go kill things and blow things up, but at the same time, you know there's this other network out there that you can lean into. But let me be a conduit to make that happen. Col. Naviere Walkewicz 36:15 That is awesome. That's fantastic. So I want to go into this period now, where we talk about you and your continued growth as a leader. What is something, Joe, that you're doing every day to be a better leader? Col. Joe Bledsoe 36:30 I have mentors, and I've tried to find mentees. I think that is where growth can happen, leaning on others for mentorship and mentees to try to talk through some things you've thought through and give experience and exposure to others, right? And that's that network we were just talking about, right? Other things I think are really important is reading and writing. Read a lot, write a lot, nobody writes good anymore, right? Thanks, ChatGPT. But being able to communicate in the written form is really important. So, writing and reading. And the other thing, too, is as a leader, just find an outlet, find something, find a hobby, find something that's fun to do, right. So, I got into running here at the Academy, because we're at high elevation, and I'm, why not, right? But find something that, like, rounds you out, right? It's fine, find an outlet that helps give you some relief from all the stresses that can happen in leadership. That's where I would say I spend a lot of time, or what I think about trying to sharpen my skills. Col. Naviere Walkewicz 37:34 Daily. So, what are you reading right now? Col. Joe Bledsoe 37:37 Oh, that's a great question. I have a couple books that are on the table. Mask of Command is one that I'm reading as I get ready to go back and potentially be in a leadership role. There's a couple other books that come to mind. I'm reading a baseball coaching book, because I coach my baseball, it's a basketball book by Coach K from Duke, as I go back to North Carolina, but it's a book, how to coach kids, right, Leadership on the Court, and it's fun to just think about training and coaching kids and how to keep them inspired. Col. Naviere Walkewicz 38:18 Oh, that's awesome. So, speaking of kids, if you were to go back in time, and talk to younger Joe Bledsoe, the third, what advice would you give him? Col. Joe Bledsoe 38:30 Yeah, if I had to go back, I would say it's worth it. Every second, work hard at the Academy, right? The doors that it opens, that's where my mind went when you asked the question, like, younger me at the Academy. Be good to Alicia, my wife, right? Be good, because she's going to be with you for a long time. So be good to her, as well as foster your, foster your friendships. They're going to mean a lot to you in the future, right? The relationships you build on that hill are going to come back in ways you have no idea years to come. So take time and prioritize the people that you meet. Col. Naviere Walkewicz 39:10 Those are really great reflections. Joe, is there anything that we haven't covered in our conversation that you would love to share with our Long Blue Leadership listeners and viewers? Col. Joe Bledsoe 39:24 Absolutely, be proud of this institution. I'm proud of it. I know you are too, Naviere. Proud of this Academy. Be proud of the cadets, be proud of the permanent party that work here. There's an A-team out there, and this is this is where it starts, right? And it's not just if you're serving in blue or in the Space Force, right? If you're out there doing awesome things for our country on the private, in the private sector, thank you. Keep doing what you're doing. There's no shade of blue in the Long Blue Line, that's my, my phrase for that one. There's no shade of blue. Serve your country, be proud. And that's — just be proud to be an Academy grad. Col. Naviere Walkewicz 40:07 That's fantastic. So, you know, in our time together, I have loved this, this, this leadership conversation, because we really span an area that I don't think a lot of people talk about, and it's, how do you demonstrate leadership in an informal way, you know, without titles and without necessarily key positions or in the hierarchical structure, and so some of the things that really stood with me, Joe, that you've covered, have been being credible, being present, and humble. I really like that, and you didn't say this in these words, but what I took from that was, you know, being honest and truthful is almost one of the most kind ways you can be right, because you're actually helping someone be better, and that really stuck with me, you know. I don't, we have an A-team, we don't need B-players, that I think you exactly said that, so definitely stuck with me. But watching the way that you have led, not with your class, not just the cadets, and, you know, certainly not the squadron that you will have here shortly as a director of operations, but I think you've continued to just be who you've always been, which is someone who leads with integrity through those pillars and certainly by example. So this has been an incredible conversation, and for anyone that is watching us and listening to this, for others that are in their leadership journeys, this is another one you're going to want to share, because it's not just about, you know, Lt. Col. Bledsoe's journey right now, it's been all of these moments and experiences and memories and they really do connect with anyone on a leadership journey. So, be sure to join in on longblueleadership.org or wherever you get your podcasts, not just to see this one, but all of our other conversations. So, Joe, thank you so much for joining us today. Col. Joe Bledsoe 41:46 Thank you Naviere. Go Air Force! Col. Naviere Walkewicz 41:48 Go Air Force!   Col. Joe Bledsoe 41:49 There we go. Col. Naviere Walkewicz 41:50 Absolutely, until next time, we'll see you on Long Blue Leadership. KEYWORDS informal leadership, peer leadership, Air Force Academy leadership, USAFA class president, fighter pilot debrief culture, building trust and credibility, leadership humility, future conflict and airpower, Long Blue Leadership podcast, military leadership lessons.     The Long Blue Line Podcast Network is presented by the U.S. Air Force Academy Association & Foundation          

As colorectal cancer rates rise among younger adults, surgeons are increasingly caring for patients with rectal cancer who are pregnant or hoping to preserve future fertility. With more individuals delaying childbearing, balancing effective cancer treatment with fertility preservation and maternal–fetal safety has become an important clinical challenge. This timely topic was recently highlighted by Dr. Sharon Suwanabol during a presentation at the American Society of Colon and Rectal Surgeons annual meeting 2026. In this episode, we explore the intersection of rectal cancer, fertility, and pregnancy through a multidisciplinary, case-based discussion. We review how surgery, chemotherapy, and pelvic radiation can affect fertility and sexual function in both men and women, and why early counseling and referral to reproductive endocrinology specialists are essential. The discussion also emphasizes that evaluation and treatment during pregnancy can often be performed safely, with care individualized based on tumor stage, gestational age, and the patient's goals and values. Hosts and discussants ·      Dr. Betelhem Yohannes, General surgery resident at the University of Washington ·      Dr. Griffen Allen, General surgery resident at the University of Washington  ·      Dr. Raga Siddharthan, Assistant Professor of Surgery in the Section of Colorectal Surgery at the University of Washington  ·      Dr. Stacey Cohen, Professor in the Division of Hematology and Oncology at the University of Washington and a gastrointestinal medical oncologist at Fred Hutch Cancer Center, specializing in colorectal and other GI cancers. Learning objectives ·      Describe the impact of rectal cancer surgery on fertility, sexual function, and future childbearing potential. ·      Review the effects of chemotherapy and pelvic radiation on reproductive health and fertility preservation. ·      Discuss available fertility preservation strategies and the importance of early pre-treatment counseling and referral. ·      Recognize the diagnostic challenges of rectal cancer during pregnancy, including overlapping gastrointestinal symptoms. ·      Review appropriate staging and workup considerations for suspected rectal cancer in pregnant patients. ·      Discuss multidisciplinary management strategies for rectal cancer during pregnancy, including individualized treatment sequencing. ·      Examine ethical and patient-centered considerations when balancing maternal cancer treatment and fetal outcomes. References  Siegel RL, Wagle NS, Star J, Kratzer TB, Smith RA, Jemal A. Colorectal cancer statistics, 2026. CA Cancer J Clin. 2026;76(2):e70067. doi:10.3322/caac.70067 [https://pubmed.ncbi.nlm.nih.gov/38240409/] Pregnancy at Age 35 Years or Older: ACOG Obstetric Care Consensus No. 11. Obstet Gynecol. 2022;140(2):348-366. doi:10.1097/AOG.0000000000004873 [https://pubmed.ncbi.nlm.nih.gov/35640237/] Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/] Druvefors E, Myrelid P, Andersson RE, Landerholm K. Female and Male Fertility after Colectomy and Reconstructive Surgery in Inflammatory Bowel Disease: A National Cohort Study from Sweden. J Crohns Colitis. 2023;17(10):1631-1638. doi:10.1093/ecco-jcc/jjad079 [https://pubmed.ncbi.nlm.nih.gov/37341355/] Ito M, Tsukada Y, Watanabe J, et al. Long-term survival and functional outcomes of laparoscopic surgery for clinical stage I ultra-low rectal cancers located within 5 cm of the anal verge: A prospective phase II trial (Ultimate trial). Ann Surg. Published online April 1, 2024. doi:10.1097/SLA.0000000000006290 [https://pubmed.ncbi.nlm.nih.gov/38629555/] Teh WT, Stern C, Chander S, Hickey M. The impact of uterine radiation on subsequent fertility and pregnancy outcomes. Biomed Res Int. 2014;2014:482968.  Johnson GGRJ, Park J, Helewa RM, Goldenberg BA, Nashed M, Hyun E. Total neoadjuvant therapy for rectal cancer: a guide for surgeons. Can J Surg. 2023 Apr 21;66(2):E196-E201. doi: 10.1503/cjs.005822. PMID: 37085291; PMCID: PMC10125160. [https://pubmed.ncbi.nlm.nih.gov/37085291/] Naren G, Guo J, Bai Q, Fan N, Nashun B. Reproductive and developmental toxicities of 5-fluorouracil in model organisms and humans. Expert Rev Mol Med. 2022 Jan 31;24:e9. doi: 10.1017/erm.2022.3. PMID: 35098910; PMCID: PMC9884763. [https://pubmed.ncbi.nlm.nih.gov/35098910/] National Comprehensive Cancer Network. (2026). NCCN Clinical Practice Guidelines in Oncology: Rectal Cancer (Version 2.2026). Retrieved from NCCN Guidelines for Rectal Cancer [https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1449] Oktay, Kutluk M.D., Ph.D.. Expert Commentary on Fertility Preservation in Colorectal Cancers: Current State and Practical Tips for the Cancer Practitioner. Diseases of the Colon & Rectum 63(6):p 726-727, June 2020. | DOI: 10.1097/DCR.0000000000001688 [https://pubmed.ncbi.nlm.nih.gov/32479532/] Stal J, YI SY, Cohen-Cutler S, et al. Fertility Preservation Discussions Between Young Adult Rectal Cancer Survivors and Their Providers: Sex-Specific Prevalence and Correlates. Oncologist. 2022;27(7):579-586. doi:10.1093/oncolo/oyac052 [https://pubmed.ncbi.nlm.nih.gov/35708892/] Gentile G, Ciccarone M. Management of fertility preservation in young female patients with gastrointestinal cancer: A case series and systematic literature review. Curr Probl Cancer. 2025;57:101221. doi:10.1016/j.currproblcancer.2025.101221 [https://pubmed.ncbi.nlm.nih.gov/39598263/] Saif MW. Management of colorectal cancer in pregnancy: a multimodality approach. Clin Colorectal Cancer. 2005;5(4):247-256. doi:10.3816/ccc.2005.n.035 [https://pubmed.ncbi.nlm.nih.gov/16183863/] Rogers JE, Dasari A, Eng C. The Treatment of Colorectal Cancer During Pregnancy: Cytotoxic Chemotherapy and Targeted Therapy Challenges. Oncologist. 2016 May;21(5):563-70. doi: 10.1634/theoncologist.2015-0362. Epub 2016 Mar 21. PMID: 27000464; PMCID: PMC4861360. [https://pubmed.ncbi.nlm.nih.gov/27000464/] Jiang Q, Hua H. Fertility in young-onset colorectal patients with cancer: a review. Oncologist. 2024;29(10):e1237-e1245. doi:10.1093/oncolo/oyae141 [https://pubmed.ncbi.nlm.nih.gov/39292850/] Dolmans MM, Hollanders de Ouderaen S, Demylle D, Pirard C. Utilization rates and results of long-term embryo cryopreservation before gonadotoxic treatment. J Assist Reprod Genet. 2015;32(8):1233-1237. doi:10.1007/s10815-015-0533-z [https://pubmed.ncbi.nlm.nih.gov/26162569/ Moawad NS, Santamaria E, Rhoton-Vlasak A, Lightsey JL. Laparoscopic Ovarian Transposition Before Pelvic Cancer Treatment: Ovarian Function and Fertility Preservation. J Minim Invasive Gynecol. 2017;24(1):28-35. doi:10.1016/j.jmig.2016.08.831 [https://pubmed.ncbi.nlm.nih.gov/27599763/] Fish R. Ovarian transposition in rectal cancer: uncertain benefit at a high price. Colorectal Dis. 2022;24(6):706-707. doi:10.1111/codi.16086 [https://pubmed.ncbi.nlm.nih.gov/35191146/] Ribeiro R, Baiocchi G, Moretti-Marques R, Linhares JC, Costa CN, Pareja R. Uterine transposition for fertility and ovarian function preservation after radiotherapy. Int J Gynecol Cancer. 2023;33(12):1837-1842. Published 2023 Dec 4. doi:10.1136/ijgc-2023-004723 [https://pubmed.ncbi.nlm.nih.gov/38104863/] Haggar F, Pereira G, Preen D, et al. Maternal and neonatal outcomes in pregnancies following colorectal cancer. Surg Endosc. 2013;27(7):2327-2336. doi:10.1007/s00464-012-2774-6 [https://pubmed.ncbi.nlm.nih.gov/23645367/] Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.  If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

What if the three most powerful words you could ever say to God are not “Send me”… but “Here I am”?In this inspiring message, Ps Byron explores Isaiah 6 and the Hebrew word Hineni—a response that means far more than simply being present. It speaks of a heart that is available, attentive, surrendered, and ready for God's purposes.Against the backdrop of a beautiful yet broken world, we're reminded that Jesus came for every person: the hurting, the hungry, the forgotten, the searching, and the successful-but-empty. And remarkably, God chooses to work through ordinary people to bring hope and healing.In this message: Why our world is both beautiful and broken  Isaiah's life-changing response: “Here I am. Send me.”  The deeper meaning of the Hebrew word Hineni Four powerful responses to God: Presence – “I am here” Attention – “I am listening” Availability – “I am ready” Surrender – “I am yours to send”  What Abraham, Moses, Ananias, and Jesus teach us about living available to God  Practical ways to live out a lifestyle of “Here I am” God isn't looking for perfection, influence, or extraordinary ability. He's looking for hearts willing to say, "Here I am."The greatest tragedy is not that there is so much need in the world. The greatest tragedy is when those who hear God's voice never respond.Here I am, Lord. Send me.Key Scriptures Isaiah 6:1–8  Genesis 22:1, 7, 11  Exodus 3:4  Acts 9:10  Hebrews 10:7 Key Takeaway"The promises of God are wrapped up in Christ-followers who are present, paying attention, available, and surrendered." — Ps Byron ChickenConnect With UsIf this message encouraged you, be sure to subscribe, share it with a friend, and join us as we continue our Send Me series.⛪ Thrive Church Helping people move towards Jesus.

In the ACOG PB 231, Multifetal Gestations Twin Triplet and Higher-Order Multifetal Pregnancies, it states, “based on the improved outcomes reported in singleton gestations, the National Institutes of Health recommends that, unless a contraindication exists, a course of antenatal corticosteroids should be administered to all patients who are at risk of delivery within 7 days and who are between 24 weeks and 34 weeks of gestation, irrespective of the fetal number”. But a BRAND NEW meta-analysis is saying the exact opposite- with a catch. Listen in for details.1. ACOG PB 2312. Felippe, Carolina Alves MS; Ruiz, Sinrraim dos Santos Chaves MD; de Souza, Rebeca Ferreira MS; de Lima, Aliny Silva MS; dos Santos, Priscila Luiza MS; Fonseca, Pandora Eloa Oliveira MS; de Almeida Silva, Ingryd MS; Montes-de-Oca-Saucedo, Carlos Roberto MD; Santana, Ana Cecília Oliveira MS; Veta Darkovski, Jasmina MD; Matlaw, Hadas Rachel MD; Fonseca Queiroz, Laura MD. Antenatal Corticosteroid Use in Twin Pregnancies: A Systematic Review and Meta-analysis. Obstetrics & Gynecology ():10.1097/AOG.0000000000006344, June 4, 2026. | DOI: 10.1097/AOG.000000000000634416% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG

The American College of Obstetricians and Gynecologists (ACOG) does not recommend routine ultrasound measurement of the lower uterine segment (LUS) thickness as part of the evaluation for trial of labor after cesarean delivery (TOLAC). ACOG Practice Bulletin No. 205 (2019) on Vaginal Birth After Cesarean Delivery does not include LUS measurement among its recommendations for TOLAC candidacy assessment. The guideline focuses on clinical factors such as type of prior uterine incision, number of prior cesarean deliveries, and other obstetric history to determine TOLAC candidacy, and emphasizes that most women with one previous low-transverse cesarean delivery should be counseled about and offered TOLAC. But what if you find a likely uterine window at the LUS? Does that mandate a repeat C-section? This topic comes from Serena, one of our podcast family members. Listen in for details. 1. Dr. Chapa's Clinical Pearls, Dec 31., 2023: LUST FOR TOLAC; and follow up episode Jan 15, 20242. ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. Committee on Practice Bulletins—Obstetrics Obstetrics and Gynecology. 2019;133(2):e110-e127. doi:10.1097/AOG.0000000000003078.3. Rozenberg P, Sénat MV, Deruelle P, et al. Evaluation of the Usefulness of Ultrasound Measurement of the Lower Uterine Segment Before Delivery of Women With a Prior Cesarean Delivery: A Randomized Trial. American Journal of Obstetrics and Gynecology. 2022. 4. Swift BE, Shah PS, Farine D. Sonographic Lower Uterine Segment Thickness After Prior Cesarean Section to Predict Uterine Rupture: A Systematic Review and Meta-Analysis. Acta Obstetricia Et Gynecologica Scandinavica. 2019. 5. McLeish SF, Murchison AB, Smith DM, et al. Predicting Uterine Rupture Risk Using Lower Uterine Segment Measurement During Pregnancy With Cesarean History: How Reliable Is It? A Review. Obstetrical & Gynecological Survey. 2023. 6. Jastrow N, Demers S, Chaillet N, et al. Lower Uterine Segment Thickness to Prevent Uterine Rupture and Adverse Perinatal Outcomes: A Multicenter Prospective study.7. American Journal of Obstetrics and Gynecology. 2016. 8. Guerby P, Bujold E, Chaillet N. Impact of Third-Trimester Measurement of Low Uterine Segment Thickness and Estimated Fetal Weight on Perinatal Morbidity in Women With Prior Cesarean Delivery. Journal of Obstetrics and Gynaecology Canada. JOGC. 2022.

Outside of pregnancy, guidelines emphasize diabetes self-management education and support to facilitate informed decision making, self-care behaviors, problem solving, and active collaboration with health care professionals. This includes, in those with good health literacy, the concept of patient-led self-titration of basal insulin results which has data that it improves glycemic management compared with clinician-led titration for type 2 diabetes among nonpregnant adults. But what about for GDM? Can patient's self manage their BASAL insulin? In this episode, we will review a new RCT published in April 2026 in the Green Journal on this very subject. As novel as this is, it is not the first to report on this as it was also published (retrospective study in the UK) in 2022. This is a novel approach to insulin in GDM but there are some questions that remain. Listen in for details.1. Boonpattharatthiti K, Wechkunanukul K, Mayang N, et al . Comparison of Insulin Titration Strategies for Glycemic Control in Type 2 Diabetes: A Systematic Review and Network Meta-Analysis.Diabetes Care. 2025. 2. Valent, Amy M. DO, MCR; Barbour, Linda A. MD, MSPH. Insulin Management for Gestational and Type 2 Diabetes in Pregnancy. Obstetrics & Gynecology 144(5):p 633-647, November 2024. | DOI: 10.1097/AOG.00000000000056403. Wang, Xiao-Yu MD; Gabbe, Steven MD; Landon, Mark B. MD; Venkatesh, Kartik K. MD, PhD et al. Patient-Led Insulin Titration for Glycemic Management With Gestational Diabetes Mellitus: A Randomized Controlled Trial. Obstetrics & Gynecology 147(4):p 501-509, April 2026. 4. McGovern AP, Hirwa KD, Wong AK, et al. Patient-led rapid titration of basal insulin in gestational diabetes is associated with improved glycaemic control and lower birthweight. Diabet Med. 2022;39:e14926. doi: 10.1111/dme.14926

Hyperemesis gravidarum (HG) represents the most severe end of the nausea and vomiting of pregnancy spectrum. It has a reported incidence of approximately 0.3–3% of pregnancies and is the most common cause of hospitalization in early pregnancy and the second most common cause of hospitalization in pregnancy overall. In June 2024, the ACOG published a Clinical Expert series summarizing the inpatient management of HG. In that guidance, it describes mirtazapine as an “alternative pharmacologic” option. How effective is this medication compared to ondansetron? A new study (published ahead of print on 12/30/25 and officially out June 2026), out of Denmark, sheds some new light on this medication. This trial is the first double-blind RCT comparing mirtazapine to ondansetron AND placebo. Although a BIG limitation of this study exists (which we will discuss), it does provide some interesting insights. Listen in for details.1. (ACOG CES) Clark, Shannon M. MD; Zhang, Xue MD; Goncharov, Daphne Arena MD. Inpatient Management of Hyperemesis Gravidarum. Obstetrics & Gynecology 143(6):p 745-758, June 2024. | DOI: 10.1097/AOG.00000000000055182. Ostenfeld, AnneDroogh, Marjoes et al.Mirtazapine or ondansetron for hyperemesis gravidarum. A randomized placebo-controlled trial. American Journal of Obstetrics & Gynecology, June 2026

Episode DescriptionIn this powerful Mother's Day message, Ps Cathy Leicher honours every kind of mother and speaks life into the sacred calling of raising children. With honesty, humour, and biblical wisdom, she unpacks the challenges of parenting, the importance of balance, and the eternal impact of training children in the ways of God. Whether you are a parent, spiritual leader, or simply reflecting on your own upbringing, this message will encourage you to build faith into the next generation with intention and grace.Key Scriptures Deuteronomy 6:5–7 — Love God and teach His ways to your children  Proverbs 22:6 — Train up a child in the way they should go  John 14:6 — Jesus is the way, the truth, and the life  Luke 15:11–32 — The Prodigal Son Big Ideas from the Message1. Every mother matters Biological, adoptive, step, foster, spiritual, and expectant mothers are all honoured and celebrated. Motherhood carries deep responsibility and grace.2. Parenting requires balance Avoid extremes: Too soft → entitlement, lack of boundaries  Too harsh → rebellion, bitterness Healthy parenting finds the “just right” balance of love and discipline. 3. Over-parenting can hinder growth From “helicopter” to “lawnmower” parenting, overprotection can prevent children from developing responsibility, resilience, and confidence.4. Faith must not be withheld Children need consistent spiritual guidance. The greatest gift a parent can give is introducing their children to Jesus early.5. Train, show, and equip Train: Build daily habits of faith and life skills  Show: Model Jesus in everyday life  Equip: Prepare children to walk in their own faith journey Key Highlights Parenting is not about perfection, but grace, prayer, and consistency  Children are shaped most in the early years (4–14 “window of opportunity”)  Legacy is not what you leave behind, but what you leave within people  Even wayward children are never beyond prayer and restoration  The Father heart of God is seen in the story of the Prodigal Son Practical Takeaways Start with your own relationship with God before teaching others  Create daily rhythms of faith in your home (conversation, prayer, Scripture)  Step back where necessary to allow children to grow responsibility  Avoid extremes—lead with love, structure, and wisdom  Never stop praying for your children, no matter their season Closing Prayer EmphasisA call to commit children—and ourselves—to God's guidance, trusting Him to lead the next generation into truth, restoration, and purpose through Jesus Christ.⛪ Thrive Church Helping people move towards Jesus.

Faithful In The Small ThingsA message on habits, identity, and long-term faithfulness through the story of David and Goliath.Episode SummaryIn this powerful message, Ps Khulu Duma reminds us that David's victory over Goliath wasn't a random miracle moment — it was the result of years of faithfulness in unseen places. Long before the giant fell, David was faithfully practicing with his sling, protecting sheep, and developing character in private.This sermon challenges us to stop despising small beginnings and to recognize that the small habits, disciplines, and decisions we make consistently are shaping who we become. Whether it's prayer, generosity, discipline, health, relationships, or leadership — God honors faithfulness in the small things.The key question isn't just “What do I want to do?” but “Who am I becoming?”Key Scriptures 1 Samuel 17  Matthew 25:21  Ephesians 4:22–24  Galatians 6:9  Zechariah 4:10 Key Takeaways Public victories are built in private faithfulness.  Small consistent habits create massive long-term change.  Identity shapes habits, and habits reinforce identity.  Start with “Who am I becoming?” before asking “What must I do?”  God rejoices in small beginnings.  Repeated faithfulness leads to spiritual harvest. Practical Habits Mentioned:Spiritual Health Think same time + ahead of time for devotional rhythms.  Pre-plan Bible reading and prayer times. Emotional Health Use physical cues before reacting.  Pause and ask: “Will my response build or break this relationship?”Physical Health Make healthy habits obvious and accessible.  Reduce friction for exercise and hydration. Finances Automate giving and saving on payday.  Build faithful stewardship through consistency. Family Schedule intentional family time.  Put what matters most in the calendar. Reflection Questions What small habit is God asking you to stay faithful in?  Who are you becoming?  What repeated actions are shaping your future?  Are there any “small beginnings” you've been tempted to despise? Next StepsThis week: Write down who you want to become.  Choose one small habit to repeat consistently.  Pray for God to strengthen your identity in Christ.  Don't underestimate the impact of small faithful steps.⛪ Thrive Church Helping people move towards Jesus.

The belief that IV dextrose is necessary to clear ketones in hyperemesis gravidarum originated from a logical, and now known to be outdated, extrapolation of basic starvation ketosis physiology and the treatment paradigm for diabetic ketoacidosis (DKA). The original experiments that led to this conclusion go back to the 1960s (Foster data). Not only is this outdated, but it is also physiologically incorrect. We've learned a lot about IV fluid replacement about hyperemesis gravidarum in the last several years- in the last data review was in January 2026 in Lancet. Even the correction of hyponatremia has evolved. Should we be following urine ketones for patients being treated for HG? Is Dextrose needed? Listen in for details.1. Nana M, Painter R, Williamson C et al. Hyperemesis gravidarum. The Lancet, Jan 2026; 407, 78-892. Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum. Obstet Gynecol. 2024 Jun 1;143(6):745-758. doi: 10.1097/AOG.0000000000005518. Epub 2024 Feb 1. PMID: 38301258.3. Ayus JC, et al.Correction rates and clinical outcomes in hospitalized adults with severe hyponatremia: a systematic review and meta-analysis. JAMA Intern Med. 2025;185(1):38-51. 4. ACOG Clinical Epert Series: Inpatient Management of Hyperemesis Gravidarium. Obstet Gynecol; 2024

Faithful When It's Costly.Faithfulness isn't built in a moment—it's formed over a lifetime. In this powerful message, Ps Byron Chicken unpacks Jesus' radical call to steadfast loyalty, sacrificial love, and daily surrender.In a world that celebrates convenience and keeps options open, biblical faithfulness can feel costly. But whether it's in our relationships, convictions, calling, finances, or walk with God, faithfulness remains one of the highest virtues we can pursue—and it's always worth it.Jesus calls us to: • Give up our own way • Take up our cross • Follow HimFollowing Jesus rarely means one dramatic decision. More often, it means a thousand small choices, made faithfully, day after day.If you've been tempted to quit, compromise, or take the easier road, this message will strengthen your resolve and remind you that a faithful life becomes a source of life for others.Key Scripture: Matthew 16:21–25In This Message: Why faithfulness is the backbone of flourishing lives and societies  The real cost of following Jesus  How to stay faithful in a culture of convenience  Practical ways to live with courage, generosity, and conviction⛪ Thrive Church Helping people move towards Jesus.

Title: Faithful in the Waiting Speaker: Donovan CogillDescription: Waiting is hard. Whether it's for answers, breakthrough, or God to move—waiting can feel slow, silent, and even discouraging. But what if God is doing His greatest work in the waiting?In this message, Faithful in the Waiting, we're reminded that delay is not denial. Through the lives of Joseph, Abraham, and David, we see a powerful pattern: the promise, the waiting, the fulfillment. And in the middle of it all, a call to remain faithful.Key Takeaways:God works in the waiting When it feels like nothing is happening, God is still moving—often in ways we cannot see. Delay is not denial Just because it hasn't happened yet doesn't mean it won't. The waiting shapes you What happens in the “middle” prepares you for what God has promised. How to Stay Faithful While You Wait:Keep doing the right things (Joseph) Faithfulness is proven in the waiting, not the breakthrough. God is not just working for you—He's working in you. Believe God's promises (Abraham) What you believe shapes who you become. Even when circumstances say otherwise, choose to trust what God has said. Trust God's timing (David) Don't rush the process or take shortcuts. God is never late—He is always on time. Powerful Truths: “God does His greatest work in the waiting.”  “Delay is not denial.”  “Faith isn't proven in the breakthrough—it's proven in the waiting.”  “God will never promote you into something your character cannot sustain.” Scripture References: Genesis 39 (Joseph's faithfulness)  Romans 4:18–22 (Abraham's faith)  1 Samuel 24:4–7 (David's restraint)  Galatians 6:9 (Don't grow weary in doing good)  Isaiah 60:22 (God's perfect timing) Final Encouragement: If you're in a season of waiting, don't give up. God hasn't forgotten you. He is faithful—yesterday, today, and forever.Stay faithful. Keep trusting. At the right time, He will come through.⛪ Thrive Church Helping people move towards Jesus.

Title: Faithful When We're Faithless Speaker: Ps Amy-Jane DumaDescription: We all experience seasons—moments where faith feels strong and others where fear, disappointment, or uncertainty make it hard to believe. In this powerful message, Ps Amy-Jane reminds us of an unchanging truth: God remains faithful, even when we feel faithless.Through personal stories and the life of Peter, we see that God's faithfulness isn't dependent on our performance—it's rooted in His character. His love sees us, pursues us, and restores us.Key Scripture: 2 Timothy 2:13 – “If we are faithless, He remains faithful, for He cannot deny Himself.”Key Thought: God's faithfulness is not dependent on our faithfulness.3 Truths About God's Faithfulness: • He sees you – Even in your weakest, most faithless moments, God looks at you with love, not condemnation. • He pursues you – When you drift, He draws near. His love doesn't give up on you. • He restores your purpose – God doesn't just forgive; He reaffirms your calling and trusts you again.Illustration: Like sitting on a chair without hesitation, we can trust God to hold us—even when we can't see or feel Him. His faithfulness remains constant.Application:

Iron-deficiency anemia during pregnancy is associated withseveral adverse pregnancy outcomes, including severe maternal morbidity, preeclampsia, placenta previa, and placental abruption. It makes sense that diagnosing and treating anemia and its underlying causes in earlypregnancy may reduce the risk of adverse outcomes, but evidence has been scarce…until now. In this episode, we will review a new retrospective study based on nationwide data that examines this very issue (Green journal, April 2026).Listen for details. 1.  Booman A, Bateman BT, Siadat S, Berube C, Igbinosa I, Leggett C, Lyell DJ, Main EK, Leonard SA. Pregnancy Outcomes Associated With Anemia in the First Trimesterand Anemia Resolution by Late Pregnancy. Obstet Gynecol. 2026 Apr 1;147(4):518-527. doi: 10.1097/AOG.0000000000006183. Epub 2026 Feb 6. PMID:41643193; PMCID: PMC12880618.2.  ACOG OCC 5: Severe Maternal Morbidity: Screening and Review; 2016 and reaffirmed 20253.  ACOG PB 233

Platelet-rich plasma (PRP) injections do not have formal FDA approval for specific clinical indications. PRP is regulated as an autologous blood product and is used "off-label" in clinical practice. However, there is substantial clinical evidence supporting its use for certain dental surgeries and musculoskeletal conditions, particularly lateral epicondylitis, knee osteoarthritis, and plantar fasciitis. The American Medical Society for Sports Medicine notes that PRP is primarily used to treat tendinopathies and osteoarthritis, though clinical efficacy results remain mixed due to variability in PRP formulations and preparation methods. As of now, there are no FDA approved uses for PRP for gynecologic use, although there has been some evidence of possible benefit in vulvar dermatoses and possiblt ovarian function enhancement. But what about its use in the vagina for sexual pleasure? Injecting into the anterior vaginal wall (around the famed G-Spot location) is nothing new. Over a decade ago, a TV show introduced the masses to the “G-Spot amplication” shot which injected collagen to that area. But there was no data for this. Well, we are back to this idea in a new RCT in the Green Journal. Can PRP light up the vaginal fires of pleasure? Listen in for details. 1. Clarke, Bayley MD; Gaddam, Neha MD; Garcia, Bobby MD; Iglesia, Cheryl B. MD; Podolsky, Robert PhD; Dieter, Alexis A. MD. Vaginal Injection of Platelet-Rich Plasma for Sexual Function: A Randomized Controlled Trial. Obstetrics & Gynecology ():10.1097/AOG.0000000000006256, March 19, 2026. | DOI: 10.1097/AOG.00000000000062562. Finnoff JT, Awan TM, Borg-Stein J, et a American Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports Medicine. Clinical Journal of Sport Medicine : Official Journal of the Canadian Academy of Sport Medicine. 2021. 3. Alsousou J, Ali A, Willett K, Harrison P. The Role of Platelet-Rich Plasma in Tissue Regeneration.Platelets. 2012.

Well, it's no doubt we live in a culture of immediate gratification. When we need to know something, we must know it immediately! This even applies to couples seeking pregnancy and their desire to find out if their monthly attempts have been successful. However, there is a problem with trying to prove pregnancy too promptly. In this episode, we will review a new publication just released on March 1st, 2026 out of the Green journal. These authors evaluated a prospective cohort (PRESTO cohort) of pregnancy planners to analyze their pregnancy test taking behaviors and their outcomes. The results are eye-opening. So, when is the best time to check a pregnancy test? Listen in for details. 1. Sundermann AC, Jasper EA, Jukic AMZ, Rothman KJ, Wise LA. Pregnancy Test Use and Timing of Pregnancy Detection in a Prospective Cohort of Pregnancy Planners. Obstet Gynecol. 2026 Mar 1;147(3):394-403. doi: 10.1097/AOG.0000000000006157. Epub 2026 Jan 8. PMID: 41505757; PMCID: PMC12788791.2. Wilcox AJ, Baird DD, Dunson D, McChesney R, Weinberg CR. Natural Limits of Pregnancy Testing in Relation to the Expected Menstrual Period. The Journal of the American Medical Association. 2001.

Podcast family we've all heard the rumors that oursmartphones are “LISTENING TO US”. Well, some of that is actually true, and trust me I'm not a conspiracy theorist. Our smartphones are capable of remarkable things. A new publication from the Green journal (released ahead ofprint on 03/05/2026 ) is proposing that it may now be able to detect fetal movement, fetal breathing, and even fetal hiccups when placed over the abdomen! Yep, it's not science fiction... it's science innovation. While this is not ready for prime time just yet, the science is absolutely astounding. In this quicky episode we will briefly summarize a fascinating new innovative study which proposes that our iPhones may be able to be a fetal movement detector.1.     Moise, Kenneth Jr MD; Gaither, Kelly PhD;Madden-Rusnak, Anna PhD; Lowry, Kathy RN, MSN; Hutson, Emily RN, MSN; Bruns, Danielle RDMS; Valero, Reinaldo MD, RDMS. Smartphone Detection of FetalMovements Using Artificial Intelligence. Obstetrics & Gynecology ():10.1097/AOG.0000000000006228, March 5, 2026. | DOI:10.1097/AOG.00000000000062282.     Lai J, Woodward R, Alexandrov Y, et al Performanceof a Wearable Acoustic System for Fetal Movement Discrimination. PloS One. 2017. 3.     Ashik AK, Gutierrez R, Ashraf F, et al. AMachine Learning Model for Assessing Fetal Health During Pregnancy. Frontiers in Bioengineering and Biotechnology. 2025. 4.     Antepartum Fetal Surveillance: ACOG PracticeBulletin, Number 229. Obstetrics and Gynecology. 2021.5.     Monitoring a Pregnancy at Home With a SmartphoneThis wearable device provides real-time ECG monitoring of a fetus: https://spectrum.ieee.org/pregnancy-heartbeat-monitor-smartphone

Neither the ACOG nor SMFM recommend strict bed rest for preterm birth prevention, or nor preeclampsia. Yet tradition often conflicts with evidence. A prior 2009 survey of MFM specialists, published in the AJOG, on the use of bed rest revealed that 71% used activity restriction in their practice for arrested preterm labor, despite the majority believing it had minimal or no benefit. The authors concluded, “Because most obstetricians in our survey indicated they would prescribe bed rest believing it was associated with minimal or no benefit, it is possible that even if a randomized, prospective trial showed no benefit associated with bed rest, it would still remain a common recommendation.” This brings us to a brand new publication from the Green Journal which is an ancillary study of two randomized trials of preterm birth prevention in women with a short cervical length. These authors sought to evaluate the amount of physical activity in patients at high risk for preterm birth and pregnancy latency and preterm birth. What did they find? It is a bit shocking. Listen in for details.1. Fox, Nathan S. et al. The recommendation for bed rest in the setting of arrested preterm labor and premature rupture of membranes. American Journal of Obstetrics & Gynecology, Volume 200, Issue 2, 165.e1 - 165.e6 https://www.ajog.org/article/S0002-9378(08)00909-5/fulltext2. Sciscione, Anthony C. DO; Booker, Whitney A. for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units (MFMU) Network, Bethesda, Maryland. Activity Restriction in Pregnancy and the Risk of Early Delivery: The AWARE Study. Obstetrics & Gynecology ():10.1097/AOG.0000000000006225, February 19, 2026. | DOI: 10.1097/AOG.0000000000006225 https://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=9900&issue=00000&article=01460&type=FulltextVisit our SPONSOR's Webpage for information on the Hemorrhage View C-Section Drape: www.perspectivemedical.org

We recently covered an SMFM abstract that was presented at the annual Pregnancy Meeting held in early February 2026. The authors were from my Alma Mater, UT Southwestern/Parkland Hospital. This was a well-done study comparing 162 milligrams aspirin to 81 milligrams of aspirin. The results were very encouraging! However, aspirin definitely has an awkward acumen. It would be wonderful if ALL the data just leaned in the same direction... but it doesn't! Enter our podcast family member, and my friend Alex. Alex sent me an incredible and insightful message which was a rebuttal to my Southwestern colleagues' findings. In this episode you'll hear Alex's rebuttal and clinical conundrum, and we will explain why these two seemingly paradoxical findings makes sense. Listen in for details.1. Khander, Amrin MD; Thomas, Charlene MS; Matthews, Kathy MD; Christos, Paul DrPH; Alcus, Claire BA; Alam, Tanvir BS; Bush, Leah BA; Deshmukh, Diksha BA; Chasen, Stephen T. MD; Riley, Laura E. MD; Skupski, Daniel W. MD; August, Phyllis MD, MPH; Malha, Line MD, MS. Comparison of 162 mg and 81 mg Aspirin for Prevention of Preeclampsia: A Randomized Controlled Trial. Obstetrics & Gynecology 147(1):p 87-96, January 2026. | DOI: 10.1097/AOG.0000000000006100

There has been a shift in cervical cancer screening from primary cytology based to HPV based. Even HPV screening has had its evolution from physician collected samples to patient self-collection, either in a clinical setting or at home with an approved collection system. In May 2025, the FDA cleared the first at-home self-collection kit for HPV screening, specifically the Teal Wand by Teal Health. Now, we are seeing the advent of POSSIBLY another avenue for cervical HPV testing- although it is a bit awkward: the use of menstrual blood as an HPV screening test. In this episode we will review a new cross-sectional, population-based study from China which compared testing menstrual blood for human papillomavirus during cervical cancer screening to clinician-collected cervical samples for human papillomavirus (HPV). This concept, and these results, are not new at all! And there are important limitations to consider at this time. Listen in for details.1. Testing menstrual blood for human papillomavirus during cervical cancer screening in China: cross sectional population based study. BMJ 2026; 392 doi: https://doi.org/10.1136/bmj-2025-084831 (Published 04 February 2026)BMJ 2026;392:e084831https://www.bmj.com/content/392/bmj-2025-0848312. Naseri S, Young S, Cruz G, Blumenthal PD. Screening for High-Risk Human Papillomavirus Using Passive, Self-Collected Menstrual Blood. Obstet Gynecol. 2022 Sep 1;140(3):470-476. doi: 10.1097/AOG.0000000000004904. Epub 2022 Aug 3. PMID: 35926207; PMCID: PMC9377370.3. Fokom Domgue J, Chandra M, Oladoyin O, Desai M, Yu R, Shete S. Women's Preferences for Home-Based Self-Sampling or Clinic-Based Testing for Cervical Cancer Screening. JAMA Netw Open. 2026;9(2):e2558841. doi:10.1001/jamanetworkopen.2025.58841

We have covered the subject of whether to include the decidual (innermost) layer when closing the uterine incision during cesarean section (CS) on at least 2 episodes. The most recent was in September 2025, when we focused on a published (September 2025) systematic review and meta-analysis from the Green Journal. Back then, we compared those new findings to our prior episode from 2023 on the same matter. Well, we are back at it again with the same subject as there is a new EXPERT REVIEW from the AJOG on hysterotomy closure technique which just came out January 2026. What did these authors conclude? There are also some controversial suggestions made by the authors. Listen in for details. 1. Antoine C, Meyer JA, Silverstein J, Buldo-Licciardi J, Lyu C, Timor-Tritsch IE. Endometrium-Free Closure Technique During Cesarean Delivery for Reducing the Risk of Niche Formation and Placenta Accreta Spectrum Disorders. Obstet Gynecol. 2025 Jun 1;145(6):674-682. doi: 10.1097/AOG.0000000000005813. Epub 2025 Jan 9. PMID: 39787602. 2. Gialdini, Celina et al.Evidence-based surgical procedures to optimize caesarean outcomes: an overview of systematic reviews. eClinicalMedicine- Lancet (June 2024), Volume 72, 102632 3. Dahlke, Joshua D. MD; Mendez-Figueroa, Hector MD; Maggio, Lindsay MD, MPH; Sperling, Jeffrey D. MD, MS; Chauhan, Suneet P. MD, Hon DSc; Rouse, Dwight J. MD. The Case for Standardizing Cesarean Delivery Technique: Seeing the Forest for the Trees. Obstetrics & Gynecology 136(5):p 972-980, November 2020. | DOI: 10.1097/AOG.0000000000004120 4. Antoine C, Timor-Tritsch IE, Bujold E, Young BK, Reece EA. Endometrium-free closure technique for hysterotomy incision at cesarean delivery. Am J Obstet Gynecol. 2026 Jan;233(6S):S103-S114. doi: 10.1016/j.ajog.2025.07.009. PMID: 41485813.

Back in March of 2025, the green journal (obstetrics andgynecology) published A systematic review and meta-analysis on 2 medications (non-hormonal) and their efficacy in menopausal hot flash relief period these medications were Fezolinetant and Elinzanetant. However, the editors have just recently released an “Expression of Concern” about this review. Listen in for details. 1.     Menegaz de Almeida, Artur MS; Oliveira, PalomaMS; Lopes, Lucca MD; Leite, Marianna MS; Morbach, Victória MS; Alves Kelly,Francinny MD; Barros, Ítalo MS; Aquino de Moraes, Francisco Cezar MS;Prevedello, Alexandra MD. Fezolinetant and Elinzanetant Therapy for MenopausalWomen Experiencing Vasomotor Symptoms: A Systematic Review and Meta-analysis.Obstetrics & Gynecology 145(3):p 253-261, March 2025. | DOI:10.1097/AOG.00000000000058122.     Expression of Concern: Fezolinetant andElinzanetant Therapy for Menopausal Women Experiencing Vasomotor Symptoms: ASystematic Review and Meta-Analysis. Obstetrics & Gynecology():10.1097/AOG.0000000000006180, January 16, 2026. | DOI: 10.1097/AOG.0000000000006180

Ursodiol (ursodeoxycholic acid) is a prescription bile acid medication used to dissolve cholesterol gallstones, prevent gallstones during rapid weight loss, and treat liver diseases like primary biliary cholangitis (PBC) by reducing toxic bile acids and cholesterol production. It works by changing bile composition, making it less saturated with cholesterol, and is available as oral medication. Of course, it is also the foundational medication for treatment of diagnosed Intrahepatic Cholestasis of Pregnancy (ICP). Does this medication reduce adverse perinatal outcomes? In this episode, we will review a new study from the Green Journal, which will be out in February 2026, examining the recurrence risk for ICP using data from NY. In a patient with prior history of ICP, is there any guidance on monitoring of serum bile acids in the subsequent pregnancy before symptoms develop? We will explain. PLUS we will review the data on whether Ursodiol may hold promise in recurrence prevention or in reduction of adverse outcomes once the condition is diagnosed. Listen in for details. 1. 2019: Chappell LC, Bell JL, Smith A, Linsell L, Juszczak E, Dixon PH, Chambers J, Hunter R, Dorling J, Williamson C, Thornton JG; PITCHES study group. Ursodeoxycholic acid versus placebo in women with intrahepatic cholestasis of pregnancy (PITCHES): a randomised controlled trial. Lancet. 2019 Sep 7;394(10201):849-860. doi: 10.1016/S0140-6736(19)31270-X. Epub 2019 Aug 1. PMID: 31378395; PMCID: PMC6739598. https://pubmed.ncbi.nlm.nih.gov/31378395/2. February 08, 2025: Rahim, Mussarat N et al. Pregnancy and the liver. The Lancet. 2021; Volume 405, Issue 10477, 498 – 513 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02351-1/fulltext3. SMFM CS 53; 20214. Rosenberg, Henri M. MD; Sarker, Minhazur R. MD; Ramos, Gladys A. MD; Bianco, Angela MD; Ferrara, Lauren MD; DeBolt, Chelsea A. MD. Intrahepatic Cholestasis of Pregnancy Recurrence in a Subsequent Pregnancy. Obstetrics & Gynecology 147(2):p 239-241, February 2026. | DOI: 10.1097/AOG.0000000000006033 https://journals.lww.com/greenjournal/fulltext/2026/02000/intrahepatic_cholestasis_of_pregnancy_recurrence.13.aspx5. Ovadia C, Sajous J, Seed PT et al. Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy: a systematic review and individual participant data meta-analysis. Lancet Gastroenterol Hepatol. 2021 Jul;6(7):547-558. doi: 10.1016/S2468-1253(21)00074-1. Epub 2021 Apr 27. PMID: 33915090; PMCID: PMC8192305.6. EASL Clinical Practice Guidelines on the management of liver diseases in pregnancy. European Association for the Study of the Liver; 2023

In this sponsored podcast hear from Stuart Gerrett, Sales Director for Precision Logistics at Marken, who discusses the aviation industry's parts crisis and how precision logistics strategies from the pharmaceutical sector could help solve the growing aircraft on ground (AOG) challenge. Find out more here

An easy way to learn APGAR, a scoring system designed to assess newborns. Includes APGAR mnemonic! PDFs available here: https://rhesusmedicine.com/pages/paediatricsConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Buy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is the APGAR Score?0:19 APGAR Score Mnemonic1:50 APGAR Score Interpretation / APGAR Score MeaningMSD Manual Professional Edition (2025) Neonatal resuscitation. MSD Manual Professional Edition. Available at: https://www.msdmanuals.com/professional/pediatrics/perinatal-problems/neonatal-resuscitation MedlinePlus (2024) Apgar score. MedlinePlus Medical Encyclopedia. Available at: https://www.medlineplus.gov/ency/article/003402.htm American College of Obstetricians and Gynecologists (2015) Committee Opinion No. 644: The Apgar score. Obstetrics & Gynecology, 126(4), pp.e52–e55. DOI: 10.1097/AOG.0000000000001108. Available at: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2015/10/the-apgar-score LINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/Disclaimer: Please remember this video and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

Uterine rupture or dehiscence associated with TOLAC results in the most significant increase in the likelihood of additional maternal and neonatal morbidity. It should be noted that the terms “uterine rupture” and “uterine dehiscence” are not consistently distinguished from each other in the literature and often are used interchangeably. Furthermore, the reported incidence of uterine rupture varies in part because some studies have grouped true, catastrophic uterine rupture together with asymptomatic scar dehiscence. In January 2026, a new meta-analysis examines the relationship between oxytocin use with TOLAC and uterine rupture. In this episode, we will summarize the key findings in that study and review the data on the use of internal monitors during TOLAC. Do internal monitors (FSE, IUPC) offer a safer TOLAC compared with external monitors? Listen in for details.1. Nicolì, Pierpaolo et al.Oxytocin dosing during trial of labor after cesarean to minimize the risk of uterine rupture: a systematic review and meta-analysisAmerican Journal of Obstetrics & Gynecology MFM, Volume 8, Issue 1, 1018462. Practice Bulletin No. 184: Vaginal Birth After Cesarean Delivery. Obstetrics & Gynecology 130(5):p e217-e233, November 2017. | DOI: 10.1097/AOG.00000000000023983. ACOG Clinical Practice Guideline No. 10:Intrapartum Fetal Heart Rate Monitoring: Interpretation and Management. Obstetrics & Gynecology 146(4):p 583-599, October 2025. | DOI: 10.1097/AOG.00000000000060494. Bruno AM, Allshouse AA, Metz TD. Maximum Oxytocin Dose and Uterine Rupture During Trial of Labor After Cesarean. Obstet Gynecol. 2025 Dec 1;146(6):843-850. doi: 10.1097/AOG.0000000000006106. Epub 2025 Oct 30. PMID: 41325062.

It's so interesting to see how medical evidence evolves, and changes, over time. The result of course is that clinical practice evolves and changes as well. The story of umbilical cord management at time of delivery highlights this very issue very well. The ACOG first recommended delayed cord clamping (DCC) in 2012, for preterm infants, as data showed marked improvement in neonatal outcomes in that population. In this episode, we will briefly walk through the timeline from 2012 to the latest update on DCC which came from the AAP in October 2025, just one month after the ACOG had their DCC update. This story also exemplifies how professional medical societies don't always have the SAME recommendations, with small tweaks, in their guidance. So, Dr Chapa and I will summarize these key updates…Listen in for details!1. ACOG 2012: DCC for preterm infants only 2. ACOG 2016: ACOG Recommends Delayed Umbilical Cord Clamping for All Healthy Infants, including term: https://mdedge.com/obgynnews/article/121349/obstetrics/acog-supports-delayed-umbilical-cord-clamping-term-infants3. ACOG Dec 2020, CO 814: Delayed Umbilical Cord Clamping After Birth4. ACOG Obstet Gynecol. January 2022; 139(1): 121–137. doi:10.1097/AOG.0000000000004625. Management of Placental Transfusion to Neonates After Delivery5. ACOG (ePUB July ) Sept 2025: ACOG releases a Clinical Practice Update: An Update to Clinical Guidance for Delayed Umbilical Cord Clamping After Birth in Preterm Neonates6. AHA/AAP Oct 2025 Update: Neonatal Resuscitation: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Misoprostol, as an E1 prostaglandin, is primarily used in obstetrics for cervical ripening (when the Bishop Score is under 6) and/or for labor INDUCTION (to begin labor). IV oxytocin is the principal agent used to augmentlabor, as needed, once labor has begun. In the US, misoprostol is not typically used after 4-6 cm cervical dilation. However, in a patient who requires augmentation,and who declines Pitocin while asking or oral misoprostol, can that be used? Is that evidence-based? The data may surprise you. Listen in for details. 1.     SOGC Guideline No. 432c: Induction of Labour Robinson,Debbie Campbell, Kim Hobson, Sebastian R. MacDonald, W. Kim Sawchuck, DianeWagner, Brenda et al. Journal of Obstetrics and Gynaecology Canada , Volume 45, Issue 1, 70 - 77.e32.     Bracken H, Lightly K, Mundle S, et al. OralMisoprostol Alone Versus Oral Misoprostol Followed by Oxytocin for Labour Induction in Women With Hypertension in Pregnancy (MOLI): Protocol for a Randomised Controlled Trial. BMC Pregnancy and Childbirth. 2021;21(1):537.doi:10.1186/s12884-021-04009-8.3.     Bleich AT, Villano KS, Lo JY, et al. OralMisoprostol for Labor Augmentation: A Randomized Controlled Trial. Obstetrics and Gynecology. 2011;118(6):1255-1260. doi:10.1097/AOG.0b013e318236df5b.4.     Ho M, Cheng SY, Li TC. Titrated Oral MisoprostolSolution Compared With Intravenous Oxytocin for Labor Augmentation: A Randomized Controlled Trial. Obstetrics and Gynecology. 2010;116(3):612-618. doi:10.1097/AOG.0b013e3181ed36cc. STRONG COFFEE PROMO CODE:https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Actinomyces species are considered part of the normal vaginal and urogenital tract flora. The percentage of Pap smears containing Actinomyces-like organisms varies but is most commonly reported as approximately 7% among women using IUDs. That number is supported by multiple sources, including the Infectious Diseases Society of America guideline and several clinical studies. The incidence can be higher or lower depending on the type of IUD; for example, copper IUDs have been associated with rates up to 20%, while levonorgestrel-releasing IUDs show lower rates around 2.9%. In women with an IUD, who are found to have this finding on their liquid-based Pap smear, what is the appropriate management? In this episode, which comes from one of our podcast family members, we will discuss this topic and it's management in both symptomatic and symptomatic (pelvic pain) IUD wearing women. 1. McHugh KE, Sturgis CD, Procop GW, Rhoads DD. The Cytopathology of Actinomyces, Nocardia, and Their Mimickers. Diagnostic Cytopathology. 2017;45(12):1105-1115. doi:10.1002/dc.23816.2. Practice Bulletin No. 186: Long-Acting Reversible Contraception: Implants and Intrauterine Devices. Obstetrics and Gynecology. 2017;130(5):e251-e269. doi:10.1097/AOG.0000000000002400.3. Miller JM, Binnicker MJ, Campbell S, et al. Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 2024; ciae104. doi:10.1093/cid/ciae104.5. Carrara J, Hervy B, Dabi Y, et al. Added-Value of Endometrial Biopsy in the Diagnostic and Therapeutic Strategy for Pelvic Actinomycosis. Journal of Clinical Medicine. 2020;9(3):E821. doi:10.3390/jcm9030821.

Recurrent pregnancy loss (RPL) affects approximately 5% of couples and is an emotional burden on those affected. There is some evidence that vaginal progesterone supplementation may be considered in patients with recurrent pregnancy loss who are experiencing vaginal bleeding during the first trimester. But what about prophylactic low dose aspirin in the first trimester, or preconceptionally, for unexplained RPL? Is that evidence-based? A new publication from the SMFM's journal Pregnancy has examined this. Listen in for details. 1. 22 November 2025: Low-dose aspirin in unexplained recurrent pregnancy loss: A systematic review and meta-analysis (Pregnancy): https://obgyn.onlinelibrary.wiley.com/doi/10.1002/pmf2.700992. American College of Obstetricians and Gynecologists' Committee on Obstetric Practice, T. Flint Porter, Cynthia Gyanff-Bannerman, Tracy Manuck. Low-Dose Aspirin Use During Pregnancy. American College of Obstetricians and Gynecologists (2018)3. Naimi AI, Perkins NJ, Sjaarda LA, et al. The Effect of Preconception-Initiated Low-Dose Aspirin on Human Chorionic Gonadotropin-Detected Pregnancy, Pregnancy Loss, and Live Birth : Per Protocol Analysis of a Randomized Trial. Annals of Internal Medicine. 2021;174(5):595-601. doi:10.7326/M20-0469.4. Lee EE, Jun JK, Lee EB.Management of Women With Antiphospholipid Antibodies or Antiphospholipid Syndrome During Pregnancy. Journal of Korean Medical Science. 2021;36(4):e24. doi:10.3346/jkms.2021.36.e24.5. de Assis V, Giugni CS, Ros ST. Evaluation of Recurrent Pregnancy Loss. Obstet Gynecol. 2024 May 1;143(5):645-659. doi: 10.1097/AOG.0000000000005498. Epub 2024 Jan 4. PMID: 38176012.

Podcast Family, we have covered the subject of Measles previously on this show (links below). Those episodes were a preview of what has now been released ahead of print as a narrative review in the Green Journal! In this episode, we will summarize the KEY points of measles infection in pregnancy and re-state the “rule of 4” and the importance of the number 10 regarding this.1. Feb 24, 2025: Measles 101: https://open.spotify.com/episode/4lXrpqKTJPdDcTXPxpEmcb2. April 27, 2019: Measles!! ACOG Practice Advisory: https://creators.spotify.com/pod/profile/dr-hector-chapa/episodes/MEASLES---ACOG-practice-advisory-e3s1p43. Joseph, Naima T. MD, MPH. Measles in Pregnancy: Clinical Considerations and Challenges. Obstetrics & Gynecology ():10.1097/AOG.0000000000006126, November 14, 2025. | DOI: 10.1097/AOG.0000000000006126

Well, from time to time we cover RANDOM tidbits of information which cover RANDOM questions and/or RANDOM patient care issues that we encounter. In this episode we will cover one OB issue related to recurrent pregnancy loss, one GYN issue related to unilateral breast swelling in a patient with SLE, and one RANDOM life perspective response from a mock interview that I participated in for a residency candidate. Listen in fordetails!1.     Viviana DO; Giugni, Claudio Schenone MD; Ros, Stephanie T. MD, MSCI. Factor V and recurrent pregnancy loss: de Assis, Evaluation of Recurrent Pregnancy Loss. Obstetrics & Gynecology 143(5):p 645-659, May 2024. | DOI: 10.1097/AOG.0000000000005498Unilateral Breast Swelling with SLE: 2.     Voizard B, Lalonde L, Sanchez LM, et al. LupusMastitis as a First Manifestation of Systemic Disease: About Two Cases With a Review of the Literature. European Journal of Radiology. 2017;92:124-131. doi:10.1016/j.ejrad.2017.04.023.3.     Kinonen C, Gattuso P, Reddy VB. Lupus Mastitis:An Uncommon Complication of Systemic or Discoid Lupus. The American Journal of Surgical Pathology. 2010;34(6):901-6. doi:10.1097/PAS.0b013e3181da00fb.4.      Summers TA, Lehman MB, Barner R, Royer MC. Lupus Mastitis: A Clinicopathologic Review and Addition of a Case. Advances in Anatomic Pathology.2009;16(1):56-61. doi:10.1097/PAP.0b013e3181915ff7.5.     Jiménez-Antón A, Jiménez-Gallo D,Millán-Cayetano JF, Navarro-Navarro I, Linares-Barrios M. Unilateral Lupus Mastitis.Lupus. 2023;32(3):438-440. doi:10.1177/09612033221151011.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

The ACOG acknowledges that maternal obesity affects labor curves and recommends allowing more time for cervical dilation before diagnosing labor arrest in obese patients. This approach aims to avoid unnecessary interventions, such as premature cesarean delivery, which may occur if standard labor curves are strictly applied to obese women. In this episode, we will review a new study from the AJOG (08 Nov 2025) which describes labor progression and duration according to maternal body mass index, validating the need (possibly) for a BMI -based labor curve. Has there been advocates of a BMI-based labor curve? Listen in for details.1. Edwards, Sara et al. Characterizing Labor Progression and Duration According to Maternal Body Mass Index. American Journal of Obstetrics & Gynecology, Volume 0, Issue 02. Lundborg L, Liu X, Åberg K, et al. Association of Body Mass Index and Maternal Age With First Stage Duration of Labour. Scientific Reports. 2021;11(1):13843. doi:10.1038/s41598-021-93217-5.3. Kominiarek MA, Zhang J, Vanveldhuisen P, et al. Contemporary Labor Patterns: The Impact of Maternal Body Mass Index. American Journal of Obstetrics and Gynecology. 2011;205(3):244.e1-8. doi:10.1016/j.ajog.2011.06.014.4. Norman SM, Tuuli MG, Odibo AO, et al. The Effects of Obesity on the First Stage of Labor.Obstetrics and Gynecology. 2012;120(1):130-5. doi:10.1097/AOG.0b013e318259589c.

Taking folic acid prior to conception and during pregnancy can help protect the unborn baby from developing abnormalities. Supplements are particularly important for women who have epilepsy, as anti-seizure medication (previously known as anti-convulsants or anti-epileptic drugs) can lead to a deficiency in folic acid. Until 2023, high doses of 4-5 mg per day were recommended. However, this has changed as the data has changed. Did you know the SMFM no longer recommends “high dose” folic acid preconceptionally for patients on seizure medications? This is also highlighted in a recently released epub from Obstetrics and Gynecology (Green Journal) on October 31, 2025. Listen in for details. 1. Mokashi, Mugdha MD, MPH; Cozzi-Glaser, Gabriella MD; Kominiarek, Michelle A. MD, MS. Dietary Supplements in the Perinatal Period. Obstetrics & Gynecology ():10.1097/AOG.0000000000006098, October 31, 2025. | DOI: 10.1097/AOG.00000000000060982. Asadi-Pooya AA. High dose folic acid supplementation in women with epilepsy: are we sure it is safe? Seizure. 2015 Apr;27:51-3. doi: 10.1016/j.seizure.2015.02.030. Epub 2015 Mar 7. PMID: 25891927.3. https://aesnet.org/about/aes-press-room/press-releases/guideline-issued-for-people-with-epilepsy-who-may-become-pregnant4. Turner C, McIntosh T, Gaffney D, Germaine M, Hogan J, O'Higgins A. A 10-year review of periconceptual folic acid supplementation in women with epilepsy taking antiseizure medications. J Matern Fetal Neonatal Med. 2025 Dec;38(1):2524094. doi: 10.1080/14767058.2025.2524094. Epub 2025 Jun 30. PMID: 40588438.5. https://www.aan.com/PressRoom/Home/PressRelease/5170#:~:text=The%20guideline%20recommends%20that%20people,and%20possibly%20improve%20neurodevelopmental%20outcomes.6. https://aesnet.org/about/aes-press-room/press-releases/guideline-issued-for-people-with-epilepsy-who-may-become-pregnant

Elinzanetant, sold under the brand name Lynkuet, receivedapproval from the U.S. Food and Drug Administration (FDA) on October 24, 2025, for the treatment of moderate to severe hot flashes due to menopause.  How is this different than Fezolinetant, which was approved in 2023? Listen in for details. 1.   Menegaz de Almeida, Artur MS; Oliveira, Paloma MS; Lopes, Lucca MD; Leite, Marianna MS; Morbach, Victória MS; Alves Kelly, Francinny MD; Barros, Ítalo MS; Aquino de Moraes, Francisco Cezar MS; Prevedello, Alexandra MD. Fezolinetant and Elinzanetant Therapy for Menopausal Women Experiencing Vasomotor Symptoms: A Systematic Review and Meta-analysis. Obstetrics & Gynecology 145(3):p 253-261, March 2025. | DOI: 10.1097/AOG.00000000000058122.     Pinkerton JV, Simon JA, Joffe H, Maki PM, NappiRE, Panay N, Soares CN, Thurston RC, Caetano C, Haberland C, Haseli Mashhadi N, Krahn U, Mellinger U, Parke S, Seitz C, Zuurman L. Elinzanetant for the Treatment of Vasomotor Symptoms Associated With Menopause: OASIS 1 and 2 Randomized Clinical Trials. JAMA. 2024 Aug 22;332(16):1343–54. doi: 10.1001/jama.2024.14618. Epub ahead of print. PMID: 39172446; PMCID: PMC11342219.3.     Cardoso F, Parke S, Brennan DJ, Briggs P,Donders G, Panay N, Haseli-Mashhadi N, Block M, Caetano C, Francuski M, Haberland C, Laapas K, Seitz C, Zuurman L. Elinzanetant for Vasomotor Symptomsfrom Endocrine Therapy for Breast Cancer. N Engl J Med. 2025 Aug 21;393(8):753-763. doi: 10.1056/NEJMoa2415566. Epub 2025 Jun 2. PMID: 40454634.STRONG COFFEE PROMO: 20% Off Strong CoffeeCompany https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

On January 18, 2020, we released an episode called “Vaginal Vit C for BV? Yep, it's DATA”. That was 5 years ago! Now, in the Green Journal, a new systematic review and meta-analysis is examining this subject….AGAIN. Plus, this is not the only systematic review to investigate this; a similar review was published in Acta Obstétrica e Ginecológica Portuguesa earlier this year (2025) in March. So, did we get it right 5 years ago? Can vaginal Vit C help in eliminating BV? Listen in for details!1. Khaikin, Yannay MD; Elangainesan, Praniya MD, MSc; Winkler, Eliot MD, MSc; Liu, Kuan PhD, MMath; Selk, Amanda MD, MSc; Yudin, Mark H. MD, MSc. Intravaginal Vitamin C for the Treatment and Prevention of Bacterial Vaginosis: A Systematic Review and Meta-analysis. Obstetrics & Gynecology ():10.1097/AOG.0000000000006092, October 23, 2025. | DOI: 10.1097/AOG.0000000000006092; https://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=9900&issue=00000&article=01389&type=Fulltext2. Acta Obstétrica e Ginecológica Portuguesa (March 2025): chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://scielo.pt/pdf/aogp/v19n1/1646-5830-aogp-19-01-40.pdf3. Chapa Clinical pearls 2020: https://podcasts.apple.com/gh/podcast/vaginal-vit-c-for-bv-yep-its-data/id1412385746?i=1000463002444

I was recently asked to OPINE on the labor management for a patient who was receiving IV Pitocin for augmentation, who experienced a placental abruption. One physician stated that in "his opinion", Pitocin increased the risk of placental abruption intrapartum, a point which the original treating physician refuted. So, I was asked to be the "referee" on the play. IV Pitocin can result in some maternal-fetal complications but is abruption one of them as a stand-alone complication. Was the first reviewer's opinion correct? Listen in for details.1. Ben-Aroya Z, Yochai D, Silberstein T, Friger M, Hallak M, Katz M, Mazor M. Oxytocin use in grand-multiparous patients: safety and complications. J Matern Fetal Med. 2001 Oct;10(5):328-31. doi: 10.1080/714904358. PMID: 11730496.2. Morikawa M, Cho K, Yamada T, et al. Do Uterotonic Drugs Increase Risk of Abruptio Placentae and Eclampsia? Archives of Gynecology and Obstetrics. 2014;289(5):987-91. doi:10.1007/s00404-013-3101-8.3. ACOG: First and Second Stage Labor Management: ACOG Clinical Practice Guideline No. 8. Obstetrics and Gynecology. 2024;143(1):144-162. doi:10.1097/AOG.0000000000005447.4. Pitocin. FDA Drug Label. Food and Drug Administration Updated date: 2024-08-125. Litorp H, Sunny AK, Kc A. Augmentation of Labor With Oxytocin and Its Association With Delivery Outcomes: A Large-Scale Cohort Study in 12 Public Hospitals in Nepal.Acta Obstetricia Et Gynecologica Scandinavica. 2021;100(4):684-693. doi:10.1111/aogs.13919.

Current guidelines recommend universal collection of a vaginal-rectal swab for GBS colonization at 36-37 weeks and 6 days for the identification of patients who require intrapartum IV antibiotic coverage to prevent early onset neonatal GBS infection/sepsis. Recently, we had a patient in clinic whose GBS culture at 36 weeks was negative. Good right? Well, the patient was on amoxicillin at the time for pharyngitis. Did that course of oral PCN based therapy affect the GBS culture result? Should we believe that culture or could it be a false negative, demanding rescreen after therapy completion? There is currently a GAP here in the guidance. In this episode we will cover this controversial scenario, look at the data, and provide a real-world implementable approach to this case.1. Kim DD, Page SM, McKenna DS, Kim CM. Neonatal Group B Streptococcus Sepsis After Negative Screen in a Patient Taking Oral Antibiotics. Obstetrics and Gynecology. 2005;105(5 Pt 2):1259-61. doi:10.1097/01.AOG.0000159040.51773.bf.2. ACOG CO Number 797 (Replaces Committee Opinion No. 782, June 2019.); 20203. Mackay G, House MD, Bloch E, Wolfberg AJ. A GBS culture collected shortly after GBS prophylaxis may be inaccurate. J Matern Fetal Neonatal Med. 2012 Jun;25(6):736-8. doi: 10.3109/14767058.2011.596961. Epub 2011 Aug 1. PMID: 21801141.STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

On March 7, 2025, we released an episode summarizing key aspects of a NEJM publication regarding male partner therapy for women with recurrent BV. Although that study had limitations, the results were very surprising. Now, on 10/16/25 (7 months later), the ACOG has a new Clinical Practice Update (CPU) on this very issue. In this episode we will briefly summarize that March 2025 NEJM publication and highlight the TWO updated clinical recommendations from the ACOG regarding male partner therapy for the prevention of BV in women. PLUS, we will briefly discuss why although male partner therapy should be considered, partner EPT is “not recommended” at this time by the ACOG. 1. ACOG CLINICAL PRACTICE UPDATE: Concurrent Sexual Partner Therapy to Prevent Bacterial Vaginosis Recurrence Obstetrics & Gynecology ():10.1097/AOG.0000000000006102, October 16, 2025. | DOI: 10.1097/AOG.00000000000061022. Chapa Clinical Pearls March 2025 Episode: https://open.spotify.com/episode/4sW9tTe9CdYVQsCRBjqQQP3. Vodstrcil LA, Plummer EL, Fairley CK, Hocking JS, Law MG, Petoumenos K, et al. Male-partner treatment to prevent recurrence of bacterial vaginosis. N Engl J Med 2025;392:947–57. doi: 10.1056/NEJMoa2405404STRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

Podcast family, as we have said on many previous occasions, we get episode suggestions from either real-world patient encounters, from things that are hot in press, and/or from podcasts family member suggestions. Recently, one of our podcast family members asked me about the utility ofperforming pelvic floor muscle therapy (PFMT) antepartum. Is this evidence-based? Does performing PFMT help with postpartum urinary incontinence? Not all PFMTs are Kegel exercises! In this episode, we will review peripartum urinary incontinence and answer the question, “Is there value in teaching antepartum PFMT?”. We will summarize key concepts from the Oct 2025 Narrative Review on thissubject from the Green Journal (Obstet Gynecol).1.     Siddique, Moiuri MD, MPH; Hickman, Lisa MD;Giugale, Lauren MD. Peripartum Urinary Incontinence and Overactive Bladder.Obstetrics & Gynecology 146(4):p 466-472, October 2025. | DOI:10.1097/AOG.00000000000059932.     Woodley SJ, Lawrenson P, Boyle R, et al. PelvicFloor Muscle Training for Preventing and Treating Urinary and Faecal Incontinence in Antenatal and Postnatal Women. The Cochrane Database of SystematicReviews. 2020;5:CD007471. doi:10.1002/14651858.CD007471.pub4.3.     Pelvic Floor Muscle Training to Prevent andTreat Urinary and Fecal Incontinence in Antenatal and Postnatal Patients. AmericanAcademy of Family Physicians (2021). Practice Guideline STRONG COFFEE PROMO: 20% Off Strong CoffeeCompany https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

In the 09/1/2018 Society for Academic Specialists in General Obstetrics and Gynecology's (SASGOG's) Pearls of Exxcellence publication, “Management of Preeclampsia at Term”, it states: “If hypertension management requires acute IV treatment, it is often prudent to initiate oral labetalol or EXTENDED-release nifedipine to maintain blood pressures below the severe range. Intrapartum blood pressure management and consultation should not delay progress towards delivery. Fetal monitoring should be continuous.” In the original ACOG CO 692 from 2017, oral nifedipine was first referenced as an alternative to IV meds GIVEN INTRAPARTUM, stating, “Although relatively less information currently exists for the use of calcium channel blockers for this clinical indication, the available evidence suggests that immediate release oral nifedipine also may be considered as a first-line therapy, particularly when intravenous access is not available.” This may be given orally as 10mg, 20mg, and 20 mg separated in time by 20 minutes per dose. Notice it says “immediate release oral nifedipine”. But what about EXTENDED release nifedipine intrapartum as stated by the SASGOG? Is that an option after immediate attentive and therapy has been given with IV anti-hypertensives? Listen in for details.1. Emergent Therapy for Acute-Onset, Severe Hypertension During Pregnancy and the Postpartum Period: Committee Opinion, Number 692. Obstetrics & Gynecology 129(4):p e90-e95, April 2017. | DOI: 10.1097/AOG.00000000000020192. Gestational Hypertension and Preeclampsia: ACOG Practice Bulletin, Number 222. Obstet Gynecol. 2020 Jun;135(6):e237-e260. doi: 10.1097/AOG.0000000000003891. PMID: 32443079.3. Cleary EM, Racchi NW, Patton KG, Kudrimoti M, Costantine MM, Rood KM. Trial of Intrapartum Extended-Release Nifedipine to Prevent Severe Hypertension Among Pregnant Individuals With Preeclampsia With Severe Features. Hypertension. 2023 Feb;80(2):335-342. doi: 10.1161/HYPERTENSIONAHA.122.19751. Epub 2022 Oct 3. PMID: 36189646.STRONG COFFEE PROMO: 20% Off Strong Coffee Company ⁠https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

What does leadership look like at the highest levels of service?  SUMMARY In this episode of Long Blue Leadership, Col. (Ret.) Michael Black '85 discusses his journey from cadet to commanding the White House Communications Agency. He reflects on what it means to be a calm, steady presence in high-pressure environments — and how small daily practices can shape a lifetime of leadership. The full episode is now available.   SHARE THIS PODCAST FACEBOOK  |  LINKEDIN   MICHAEL'S LEADERSHIP TAKEAWAYS Develop a personal leadership philosophy that guides your actions (like Michael's 5F's: Family, Fitness, Flying, Fairness, and Fun). Always be aware that people are watching you and learning from your example, even when you don't realize it. Nurture relationships continuously - they are critical for long-term success and mentorship. Practice empathy and compassion, especially during difficult moments like delivering challenging news Maintain a holistic approach to fitness - physical, mental, and spiritual well-being are interconnected. Take pride in leaving organizations better than you found them and focus on developing future leaders. Be fair and be perceived as fair - understanding different perspectives is crucial to effective leadership. Incorporate fun and balance into your professional life to maintain team morale and personal resilience. Stay connected to your roots and be willing to mentor the next generation, sharing your experiences and lessons learned. Continuously practice self-reflection and ensure you're living up to your core values and leadership principles.   CHAPTERS Chapter 1 - 0:00:00 - 0:08:55: Family and Military Roots   Michael Black shares his background as a military brat and the educational legacy of his family. Chapter 2 - 0:08:55 - 0:12:10: Delivering a Difficult Notification A profound leadership moment where Black sensitively delivers news of a combat-related death to a staff sergeant's family. Chapter 3 - 0:12:10 - 0:18:40: The 5F Leadership Philosophy Introduction Col. Black explains the origin and core components of his leadership framework: Family, Fitness, Flying, Fairness, and Fun. Chapter 4 - 0:18:40 - 0:25:59: Detailed Exploration of 5F Philosophy   In-depth breakdown of each leadership principle, including personal anecdotes and practical applications. Chapter 5 - 0:25:59 - 0:32:21: Family Legacy and Academy Experience   Discussion of his son's Air Force Academy journey and the importance of nurturing relationships across generations. Chapter 6 - 0:32:21 - 0:38:36: Mentorship and Relationship Building Michael shares his approach to mentoring cadets and the significance of maintaining long-term professional connections. Chapter 7 - 0:38:36 - 0:40:13: Leadership in Civilian and Nonprofit Sectors Reflection on applying military leadership principles in private and nonprofit environments. Chapter 8 - 0:40:13 - 0:41:28: Personal Reflection and Leadership Advice  Final thoughts on leadership, self-improvement, and the importance of continuous personal development.   ABOUT COL. BLACK BIO Michael “Mike” B. Black, vice president for Defense, joined the nonprofit Armed Forces Communications and Electronics Association International in July 2022. He is a senior cyber/information technology leader with more than four decades of experience in cyber operations, communications, project/program management, leadership disciplines and organizational development. As AFCEA's vice president for Defense, Col. Black builds strong professional relationships with government, industry and academia partners to position AFCEA International as a leader in the cyber, defense, security, intelligence and related information technology disciplines. Col. Black leads defense operations in support of planning and executing global, large-scale, technically focused, trade shows/conferences supporting Army, Navy, Marine Corps, Air Force, Space Operations, Cyber and Homeland Security.  Col. Black is focused on providing opportunities for engagement between and among government, industry and academia. Prior to joining AFCEA International, Col. Black served as chief operating officer at Concise Network Solutions for four years, directly supporting the CEO in developing, executing and managing CNS's master business plan. Prior to joining CNS, he served as the COO and chief corporate development officer at JMA Solutions for two and a half years, working in concert with senior executives to lead operations and the planning and execution of strategies. Prior to joining JMA Solutions, he served as the COO at Premier Management Corporation for four years, where he was responsible for day-to-day operations, all business units and the company's profit and loss. Prior to joining the private sector, Col. Black spent 26 years in the U.S. Air Force holding various communications and leadership positions at many levels. He culminated his distinguished military career as a colonel, commander, White House Communications Agency, leading a 1,200-person team of selectively manned military, then-Department of Defense civilian and contract personnel to provide “no fail” telecommunications services for the president, vice president, named successors, first lady, senior White House staff, National Security staff, U.S. Secret Service and the White House Military Office. Col. Black holds a Bachelor of Science in basic science from the U.S. Air Force Academy, where he was a Distinguished Military Graduate. He holds a Master of Science in national resource strategy, with an information operations concentration, from the National Defense University, Industrial College of the Armed Forces; a Master's Degree in military arts and science from the Army Command & General Staff College; and a Master of Arts Degree in management from Webster University. He is a published author, including writing several leadership articles for The New Face of Leadership Magazine as well the thesis Coalition Command, Control, Communication, and Intelligence Systems Interoperability: A Necessity or Wishful Thinking? BIO EXCERPTED FROM AFCEA.ORG   CONNECT WITH MICHAEL IG: @chequethemike FB: @michael black LinkedIn: Michael Black   CONNECT WITH THE LONG BLUE LEADERSHIP PODCAST NETWORK TEAM Send your feedback or nominate a guest: socialmedia@usafa.org Ted Robertson | Producer:  Ted.Robertson@USAFA.org    Ryan Hall | Director:  Ryan.Hall@USAFA.org  Bryan Grossman | Copy Editor:  Bryan.Grossman@USAFA.org Wyatt Hornsby | Executive Producer:  Wyatt.Hornsby@USAFA.org      ALL PAST LBL EPISODES  |  ALL LBLPN PRODUCTIONS AVAILABLE ON ALL MAJOR PODCAST PLATFORMS   TRANSCRIPT SPEAKERS Guest, Col. (Ret.) Michael Black '85 | Host, Lt. Col. (Ret.) Naviere Walkewicz '99   Naviere Walkewicz Welcome to Long Blue Leadership, where transformative journeys of Air Force Academy graduates come to life. There are moments in a leader's life that leave a permanent mark. For my guest today, Col. (Ret.) Michael Black, USAFA Class of '85, one such moment came when he was actually sent to deliver news of a combat-related death. It was the first time he'd ever been tasked with that duty, and knew he only had one chance to get it right. As he sat with the widow, Michael found the strength to guide the family through their grief. That part of Michael's story speaks to the depth of his empathy and the calm steadiness that defines him as a leader. We'll explore much more of Michael's journey, from leading the White House Communications team to mentoring cadets at the Academy to daily practices that ground him and the framework that guides him today, what he calls the five Fs of leadership: family, fitness, flying, fairness and fun a guide not only for his life, but for the leaders he inspires. Michael, welcome to Long Blue Leadership. Michael Black Naviere, thank you for having me, and thank you for that very kind introduction. I'm so happy to be here, and I'm just thankful for what you guys do, the AOG and putting this together and telling stories. I think this is amazing. So thank you for the opportunity. Naviere Walkewicz Well, we're grateful you're here. You got your silver on. You got your ‘85 Best Alive, you know, I mean, I'm just blown away here. The class crest… Michael Black Yeah, got it all, you know, the crest and the two squadrons that I was in. I'm just excited, back here for our 40th reunion. Yeah. So that's amazing. So fellowship and fun with your classmates, and just seeing the mountains, you know. Getting off the plane and looking west and seeing the mountains and seeing God's creation is just amazing. And then, of course, the Academy in the background, you know, pretty excited. Naviere Walkewicz Wonderful, wonderful. Well, we're going to jump right in. And actually, the topic is a bit sensitive, but I think it's really important, because we know that when we all raise our right hand, some are prepared and they give all. But not everyone has to actually give the news to the family when their loved one is lost, so maybe you can share what that was like. Michael Black Thank you for allowing me to talk about that. You hit the nail on the head when you said you only have one chance to get it right when you're talking to the family. And so I had a young staff sergeant that was deployed down range at the Horn of Africa, and he happened to be a radio operator in a helicopter supporting the Marines. And there was a mid-air collision that happened while he was deployed, and he was one of the people that perished. So the first notification that I had to make was duty status: whereabouts unknown — to say that to the family. And of course, you can think about the range of emotions that are associated with that. They don't know. We don't know.   Naviere Walkewicz There's still hope. There's not hope.   Michael Black So that was the first day. So going over there with my first sergeant, a medical team, chaplain, you know, that kind of thing, to support us and the family.   Naviere Walkewicz And what rank were you at that time?   Michael Black So I was a lieutenant colonel. So I was a squadron commander of the 1st Comm Squadron at Langley Air Force Base. And I like to say, you don't get to practice that. You have one time to get it right. At least back then, there was not a lot of training to do that. It doesn't happen that often, and so having to make that notification was a tough thing. It was one of the hardest things, if not the hardest thing, I had to do in the service. Two young boys. He had two sons, and at the time, his spouse was military as well, so I go over there to do that the first day. You can imagine, you know, knocking on the door, right, and I'm in uniform, and just the emotions that they can be going through. So we're sitting on the couch in their house, two young boys. I believe their ages were 3 and 5 at the time, they were very young. And I explained to Michelle what we knew. And again, it's scripted. I can't say more or less than that, because 1) don't know, right? And 2), you just don't want to speculate on anything. And then we're waiting to find out his status. So then I have to go back the next day to make that notification, and you're representing the chief of staff of the United States Air Force, and that's kind of something that's scripted for you. “I'm here on the behalf of the Chief of Staff of the United States Air Force, and I regret to inform you of the untimely death of your spouse.” The part that was even more heartening for me was after I told her, and with the boys sitting, I believe, on either side of me, she said, “And now Col. Black is going to tell you what happened to your dad.” That was a tough thing to do. And I would say it was the hardest thing that I had to do in the Air Force, in my career, and reflect on “you have one chance to get that right.” I believe we got it right, me and my team, but that was tough. Naviere Walkewicz Wow. Have you kept in touch with the family? Michael Black Yes, I keep in touch with Michelle, just from — just a personal because I'm very personal, outgoing, as you know. And so I've kept in touch with Michelle and the boys. But we're forever bonded by that, and I think that's important to stay in touch. And that's kind of one of my things I think we'll get into a little bit later in the conversation, but that's what I do. Naviere Walkewicz Well, it touches, certainly into, I think, that the family aspect of the five Fs, and because it seems like you even take in them as your family. And I'm curious about your family, because when you're going through that, I mean, you have at least a son — you have son, right?   Michael Black Yes, and two daughters.   Naviere Walkewicz Two daughters. So were you thinking about — did you put on your dad hat in that moment?   Michael Black I certainly did put on my dad hat and, and I think that helped in things. And I think all of the training that I got along the way about dealing with tough situations, and being a leader, it helped. But I took it upon myself after that to talk to other commanders. And in fact, my wing commander at the time, Burt Field, Gen. field was a '79 grad, and we talked, and that also brought him and I closer, because he also asked me to brief the other squadron commanders on that process and how I handled that. And I know when — to this day, Gen. Field and I are still very connected, and he's pretty engaged right now with the Air Force Association's birthday and all that. But a great mentor of mine who also helped in dealing with that. But he was extremely supportive and, and I think that had a factor in just how he evaluated me, right, how I handled that situation?   Naviere Walkewicz Well, it sounds like you certainly picked up some of those traits of taking care of your people recognizing empathy within processes and sharing it. I'm curious, were you always like this, or did you see some of this emulated from your family? Michael Black No, it's a great question. I am a military brat. My dad was in the Army. My dad went to Tuskegee — it was called Tuskegee Institute at that time. My mom went to Alabama A&M, so two schools in Alabama. They're from a very small towns in Alabama. My dad's from Beatrice, Alabama — which is less than 200 people today — and my mom is from Vredenburgh, Alabama. It's about 15 miles away, and it's even smaller than Beatrice. But they went to the same elementary school and high school, so high school sweethearts, and then they went off to college. And then dad got a direct commission in the Army, the Signal Corps. Well, he started out Medical Service Corps, but getting back to your question, so yes, family with that, and even take a step further back to my grandparents, on both sides of the family, but particularly with my paternal grandparents, they went out and visited the Tuskegee Institute at that time, and they saw the statue of Lifting the Veil of Ignorance there, and they decided at that point that they wanted their kids to go to that school. And so there's seven kids within my dad's family, and six of them went to Tuskegee. Naviere Walkewicz   Wow. So I want to fast forward a little bit, and you can certainly share whether it was during the Academy or after graduation, but you have kind of had this great foundation from your family. Let's talk a little bit about the Academy or after-Academy experience, where you had seen additional time where you had grown as a leader. Was there a particular experience that can come to mind, where another shaping of this leadership journey that you've been on? Michael Black Yeah, I think there's multiple throughout my career. I mean, I went to the Army Command and General Staff College for my intermediate professional military education. And there's a story there too. My dad was in the Army, and so I wanted to experience some of the things that my dad did, even though I was Air Force. And so one of my mentors, now-retired Lt. Gen. Harry Raduege, was instrumental in me getting selected for Army Command and General Staff College. And so I went there, and I think that was a big portion of my shaping, although had mentors and folks and coaches in my life leading up to that were, you know, helped shape me, but going to that school… And what I noticed when I got there that the Army was very serious about leadership and leadership philosophy, so much so that we took a class on that where we had to develop a leadership philosophy. And so in taking that class, before the Christmas break, I found out that I was going to be a squadron commander. So I was a major, and I was going to be a squadron commander. And so in that leadership course, I said, “Well, I'm going to go be a squadron commander. I'm going to the fifth combat con group in Georgia. Let me make this philosophy that I'm doing in class be my philosophy, so that when I get there…” And that was really the first time that I thought very serious about, “OK, what is my leadership philosophy?” And I had been a flight commander before, and had people under my tutelage, if you will. But being a squadron commander, you know, being on G series orders. And you know, we know how the military takes the importance of being a commander. And so having that so I did decide to develop my philosophy during that time. And you mentioned the five Fs earlier. And so that was — that became the opportunity to develop that. So family, that's what it was. That's when I developed that — in that course. So family, fitness, flying, fairness and fun — the five Fs. I worked on that when I got there. And so then when I got to take command, I had prepared all of that stuff in this academic environment, and I used it to a T and I briefed the squadron after I took command. I think this is my command philosophy, the five Fs. I subsequently had the opportunity to command two more times after that, another squadron, and then at the White House Communications Agency, which is now wing command equivalent. So had the opportunity to tweak and refine, but the foundation was still the five Fs. And so in doing that, and I can go into a little detail. So you know, family is your immediate family, your your blood family, and that that kind of thing. But family also encompasses your unit, your extended family, you know, and part of that. And so I always tell people you know, your family, you don't want to be the only one at your retirement ceremony because you neglected your family. And I've done many retirement ceremonies. In fact, I've done 25-plus since I retired. Well, that shows you really made no so family is, is important, take care of your family. And I, you know, one of the things I said about that to the folks was if you in your unit, if folks are getting assigned unit, permanent changes, station, PCS to your unit, and they haven't found the place to live in the due time and whatever the house hunting days are, I always gave my folks the option of give them some more time to find a place. They may be looking for schools, I mean looking for a place that just fits the environment that they need. And let's give them that time now, because they're not going to be effective in the organization if they're worried about where they have to live, where their kids are going to go to school and that kind of thing. So take care of all of that, and then get them to work, and they'll be that much more effective because they won't have to worry about where they're living, where the kids are going to school. So take care of your family fitness. You understand physical fitness and what you do and all of that, and I admire all of your accomplishments in that. And so physical fitness in the military kind of goes without saying. You have to maintain certain standards and do that, and do a PT and take a test and that kind of thing. But fitness is more than just physical fitness. It's spiritual and mental fitness. Now I would never be one to tell somebody this is how you need to nurture your spiritual and mental fitness. I think that's personal. But if your spiritual mental fitness is not being nourished, you're not going to be doing yourself any good, your team any good. And honestly, you would be able to tell if an individual is struggling with their spiritual or mental fitness, particularly as a leader and just kind of looking and observing characteristics and the behavior of folks. So I basically told my team, I want you to do whatever it takes to nurture your spiritual and mental fitness, whatever you need to do — if it's meditating, if it's praying, if it's walking, whatever is personal to you, but make sure that it's nurtured. But I also told my folks that if you think my spiritual fitness and mental fitness is out of balance, I want you to tell me, because I might have blinders on. I could be focused on things, just like they could be focused on things, and I would tell them. And I think folks really appreciated the candor and the openness of the leader, the commander, you know, saying that, yes, I want you to tell me if you think my spiritual mental fitness is, you know, is out of balance.   Naviere Walkewicz Did you ever have anyone tell you that?   Michael Black I did. I had strong relationships with my first sergeant, or my command sergeant major, the senior enlisted adviser. So we were, you know, we're hand-in-hand and all the places I was at. And so, yes, I've had them. I've had my wife tell me that. So I think that's important. I just — like I said, you can easily have blinders on and maybe just not see that or have blind spots. And speaking of that, I've written a leadership article on blind spots. I've kind of studied that and understand that. Flying — at the time the primary mission of the Air Force was flying. And so I'd always say, “What is your role in supporting the primary mission, or what is our role in supporting the primary mission of the Air Force?” So make sure you understand that. As a communicator, how do you contribute to the primary mission, or as a logistician, or as information management? But understand what your role is in the primary mission of the Air Force. Fairness, as a leader — it is so important for the leader to be fair, right? It can affect good order and discipline if you're not fair, but equally important is to be perceived as being fair. So I could think I'm being fair, I could think that I'm being fair, but if the perception of the unit, the team, is that I'm not being fair, that's just as detrimental to the mission as actually not being fair. And so I think perceptions are important, and you need to understand that. You need to be aware of the perceptions; you need to be ready to receive the information and the feedback from your team on that. And so I stress the importance of also the perception people have different management. I could be looking at something over there, and I say, “OK, yeah, sky is blue over there,” but somebody's looking at it from a different you know, they may see a touch of some clouds in there, and so they see some light in there, and from their vantage point. And it's just like that in life: Respect everybody's vantage point in things. And so that was the fairness aspect. Then finally, fun. I'm a person that likes to have fun.   Naviere Walkewicz You are?!   Michael Black Yes, I am. I'm a person that loves to have fun. And so for me, I grew up playing sports. And so I played sports throughout my Air Force career. So that was kind of one of the things I did for fun, intramurals.   Naviere Walkewicz What was your favorite sport?   Michael Black My favorite sport was baseball growing up. I mean, I dreamed about trying to play in the Major Leagues and that kind of stuff. And I played on a lot of baseball teams growing up, and then when I got into the service, played softball, and I played competitive softball. Back in the day, they have base softball teams, and so you would, you know, try out for the team, and I would try out, and I played on base team at probably at least four or five bases that I was at. So I was, these are my own words: I was good. So I played and was very competitive in intramurals. That's another way to bring your team together — camaraderie. They see the boss out there playing. And I always would tell folks that on the squadron team: They're not playing me because I'm the commander. They're playing me because I'm good. I can contribute to the wins in a game. But so it's very competitive. I wasn't a win at all costs, but it wasn't fun to lose. So being competitive and fun. So that's one of the things I did for fun. I also follow professional sports. San Antonio Spurs is my basketball team; Washington Commanders, my football team. So I would go to those events, those games, those contests and stuff like that. Music, concerts, still do that kind of stuff with my kids and my family incorporate fun into — so it's not all work and no play. I think you do yourself justice by, winding down relaxing a little bit and having fun and that kind of thing. And so I encourage my team to do that. Wasn't gonna tell people what they needed to do for fun. I think that's personal, but having fun is important and it helps strike that balance. So that's really the five Fs. And I carried that, as I said, every time I command, every time I've, you know, unit that I've been associated with, particularly after the 2000 graduation from Army Command and Staff College. And I still carry that five Fs today And incidentally, I think the if you bump into somebody who was in one of my units, they're going to remember the five Fs, or some portion of it. In fact, I have a couple mentees that commanded after me, and they adopted the five Fs as their command philosophy. And that's kind of something that's very satisfying as a leader to have somebody adopt your leadership style. They think that it was good for them while they were in the unit. And it's very flattering to see that afterwards. I mean, so much so that I've had people that were in my unit, and then they got assigned to one of my mentee's unit, and they would call me up and they'd say, “Hey, Col. Black, you know, Col. Packler says his command philosophy is the five Fs.” Yeah, I said Marc was in my unit at Langley, and he probably felt that. But that's, that's a true story. Naviere Walkewicz That's a legacy, right there; that's wonderful. Well, speaking of legacy, you have a son that's also a graduate. So talk about that. I mean, you were expected to go to college. It wasn't an if, it was where? How about your children? Was that kind of the expectation? Michael Black So my wife is a college graduate. She's a nurse as well. And so we preached education throughout. And just as an aside, shout out to my wife, who just completed her Ph.D.   Naviere Walkewicz Wow, congratulations!   Michael Black Yes. Wilda Black, last week, in doing that. And so between my family, my immediate family — so my wife, and my two daughters and my son, there are 15 degrees between us.   Naviere Walkewicz And you?   Michael Black And me. So five us, there are 15 degrees. My wife has two master's, a bachelor's and now a Ph.D. My oldest daughter has a bachelor's and two master's. My son has a bachelor's and a master's. My younger daughter has a bachelor's and a master's, and I have a bachelor's and three master's degrees. So I think that adds up to 15.   Naviere Walkewicz I lost count. Social sciences major here.   Michael Black So yes, education. And so my son — he really liked quality things, likes quality things growing up. And so he was looking at schools and researching and looking at the Ivy League, some of the Ivy League schools, and some other schools that, you know, had strong reputations. I purposely did not push the Air Force Academy to him because I didn't want him to go for the wrong reasons. I didn't want him to go because I went there and that kind of thing. But late in the game, you know, in his summer, going into his senior year of high school, he came to me and said, “Hey…” and I'm paraphrasing a little bit, “Dad, you know, your alma mater is pretty good, you know, pretty, you know, pretty has a strong reputation.” And I said, “Yeah, you know, you know, strong academic curriculum and everything else there.” So that summer he said, “Well, I'm thinking I might want to go there.” And I'm thinking to myself, “That's a little bit late in the game, like the summer going into senior year.”   Naviere Walkewicz Did you recruit your mom again?   Michael Black Mom got involved. And then I think you know Carolyn Benyshek. So Carolyn was the director of admissions. I reached out to her and just said, “Hey, I got my son that's interested.” They were actually coming to Baltimore, I believe, for a…   Naviere Walkewicz The Falcon Experience. Right.   Michael Black And so we went to see her, and I'll just kind of say the rest is history. Through her help and guidance, through my son's qualifications — he was able to get in. He went to the Prep School, which is great, and I just want to give a shout out to the Prep School for that. I did not attend the Prep School, but I saw the value of my son going to the Prep School and then coming to the Academy. So I just to this day, thankful for our Prep School and how they prepare folks.   Naviere Walkewicz We feel similarly about that.   Michael Black So, yeah. So he went. And so, of course, a proud dad, right? Your son following in your footsteps, and that kind of thing. So Clinton, Clinton Black is in the Space Force now, and he's assigned to Vandenberg. But my son, he was a soccer player growing up, played a lot of competitive soccer, came here and decided that he wanted to do Wings of Blue, and so he was on Wings of Blue parachute team. And the neat thing about that is that the jump wings that my son wears are the jump wings that my dad earned at Airborne School in 1964, '65 — sometime in the early ‘60s. And so my dad was still living at the time and so he was able to come out here and pin the wings on Clinton. So it skipped a generation because I didn't jump or anything. But my son jumped, and he has mid-500 number of jumps that he's had. And so my dad was able to see him jump, and that was even though Airborne is a teeny bit different than free fall, but still, you know, parachuting, and all of that. So getting to see Clinton excel and do that and see him jump into the stadium, and that kind of thing. He jumped with some of the former Navy SEALs in the X Games, you know, in the mountains. So that was just a proud parent moment. Naviere Walkewicz Wow. That is very exciting. And so, through all of these experiences that you had, I keep wanting to go back to the five Fs .yYu had mentioned earlier that you did some refinement to it. So where you are now, how are you using them? How have they been refined? I mean, flying. What is that? Michael Black So, I asked people to take a little bit of a leap in that, understand where it came from, in my 5s but that aspect refers to the mission, right? And so the Air Force mission has evolved to include space and that kind of thing. But even on the private side, the civilian side, I still use the five F's. And so the flying aspect just refers to the mission, or whatever the mission of your organization is. And so there was some refinement as we brought in space into our mission, but it really reflected on the mission. And so I had different AFSCs that worked for me in in the different units that I was at, and also different services. And so understanding the service aspect of things also was something that I had to take into consideration as far as keeping and refining that, at the White House Communications Agency, about 1,200 military — more Army than Air Force, more Air Force than Navy, more Navy than Marine Corps, and more Marine Corps than Coast Guard. And so being an Air Force commander of a joint unit that had more Army folks in it, you have to understand that lingo, and be able to speak cool and that kind of thing. Dad loved that. And so going to the Army Command General Staff College, and, getting some of that philosophy and understanding that. And then I went to what's now called the Eisenhower School, now ICAF, the Industrial College of the Armed Forces, which is another joint school. And so being around that helped me in those aspects. But really applying that throughout and after I retired, I did 10 years in the private sector with a couple of different small businesses that were government contracted focused, providing professional services, but still, as the chief operating officer of each one of those, it's a pretty high leadership position within the company and so I talked about the five Fs in some terms that my team could understand that, and so still apply that. And then now, with three years working for the nonprofit, the AFCEA organization, where we bring government, industry and academia together to do IT, cyber kind of things, machine learning, artificial intelligence — I still have that philosophy to buy that and what I do, I think it's something that's applicable across the board, not just military. At least I've made it applicable. Naviere Walkewicz I was just gonna ask that, because talk about the private sector and — some of our listeners, they take off the uniform, but they still have that foundation of the military, but they're working with people who maybe don't have that foundation of the military. So how did you translate that in a way that they could feel that same foundation, even though they hadn't gone through a military family or through the Air Force Academy? Michael Black Yeah, no, that's a great question, Naviere. And I think, as a leader, you have to be aware of that. You have to be aware of your team and their background and their experiences. You also you have to speak their lingo, right? I mean, I can't talk just Air Force or military lingo. We talk a lot in acronyms. Naviere Walkewicz Like AFCEA. And I'm sure many know it but would you mind spelling it out? Michael Black Armed Forces Communications Electronics Association. And even though we have that we are more than the armed forces now, so we really are known by just AFCEA, even though that's what that acronym stands for. So I mean, I work with Homeland Security, VA and that kind of thing. But to your point, getting folks to understand where I'm coming from, and I need to understand where they're coming from, you have to take the time, put in the work to do that, so that you can communicate with your folks, and so that they understand where you're coming from, and also, so that they feel valued, right? That you understand where they're coming from. And I think all of that is important. And I tried to make sure that I did that, and I had coaches, mentors and sponsors along the way. So I learned when some of my mentors transition from the military time, and so when they went to go work in the private sector, I still lean on them. “OK, how did you make this transition? And what is it about? And what are the similarities and what are the differences? What do I need to consider in doing that?” And I'm thankful, and that goes back to one key point that I want to make about relationships and nurturing that relationship. I mentioned Gen. Field, worked for him in the early 2000s. But here we are, 2025, and he's in my contacts, he will take my call, he will respond to a text, and vice versa. You know, building that relationship. And so he's with a nonprofit now, and so I still stay in touch with him. The director of the White House Military Office was a Navy admiral that I worked for when I was at the White House. He is now the president and CEO of the United States Naval Institute — Adm. Spicer. You know, 20-something, 15 years ago, worked for him and now we're working together on a big conference. But those relationships are important in nurturing those relationships. And I learned about nurturing from my family. You know, my grandparents, who did that. My grandfather was a farmer. He had to nurture his crops for them to produce. So the same thing, analogy applies in relationships; you have to nurture that relationship. And you know, it circled all the way back to, you know, our 40-year reunion now, and my classmates that are here and nurturing those relationships with those classmates over the years is important to me. I'm the connector within my class, or the nucleus. I mean, those are two nicknames that my classmates have given me: the Col. Connector and Nucleus, and I embrace those. Naviere Walkewicz Yes, that's wonderful. I know that you also mentor cadets. And I think my question for you, from the aspect of some of our listeners, is, did you seek out the cadets? Did they seek you out? How does that mentorship relationship start? Because you talked about how, like, for example, Gen. Field, you had that relationship years ago. That's kind of carried through. But how do you know when that mentorship is beginning? Michael Black I think both of those aspects, as you mentioned. Do they seek that? There are cadets that seek that based upon just what they've experienced and what they've learned. And then some of the cadets know people that I know, and so they've been referred to me, and all that. Some were — like their parents, I worked with their parents. I mean, particularly in the Class of 2023 there are three young ladies that I mentored in the Class of 2023 one whose father worked with me on the White House Communications Agency, one whose mother babysat my kids OK. And then one who's ROTC instructor in junior in high school was my first sergeant. So in those three instances, I was connected to those folks through relationship with either their parents or somebody that worked for me and that that kind of thing. And that was a neat thing to, you know, to be here. I did the march back with those young ladies, and then I connected those three young ladies who did not know each other at the march back, when we got back on the Terrazzo, I found all three of them and explained my relationship with each of them. And they were able to be connected throughout and two of them I actually commissioned, So that was really, really nice. And so, you know, seeking mentorship is, well, mentorship has just been important to me. I benefited from mentorship, and I want to return that favor. I am the chairman of the Air Force Cadet Officer Mentor Association, AFCOMA, whose foundation is mentorship, fellowship and scholarship, and so I'm passionate about mentorship and doing that. I've seen the benefits of it. People did it for me, and I think you can shorten the learning curve. I think you can just help folks along the way. So I'm very passionate about that. Naviere Walkewicz Well, this has been amazing. I think there's two questions I have left for you. The first one being — and I think we've learned a lot about this along the way — but if you were to summarize, what is something you are doing every day to be better as a leader? Michael Black I think every day I take a deep look inside myself, and am I living and breathing my core values? And what am I doing to help the next generation? You know, trying to put that on my schedule, on my radar, that's important to me. And whether I'm at work with AFCEA, whether I'm out here at my 40th reunion, whether I'm on vacation, I always take the time to mentor folks and pass on that. I think that's something that's passionate for me. You mentioned, when we talked about the retirement ceremonies. I mean, I've done 20-plus since I retired. In fact, I have one in November, but it will be my 27th retirement ceremony since I retired. And those things are important to me. And so I reflect, I try to keep my fitness — my physical, spiritual and mental fitness, in balance every day so that I can be effective and operate at a peak performance at the drop of the hat. You know, being ready. And so that's important to me. So there's some self-analysis, and I do live and breathe the five F's. I think that's important. And I think I've proven to myself that that is something that is relatable, not only to my time in the military, but my time in the private sector, and now my time in a nonprofit. And I just continue to do that so self-reflection and really practicing particularly the fitness aspect of the five Fs. Naviere Walkewicz Wow, that's outstanding. And then you probably share this with your mentees. But what is something that you would help our aspiring leaders — those who are already in leadership roles in any facet of it — but what is something that they can do today so that they will be more effective as a leader? Michael Black So I think being aware that people are watching you and your actions. Even when you think that somebody is not watching, they are watching. And so they are trying to learn what to do next, and to be aware of that. And so I think, again, that goes with what you asked me first: What do I do every day. But also being aware of that, so that you can be that example to folks. And then take the time, have some pride in leaving the organization better than it was when you got there. I mean, it's a cliche, but I think I take a lot of pride in that. And then, when the team does good, everybody does good, so you shouldn't necessarily be out there for any kind of glory. That's going to come. But do it for the right reasons. And provide… give the people the tools, the resources and the environment to be successful. And in… I just take satisfaction when I see one of my mentees get squadron command, go do something like the current commander of the White House Communications Agency, Col. Kevin Childs. He was a captain and a major in the organization when I was there. Nothing makes me happier than to see my mentees excel. And then, in this particular instance, he's holding a job that I had, and we still talk. I mean, he had me come out there to speak to the unit about a month ago. And those things give me a lot of pride and satisfaction and confirmation that I am doing the right thing. And so I'm excited about that. Naviere Walkewicz Well, I can say, from the time that I met you a few years ago, you are living what your five Fs. I see it every time you help champion others. Every time I'm around you I'm  energized. So this has been a true joy. Has there been anything that I haven't asked you that you would like to share with our listeners? Michael Black Well, I do want to say personally, thank you to you for all that you do and what the association is doing here. This Long Blue conversation, Long Blue Line — I think this is important to share. There's a Class of 1970 that's in the hotel with us, and I don't know, really, any of those folks, but when I see them walking around with their red hat on — that was their color — and I think about, “OK, 15 years before me.” And so I'm 62. These guys are, if I did the public math, right, 77, 78, maybe even older, depending upon what they did, and still out there doing things, and some of them here with their spouses and that kind of thing. I was just talking to one of the classmates this morning, I said, “You know, I wonder if we're going to be like this when our 55th reunion is,” and they were walking around, and most were in good health and able to do things. So that gives a lot of pride. But, what you're doing, what the rest of the folks here are doing, I think this is amazing. I love the new building, the studio that we're in. This is my first time in the new building, so I'm thankful for this opportunity, and just excited about what you guys do. Naviere Walkewicz Well, thank you so much for that. It's been an absolute pleasure having you on Long Blue Leadership. Michael Black Well, I appreciate it. It's been an honor, and I'm glad you guys timed this for my '85 Best Alive reunion and in the new studio. Naviere Walkewicz Yes, wonderful. Well, as we bring today's conversation to a close, Michael left a reminder for us that stands to me. As a leader, you're always on, you're always being watched. You know your steady presence and deep empathy were forged in life's hardest moments, from guiding a young family through unimaginable loss to breaking the barriers at the highest levels of service to mentoring cadets who will carry forward the legacy of leadership. And then there's that framework he lived by, the five Fs of leadership. It is practical as it is powerful, family, fitness, flying mission, fairness and fun, each one a reminder that leadership is about balance grounding and the courage to keep perspective no matter the challenge. His story reminds us that true leaders create more leaders, and when we anchor ourselves in purpose, faith and these five Fs, we leave behind a legacy that lasts. Thank you for listening to Long Blue Leadership. I'm Lt. Col. (Ret.) Naviere Walkewicz. Until next time. KEYWORDS Michael Black, Air Force leadership, 5F leadership philosophy, military mentorship, leadership development, combat communication, White House Communications, Space Force, veteran leadership, empathetic leadership, military career progression, leadership principles, professional growth, organizational effectiveness, cadet mentoring, military communication strategy, leadership resilience, Air Force Academy graduate, leadership philosophy, team building, professional relationships.       The Long Blue Line Podcast Network is presented by the U.S. Air Force Academy Association & Foundation    

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-452 Overview: The healthcare landscape is undergoing a sea change, significantly impacting established, evidence-based recommendations. Media coverage suggests that the HHS Secretary plans to release a report linking acetaminophen use during pregnancy with an increased risk of autism spectrum disorder (ASD) in offspring as well as linking maternal folate deficiency with ASD—associations that have not been supported by evidence. If promoted by public health agencies, such discrepancies pose a dilemma for clinicians who have relied on and trusted that guidance reflects evidence and is grounded in scientific methods. Join us to review the evidence on acetaminophen and ASD risk and learn strategies to ensure your practice is based on valid findings. Episode resource links: Ahlqvist VH, Sjöqvist H, Dalman C, et al. Acetaminophen Use During Pregnancy and Children's Risk of Autism, ADHD, and Intellectual Disability. JAMA. 2024;331(14):1205–1214. doi:10.1001/jama.2024.3172   Damkier, P., Gram, E. B., Ceulemans, M., Panchaud, A., Cleary, B., Chambers, C., Weber-Schoendorfer, C., Kennedy, D., Hodson, K., Grant, K. S., Diav-Citrin, O., Običan, S. G., Shechtman, S., & Alwan, S. (2025). Acetaminophen in Pregnancy and Attention-Deficit and Hyperactivity Disorder and Autism Spectrum Disorder. Obstetrics and gynecology, 145(2), 168–176. https://doi.org/10.1097/AOG.0000000000005802   Ji Y, Azuine RE, Zhang Y, et al. Association of Cord Plasma Biomarkers of In Utero Acetaminophen Exposure With Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder in Childhood. JAMA Psychiatry. 2020;77(2):180–189. doi:10.1001/jamapsychiatry.2019.3259   Hirota T, King BH.  Autism Spectrum Disorder: A Review. JAMA. 2023;329(2):157–168. doi:10.1001/jama.2022.23661   Liu, X., Zou, M., Sun, C., Wu, L., & Chen, W. X. (2022). Prenatal Folic Acid Supplements and Offspring's Autism Spectrum Disorder: A Meta-analysis and Meta-regression. Journal of autism and developmental disorders, 52(2), 522–539. https://doi.org/10.1007/s10803-021-04951-8   DSM-5-TR: Neurocognitive Disorders Supplement; October 2022. https://psychiatryonline.org/pb-assets/dsm/update/DSM-5-TR_Neurocognitive-Disorders-Supplement_2022_APA_Publishing.pdf https://www.npr.org/sections/shots-health-news/2025/09/06/nx-s1-5532143/hhs-responds-to-report-about-autism-and-acetaminophen Guest: Susan Feeney, DNP, FNP-BC, NP-C   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com   

Just today in clinic, we had a patient, who was well into her third trimester, come to her regular scheduled appointment with new onset left-sided facial droop. Yeah, that's concerning! A complete history and physical was performed and the diagnosis was made of Bell's palsy. This is not a rare event and it can be extremely stressful for the affected mother to be because everybody knows facial droop is not normal! And we have recent data regarding this. In July 2025 in the Journal of Plastic, Reconstructive, and Aesthetic Surgery, authors confirmed that Bell's palsy can have real negative functional and psychosocial implications for those affected. So, in this episode, we are going to discuss Bell's palsy in pregnancy. How do we differentiate this from the more serious differential, which is a stroke? What about treatment? Listen in for details. 1. Wesley, Shaun R. MD; Vates, G. Edward MD, PhD; Thornburg, Loralei L. MD. Neurologic Emergencies in Pregnancy. Obstetrics & Gynecology 144(1):p 25-39, July 2024. | DOI: 10.1097/AOG.00000000000055752. Vrabec JT, Isaacson B, Van Hook JW. Bell's Palsy and Pregnancy.Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery. 2007;137(6):858-61. doi:10.1016/j.otohns.2007.09.009.3. Evangelista V, Gooding MS, Pereira L.Bell's Palsy in Pregnancy.Obstetrical & Gynecological Survey. 2019;74(11):674-678. doi:10.1097/OGX.00000000000007324. JPRAS (July 2025): https://www.jprasurg.com/article/S1748-6815(25)00328-6/fulltextSTRONG COFFEE PROMO: 20% Off Strong Coffee Company https://strongcoffeecompany.com/discount/CHAPANOSPINOBG

In 2023, we released 2 episodes on obstructive sleep apnea (OSA) and adverse pregnancy. Now, on September 16, 2025, a new publication from JAMA Network Open adds more insights to disturbed sleep and adverse pregnancy outcomes. How does insomnia affect pregnancy? And is there any data on night shift work and its altered circadian rhythms on adverse pregnancy outcomes? Listen in for details. 1. Ross N, Baer RJ, Oltman SP, et al. Ischemic Placental Disease and Severe Morbidity in Pregnant Patients With Sleep Disorders. JAMA Netw Open. 2025;8(9):e2532189. doi:10.1001/jamanetworkopen.2025.321892. Cai C, Vandermeer B, Khurana R, et al. The Impact of Occupational Shift Work and Working hours during Pregnancy on Health Outcomes: a systematic Review and Meta-Analysis.American Journal of Obstetrics and Gynecology. 2019;221(6):563-576. doi:10.1016/j.ajog.2019.06.051.3. Dominguez JE, Cantrell S, Habib AS, Izci-Balserak B, Lockhart E, Louis JM, Miskovic A, Nadler JW, Nagappa M, O'Brien LM, Won C, Bourjeily G. Society of Anesthesia and Sleep Medicine and the Society for Obstetric Anesthesia and Perinatology Consensus Guideline on the Screening, Diagnosis, and Treatment of Obstructive Sleep Apnea in Pregnancy. Obstet Gynecol. 2023 Aug 1;142(2):403-423. doi: 10.1097/AOG.0000000000005261. Epub 2023 Jul 5. PMID: 37411038; PMCID: PMC10351908.4. Kader M, Bigert C, Andersson T, et al . Shift and Night Work During Pregnancy and Preterm Birth-a Cohort Study of Swedish Health Care Employees. International Journal of Epidemiology. 2022;50(6):1864-1874. doi:10.1093/ije/dyab135.STRONG COFFEE PROMO: 20% Off Strong Coffee Companyhttps://strongcoffeecompany.com/discount/CHAPANOSPINOBG

On Sept 10, 2023, er released an episode titled, “CS Ut Closure: Decidua or No Decidua?”. We highlighted the importance of AVOIDING the decidua at hysterotomy closure at CS. Now, in Sept 2025, in Obstetrics and Gynecology (the Green Journal), there is a new systematic review and meta-analysis on this very topic. Does this new study CONFIRM or REFUTE what we explained 2 years ago? Listen in for details. 1. Sept 10, 2023 Chapa Clinical Pearls Podcast: CS Ut Closure: Decidua or No Decidua?2. Lino GM, Galvão PVM, da Silva MLF, Conrado GAM. Not Closing Compared With Closing the Endometrial Layer During Cesarean Delivery: A Systematic Review and Meta-analysis. Obstet Gynecol. 2025 Jun 12;146(3):e55-e63. doi: 10.1097/AOG.0000000000005974. PMID: 40505112.

We have a wonderful podacst community! Within 24 hours of our immediate past episode release, one close friend- and fellow OBGYN, Dr. Eric Colton (OB Hospitalist Group) reached out and shared valuable words of wisdom regarding a potentially deadly complication of the CS-scar defect...the CS scar ectopic pregnancy. Listen in for Dr. Colton's cameo and details. 1. Ban, Yanli MD, PhD; Shen, Jia MD; Wang, Xia MD; Zhang, Teng MD, PhD; Lu, Xuxu MD; Qu, Wenjie MD; Hao, Yiping MD; Mao, Zhonghao MD; Li, Shizhen MD; Tao, Guowei MD, PhD; Wang, Fang MD, PhD; Zhao, Ying MD, PhD; Zhang, Xiaolei MD, PhD; Zhang, Yuan MD, PhD; Zhang, Guiyu MD, PhD; Cui, Baoxia MD, PhD. Cesarean Scar Ectopic Pregnancy Clinical Classification System With Recommended Surgical Strategy. Obstetrics & Gynecology 141(5):p 927-936, May 2023. | DOI: 10.1097/AOG.0000000000005113

Traditionally, we have learned that any imbalance in the estrogen: progesterone relationship can trigger irregular uterine bleeding. That makes sense, right? During anovulation, prolonged unopposed estrogen can result in HMB. In such a case, we give progesterone as both a therapeutic as well as diagnostic intervention. On the contrary, with progestin only contraception, we consider estrogen predominant products when progesterone breakthrough bleeding (BTB) occurs to restore endometrial stabilization. But a new RCT (AJOG) adds credence to adding MORE progesterone in cases of progesterone associated BTB. Listen in for details.1. Zigler RE, Madden T, Ashby C, Wan L, McNicholas C. Ulipristal Acetate for Unscheduled Bleeding in Etonogestrel Implant Users: A Randomized Controlled Trial. Obstet Gynecol. 2018 Oct;132(4):888-894. doi: 10.1097/AOG.0000000000002810. PMID: 30130351; PMCID: PMC6153077.2.ANDRADE MCR, et al. Norethisterone for Prolonged Uterine Bleeding Associated with Etonogestrel Implant (IMPLANET): A Randomized Controlled Trial, American Journal of Obstetrics and Gynecology (2025), doi: https://doi.org/10.1016/j.ajog.2025.08.029.

Routine vaginal examinations (VEs) are a standard component of intrapartum care, traditionally performed at regular intervals to monitor cervical dilation, effacement, and fetal station, which are indicators of labor progression. Yet, the American College of Obstetricians and Gynecologists states that there is insufficient evidence to recommend a specific frequency for cervical examinations during labor, and examinations should be performed as clinically indicated. Now, a recently published RCT form AJOG MFM is adding additional credence to that. Can we space out clinical exams in otherwise “low-risk” laboring women to 8 hours? Listen in for details. 1. AJOG MFM: (08/18/25) Routine Vaginal Examination Scheduled At 8 vs 4 Hours In Multiparous Women In Early Spontaneous Labour: A Randomised Controlled Trial https://www.sciencedirect.com/science/article/abs/pii/S25899333250016122. Nashreen CM, Hamdan M, Hong J, et al.Routine Vaginal Examination to Assess Labor Progress at 8 Compared to 4 h After Early Amniotomy Following Foley Balloon Ripening in the Labor Induction of Nulliparas: A Randomized Trial. Acta Obstetricia Et Gynecologica Scandinavica. 2024;103(12):2475-2484. doi:10.1111/aogs.14975.3. First and Second Stage Labor Management: ACOG Clinical Practice Guideline No. 8. Obstetrics and Gynecology. 2024;143(1):144-162. doi:10.1097/AOG.0000000000005447.4. Moncrieff G, Gyte GM, Dahlen HG, et al. Routine Vaginal Examinations Compared to Other Methods for Assessing Progress of Labour to Improve Outcomes for Women and Babies at Term. The Cochrane Database of Systematic Reviews. 2022;3:CD010088. doi:10.1002/14651858.CD010088.pub3.5. Gluck, O., et al. (2020). The correlation between the number of vaginal examinations during active labor and febrile morbidity, a retrospective cohort study. [BMC Pregnancy and Childbirth]6. Pan, WL., Chen, LL. & Gau, ML. Accuracy of non-invasive methods for assessing the progress of labor in the first stage: a systematic review and meta-analysis. BMC Pregnancy Childbirth 22, 608 (2022). https://doi.org/10.1186/s12884-022-04938-y

In the last 2 episodes we covered new updates in menopausal hormone therapy. However, we did not address TESTOSTERONE use. This episode idea comes from one our podcast family members and good friend, Eric. Eric is 100% correct: Testosterone replacement, when done correctly, has come along way. When is this indicated? Is this endorsed by professional medical/endocrine groups? What's the dose? We have fun stuff to review, so listen in!1. Davis SR, Baber R, Panay N, Bitzer J, Perez SC, Islam RM, Kaunitz AM, Kingsberg SA, Lambrinoudaki I, Liu J, Parish SJ, Pinkerton J, Rymer J, Simon JA, Vignozzi L, Wierman ME. Global Consensus Position Statement on the Use of Testosterone Therapy for Women. J Clin Endocrinol Metab. 2019 Oct 1;104(10):4660-4666. doi: 10.1210/jc.2019-01603. PMID: 31498871; PMCID: PMC6821450.2. Sharon J. Parish, James A. Simon, Susan R. Davis, Annamaria Giraldi, Irwin Goldstein, Sue W. Goldstein, Noel N. Kim, Sheryl A. Kingsberg, Abraham Morgentaler, Rossella E. Nappi, Kwangsung Park, Cynthia A. Stuenkel, Abdulmaged M. Traish, Linda Vignozzi, International Society for the Study of Women's Sexual Health Clinical Practice Guideline for the Use of Systemic Testosterone for Hypoactive Sexual Desire Disorder in Women, The Journal of Sexual Medicine, Volume 18, Issue 5, May 2021, Pages 849–867, https://doi.org/10.1016/j.jsxm.2020.10.0093. Levy, Barbara MD, MSCP; Simon, James A. MD, MSCP. A Contemporary View of Menopausal Hormone Therapy. Obstetrics & Gynecology 144(1):p 12-23, July 2024. | DOI: 10.1097/AOG.00000000000055534. NAMS The 2022 hormone therapy position statement of The North American Menopause Society: chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/https://menopause.org/wp-content/uploads/professional/nams-2022-hormone-therapy-position-statement.pdf