Podcasts about GDM

In this episode of The Birth Lounge podcast, host HeHe discusses one of the most requested topics, Gestational Diabetes Mellitus (GDM), with midwife Melissa Chappell. Melissa, who owns Utah Birth Suites and founded Songbird Maternity, offers a holistic view on women's health and is a staunch advocate for informed consent and patient autonomy. The conversation dives deep into what GDM is, how it occurs, the importance of testing, and why the typical 50-gram glucose challenge may not always reflect reality. The duo also covers alternative testing methods, including continuous glucose monitoring, diet and exercise's role, and the impact of GDM on the baby. Melissa sheds light on the myths and truths about GDM, the implications of controlled versus uncontrolled GDM, and the risks associated with traditional medical practices, such as induction. Listeners will walk away feeling informed and empowered to engage in confident discussions with their healthcare providers. Tune in to get evidence-based insights, especially focusing on holistic and patient-centered care approaches for managing gestational diabetes.   00:00 Introduction to Gestational Diabetes 01:27 Meet Our Expert Guest: Melissa Chappell 02:33 Understanding Gestational Diabetes Mellitus (GDM) 03:03 Testing and Alternatives for Gestational Diabetes 03:53 Impact of Gestational Diabetes on Mother and Baby 10:16 Historical Perspective and Current Statistics 12:42 Challenges with Current Testing Methods 16:26 Managing Gestational Diabetes: Diet and Monitoring 24:07 Risks and Misconceptions about Big Babies 31:37 Pitocin Use and Its Implications 39:13 Increased Medical Interventions in Pregnancy 40:17 The Impact of Glucose Restriction on Babies 42:31 Research Findings on Blood Glucose Thresholds 44:24 Managing Gestational Diabetes with Diet and Exercise 48:50 Alternative Testing Methods for Gestational Diabetes 01:00:06 Understanding HbA1c and Its Limitations 01:08:04 Postpartum Care for Babies of Gestational Diabetic Mothers 01:12:42 Connecting with Melissa and Doula Training Opportunities 01:14:40 Conclusion and Final Thoughts   Guest Bio: Melissa Chappell, LDEM, CPM is a midwife and owner of two birth centers in Utah, and as well is a doula trainer of over 22 years. She is passionate about women's health from a holistic and nourishing perspective, and advocates for women's wellness in all areas of their lives. She has worked with midwives and birthing women all over the world, including in Haiti, Ethiopia, and Kenya, and loves seeing how women's lives improve with access to safe and effective midwifery care. She is the mother of 4 children and 4 grandchildren that she adores. In between catching babies, Melissa loves to explore as much of the world as she can – from international travel to exploring the mountains in her backyard. INSTAGRAM: Connect with HeHe on IG  Connect with Melissa on IG    BIRTH EDUCATION: Join The Birth Lounge here for judgment-free childbirth education that prepares you for an informed birth and how to confidently navigate hospital policy to have a trauma-free labor experience!   Download The Birth Lounge App for birth & postpartum prep delivered straight to your phone!   LINKS MENTIONED: Lily Nichols: Real Food in Pregnancy    Use code HeHe to sign up for doula education and 25% off the Birth Education Library with Melissa at https://www.melissachappell.com/   RESEARCH: https://www.cochranelibrary.com/web/cochrane/content?templateType=full&urlTitle=/cdsr/doi/10.1002/14651858.CD012394.pub3&doi=10.1002/14651858.CD012394.pub3&type=cdsr&contentLanguage=   https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-023-05779-z   Gestational diabetes and the risk of late stillbirth: a case-control study from England, UK - PubMed   https://www.cochranelibrary.com/web/cochrane/content?templateType=full&urlTitle=/cdsr/doi/10.1002/14651858.CD011624.pub3&doi=10.1002/14651858.CD011624.pub3&type=cdsr&contentLanguage=   Big Babies: the risk of care provider fear | Dr Rachel Reed  

This is a blogpost version of a talk I gave earlier this year at GDM. Epistemic status: Vague and handwavy. Nuance is often missing. Some of the claims depend on implicit definitions that may be reasonable to disagree with. But overall I think it's directionally true. It's often said that mech interp is pre-paradigmatic. I think it's worth being skeptical of this claim. In this post I argue that: Mech interp is not pre-paradigmatic. Within that paradigm, there have been "waves" (mini paradigms). Two waves so far. Second-Wave Mech Interp has recently entered a 'crisis' phase. We may be on the edge of a third wave. Preamble: Kuhn, paradigms, and paradigm shifts First, we need to be familiar with the basic definition of a paradigm: A paradigm is a distinct set of concepts or thought patterns, including theories, research [...] ---Outline:(00:58) Preamble: Kuhn, paradigms, and paradigm shifts(03:56) Claim: Mech Interp is Not Pre-paradigmatic(07:56) First-Wave Mech Interp (ca. 2012 - 2021)(10:21) The Crisis in First-Wave Mech Interp(11:21) Second-Wave Mech Interp (ca. 2022 - ??)(14:23) Anomalies in Second-Wave Mech Interp(17:10) The Crisis of Second-Wave Mech Interp (ca. 2025 - ??)(18:25) Toward Third-Wave Mechanistic Interpretability(20:28) The Basics of Parameter Decomposition(22:40) Parameter Decomposition Questions Foundational Assumptions of Second-Wave Mech Interp(24:13) Parameter Decomposition In Theory Resolves Anomalies of Second-Wave Mech Interp(27:27) ConclusionThe original text contained 6 footnotes which were omitted from this narration. --- First published: June 10th, 2025 Source: https://www.lesswrong.com/posts/beREnXhBnzxbJtr8k/mech-interp-is-not-pre-paradigmatic --- Narrated by TYPE III AUDIO. ---Images from the article:

Episode 193: Gestational Diabetes IntroJesica Mendoza (OMSIII) describes the pathophysiology of gestational diabetes and the right timing and method of screening for it. Dr. Arreaza adds insight into the need for culturally-appropriate foods, such as vegetables in Mexican cuisine.    Written by Jesica Mendoza, OMSIII, Western University of Health Sciences, College of Osteopathic Medicine of the Pacific. Editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.DefinitionGestational diabetes mellitus (GDM) is a condition that occurs to previously non-diabetic pregnant women, caused by glucose intolerance at around the 24th week of gestation. PathophysiologyGDM arises due to an underlying pancreatic beta cell dysfunction in the mother which leads to a decrease in the amount of insulin produced and thus leads to higher blood sugar levels during pregnancy. The placenta of the fetus will produce hPL (human placental lactogen) to ensure a steady supply of sugars to the fetus, creating an anti-insulin effect. However, hPL readily crosses the placental barrier causing the mothers insulin requirement to increase, when the mother's pancreas cannot increase production of insulin to that level needed to counter the effect of hPL they become diabetic, and this leads to gestational diabetes. So, basically the placenta is asking for more glucose for the baby and the mother's pancreas struggles to keep the glucose level within normal limits in the body of the mother. If left untreated, high levels of glucose in the mother can cause glucotoxicity in the mother.“Glucotoxicity” refers to the toxic effect of glucose. Glucose is the main fuel for cell functions, but when it is high in the bloodstream, it causes toxicity to organs. Prevalence of GDM.The CDC reports mean prevenance of GDM is 6.9%. In U.S. mothers the prevenance increased from 6.0% in 2016 to 8.3% in 2021. Many different factors have played a role in increasing gestational diabetes in American mothers, some of those being the ongoing obesity epidemic with excess body weight being a known risk factor for insulin resistance. Another being advanced maternal age (AMA) as more American women have children later in life their body becomes less sensitive to insulin and requires a higher insulin output on top of the insulin that is required for the fetus. The “American diet” is also something that has a big effect in diabetes development. With the increase of high-carb foods that are readily available, the diet of Americans has declined and is affecting the metabolic health of mothers as they carry and deliver their children. Despite ongoing awareness of GDM, 6% to 9% of pregnant women in the United States are diagnosed with gestational diabetes, and the prevalence continues to increase worldwide. It is estimated that in 2017 18.4 million pregnancies were affected by GDM in the world, which then continued to increase to 1 in 6 births to women with GDM in 2019. It was also found that women living in low-income communities were disproportionately affected due to limited healthcare access. Additionally, women with GDM had a 1.4-fold increase in likelihood of undergoing a c-section, with 15% increase in risk of requiring blood transfusion. Screening for GDMGestational diabetes is screened between the 24th to 28th week of gestation in all women without known pregestational diabetes. In women who have high-risk for GDM the screening occurs during the first trimester, these women usually have at least one of the following: BMI > 30, prior history of GDM, known impaired glucose metabolism, and/or a strong family history of diabetes. The screening during the first trimester is to detect “pregestational diabetes” because we have to keep a good glycemic control to improve outcomes of pregnancy. So, if it's positive, you start treatment immediately. If these women are found to have a normal glucose, they repeat the testing again as done normally, at 24-28 weeks of gestation. How do we screen?The screening itself consists of two types of approaches. The two-step approach includes a 50-gram oral glucose tolerance test (OGTT), where blood glucose is measured in an hour and if it is below 140 they are considered to not have GDM, however if the reading is greater than 140 they must then do a 3-hour, 100g oral glucose tolerance test. The 3-hour OGTT includes measuring the blood sugars at Fasting which should be less than 95, at 1 hour at less than 180, at 2 hours at less than 155, and at 3 hours at less than 140. If 2 or more of these values exceed the threshold the patient is diagnosed with gestational diabetes mellitus. The one-step approach includes 75g after an overnight fast. Blood glucose is measured while fasting which should be less than 92, at 1 hour less than 180 and at 2 hours less than 153. If any one of these values is exceeded, the patient is diagnosed with GDM.If the mother is found to be GDM positive during pregnancy she will also need continued screening post-partum to monitor for any development of overt diabetes. The testing is usually 75g 2-hour OGTT at 6-12 weeks postpartum. If this testing is normal, then they are tested using HbA1c every 3 years. If the post-partum testing shows pre-diabetes, annual testing is recommended using HbA1c measurements. Maternal complications Women with GDM are at an increased risk for future cardiovascular disease, T2DM, and chronic kidney disease. GDM is also associated with increased likelihood of developing pre-eclampsia following delivery. Pre-eclampsia is a complication seen in pregnancy characterized by high blood pressure, proteinuria, vision changes, and liver involvement (high LFTs). Pre-eclampsia can then progress to eclampsia or HELLP syndrome, both of which can include end organ damage. Additionally, she can develop polyhydramnios which leads to overstretching of the uterus and can induce pre-term labor, placental abruption, and or uterine atony, all of which additionally put the mother at increased risk for c-section. All of these maternal complications that stem from GDM lead to complications and extended hospitalization. Child's complications Although there is an increased set of risks for the mother, the neonate can also develop a variety of risks due to the increased glucose while in utero. While the fetus is growing, the placenta is the source of nutrition for the fetus. As the levels of glucose in the mother increase so does the amount of glucose filtered through the placenta and into the fetal circulation. Over time the glucose leads to oxidative stress and inflammation with activation of TGF-b which leads to fibroblast activation and fibrosis of the placenta. This fibrosis decreases the nutrient and oxygen exchange for the fetus. As the fetus attempts to grow in this restrictive environment its development is affected. The fetus can develop IUGR (intrauterine growth restriction) leading to a small for gestation age newborn which can then lead to another set of complications. The low oxygen environment can lead to increased EPO production and polycythemia at birth which can then lead to increased clotting that can travel to the newborn brain. Newborns can also be born with fetal acidosis due to the anerobic metabolism and lactic acid buildup in fetal tissues which can cause fetal encephalopathy leading to cerebral palsy and developmental delay. And the most severe of newborn complications to gestational diabetes can lead to fetal demise. Furthermore, the increase of glucose can also lead to macrosomia in the infant which can often lead to a traumatic delivery and delivery complications such as shoulder dystocia and brachial plexus injury. Brachial plexus injury sometimes resolves without sequela, but other times can lead to permanent weakness or paralysis of the affected arm. The baby can be born too small or too big.Additionally, once the fetus is born the cutting of the umbilical cord leads to a rapid deceleration in blood glucose in the fetal circulation and hypoglycemic episodes can occur, that often lead to NICU admission. The insulin that is created by the fetus in utero to accommodate the large quantities of glucose is known to affect lung maturation as well. The insulin produced inhibits surfactant production in the fetus. Upon birth some of the newborns also have to be placed on PEEP for ventilation and some children require treatment with surfactant to prevent alveolar collapse and/or progression to NRDS created by the low surfactant levels. Additionally, neonates who are macrosomic, which is usually seen in GDM mothers, are larger and stronger and when put on PEEP to help increase ventilation the newborn's stronger respiratory effort can lead to higher pulmonary pressures and barotrauma such as neonatal pneumothorax.Long term complications to the child of a mother with GDM also occur. As the child grows, they are also at an increased risk for developing early onset obesity because of the increased adipose storage triggered by the increase in insulin in response to the high glucose in utero. This then can lead to a higher chance of developing type 2 diabetes mellitus in the child. With diabetes, also comes an increase in cardiovascular risk as the child ages and becomes an adult. The effects of GDM go beyond the fetal life but continue through adulthood.What can be done?Gestational Diabetes Mellitus has many severe and lifelong consequences for both the mother and the child and prevention of GDM would help enhance the quality of life of both. Many of the ways to prevent GDM complications include patient education and dietary modifications with a diet rich in whole grains, fruits, vegetables and lean proteins. Benefits of some vegetables in the Mexican cuisine that may be beneficial: Nopales, Chayote, and Jicama. Those are good alternatives for highly processed carbs.Mothers are usually offered nutritional counseling to help them develop a tailored eating plan. This and 30 minutes of moderate exercise daily is recommended to increase insulin sensitivity and lower the post-prandial glucose levels. If within 2 weeks of implementing lifestyle changes alone the glucose measurements remain high, then medications like insulin can be put onboard to manage the GDM. If they require insulin, I think it is time to refer to a higher level of care, if available, high risk OB clinic.Conclusion: Now we conclude episode number ###, “[TITLE].” [summary here]. _____________________References:Eades CE, Burrows KA, Andreeva R, Stansfield DR, Evans JM. Prevalence of gestational diabetes in the United States and Canada: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2024 Mar 15;24(1):204. doi: 10.1186/s12884-024-06378-2. PMID: 38491497; PMCID: PMC10941381. https://pubmed.ncbi.nlm.nih.gov/38491497/QuickStats: Percentage of Mothers with Gestational Diabetes,* by Maternal Age — National Vital Statistics System, United States, 2016 and 2021. Weekly / January 6, 2023 / 72(1);16. https://www.cdc.gov/mmwr/volumes/72/wr/mm7201a4.htm?utmAkinyemi OA, Weldeslase TA, Odusanya E, Akueme NT, Omokhodion OV, Fasokun ME, Makanjuola D, Fakorede M, Ogundipe T. Profiles and Outcomes of Women with Gestational Diabetes Mellitus in the United States. Cureus. 2023 Jul 4;15(7):e41360. doi: 10.7759/cureus.41360. PMID: 37546039; PMCID: PMC10399637. https://pmc.ncbi.nlm.nih.gov/articles/PMC10399637/?utmPerlman, J. M. (2006). Summary proceedings from the neurology group on hypoxic-ischemic encephalopathy. Pediatrics, 117(3), S28–S33.DOI: 10.1542/peds.2005-0620C.Low, J. A. (1997). Intrapartum fetal asphyxia: definition, diagnosis, and classification. American Journal of Obstetrics and Gynecology, 176(5), 957–959.DOI: 10.1016/S0002-9378(97)70609-0.Hallman, M., Gluck, L., & Liggins, G. (1985). Role of insulin in delaying surfactant production in the fetal lung. Journal of Pediatrics, 106(5), 786–790.DOI: 10.1016/S0022-3476(85)80227-0.Sweet, D. G., Carnielli, V., Greisen, G., et al. (2019). European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update. Neonatology, 115(4), 432–450.DOI: 10.1159/000499361.Raju, T. N. K., et al. (1999). Respiratory distress in term infants: when to suspect surfactant deficiency. Pediatrics, 103(5), 903–909.DOI: 10.1542/peds.103.5.903.Burns, C. M., Rutherford, M. A., Boardman, J. P., & Cowan, F. M. (2008). Patterns of cerebral injury and neurodevelopmental outcomes after symptomatic neonatal hypoglycemia. Pediatrics, 122(1), 65–74.DOI: 10.1542/peds.2007-2822.Dabelea, D., et al. (2000). Long-term impact of maternal diabetes on obesity in childhood. Diabetes Care, 23(10), 1534–1540.DOI: 10.2337/diacare.23.10.1534.Dashe, J. S., et al. (2002). "Hydramnios: Etiology and outcome." Obstetrics & Gynecology, 100(5 Pt 1), 957–962.DOI: 10.1016/S0029-7844(02)02279-6.Long-term cost-effectiveness of implementing a lifestyle intervention during pregnancy to prevent gestational diabetes mellitus: a decision-analytic modelling study. Diabetologia.American College of Obstetricians and Gynecologists. (2018). Practice Bulletin No. 190: Gestational Diabetes Mellitus. Obstetrics & Gynecology, 131(2), e49–e64. https://doi.org/10.1097/AOG.0000000000002501Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

In a heartfelt conversation, Taime Downe opens up about coping with the loss of his fiancée Kim and how it reinforced his commitment to sobriety. Despite tour challenges, including an early bus breakdown, he's finding strength through music and his band family. Downe also discusses Faster Pussycat's latest single 'Motorbike,' their approach to releasing new music, and their extensive upcoming tour with The Supersuckers.Plus, former Guns N' Roses and Sixx:AM guitarist DJ Ashba discusses his innovative venture into GDM, blending rock guitar with dance music. He shares insights about performing at Vegas clubs, his creative process, and the challenges of bridging two distinct musical worlds. Ashba also discusses the status of Sixx:AM, his memorable moments with GNR, and how his successful fabrication business allows him creative freedom to explore new musical territories. Catch Eddie Trunk every M-F from 3:00-5:00pm ET on Trunk Nation on SiriusXM Faction Talk Channel 103.And don't forget to follow Eddie on Twitter and Instagram!Follow the link to get your free 3-month trial of SiriusXM: http://siriusxm.com/eddietrunk Find all episodes of Trunk Nation: https://siriusxm.com/trunknation

Audio note: this article contains 31 uses of latex notation, so the narration may be difficult to follow. There's a link to the original text in the episode description. Lewis Smith*, Sen Rajamanoharan*, Arthur Conmy, Callum McDougall, Janos Kramar, Tom Lieberum, Rohin Shah, Neel Nanda * = equal contribution The following piece is a list of snippets about research from the GDM mechanistic interpretability team, which we didn't consider a good fit for turning into a paper, but which we thought the community might benefit from seeing in this less formal form. These are largely things that we found in the process of a project investigating whether sparse autoencoders were useful for downstream tasks, notably out-of-distribution probing.TL;DR To validate whether SAEs were a worthwhile technique, we explored whether they were useful on the downstream task of OOD generalisation when detecting harmful intent in user prompts [...] ---Outline:(01:08) TL;DR(02:38) Introduction(02:41) Motivation(06:09) Our Task(08:35) Conclusions and Strategic Updates(13:59) Comparing different ways to train Chat SAEs(18:30) Using SAEs for OOD Probing(20:21) Technical Setup(20:24) Datasets(24:16) Probing(26:48) Results(30:36) Related Work and Discussion(34:01) Is it surprising that SAEs didn't work?(39:54) Dataset debugging with SAEs(42:02) Autointerp and high frequency latents(44:16) Removing High Frequency Latents from JumpReLU SAEs(45:04) Method(45:07) Motivation(47:29) Modifying the sparsity penalty(48:48) How we evaluated interpretability(50:36) Results(51:18) Reconstruction loss at fixed sparsity(52:10) Frequency histograms(52:52) Latent interpretability(54:23) Conclusions(56:43) AppendixThe original text contained 7 footnotes which were omitted from this narration. --- First published: March 26th, 2025 Source: https://www.lesswrong.com/posts/4uXCAJNuPKtKBsi28/sae-progress-update-2-draft --- Narrated by TYPE III AUDIO. ---Images from the article:

It's In the News.. a look at the top headlines and stories in the diabetes community. This week's top stories: Learning more about the FDA letter sent to Dexcom, news from ATTD including a bihormonal pump from a Dutch company, time in tight range update, more studies about using insulin and GLP-1 medications, eating chili to prevent gestational diabetes (really!) and more..  Find out more about Moms' Night Out  Please visit our Sponsors & Partners - they help make the show possible! Learn more about Gvoke Glucagon Gvoke HypoPen® (glucagon injection): Glucagon Injection For Very Low Blood Sugar (gvokeglucagon.com) Omnipod - Simplify Life Learn about Dexcom   Check out VIVI Cap to protect your insulin from extreme temperatures The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Episode transcription with links: Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and every other Friday I bring you a short episode with the top diabetes stories and headlines happening now. XX Our top story this week: Dexcom Dive Brief: A warning letter posted Tuesday by the Food and Drug Administration revealed quality control issues with Dexcom's continuous glucose monitors. The FDA raised concerns with a design change to a component used in the resistance layer of Dexcom's sensors. The sensors with the new component were less accurate than those with the original component, according to the warning letter. Dexcom has ceased distribution of G7 sensors with the component, but the company's response did not address affected G6 sensors. J.P. Morgan analyst Robbie Marcus wrote in a research note Tuesday that the letter concerns a chemical compound that the sensor wire is dipped in. Dexcom began producing the compound internally to add redundancy to its supply chain.   Dive Insight: Dexcom Chief Operating Officer Jake Leach said in an interview with MedTech Dive last week that the company does not expect the warning letter to affect future product approvals, including a 15-day version of its G7 CGM, and there's no need yet to recall products. Dexcom has submitted the device to the FDA and anticipates a launch in the second half of the year.   Marcus, after speaking to company leadership and a quality control expert, wrote that many of the issues outlined in the letter could be addressed quickly. He added that the warning letter could explain minor delays in approval to the 15-day sensor, but Dexcom is still within the 90-day window for a 510(k) submission.   “While there's always a risk this could impede future product approvals,” Marcus wrote, “we do not expect this to materially delay the 15 day G7 sensor approval.”   The warning letter followed an FDA inspection last year of Dexcom's facilities in San Diego and Mesa, Arizona. Marcus wrote that after the FDA requested additional information and a separate 510(k), Dexcom stopped in-sourcing the compound and reverted back to the external supplier.   Dexcom's devices were misbranded because the company did not submit a premarket notification to the FDA before making major changes to the sensors, according to the warning letter. The sensors with the changed coating “cause higher risks for users who rely on the sensors to dose insulin or make other diabetes treatment decisions,” the letter said.     The FDA raised other concerns in the warning letter, including procedures to monitor the glucose and acetaminophen concentrations used in testing of the G6 and G7 CGMs. The FDA also cited problems with Dexcom's handling last year of a deficiency in its G6 sensors with dissolved oxygen content values, a key input for measuring blood glucose levels. https://www.medtechdive.com/news/dexcom-warning-letter-cgm-coating-change/743597/ XX Lots of studies and info out of the recent ATTD conference. One highlight that has been sort of under the radar: a Dutch company has been using a Bihormonal fully closed-loop system for the treatment of type 1 diabetes in the real world. This is a company called Inreda (in-RAY-duh). The Inreda AP® is an automatic system (closed loop) and independently regulates the blood glucose level by administering insulin and glucagon. The AP5 is certified in Europe and is being used in multiple studies and projects. The AP®6 is currently under development. https://www.inredadiabetic.nl/en/discover-the-ap/ https://pubmed.ncbi.nlm.nih.gov/38443309/ XX Let's talk about time in tight range. If you follow me and diabetes connections on social, you likely saw a video I made about this – it blew up last week. If not.. time in range has been a metric for a short while now.. in 2019 there was a consensus report advising a goal of 70% of time in the 70-180 mg/dL range for most people with type 1 diabetes (T1D) and type 2 diabetes (T2D), with modifications for certain subgroups. Recently we've been hearing more about 70-140 mg/dL — for longer periods as “time in tight range (TiTR).” At ATTD there was more talk about calling that range TING, or “time in normal glycemia.     There's a great writeup that I'll link up from the great Miriam Tucker on Medscape about a debate that happened at ATTD. On March 22, 2025, two endocrinologists debated this question at the Advanced Technologies & Treatments for Diabetes (ATTD) 2025. Anders L. Carlson, MD, medical director of the International Diabetes Center (IDC), Minneapolis, took the positive side, while Jeremy Pettus, MD, assistant professor of medicine at the University of California San Diego, who lives with T1D himself, argued that it's too soon.   https://www.medscape.com/viewarticle/should-time-tight-range-be-primary-diabetes-goal-2025a100073q?form=fpf   XX Sequel Med Tech announces its twist pump will be firs paired with Abbott's FreeStyle Libre 3 Plus. The twist has FDA approval for ages 6 and up and is set to begin its commercial launch by the end of June. The pump—designed by inventor Dean Kamen's Deka Research & Development—also incorporates the FDA-cleared Tidepool Loop software program, to record CGM blood sugar readings, make predictions based on trends and adjust its background insulin levels accordingly. https://www.fiercebiotech.com/medtech/sequel-med-tech-connects-twiist-insulin-pump-abbotts-cgm-ahead-market-debut XX Dexcom's longer-lasting CGM sensor looks promising, based on study results presented at the conference. The trial showed that the new 15-day G7 system is slightly more accurate than the current G7. The accuracy of CGM can be measured using MARD (mean absolute relative difference), which shows the average amount a CGM sensor varies from your actual glucose levels (a lower number is better).  The 15-day G7 has a MARD value of 8.0%, about the same as the Abbott Freestyle Libre 3. The Dexcom G7 15 Day is awaiting FDA approval and is not yet available in the U.S.   XX Little bit of news from Modular Medical.. they plan to submit their patch pump to the FDA late summer or fall of this year. The MODD1 product, a 90-day patch pump, features new microfluidics technology to allow for the low-cost pumping of insulin. Its new intuitive design makes the product simple to use and easier to prescribe. It has a reservoir size of 300 units/3mL. Users can monitor the pump activity with their cell phone and do not require an external controller. The pump uses a provided, single-use, disposable battery. Modular Medical picked up FDA clearance for MODD1 in September. The company also raised $8 million to end 2024. Its founder, Paul DiPerna, previously founded leading insulin pump maker Tandem Diabetes Care. DiPerna invented and designed Tandem's t:slim pump. By developing its patented insulin delivery technologies, the company hopes to improve access to glycemic control. Its founder, Paul DiPerna, previously founded leading insulin pump maker Tandem Diabetes Care. DiPerna invented and designed Tandem's t:slim pump. https://www.drugdeliverybusiness.com/modular-medical-announces-12m-private-placement/ XX More from attd – type 2 news? https://www.drugdeliverybusiness.com/biggest-diabetes-tech-news-attd-2025/ XX Another study that says people with type 1 who use a GLP-1 medication get better outcomes. In this study, those who use GLP-1 with insulin are 55% less likely to have a hyperglycemia-related ED visit, 26% less likely to have an amputation-related visit, and 29% less likely to have a diabetic ketoacidosis (DKA)-related ED visit in the following year compared to those on insulin alone. Although they are not approved for T1D, some patients may receive them off-label or for weight control. Pretty big study for an off label drug: compared 7,010 adult patients with T1D who were prescribed GLP-1s and insulin to 304,422 adult patients with T1D who were on insulin alone.  It is important to note that the rates of new diabetic complications in one year for both groups were around 1%, indicating that these are uncommon outcomes regardless of medication use. https://www.epicresearch.org/articles/some-diabetic-complications-less-likely-among-type-1-diabetics-on-glp-1s   XX Early research here but exposure to antibiotics during a key developmental window in infancy may stunt the growth of insulin-producing cells in the pancreas and boost risk of diabetes later in life The study, is published this month in the journal Science, it's a study in mice. These researchers are working off the idea that when while identical twins share DNA that predisposes them to Type 1 diabetes, only one twin usually gets the disease. She explained that human babies are born with a small amount of pancreatic “beta cells,” the only cells in the body that produce insulin.   But some time in a baby's first year, a once-in-a-lifetime surge in beta cell growth occurs.   “If, for whatever reason, we don't undergo this event of expansion and proliferation, that can be a cause of diabetes,” Hill said.   They found that when they gave broad-spectrum antibiotics to mice during a specific window (the human equivalent of about 7 to 12 months of life), the mice developed fewer insulin producing cells, higher blood sugar levels, lower insulin levels and generally worse metabolic function in adulthood.   in other experiments, the scientists gave specific microbes to mice, and found that several they increased their production of beta cells and boosted insulin levels in the blood. When male mice that were genetically predisposed to Type 1 diabetes were colonized with the fungus in infancy, they developed diabetes less than 15% of the time. Males that didn't receive the fungus got diabetes 90% of the time. Even more promising, when researchers gave the fungus to adult mice whose insulin-producing cells had been killed off, those cells regenerated. Hill stresses that she is not “anti-antibiotics.” But she does imagine a day when doctors could give microbe-based drugs or supplements alongside antibiotics to replace the metabolism-supporting bugs they inadvertently kill.   .   “Historically we have interpreted germs as something we want to avoid, but we probably have way more beneficial microbes than pathogens,” she said. “By harnessing their power, we can do a lot to benefit human health.”     https://www.eurekalert.org/news-releases/1078112 XX Future watch for something called BeaGL - created by researchers at the University of California Davis and UC Davis Health who were inspired by their own personal experiences with managing T1D.   BeaGL is designed to work with CGMs and has security-focused machine learning algorithms to make predictive alerts about anticipated glucose changes, which are sent to a device. In this case, a smartwatch. The end goal is for BeaGL to be completely automated to reduce the cognitive load on the patient, particularly for teens. It's still in research phase but six student with T1D have been using it for almost a year.     https://health.ucdavis.edu/news/headlines/with-ai-a-new-metabolic-watchdog-takes-diabetes-care-from-burden-to-balance/2025/02 XX Investigators are searching for a way forward after two long-term diabetes programs were terminated following the cancellation of their National Institutes of Health (NIH) funding, the result of federal allegations that study coordinator Columbia University had inappropriately handled antisemitism on campus. The programs include the three-decades-old Diabetes Prevention Program (DPP) and its offshoot, the Diabetes Prevention Program Outcomes Study (DPPOS). “We are reeling,” said David Nathan, MD, a previous chair of both the DPP and the DPPOS and an original leader of the landmark Diabetes Control and Complications Trial. Nathan is also founder of the Massachusetts General Hospital Diabetes Center in Boston, one of the 30 DPPOS sites in 21 states. On March 7, the Trump administration cancelled $400 million in awards to Columbia University from various federal agencies. While Columbia University agreed on March 21 to changes in policies and procedures to respond to the Trump administration's charges, in the hopes that the funding would be restored, DPPOS Principal Investigator Jose Luchsinger, MD, told Medscape Medical News that as of press time, the study was still cancelled. https://www.medscape.com/viewarticle/diabetes-prevention-program-cancellation-colossal-waste-2025a100076h XX XX Type 2 diabetes may quietly alter the brain in ways that mimic early Alzheimer's. This was only an animal study – but researchers say the high comorbidity of type 2 diabetes (T2D) with psychiatric or neurodegenerative disorders points to a need for understanding what links these diseases.   https://scitechdaily.com/how-diabetes-quietly-rewires-the-brains-reward-and-memory-system/ XX Eating chili once a month when you're pregnant seems to lower the risk of developing gestational diabetes. This is a real study! While chili showed a link to lower gestational diabetes risk, dried beans and bean soup had no significant effect, even among women who ate them more frequently. Some studies suggest that diets high in beans and legumes, including the Mediterranean diet, reduce GDM risk. While studies link beans to lower diabetes risk, their specific impact on GDM remains unclear. This study analyzed data from 1,397 U.S. pregnant women who participated in the Infant Feeding Practices Study II, conducted between 2005 and 2007. Chili consumption varied significantly by race, education, household size, income, supplemental nutrition status, and region. Non-Hispanic Black mothers consumed the most (0.33 cups/week), while those with higher income and education levels consumed less. Regional differences also influenced chili intake. One possible mechanism for chili's effect is capsaicin, a bioactive compound found in chili peppers, which has been linked to metabolic benefits in other studies. However, further research is needed to confirm this potential role in GDM prevention. Dried bean and bean soup consumption had no clear association with GDM. The study highlights limitations due to self-reported dietary data and the need for more detailed dietary measures. https://www.news-medical.net/news/20250317/Could-a-little-spice-in-your-diet-prevent-gestational-diabetes.aspx XX

One in five women in the U.S. have a BMI of 30 or more at the START of pregnancy. Around 1 in 5 women gain more than 40 pounds during pregnancy, which is more than any woman should gain. Only about one-third of women gain the recommended amount of weight during pregnancy. Gaining too much weight during pregnancy can increase the risk of HDP, GDM, fetal macrosomia, and can cause complications of birth, such as shoulder dystocia or preterm birth. Excessive weight gain during pregnancy can also increase the likelihood of postpartum weight retention. But what about stillbirth risk? Does excessive maternal weight gain during pregnancy increase still birth risk? The ACOG recommends antepartum fetal surveillance based on pre-pregnancy BMI. Why is maternal weight during pregnancy not an indication for an antepartum fetal surveillance? The data may surprise you! Listen in for details.

Understanding Gestational Diabetes – Risks, Complications & Treatment In this episode of MamaDoc BabyDoc, we dive into gestational diabetes—a condition that affects nearly 10% of pregnancies. Join our OB/Gyn and pediatrician duo as we break down the risk factors, potential complications for both mom and baby, and the best strategies for managing blood sugar during pregnancy. We'll also discuss how gestational diabetes can impact long-term health and what steps you can take to ensure a healthy pregnancy and delivery. Whether you're currently expecting, planning for pregnancy, or just curious about the topic, this episode is packed with essential information every parent should know!

(We were made aware that this original posting had the last section DROPPED accidentally)...here is the full episode! Ahhh...TECHNOLOGY! *This is why AI will likely replace our production team...Just kidding production team, just kidding).Episode Details:Well, we typically focus on ONE or maybe TWO publications to highlight and review. However, in this episode, which we have decided to call, “Survey said…!”, we will go through some common and REAL WORLD “mental battles”regarding what is and what is not part of a diagnostic criteria. These are every day OBGYN things that we KNOW, but when asked to define them…we can easily get ourselves confused. We are going to clear these up…Game Show style!  First, when only one abnormal value is found in the two-step, 100-gram GTT,  it is called borderline GDM, or impaired glucose tolerance. But what is it called when there is an abnormal (failed) 1-Hour 50 gram, but completely normal 3-Hr 100-gram GTT? Is this also called “impaired glucose tolerance”? We….the Survey Said…! (Yep, we'll get to that). Secondly, does the criteria for Preeclampsia with Severe Criteria include platelets of 100,000 or not? The Survey Said…! (Yep, we'll cover that). We will also review the numbers for MVP oligo, for a “normal” postmenopausal ES, and MORE! Listen in for details!

Well, we typically focus on ONE or maybe TWO publications to highlight and review. However, in this episode, which we have decided to call, “Survey said…!”, we will go through some common and REAL WORLD “mental battles” regarding what is and what is not part of a diagnostic criteria. These are every day OBGYN things that we KNOW, but when asked to define them…we can easily get ourselves confused. We are going to clear these up…Game Show style! First, when only one abnormal value is found in the two-step, 100-gram GTT, it is called borderline GDM, or impaired glucose tolerance. But what is it called when there is an abnormal (failed) 1-Hour 50 gram, but completely normal 3-Hr 100-gram GTT? Is this also called “impaired glucose tolerance”? We….the Survey Said…! (Yep, we'll get to that). Secondly, does the criteria for Preeclampsia with Severe Criteria include platelets of 100,000 or not? The Survey Said…! (Yep, we'll cover that). We will also review the numbers for MVP oligo, for a “normal” postmenopausal ES, and MORE! Listen in for details!

Primer programa de este año 2025, traemos bastante polémica esta vez. Arrancamos con una polémica por un juego ilustrado parcialmente por la IA, nos mojamos en el asunto. Devir ha comprado Maldito Games, sin duda la noticia del último mes, os damos nuestra opinión al respecto. ¿Alguna vez has discutido fuertemente con un amigo jugando a un juego de mesa? Para terminar, reseña de uno de los mejores juegos del 2024, Shackleton Base, del cual hemos hecho un tutorial de como jugar. SUMARIO: 00:00:32 Regalos de navidad y con que hemos arrancado jugando 00:20:33 Átomo compra GDM y Devir compra Maldito Games 00:37:40 Ilustraciones IA en los juegos de mesa 01:01:31 Discusiones en los juegos de mesa 01:08:01 Reseña Shackleton Base a Journey to the moon Podéis seguirnos en todas las redes y escucharnos a través de: https://linktr.ee/Jugando.con.da2 Tutorial Shackleton Base: https://youtu.be/9MOpuadIOcA?si=5ZxMpXAA4Mu9ftqn

In this episode, we will cover 2 topics: the first is brand new in print (01/06/2025 ), and the second is just weird. In the “new” portion we'll summarize a new randomized study published in JAMA Network dealing with gestational diabetes. Should we add glyburide to metformin for GDM control? Listen in for details. In the second portion, we'll focus on unilateral ovarian absence not related to previous removal. Yep! This is why it's very important to check the adnexa at “routine” C-section or “routine” gynecological surgery. It is possible to be missing an ovary…and its weird! Listen in for details!

In this episode, we sit down with Tom Hopcroft, the British entrepreneur and founder of Guiris de Mierda, a vibrant community bringing expats and locals together in Madrid. Tom shares his journey from the UK's corporate grind to creating a network that fosters authentic connections, unforgettable events, and a sense of belonging.We dive into what it means to be a "guiri," the challenges of building a community-based business abroad, and how Tom's adventures—like walking the Camino de Santiago and skateboarding across Spain—have shaped his approach to life and work.From navigating cultural differences to crafting viral content, building brand partnerships, and scaling GDM to other cities, this episode is packed with insights for anyone curious about expat life, entrepreneurship, or the art of growing a mission-driven brand.Tune in for a lively conversation about community, culture, and making it work abroad------Timestamps:02:16 What is a Guiri?05:57 GDM Events, Investing in Spain, More than "Siesta y Fiesta"09:55 Journey from Merch to Content to the 1st Meet-up17:07 Why the Name "Guiris de Mierda"?17:59 When Did You Realize This Was a Business?21:24 Golden Guiris and the Subscription Model25:31 Learning From Other Communities27:43 Viral Content to Booked Events Flywheel28:32 Finding Your Niche31:39 Skateboarding Across Spain33:42 Content Strategy (Personal v Business Brand)37:40 Hosting and Organizing Live Events40:03 Getting Sponsorships and Partnerships44:51 GDM Expanding to Barcelona (1st Event)46:00 Content Creation Workshop49:42 Questions From the Audience56:18 Rapid Fire Questions------Follow Tom:https://www.instagram.com/tomcharliedesignFollow Guiris de Mierda:https://www.instagram.com/guirisdemierdahttps://linktr.ee/tomcharliedesignWatch Tom's Backstory:https://www.youtube.com/watch?v=1BOfWd4lts4

In this episode, Trista explores the complexities of managing pregnancy with PCOS, focusing on dietary considerations, the safety of medications and supplements, and the importance of mental health during the postpartum period. She emphasizes the need for careful monitoring of blood sugar levels, the role of insulin and metformin, and the significance of support systems for new parents. You'll learn: Why managing glycemic load is crucial for pregnant individuals with PCOS Safe and effective treatments for gestational diabetes How postpartum mental health is a significant concern for new parents Navigating potential chest feeding challenges for those with PCOS Episode Links: How to Manage Gestational Diabetes with Diet and Lifestyle 1-on-1 Nutrition Coaching References: Choudhury, A. A., & Rajeswari, V. D. (2022). Polycystic ovary syndrome (PCOS) increases the risk of subsequent gestational diabetes mellitus (GDM): A novel therapeutic perspective. Life Sciences (1973), 310, 121069–121069. https://doi.org/10.1016/j.lfs.2022.121069 Diabetes Canada. (2024). Gestational diabetes. https://www.diabetes.ca/about-diabetes/gestational Facchinetti, F., Cavalli, P., Copp, A. J., D'Anna, R., Kandaraki, E., Greene, N. D. E., & Unfer, V. (2020). An update on the use of inositols in preventing gestational diabetes mellitus (GDM) and neural tube defects (NTDs). Expert Opinion on Drug Metabolism & Toxicology, 16(12), 1187–1198. https://doi.org/10.1080/17425255.2020.1828344 Ibrahim, I., Bashir, M., Singh, P., Al Khodor, S., & Abdullahi, H. (2022). The Impact of Nutritional Supplementation During Pregnancy on the Incidence of Gestational Diabetes and Glycaemia Control. Frontiers in Nutrition (Lausanne), 9, 867099–867099. https://doi.org/10.3389/fnut.2022.867099 Jorquera, G., Echiburú, B., Crisosto, N., Sotomayor-Zárate, R., Maliqueo, M., & Cruz, G. (2020). Metformin during Pregnancy: Effects on Offspring Development and Metabolic Function. Frontiers in Pharmacology, 11, 653–653. https://doi.org/10.3389/fphar.2020.00653 Koric, A., Singh, B., VanDerslice, J. A., Stanford, J. B., Rogers, C. R., Egan, D. T., Agyemang, D. O., & Schliep, K. (2021). Polycystic ovary syndrome and postpartum depression symptoms: a population-based cohort study. American Journal of Obstetrics and Gynecology, 224(6), 591.e1-591.e12. https://doi.org/10.1016/j.ajog.2020.12.1215 Ryssdal, M., Vanky, E., Stokkeland, L. M. T., Jarmund, A. H., Steinkjer, B., Løvvik, T. S., Madssen, T. S., Iversen, A.-C., & Giskeødegård, G. F. (2023). Immunomodulatory Effects of Metformin Treatment in Pregnant Women With PCOS. The Journal of Clinical Endocrinology and Metabolism, 108(9), e743–e753. https://doi.org/10.1210/clinem/dgad145 Slouha, E., Alvarez, V. C., Gates, K. M., Ankrah, N. M. N., Clunes, L. A., & Kollias, T. F. (2023). Gestational Diabetes Mellitus in the Setting of Polycystic Ovarian Syndrome: A Systematic Review. Curēus (Palo Alto, CA), 15(12), e50725–e50725. https://doi.org/10.7759/cureus.50725 Vanky, E., Isaksen, H., Haase Moen, M., & Carlsen, S. M. (2008). Breastfeeding in polycystic ovary syndrome. Acta Obstetricia et Gynecologica Scandinavica, 87(5), 531–535. https://doi.org/10.1080/00016340802007676

El juego en cuestión es “Not Alone, de la editorial GdM: https://gdmgames.com/catalog/notalone/Te dejo enlazados otros episodios de Al Daily en los que he hablado de juegos de mesa:- 11 ¿A qué juegos de mesa he jugado más en el primer trimestre de 2024? https://podcasters.spotify.com/pod/show/al-daily-podcast/episodes/11---A-qu-juegos-de-mesa-he-jugado-ms-en-el-primer-trimestre-de-2024-e2ie5gq/a-ab605n1- 32 ¿Qué juego de mesa he probado este fin de semana? https://podcasters.spotify.com/pod/show/al-daily-podcast/episodes/32---Qu-juego-de-mesa-he-probado-este-fin-de-semana-e2jmphm/a-ab953tp- 48 ¿Qué juegos de mesa tengo por estrenar? https://podcasters.spotify.com/pod/show/al-daily-podcast/episodes/48---Qu-juegos-de-mesa-tengo-an-por-estrenar-e2kj4tu/a-abb9aqq- 55 ¿Qué juegos de mesa me llevo a la piscina o a la playa? https://podcasters.spotify.com/pod/show/al-daily-podcast/episodes/55---Qu-juegos-de-mesa-me-llevo-a-la-pisci-o-la-playa-e2kvrn2/a-abc6ol6- 72 ¿Cuáles son mis juegos de mesa para partidas entre 2? https://podcasters.spotify.com/pod/show/al-daily-podcast/episodes/72---Cules-son-mis-juegos-de-mesa-para-partidas-entre-2-e2ls63v/a-abe41g7- 102 ¿Qué juegos me encanta para jugar en equipo? https://podcasters.spotify.com/pod/show/al-daily-podcast/episodes/102---Qu-juegos-me-encantan-para-jugar-en-equipo-e2o7ull/a-abh5v66- 111 ¿A qué dos juegos me he enganchado este fin de semana? https://podcasters.spotify.com/pod/show/al-daily-podcast/episodes/111---A-qu-dos-juegos-de-mesa-me-he-enganchado-este-fin-de-semana-e2ooqr2/a-abhtiukDime qué te ha parecido este capitulo y deja un comentario en ivoox o Spotify.Si lo prefieres, envíame un correo electrónico a la dirección de gmail almadailypodcast. En redes soy @almajefi y me encuentras en X / Twitter, Bluesky, Threads, Instagram y Telegram.

In this episode Karen explores with Lily Nicoles the importance of good nutrition for Pregnancy. They discuss not only what good nutrition  and "Real Food" means but ways in which pregnant women and people ensure they are eating well for themselves and their babies. Karen and Lily also talk about gestational diabetes (GDM) and ways in which those who are diagnosed with GDM can use their diet to help reduce the impact of a GDM diagnosis. Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based nutrition. Her work is known for being research-focused, thorough, and sensible. She is the founder of the Institute for Prenatal Nutrition®, co-founder of the Women's Health Nutrition Academy, and the author of three books: Real Food for Fertility (co-authored with Lisa Hendrickson-Jack), Real Food for Pregnancy, and Real Food for Gestational Diabetes. Lily's bestselling books have helped tens of thousands of mamas (and babies!), are used in university-level maternal nutrition and midwifery courses, and have even influenced prenatal nutrition policy internationally. She writes at https://lilynicholsrdn.com. When she steps away from writing, you can find her spending time with her husband and two children — most likely outside or in the kitchen.

Det er stenhårdt arbejde at være gravid med diabetes. Hvert år gennemfører ca. 2400 kvinder en graviditet, samtidig med at de har diabetes. Nogle af dem har type 1 eller type 2-diabetes med sig ind i graviditeten, og andre udvikler en særlig form for diabetes i graviditeten, også kaldet graviditetsdiabetes (GDM). Sammen med professor og overlæge Elisabeth R. Mathiesen, der til daglig er tillnyttet Center for Gravide med Diabetes på Rigshospitalet, bliver vi her klogere på, hvordan det er være gravid med diabetes. Hvad er det for komplikationer og risici, man er opmærksom på? Hvilket graviditetsforløb kan man forvente? Hvad er behandlingsforløbet, og hvad skal man selv være opmærksom på før, under og efter graviditeten?

In November's Green Journal, Drs Amy Valent and Linda Barbour will publish their Clinical Expert Series (CES) on insulin management in GDM and Type 2 DM in pregnancy. This is a FANTASTIC document and is our subject matter in this episode. Here, we will give clinical pearls for insulin initiation in pregnancy based on 3 regimens (NPH/Reg; NPH/RAAs; Basal-Bolus) and their initiation in an easy to follow format. Congratulations to Drs Valent and Barbour on a wonderful CES.

On May 22, 2024, we summarized a then soon-to-be-released ACOG CPU on Screening for GDM in Pregnancy and Postpartum. That CPU was officially released July 2024. That update endorsed the possibility of immediate postpartum GTT testing with a 75-gram OGTT. Now, on September 19, 2024, authors from UT Houston have published a systematic review/meta-analysis on this subject. In this episode, we will review what this data is and what it isn't. Listen in for details.

GDM 773 - This episode features a mix from Kaeno. For more, check out www.facebook.com/kaeno.music & @kaeno. Global Dance Mission 773 (Soundcloud & Mixcloud) features Kaeno in the mix! Kaeno is back with an exclusive set designed to ignite your senses. Enjoy an epic, energetic journey with tracks from a variety of top producers! Time to dance… Kaeno is your guide… peace, love, beats… KEEP THE VIBE ALIVE! Tracklist ---- 01. John O'Callaghan – Space & Time (Indecent Noise Lifestream Edit) 02. Paul Webster – Corruption (Original Mix) 03. Tillmann Uhrmacher – The Pride In Your Eyes (Martin Roth Remix) 04. Lustral – I Feel You (John O'callaghan Remix) 05. Igor S – Airforce One (Will Rees Extended Remix) 06. Joyhauser – PULSAR (Original Mix) 07. David Forbes – 12K.MCG (Original Mix) 08. Mark Sherry – Imbecile (Smith & Brown Remix) 09. Mario Piu – Mario Piu – Communication (Indecent Noise Remix) 10. Gigi Dagostino – Bla Bla Bla (Black XS Bootleg) 11. Will Atkinson – Beans (Extended Mix) 12. David Forbes – Randomize 13. Blue Serigala – Come Closer (Will Rees Remix) 14. I.D. 15. Bryan Kearney & Plumb – All Over Again (Karney Dark Dub Extended Mix) 16. Bicep – Glue (Karney Belfast Bootleg) 17. Push – Strange World (2000 Remake) 18. M.I.K.E. Push – Liquid Overdose – Ancient Space (Fred Baker Remix) 19. Mark Sixma, Orjan Nilsen & Push – Urban Shakedown (nilsix Remix) (Extended Mix) 20. Joint Operations Centre – Timelapse (Sean Tyas pres. abstrkt Extended Remix) 21. Calvin Logue – Do What You Want (Robbie Graham Rework) 22. Robbie Seed & Jimmy Chou & Digital Vision – No More Tears (Extended Mix) 23. onTune – Panaceum (Extended Mix) 24. T78 & D72 – Throw This (Extended Mix) 25. Joseph James (IRL) – Darkness (Original Mix) 26. John Meva – Dream & Fly (Extended Mix) 27. Sam Paganini – Rave (Adam Beyer & Layton Giordani Remix) (Connor Woodford Rework) 28. Thomas Schumacher – When I Rock (A.D.H.S. Remix) 29. Inoblivion – When Darkness Falls (Extended Mix) 30. John Askew – Afterburner (Extended Mix) 31. DK8 – Murder Was The Bass (Robbie Van Doe's Tripping Balls Rework) 32. Adam Ellis & Sid Jay – The Last Stylebender (Extended Mix) 33. Derek Ryan – Escape (Extended Mix)

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: How the AI safety technical landscape has changed in the last year, according to some practitioners, published by tlevin on July 26, 2024 on LessWrong. I asked the Constellation Slack channel how the technical AIS landscape has changed since I last spent substantial time in the Bay Area (September 2023), and I figured it would be useful to post this (with the permission of the contributors to either post with or without attribution). Curious if commenters agree or would propose additional changes! This conversation has been lightly edited to preserve anonymity. Me: One reason I wanted to spend a few weeks in Constellation was to sort of absorb-through-osmosis how the technical AI safety landscape has evolved since I last spent substantial time here in September 2023, but it seems more productive to just ask here "how has the technical AIS landscape evolved since September 2023?" and then have conversations armed with that knowledge. The flavor of this question is like, what are the technical directions and strategies people are most excited about, do we understand any major strategic considerations differently, etc -- interested both in your own updates and your perceptions of how the consensus has changed! Zach Stein-Perlman: Control is on the rise Anonymous 1: There are much better "model organisms" of various kinds of misalignment, e.g. the stuff Anthropic has published, some unpublished Redwood work, and many other things Neel Nanda: Sparse Autoencoders are now a really big deal in mech interp and where a lot of the top teams are focused, and I think are very promising, but have yet to conclusively prove themselves at beating baselines in a fair fight on a real world task Neel Nanda: Dangerous capability evals are now a major focus of labs, governments and other researchers, and there's clearer ways that technical work can directly feed into governance (I think this was happening somewhat pre September, but feels much more prominent now) Anonymous 2: Lots of people (particularly at labs/AISIs) are working on adversarial robustness against jailbreaks, in part because of RSP commitments/commercial motivations. I think there's more of this than there was in September. Anonymous 1: Anthropic and GDM are both making IMO very sincere and reasonable efforts to plan for how they'll make safety cases for powerful AI. Anonymous 1: In general, there's substantially more discussion of safety cases Anonymous 2: Since September, a bunch of many-author scalable oversight papers have been published, e.g. this, this, this. I haven't been following this work closely enough to have a sense of what update one should make from this, and I've heard rumors of unsuccessful scalable oversight experiments that never saw the light of day, which further muddies things Anonymous 3: My impression is that infosec flavoured things are a top ~3 priority area a few more people in Constellation than last year (maybe twice as many people as last year??). Building cyberevals and practically securing model weights at frontier labs seem to be the main project areas people are excited about (followed by various kinds of threat modelling and security standards). Thanks for listening. To help us out with The Nonlinear Library or to learn more, please visit nonlinear.org

Join Dr. Renda Knapp and Dr. Rachel Schultz as they review the routine prenatal tests that are offered in pregnancy.  In this episode they specifically address NIPT, the screen for gestational diabetes and GBS testing and why these tests are important. 

We know research is crucial for making continued advances in diabetes care for all populations. Rachel Stahl-Salzman, MS, RD, CDN, CDCES, and Kerri Knippen, PhD, RDN, LD, BC-ADM, FAND, join us on The Huddle to talk about their latest research projects related to pregnancy in diabetes, some of the outcomes and learnings of each study, and how diabetes care and education specialists can be leaders in this work, even without a research background.View Rachel's research poster diving deeper into this topic here: Annual QIPS Symposium | Weill Department of Medicine (cornell.edu)Learn more about Kerri's project here: https://www.eeds.com/enduring_material.aspx?AIN=005243415&SIN=230144&Display_Portal_Nav=true https://bsmh.zoom.us/rec/play/dNYY9PJAVNjh_wJCglFQuYOU9GYRTC4JYP1xEr3eqd5037qGu1kvWbgs0Mw35SdAhBtm-W66tyZCnDv8.FBeiYIeEMAKXck4F?canPlayFromShare=true&from=share_recording_detail&startTime=1713455116000&componentName=rec-play&originRequestUrl=https%3A%2F%2Fbsmh.zoom.us%2Frec%2Fshare%2F6jgesPiUBq5EIbX8P7K0pzRJ4yKEb-HPxmBMMhqUZxbBBqREek8OvlNR7vh3aQR2.hQwbtfqHOQ8tp3uF%3FstartTime%3D1713455116000Join the poster presentations at #ADCES24 to learn even more about Kerri and Rachel's work! Learn more and register for the conference here: ADCES24 (adcesmeeting.org)Learn more about the ADCES Foundation here: ADCES Foundation Listen to more episodes of The Huddle at adces.org/perspectives/the-huddle-podcast.Learn more about ADCES and the many benefits of membership at adces.org/join.

Kristian is back with the GDM guys to cover more of the upcoming book. They take a deep dive into the rogue changes, wizard changes, and a small contingent of spells that have been shown.

The GDM guys and their 2 guests have a long conversation about the upcoming players handbook for Dungeons and Dragons. While they don't dive to deeply into the classes as of yet there is still an incredible amount of information to cover.

This conversation is all about gestational diabetes with a Registered Dietitian who specializes in the condition -- Leslee Flannery, RD. Listen in to hear: What is gestational diabetes? What causes gestational diabetes / risk factors How can we prevent gestational diabetes Rate of type 2 diabetes AFTER gestational diabetes Risks of gestational diabetes to mom and babyDo you have to be induced early if you have GDM? Best ways to manage blood sugars with OR without gestational DMDiet & other habits Medications - are they needed? What are the options - pros & cons Relationship with food during pregnancy How to handle GDM diagnosis with a history of disordered eatingWhat to do postpartum after a gestational DM diagnosis – screenings, etc. Nutrition tips for postpartum And more! CONNECT WITH LESLEE: Follow her on IG: @gestational.diabetes.nutritionSupport Group / Resources: click here Affiliate Links: Expecting and Empowered – workout app for pregnancy and postpartum – use my code WELLNESSFORTHEWIN to save on your annual app subscription FullWell Fertility – supplements for before, during and after pregnancy (I love their prenatals and fish oil supps and they have lots of others, too!) -- affiliate code WELLNESSFORTHEWINTubby Todd – bath soaps, shampoos, mineral sunscreen, diaper cream and so much more for your little ones! Use my affiliate link for 10% off – click here  Follow me on IG at @wellnessforthewin and @wellnessforthewinpod Check out my blog for healthy recipes & wellness tips! JOIN MY EMAIL LIST HERE! Please be sure to rate, review and subscribe to the podcast!

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: Superposition is not "just" neuron polysemanticity, published by Lawrence Chan on April 26, 2024 on The AI Alignment Forum. TL;DR: In this post, I distinguish between two related concepts in neural network interpretability: polysemanticity and superposition. Neuron polysemanticity is the observed phenomena that many neurons seem to fire (have large, positive activations) on multiple unrelated concepts. Superposition is a specific explanation for neuron (or attention head) polysemanticity, where a neural network represents more sparse features than there are neurons (or number of/dimension of attention heads) in near-orthogonal directions. I provide three ways neurons/attention heads can be polysemantic without superposition: non--neuron aligned orthogonal features, non-linear feature representations, and compositional representation without features. I conclude by listing a few reasons why it might be important to distinguish the two concepts. Epistemic status: I wrote this "quickly" in about 12 hours, as otherwise it wouldn't have come out at all. Think of it as a (failed) experiment in writing brief and unpolished research notes, along the lines of GDM or Anthropic Interp Updates. Introduction Meaningfully interpreting neural networks involves decomposing them into smaller interpretable components. For example, we might hope to look at each neuron or attention head, explain what that component is doing, and then compose our understanding of individual components into a mechanistic understanding of the model's behavior as a whole. It would be very convenient if the natural subunits of neural networks - neurons and attention heads - are monosemantic - that is, each component corresponds to "a single concept". Unfortunately, by default, both neurons and attention heads seem to be polysemantic: many of them seemingly correspond to multiple unrelated concepts. For example, out of 307k neurons in GPT-2, GPT-4 was able to generate short explanations that captured over >50% variance for only 5203 neurons, and a quick glance at OpenAI microscope reveals many examples of neurons in vision models that fire on unrelated clusters such as "poetry" and "dice". One explanation for polysemanticity is the superposition hypothesis: polysemanticity occurs because models are (approximately) linearly representing more features[1] than their activation space has dimensions (i.e. place features in superposition). Since there are more features than neurons, it immediately follows that some neurons must correspond to more than one feature.[2] It's worth noting that most written resources on superposition clearly distinguish between the two terms. For example, in the seminal Toy Model of Superposition,[3] Elhage et al write: Why are we interested in toy models? We believe they are useful proxies for studying the superposition we suspect might exist in real neural networks. But how can we know if they're actually a useful toy model? Our best validation is whether their predictions are consistent with empirical observations regarding polysemanticity. ( Source) Similarly, Neel Nanda's mech interp glossary explicitly notes that the two concepts are distinct: Subtlety: Neuron superposition implies polysemanticity (since there are more features than neurons), but not the other way round. There could be an interpretable basis of features, just not the standard basis - this creates polysemanticity but not superposition. ( Source) However, I've noticed empirically that many researchers and grantmakers identify the two concepts, which often causes communication issues or even confused research proposals. Consequently, this post tries to more clearly point at the distinction and explain why it might matter. I start by discussing the two terms in more detail, give a few examples of why you might have po...

Globally 8th March is marked as the “International Women's Day”, while in India 10th March is being recognized as National “Gestational Diabetes Mellitus (GDM) Awareness day” on the occasion of birthday of Dr. V. Seshiah (Padmashri), who has done the pioneering work in the field of pregnancy diabetes in our country. High blood glucose in mother during pregnancy enters into foetal circulation which stimulates beta cells of foetus to secret insulin, causing hyperinsulinemia in the developing foetus. This increases the risk of developing non-communicable diseases like diabetes, obesity, hypertension & heart disease in their adolescent & adult life. Early detection & intense treatment of high glucose of pregnancy can save these children from developing diabetes in future, which is termed as “Primordial Prevention”. Thus every pregnant woman should be screened for diabetes at the first antenatal visit. Also, 50% of GDM women develop frank diabetes in 1-5 years after delivery. So, after delivery every GDM women should screen herself for diabetes after 6 weeks, 6 months and then annually to avoid future complications. “If you educate a man, you educate a man but if you educate a woman, you educate the generations,” said Dr. Gupta, on this occasion, while emphasizing upon the mission education of hello diabetes. Recorded on 8th March 2024.

Since the late 1990s, the standard practice for GDM care has been to measure postprandial glucose values. For patients with pre-gestational diabetes, whether type I or type II, the ACOG recommends multi-level glucose checks (fasting, pre-meal , postprandial, and nighttime). But what about in the immediate postpartum interval? In patient's with pre-existing diabetes, should blood sugars be checked pre-meal (qAC) or postprandial while still in the hospital, and after discharge? The topic for this episode comes from one of our podcast family members who had this clinical dilemma? In this episode, we will review the data and recommendations from the American Diabetes Association, the ACOG, and CDC. So grab your sugar-free drink of choice, and listen in!

Everyone is aware of Type 1 DM (Insulin dependent diabetes, seen commonly in children) & Type 2 DM (usually seen in adults & majority are controlled on oral drugs & Lifestyle Modification ). Gestational Diabetes Mellitus (GDM) is a kind of diabetes, which appears in the 2nd or 3rd trimester of pregnancy and disappears after delivery. GDM occurs when the woman's beta cells are not able to overcome the antagonism created by the anti-insulin placental hormones of pregnancy. Which causes increase in the blood glucose during pregnancy. Women with a history of GDM are at increased risk of future diabetes; predominately type 2 diabetes, as are their children. Almost every 5th or 6th pregnancy women in India, may have GDM. Diabetes In Pregnancy Study Group of India (DIPSI) recommends fasting or non-fasting Oral Glucose Tolerance Challenge Test with 75g of glucose with a cut-off of ≥ 140 mg/dl after 2-hours, Every pregnant woman should be screened for glucose intolerance in the first trimester itself. If found negative, the screening test is to be performed again at 24th – 28 th week and finally around 32 nd – 34 th week. Once diagnosis is made, Medical Nutritional Therapy (MNT) is advised initially for two weeks. If MNT fails to achieve control i.e., FPG ≥ 90mg/dl and/or 2 hr PPG ≥120mg/dl, oral drugs or insulin may be initiated. Recorded on 28th January 2022.

Welcome to episode 27! In this weeks episode, Nathalie shares her journey to finding homebirth, after having a very negative experience in the hospital system, further complicated by the label of gestational diabetes. Nathalie thought that she could navigate the system with her GDM diagnosis, however over half way through her 2nd pregnancy, her doula suggested finding a homebirth private midwife to support her, and from there she discovered homebirth. We also reflect on how her anxiety was used against her, and how it impacted her pregnancy and birth experiences, and we also discuss post partum. Links to people/business/resources for this episode:Newcastle and surrounds homebirth community FB group https://www.facebook.com/groups/newcastlehomebirthcommunity/The Midwives Cauldron Podcast - Gestational Diabetes https://themidwivescauldron.buzzsprout.com/1178486/8857485-gestational-diabetes-the-baby-s-perspectiveLily Nichols Nutrition in Pregnancy https://lilynicholsrdn.com/Post partum pre-eclampsia https://www.mountsinai.org/health-library/diseases-conditions/preeclampsiaEvidence on benefits of a doula/birth support https://evidencebasedbirth.com/the-evidence-for-doulas/Anxiety in pregnancy https://panda.org.au/articles/getting-help-support-during-pregnancy/?gad_source=1&gclid=CjwKCAiA0bWvBhBjEiwAtEsoW_ey_QGj7lZvmGDaPeuNLqv5OMBeKQHA1j36NtnTEJem2XJNfsveOxoCNh4QAvD_BwEWhite Coat Syndrome https://my.clevelandclinic.org/health/diseases/23989-white-coat-syndromeKinesiology in pregnancy https://www.essentialme.com.au/blog/2019/11/02/how-kinesiology-can-help-you-conception-and-beyondReclaiming birth as a rite of passage by Dr Rachel Reed https://www.rachelreed.website/rcrpBirth Skills by Juju Sundin https://woomwomen.com.au/products/birth-skills-bookJane Hardwick Collins https://janehardwickecollings.com/Meal Train Post Partum Food Delivery https://www.mealtrain.com/CHAPTERS00:53Natalie's Hospital Birth Journey06:32Learning About Home Birth08:28Natalie's First Pregnancy and Hospital Birth09:27Disjointed Care and Gestational Diabetes Diagnosis12:14Exploring Home Birth as an Option16:30Navigating the Hospital Pathway25:35Reflecting on the Birth Experience28:26Pregnancy with Remy and Gestational Diabetes32:15Increased Nuchal Translucency and Anxiety35:41Considering Home Birth with a Private Midwife36:47Finding a Private Midwife39:10Mental Health Support during Pregnancy40:09Dealing with Gestational Diabetes42:57Pregnancy Challenges and Health Anxiety45:13Preparing for Birth with Education and Support48:29Going into Labor with Remy52:33Midwife Delay and Birth Pool55:50Birth Experience and Postpartum01:05:08Feeling Empowered and Postpartum ChallengesSupport the show

Gestational Diabetes (GDM) is vastly more prevalent in pregnancy compared to pre-existing diabetes. In 2009, the ACOG states that 7% of all pregnancies were complicated by a diabetes diagnosis, with 86% being GDM. The prevalence of GDM keeps rising in the US and globally. Metformin is increasingly prescribed in pregnancy, yet its long-term effect on the neurocognitive development of the offspring remains incompletely described. However, newly published data (March 6, 2024; AJOG) has changed that! In this episode, we will summarize and review a systematic review and meta-analysis of childhood neurodevelopmental outcomes after in utero exposure to metformin. Additionally, does some evidence suggest that metformin may be superior to insulin in pregnancy for perinatal outcomes? We will discuss all this and more, in this episode. This information will be helpful as we counsel and educate our patients on metformin use in pregnancy.

The “traditional“ Parkland management protocol for GDM included the immediate initiation of medical therapy for those with abnormal fasting blood sugar, in addition to another additional value, on the 3 hour GTT. These patients were automatically labeled as A2 GDM at time of diagnosis, rather than waiting the 1 to 2 weeks of nutritional/diet therapy. Does fasting hyperglycemia on the 100g GTT truly predict the need for subsequent medical therapy? In this episode, we will summarize new data on this subject from AJOG MFM published on February 17, 2024. Does immediate medical therapy after GDM diagnosis improve overall maternal/neonatal outcome? It's a complicated answer, and we will review it in this episode.

The ACOG has consistently recommended universal screening for gestational diabetes between 24 and 28 gestational weeks. Although controversial, the ACOG does endorse earlier screening for GDM in patients with additional risk factors. But what about patients who present for prenatal care after the 28th or 29th week? Should screening for GDM be done in the 3rd trimester? And if we do screen in the then, what is the reference range for “normal “or “abnormal”? Is it the same interpretation as when it is done between 24 and 28 weeks? Does 3rd trimester screening impact parental outcome? In this episode, we will examine the data and provide a recommendation of when testing for gestational diabetes in the 3rd trimester may have the most impact.

Episode 18 is from Jess in NSW who shares her homebirth after (traumatic) c-section (HBAC) story. An incredible story, with unfortunately a lot of drama, including problems getting a referral to a private midwife, issues around the GTT and GDM & then shockingly, after needing to transfer to hospital after Jacob was born, was treated horribly in hospital & was denied seeing or holding freshly newborn Jacob face-to-face for THREE days because of totally unaccetable reasoning surrounding Jess having COVID-19. Homebirth story begins approx 28:50Links to people/business/resources for this episode:Calmbirth https://calmbirth.com.au/Obstetric Violence & Sexual Assault in Maternity Care "Obstetric violence often focuses on labor and childbirth even when referring to maternity care, which includes pregnancy, given that these are moments in which women are particularly vulnerable to health care abuse and over-medicalization, or non-medically justified obstetric interventions, e.g., episiotomy and caesarean section. Other important components of obstetric violence are dehumanization and non-consensual care, as well as overall conversion of biological processes into pathological ones."https://journals.sagepub.com/doi/10.1177/10778012221140138https://www.westernsydney.edu.au/newscentre/news_centre/more_news_stories/study_finds_one-in-ten_australian_women_have_experienced_obstetric_violencePostnatal anxiety https://panda.org.au/articles/postnatal-anxiety-signs-and-symptoms/Birth Debrief with Core & Floor Restore https://coreandfloor.com.au/products/birth-debriefBirth Time Doco  https://www.birthtime.world/The Unbelievable Tactics of teh Formula Industry on The Midwives Cauldron https://open.spotify.com/episode/3BsQomw00EvZ5NWfYPTbEA?si=9258a8e558ec4e15CHAPTERS: 01:00Jess's traumatic first birth experience02:25Jess's home birth after caesarean story08:11Jess's experience with gestational diabetes14:49Jess's caesarean birth experience20:30Decision to have a home birth33:36Options for home birth43:36Difficulties with GP and referral45:28Care with private midwife48:17Preparing for birth and moving houses49:40Midwife's Holiday and Breach Position51:14Turning the Baby53:03Miscarriage and ECV56:14COVID Diagnosis58:08Collaborative Care and Home Preparation01:00:32Onset of Labor01:04:57Pushing and Birth01:09:40Baby's Breathing Difficulties01:13:00Separation and NICU01:21:39Postpartum and Frustrations01:28:17Reflection and Future Birth PlansSupport the show

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: What's up with LLMs representing XORs of arbitrary features?, published by Sam Marks on January 3, 2024 on The AI Alignment Forum. Thanks to Clément Dumas, Nikola Jurković, Nora Belrose, Arthur Conmy, and Oam Patel for feedback. In the comments of the post on Google Deepmind's CCS challenges paper, I expressed skepticism that some of the experimental results seemed possible. When addressing my concerns, Rohin Shah made some claims along the lines of "If an LLM linearly represents features a and b, then it will also linearly represent their XOR, ab, and this is true even in settings where there's no obvious reason the model would need to make use of the feature ab."[1] For reasons that I'll explain below, I thought this claim was absolutely bonkers, both in general and in the specific setting that the GDM paper was working in. So I ran some experiments to prove Rohin wrong. The result: Rohin was right and I was wrong. LLMs seem to compute and linearly represent XORs of features even when there's no obvious reason to do so. I think this is deeply weird and surprising. If something like this holds generally, I think this has importance far beyond the original question of "Is CCS useful?" In the rest of this post I'll: Articulate a claim I'll call "representation of arbitrary XORs (RAX)": LLMs compute and linearly represent XORs of arbitrary features, even when there's no reason to do so. Explain why it would be shocking if RAX is true. For example, without additional assumptions, RAX implies that linear probes should utterly fail to generalize across distributional shift, no matter how minor the distributional shift. (Empirically, linear probes often do generalize decently.) Present experiments showing that RAX seems to be true in every case that I've checked. Think through what RAX would mean for AI safety research: overall, probably a bad sign for interpretability work in general, and work that relies on using simple probes of model internals (e.g. ELK probes or coup probes) in particular. Make some guesses about what's really going on here. Overall, this has left me very confused: I've found myself simultaneously having (a) an argument that AB, (b) empirical evidence of A, and (c) empirical evidence of B. (Here A = RAX and B = other facts about LLM representations.) The RAX claim: LLMs linearly represent XORs of arbitrary features, even when there's no reason to do so To keep things simple, throughout this post, I'll say that a model linearly represents a binary feature f if there is a linear probe out of the model's latent space which is accurate for classifying f; in this case, I'll denote the corresponding direction as vf. This is not how I would typically use the terminology "linearly represents" - normally I would reserve the term for a stronger notion which, at minimum, requires the model to actually make use of the feature direction when performing cognition involving the feature[2]. But I'll intentionally abuse the terminology here because I don't think this distinction matters much for what I'll discuss. If a model linearly represents features a and b, then it automatically linearly represents ab and ab. However, ab is not automatically linearly represented - no linear probe in the figure above would be accurate for classifying ab. Thus, if the model wants to make use of the feature ab, then it needs to do something additional: allocate another direction[3] (more model capacity) to representing ab, and also perform the computation of ab so that it knows what value to store along this new direction. The representation of arbitrary XORs (RAX) claim, in its strongest form, asserts that whenever a LLM linearly represents features a and b, it will also linearly represent ab. Concretely, this might look something like: in layer 5, the model computes and linearly r...

We had a recording error around 4:45. Sorry about the issues. Cr'aig's fault. GDM Jay tells a tale of his Pathfinder 2E finale and finds a new stupid spell. GDM Christopher talks about knowing a guy and both the GDM guys talk about the upcoming holiday one shots.

Welcome to The Exit Plan, a podcast for business owners interested in learning more about selling their business. In this episode, Emmie Faust, a mother of four and a serial entrepreneur, takes us on her journey through various businesses and her experience in the world of entrepreneurship. From her early days in field marketing to venturing into the online gambling industry, Emmie's story is one of determination and innovation. Emmie shares how she founded Jack Media, a successful agency with about ten employees, and the pivotal moment when she decided to sell the business. Emmie also talks about the challenges of selling a business, including the absence of an earn-out and the decision to separate the management of Jack Media and GDM, a programmatic advertising venture that they launched. GDM's rapid growth and eventual acquisition are discussed, highlighting the complexities and opportunities that come with selling a business. Emmie shares her insights into the emotions and practicalities surrounding exits, emphasizing the role of luck and hard work. Emmie discusses her current venture, Female Founders Rise, a community and support network for female entrepreneurs. She discusses the challenges and triumphs of this endeavor, emphasizing the importance of accessibility and collaboration. Join Emmie Faust on her entrepreneurial journey, learn about her unconventional exits from Jack Media and GDM, and discover her commitment to supporting female entrepreneurs through Female Founders Rise.   WHAT YOU WILL LEARN: Emmie's early career on field marketing and transitioning into the online gambling industry The decision to sell Jack Media and the process of an informal merger with another agency. Balancing multiple businesses, including Jack Media and GDM, with her business partner. Emmie's experience of being pregnant during the sale and communicating this to buyers. The creation of GDM as a separate programmatic advertising venture and its rapid growth. Discussing the acquisition of GDM by another network following the sale of Jack Media. Details of the sale price and the various businesses Emmie and her partner had. Emmie's post-sale activities, such as angel investing in female founders and creating Female Founders Rise.   CONNECT WITH EMMIE: Website | emmiefaust.com LinkedIn | Emmie Faust Twitter | @emmiefaust Instagram | @emmiefaust THE EXIT PLAN The Exit Plan is for business owners that are interested in learning more about how to sell their business. Each episode Barnaby Cook interviews someone who has bought or sold a business - either a creative agency, or a production company. The conversation gets under the skin of why they wanted to sell, or were looking to acquire, how the deal was structured, how they agreed upon a valuation and what lessons they learnt along the way.  

In episode 5 of ⁠Definitely Baby⁠'s VBAC mini-series, three wonderful women share their VBAC journeys. As the stories can attest, there is so much power in equipping yourself with evidence-based information and knowledge throughout your pregnancy, especially if you're planning a VBAC. There are so many great resources and podcasts you can gather this information, and I truly believe that the power of listening to other people's journeys to VBAC is one of the best and most empowering and encouraging forms of knowledge we can equip ourselves with. Story 1: Kirsty Kirsty lives in the Gold Coast with her partner Tom and two young sons, Jasper and Toby (19 months apart). Jasper's birth was an emergency caesarean after initial ‘failure to progress' and an adverse reaction to synthetic oxytocin. It was almost 11 hours before Kirsty was able to hold Jasper which was devastating for her. Kirsty immediately knew she wanted a VBAC for her next birth so she joined a VBAC support group and began researching and reading VBAC birth stories ahead of trying to conceive. Toby's birth was a successful VBAC in a public hospital system under the MGP. Despite experiencing a 3C tear requiring surgery, Kirsty states Toby's birth was extremely healing and the 3.5 hours of post-birth skin on skin she experienced with Toby was everything she could have hoped for. Story 2: Rachael In Rachael's first pregnancy, she chose a private OB and was diagnosed with GDM at 28 weeks. This led to an induction at 39+3 with various interventions, ending in a C-section. Her son was quickly taken away, affecting bonding and breastfeeding. In her next pregnancy, she focused on regaining control and skin-to-skin contact. She researched extensively, hired a private midwife and doula, and planned a home birth. However, her home birth was cancelled due to a GDM diagnosis at 28 weeks. She included osteopathy and acupuncture in her pregnancy routine and maintained her healthcare team. At 40+5 weeks, Rachael went into spontaneous labor and went to the hospital when contractions were 5 minutes apart. Despite declining certain medical interventions, a VE revealed she was 3cm dilated, had bulging waters, and the baby was in a posterior position. She opted for a repeat C-section, which turned out to be an amazing experience. She had immediate contact with her daughter during the birth, and they asked for her consent before cutting the cord. Emma was placed on her chest for a beautiful moment, and she remained with Rachael into the recovery period. Postpartum, Rachael felt a stronger bond with Emma than she initially did with her son, and breastfeeding was easier. She was grateful for her choices, even though her VBAC resulted in another C-section, as it left her feeling empowered. Giuditta lives in Perth WA with her husband Jacob and three children, Oliver (5), Chiara (4) and James (11 months). Giuditta's first birth was an emergency c-section due to “failure to progress” from induction given when both her body and baby were not ready.  The explanations she was given were that her body did not know how to labour on its own and that she was probably an “unlucky woman” to never experience it. A few months after the birth they fell pregnant again and she knew she wanted a VBAC; however her daughter remained breech and they opted for a planned c-section. In 2021 Giuditta had a natural miscarriage at 12 weeks at home. Although a sad loss for their family, this event made her question so much more. How could she miscarry and not birth? With this in her mindset when they fell pregnant again in 2022 she knew she could have a VBA2C. She hired a private midwife as she knew this model of continuity of care was her best chance. Follow our instagram ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@definitelybabypodcast⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠for photos of this week's guests.

In this episode, we discuss the utility of repeat antibody testing at 28 weeks. Plus, new evidence about early screening for GDM, the concept of tension in the pelvic floor, the evidence about vaginal prep at the time of unplanned Cesarean, new literature about interventions for preterm birth, and the safety of Mayo (or raw eggs) during pregnancy.00:00:02 Repeating Type and Screen for RH-Negative Pregnant Women00:13:54 Evaluating Early Screening for Gestational Diabetes00:19:24 Discussing Outcomes of Gestational Diabetes Study00:27:17 Pelvic Therapy and Vaginal Cleansing00:37:30 The Controversy Surrounding Preterm Birth Interventions00:50:58 UK and US Egg Safety Standards

This episode discusses a personal story. Every fertility story is different and unique. Please don't compare your own journey to our guest's story today and seek a professional health care team to support you on your own journey.This week we are so excited to have another community guest on the podcast. Emma, a mum of two, joins us, and today we delve into her story and experiences with secondary infertility, gestational diabetes mellitus (GDM), and her preconception journey.Emma's story highlighted the emotional rollercoaster of expectations, disappointments, and the difficulty of waiting in the fertility journey. We'll emphasize the importance of support, lifestyle changes, and guided nutrition in overcoming these challenges and achieving the goal of building a family. We'll explore what initially attracted her to Fertility360, our online course, and why she decided to take further action. A heartfelt shoutout to Emma for being an incredible guest on our podcast. Thank you so much for being so open and vulnerable in sharing your story. It takes a lot of courage, and we really admire that. Want to ask us a question and have it answered on the podcast? Ask Us Here!Want to be a community guest and share your story on the podcast? Apply HereWant to keep listening? Here are some more great related episodes:Listen to Secondary Infertility, PCOS, Insulin Resistance with Bec | Real Life Fertility Story | Episode 92Listen to Gestational Diabetes - Why Does It Happen? with Helena McDonald APD | Episode 98Download our FREE pre-conception lifestyle checklist Looking for more?Grab our popular Fertility360 online multi-disciplinary course. Want to work with us 1-on-1? Fill in this quick formFollow us on Instagram @the_dietologist or endo.dietitianDance with us on TikTok @the_dietologistRead more about us and our services at The Dietologist here: thedietologist.com.auDisclaimer: The information presented in this podcast is not to be replaced by personalised medical or dietetic advice, please speak to your health care professional before making any diet or lifestyle changes. The Dietologist and its guests do not accept any liability for any harm or damages that occur from following any of the suggestions in these podcast episodes.

Gestational diabetes (GDM) is a risk factor for adverse perinatal outcomes. Currently, the ACOG recommends early screening for GDM for women “at risk”. However, other experts disagree with this approach. On October 6, 2022 we released a podcast episode called “Early GDM Screening: Evidence-based?”. In that episode we covered the controversy regarding early GDM screening, in other words- screening under 24 weeks. We have been following this story and debate for over 2 years now; we first released the episode investigating the utility of early screening back on May 7, 2021 with an episode called “early GDM screening: Does it matter?”. The controversy surrounds maternal and neonatal outcomes… does it improve with early screening? Well… we have more data now! YEP.. looks like we were vindicated in our prior messages covering this! In this episode, we will summarize key findings from a recent June 2023 publication in the NEJM titled, “Treatment of Gestational Diabetes Mellitus Diagnosed Early in Pregnancy”. The lead author is Simmons. So…should we be doing early screening for GDM? We'll highlight the data.

Here's a real world clinical conundrum: A patient first presents for prenatal care in the 3rd trimester. As healthcare providers, we play a game of “catch-up” with routine serum tests ordered to make up for time lost. But what about specific pregnancy tests that are restricted to gestational age? Take, for example, GDM screening. Currently, traditional screening for GDM occurs at 24 to 28 weeks based on the original studies by O'Sullivan and Carpenter-Coustan. Or take this parallel, clinical scenario: A patient passes routine screening between 24 and 28 weeks, but in the 3rd trimester has suspected fetal macrosomia or new onset polyhydramnios. Should we rescreen these patients for GDM? As cut off values for the GDM screens are based on a 24 - 28 week pregnancy, we don't really know what the cut off serum glucose levels should be after 28 weeks. And more importantly, does diagnosing GDM in the 3rd trimester improve maternal or neonatal outcomes? In this episode, we will walk down history's timeline of data starting in 2001 and ending with a publication in 2022. We'll discuss the findings of these publications (6 total) and at the end of the episode, I'll give you my personal perspective on the subject.

Ashley joins us today from Australia sharing her three birth stories and how she learned to truly trust herself. Driven out of the hospital due to discrimination and not being able to find support from home birth midwives, Ashley decided to go for a free birth. With a special scar, two previous Cesarean surgeries, a big baby, a high BMI, and a history of gestational diabetes, Ashley accepted all of the risks and was able to reap the beautiful benefits of undisturbed home delivery. Ashley shares with us her journey to acceptance when things didn't go the way she planned, but also how to persevere through to fight for the story she wanted. She now hosts The VBAC Homebirth Stories podcast and is a Homebirth/Freebirth Mindset Coach inspiring other women to have the courage to take back control of their birth stories!Additional LinksAshley's InstagramThe VBAC Homebirth Stories podcastHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode DetailsFull TranscriptMeagan: Hello, hello. Welcome to The VBAC Link. This is Meagan Heaton and we have Ashley here with you. Can I just tell you? She is amazing and you're going to want to listen to this episode 5 million times and then when you're done listening to it 5 million times, you're going to want to check out her Instagram and watch her videos 5 million more times because she is amazing and such a wealth of knowledge. We reached out and said, “Hey, we want to share your story on the podcast. We think it's going to be an amazing episode.” I don't think. I know it's going to be an amazing episode. Review of the WeekBefore we do that, I'm going to get a review per usual and remind you that if you would like to leave a review, we are on Google and Apple Podcasts. You can email us. Shoot us a message on Instagram. We love to add your reviews to the queue and read them on the podcast. This specific review is from Ana Neves and it says, “I've been preparing for my VBAC ever since my C-section, and listening to the stories in this podcast has not only taught and informed me all about the different options, but also inspired me. I know that when the time comes, I will be prepared and feel the power of the great and courageous people who shared their stories here.” Oh, I love that. “The great and courageous people.” Oh, I love that. I love that so much. Thank you so much for sharing your review and like I said, if you have a review to share and you want us to know how you feel about the podcast and all of these great and courageous people, please leave us a review. Ashley's StoriesMeagan: Okay, Ashley. I am so excited that you are here. It's been interesting from now in recording, we've had Australian people on the podcast a lot. It warms my heart and makes me so happy and makes me feel like I probably need to go to Australia now because one, I am obsessed with all of the knowledge you guys have on birth and I actually really like the way that birth is in Australia in a lot of ways. But I am just so honored to have you here with us. Ashley: Thank you. I am so excited to be here. That was such a beautiful, warm welcome so thank you very much for having me. Meagan: Yes, oh my gosh. I'm serious. I just love listening to you too. I just love your guys' accents. My Utah accent is pretty lame, but yeah. So let's turn the time over to you. I am so excited because I feel like I've heard little things, but I'm excited to just hear it right now with you. Go ahead. Ashley: Okay. So let's start from the first babe then. Basically, I went into that one expecting that I was going to have a vaginal birth because my mum had vaginal births, and all of the women before me did too. My mum had me in 7 hours. I was the first baby. My sister is two, so mum said, “If you have medication, you're weak. You've just got to suck it up.” So I had this, “If she could do it, I can do it.” I had this, “I'll have the epidural if I need it” sort of vibe. A lot of my friends had babies before me. They had children when they were 17-18. By the time I had mine, I was 28. I was newly married and I had watched all of my friends. They told me all of their birth stories and things. They had all had vaginal births. I thought that Cesarean birth was really for celebrities basically because when I was in high school, it was Posh Spice who was having this C-section and things like that. It was a trendy thing to do. It wasn't something that normal people did. It was an expensive thing that rich people did. Meagan: Like in Brazil. That's how it's viewed in Brazil. You are high-class if you have Cesareans. Ashley: Yeah. I mean, I went to the GP before I got pregnant and checked on my levels to make sure. I have always had a high BMI, so the doctor said to me, “The only thing I recommend is that you lose some weight because you might struggle to conceive,” so I went in knowing that there may be a hardship there. Some of the women in my workplace at the time had multiple miscarriages. My mother-in-law had 7 before my husband, so I went in with that kind of, “We'll see what happens, but it could take a while.” So I conceived within the first month of trying so that was a shock, but also so exciting. Super exciting. It was a month before my wedding, so I got sick just after my wedding for my honeymoon and all of the fun games and after that, I was just like a sloth dying because I got HG. I got HG and it was just 20 weeks of basically a challenge. Meagan: Yeah, miserable. Ashley: It was hard. I was so excited to be a mom. I couldn't wait from the time I conceived to birth the baby and have the baby in my arms. That's all I wanted. I went to the hospital and there was a bit of a mix-up between when I went to the GP and had the GTT, the test for gestational diabetes. The doctor told me that I didn't have it. I went to a hospital because that's what they do. You go to a GP and they just send you to the local public hospital and that's the one that you are allowed to go to, but they didn't really discuss any of the other avenues like private, or midwives, or homebirths or anything like that. So I went excitedly to my first appointment. I waited for over an hour and I saw some random gyno-obstetrician and they said to me, “You've got gestational diabetes so you'll be seeing us.” I was like, “No I don't. I don't have gestational diabetes.” “Yes you do,” she said and I burst out crying. It was this big thing. Basically, the difference was if I had birthed or if I had gone to the hospital in Brisbane which is the next suburb over, I wouldn't have had gestational diabetes but in the hospital that I went to, they were up with the times with the lower numbers because that was cycling at the moment. It was 2014. I had gestational diabetes and that meant that I had so many more appointments. It meant that I was only with obstetricians. It meant that I had to go to nutrition or a dietician. It was just so many appointments. It was out of control. From a very early stage, I was told, “You're going to be induced and you're going to be on insulin.” As soon as I was diagnosed, I was told, “You're going to be on medication.” Meagan: No talking about it. Ashley: “Yeah, let's see how this unravels and we're not going to start you on the pill, we're just going to go straight to insulin for you,” so it was kind of like they had already decided my fate. I was really excited to have an induction. It meant that I got a date for my baby and I was going to have my baby early. When I spoke to the other ladies in the GD who were getting induced, the lady said to me, “It's all good. I was induced and I had my baby in 5 hours.” I was like, “Awesome. Awesome.” I don't know what number baby that was for her because when it comes to induction, I know now that it really matters whether it's your second or if you've had a vaginal birth before, then an induction probably isn't going to land you with a C-section. I ended up getting my date, coming into hospital, and having no discussion. I kept asking, “Can we have a birth discussion?” It was always, “Next week. Next week. Next week.” There was no discussion about what happens at birth or really what to expect or any niceties or anything. It always felt quite cold. It was like the people didn't even want to be there, the junior obstetricians, it was like they were doing their time so to speak. It just wasn't a pleasant experience. I was expecting my first baby and I just felt like another number. Meagan: Yeah. It wasn't warm and fuzzy at all. That's for sure. Ashley: No. I just felt like it didn't feel right. It just felt really not nice. Meagan: Yeah, impersonal. Ashley: Yeah, exactly. I basically went in for my induction and my husband came in with me. That was a couple of days of having gels and people putting their fingers up and continued monitoring and just very uncomfortable. I found after they had done all of that process that my cervix was right shut up. It wouldn't open up. They said, “Okay. We are going to try and put the balloon in there.” That was the most excruciating pain. Meagan: Especially when you're not dilated. Ashley: It was excruciating and I was in so much pain. The doctor and midwife made out that I was making a big fuss because I was responding that it was painful, so they gave me a lot of gas and I was pretty much tripping out. It was really trippy. Meagan: Like nitrous oxide?Ashley: Yeah. I just felt like if this is how painful it is to put this thing in, how painful is labor going to be? How am I going to handle that if I've just been through two days of this? I think that I had a cannula in my hand as well because I couldn't really go to the bathroom without assistance from my husband. It was really getting uncomfortable. I had something up inside me. Meagan: Or poking you or something all of the time. Ashley: Yeah, exactly. So another night in the hospital we slept and then they said, “If it doesn't open and it doesn't drop out by the morning, then we'll talk about it.” I wasn't allowed to eat. I had to fast. Meagan: That's going to serve your body well. Ashley: I know. It's really cool. It's like they give you so much amazing care in the hospital to set you up for this amazing birth, and I woke up and it was still in there and nothing had changed. I felt really defeated and I felt like my body was broken like there was something wrong with me. Nobody had ever discussed or told me that there is a high failure rate to this or that this procedure can fail or that you may not be a great candidate for this procedure. Meagan: Or more time. More time can make you a different candidate statistically and raise your BISHOP score. Ashley: Yeah, they obviously did the BISHOP score and they would have seen that I wasn't a good candidate for this. They would have known that when they did all of these things to me. Now I see that as my body is so amazing that you tried to do all of this stuff to my body and my body was like, “Hell no.” Meagan: Nope. I'm keeping this baby in. Ashley: Clam shut, yeah. The junior doctor came in and she said, “Look. We recommend that you come in tomorrow for more monitoring. Go home and come back on Monday and we'll start the process again.” I was like, “What do you mean you're going to start the process again? This was really torturous.” I said, “What's the difference between a day or two? My body's not going to respond any differently. Can I just come back in two weeks?” I'm 38 weeks at this point and I'm like, “I'm not even 40 weeks. Can I come back in 2 weeks when I'm in labor?” Meagan: And a first-time mom.Ashley: Yeah, because my mom had me and my sisters right on 40 weeks, so I'm just expecting the same. She said, “No. You can't.” I was like, “Oh, okay.” She said, “No, you can't do that.” I said, “Okay.” She said, “You know what? We're just about to have an obstetrician meeting, so I'll go in there and I'll ask the consultants what they think and I'll come back with a plan.” “Okay,” I said because she also did talk about my option of being a Cesarean on the Monday and I said to her, “Look. I'm going to be honest with you. There's no way in hell that you're going to get me to come in for elective surgery. It's just not going to happen. I never wanted to birth like that and I don't want to.” She came back and she said– they obviously spoke about what I had said and they made for me later a plan to push me in the way they thought that I was going to bend the most, so they said, “Look. We've bumped all of the surgeries for the day and we're going to book you in as priority because we feel like you should be having this baby now.” I was kind of like, “Okay.” So they were bumping all of these surgeries. There were people sitting out in the waiting room waiting to have their babies, but they were going to bump me to have my baby first. I had my sister in the room who was a surgery nurse who had been pushing me to have surgery the whole time because she was traumatized. I'd been fighting her the way through like, “No. I don't want to do that. I want to have a vaginal birth.” I was so exhausted and my husband only had 5 days off of work, so he had to return in a couple of days. I had my in-laws at my house babysitting my dog and I was promised a baby. I feel like at that point, I was just like, “Okay, well if that's what you think, then okay. I'll do it.” I signed this 3-page waiver form by the way, which I was really scared of. I was like–Meagan: What am I doing? What am I signing?Ashley: My sister is getting me prepared. She just finished a shift from working upstairs in nursing and she organized for herself to get in there, so it was going to be my husband and her. They never allowed a third person, but because she worked there and knew people, she was able to weasel in. She's getting me ready like a good nurse. She's so excited. She gets to be a part of it and I'm just recording a video of, “If I die, tell my baby I love my baby.” I am so petrified. I've got video and photos and I just look at the photo and it's like me trying to look excited, but actually, I'm like, “Holy crap. This is really scary and I don't want to do this.” Meagan: Why is everybody so excited and I'm terrified? And why is no one talking to me about this? Ashley: Because I'm giving up control. They're not getting the knife, but I am. It's really scary if you've never had surgery. It's not something that we do every day and it's not something that I had ever gone through before. So off I go into surgery and it's really good that my sister was there because she got to take a lot of photos and she got to be a part of it. Meagan: That would bring some comfort maybe. Ashley: Yeah, I felt like they would step up a bit as well because they knew that it was one of their own in there and I was one of their own. She took a lot of photos and things like that, but when they were doing the spinal, no one can be in the room. I just remember feeling so petrified and shaking and looking into this big man's eyes who was holding me and thinking, “You look like a nice man. Keep me safe.” This midwife came around and she was like, “You look like a deer in headlights” because it was like all of these lights shining down at me. I'm in this crazy room with surgery stuff. I'm really scared. I'm petrified, but I went through the whole process and the obstetrician and everyone, it was Christmastime. It was early Christmas. It was December 5th and they were all having their Christmas party that night, so they were all very happy talking about the Christmas party. “You're going to the Christmas party? I'm going to the Christmas party.” I thought, “Well, they're not fast. They're not stressed. They're very happy. They're starting their day. I'm the first one. They're excited about the Christmas party.” It didn't feel very personal. I definitely didn't feel included in the process. They were just talking among colleagues. Meagan: I can so relate. So relate. Ashley: It's horrible. Meagan: Yeah. They were talking about the snow outside and how depressing it was because the one just gotten back from Hawaii. He was like, “Oh, I came back to snow.” I was like, “I'm right here. Can we talk about my baby? Can we talk about me?” Ashley: Yeah, it's very impersonal. I mean, it's one thing at the dentist to be chatting it up. I don't mind it at the dentist if they're chatting or something, or the orthodontist or something, but yes. I thought, “At least they're calm.” The baby was born in no time and then announced, “It's a baby girl.” I just thought, “Oh, can I go to sleep now? I'm not really interested in this. I'm very time. I'm shaking. This is not a great experience.” I just turned around and said, “Can I go to sleep? I don't want to hold the baby.” It's uncomfortable anyways, but I can't really hold the baby. I'm shaking. I've never really had that many drugs in my system before and off to recovery we go basically. That's a new experience as well. Yeah, it wasn't a great postpartum experience in the hospital. It was quite a negative experience with the night midwives, so I was really excited to get out. I left a day early because I just did not want to have to put up with the night staff. My husband wasn't allowed to stay. Meagan: Oh, why? Ashley: So in our hospital in the public system, some of them have got 4 or 5 to a room, so I was in a 4 or 5 to a room. They don't allow husbands to stay. I couldn't get out of bed. Meagan: I didn't know that. That's like old school.Ashley: It is old school. A lot of them are getting upgraded now because obviously, it's better to have your own room and stuff, but that's where I was lumped. No one wants to birth there because no one wants to share a room, but if you're in the catchment, that's where you get stuck unless you go private. So he got booted out at 10:00 at night, and then I was left with this witch of a midwife who every time my baby cried, she was like, “Oh, look. You're just going to have to sleep with the baby on your belly because I can't be coming back here to get the baby all of the time.” I was like, “But it's not guidelines. I'm not allowed to sleep with my baby with my chest. I can't sleep and it's stressing me out.” In my head, I'm saying those things, but yeah. It was horrific. The next morning, my husband came and I was letting loose at him. I was like, “Why weren't you here? The baby and I haven't slept.” I was so stressed. I mean, think about it. Being awake for 3 days, having been in the hospital for a long time, and then having gone and had major surgery, you're left on your own with this baby with barely any support. No one telling you what to do, trying to breastfeed with your nipples getting ripped by the way. Meagan: Pretty much abandoning you. Pretty much. Ashley: Basically. So the second night, I stayed and sorted that out, then I went home the next day. I did have a bit of a thing with the midwife. She was on again, so I ran down to the bathing room and I hid from her because– okay. One thing you should know about me is that I am a highly sensitive person, so something that someone might say to someone may not affect them as much as it would affect me. Meagan: It triggers you. Ashley: It really upsets me and being in a vulnerable position, I need someone who's gentle, nurturing, and loving. So I ran away and I hid in the bathing room with my baby. I was trying to work out why she was crying. I had fed her. I swaddled her. I changed her. I was really trying to work it out. She could hear the baby screaming and obviously thought that I was not looking after my baby. I said, “Look, I'm just trying to figure out what's happening here.” She's like, “You just need to hold her.” I was like, “No, I just need to figure out what's happening because I've got to go home with this baby and work this out.” She's like, “Why don't I take the baby and I'll look after the baby so you can get some sleep?” I'm like, “No. That's not happening.” I was so against this woman. She was like, “Here's your medication. Take your medication. I've been looking for you,” and then she sent another colleague down to come and check on me and try to convince me to give the baby up. But what I discovered by sticking to my guns and doing what I felt was intuitively right for me was that my baby was pulling her arms out of the swaddle and that was waking her up. So I put her in a little zip-up and from then on, she slept through the night. My husband came the next morning right on the dot. I had a shower. Baby was sleeping. He's like, “Where's the baby?” I'm like, “She's sleeping,” feeling like a million dollars. “I've got this. I've got this and we're checking out today.”Meagan: Yep. Get me out of here. Ashley: I went home and we struggled with breastfeeding. I got some really bad advice from one of the nurses that came to my house so I felt like a double failure. By 6 months time, I was mixed feeding to just formula feeding and I felt like a real failure. I let her down. I hadn't birthed her the way– I didn't feel like I birthed with, “When I had my baby,” or “When my baby was born.” I didn't say “When I birthed,” because I didn't feel a part of the experience. It happened to me. It wasn't inclusive to me. I just felt completely excluded. So I knew when I was going to have my second, I was having a VBAC for sure because I knew there was a thing possible. I knew about VBACs and I said to my GP, “What's the timeframe between babies?” She said, “24 months between birth and birth.” That was the thing then or whatever. I said, “Fine. I'm having 24 months.” I literally started trying within 24 months, whatever it was, 15, or whatever. I fell pregnant the second time. I was having a VBAC and I think I joined the VBAC group in Australia. I started learning all of the stuff, becoming informed and advocating. I knew that this time I wasn't having an induction because that's what caused me a C-section. I knew that I wanted to try to avoid GDM because that's what I thought was the lead-up for the induction rush. I didn't realize that my weight was obviously pushing against me so much. I didn't understand the reasons why or some of the discrimination that happened in the hospital at that point. I did the early GTT test and I passed that. I was like, “Yes. Maybe this is going to be different.” I'm going to show them. I'm educated. I know what I want. I'm informed. I'm also a people pleaser so I'm trying to get them on board with me. I'm trying to get them to agree with my decision. I'm trying to get them to be a part of my team and cheer me on and get excited.I'm just kind of getting met with obstetricians who were like, “VBAC is great and it's the best way to birth your baby.” I'm like, “Yes. This is amazing.” Meagan: You're like, “Thank you. This is what I want to hear.” Ashley: “But not for you.” I'm like, “What? Not for me?” “Well, for you, we recommend a planned Cesarean.” “Okay.” They never really spoke in plain language or explained it to me. It was only through digging and digging and digging and asking and asking and asking that I was finally able to get some answers. I essentially ended up getting gestational diabetes at 20 weeks, so then I wasn't allowed to see midwives because I had asked to see midwives and they said, “If you get GD, we won't release you.”Meagan: It disqualified you. Ashley: It disqualified me from seeing midwives. I said, “Look, you're a surgeon. Can I just see you if I need surgery?” The thing with GD is that there is a GD counselor and somebody that you report to outside of them, so why do I need to see you because you're not a GD expert or specialist? I actually see somebody. Why is a midwife not capable of looking after me? It doesn't make any sense. They're just trying to pull in all of the patients to keep their bellies full and make sure they've got jobs. I was gutted. I was absolutely gutted. I only failed by .1 on one of the tests and I wish I had known back then that I could have redone it and I probably would have passed it. It was really disappointing and I was like, “Oh, goodness me.” So I was diet-controlled through that time. I say diet-controlled because that's the readings that I gave them. I wasn't really diet-controlled but I was being a bit of a rebel because I was getting the same numbers as I was with my first baby and I was on insulin with her and insulin didn't do much. I thought, “Well, what's the difference going to be if they're the same numbers? She came out healthy and had no sugar problems or anything.” I kind of started to think, “Is this GD thing a bit overrated? If I was in a different hospital or a different country—”Meagan: I was going to say if you went somewhere else like last time, would it have been different or would it actually have been GD as well? Ashley: If I had gone somewhere different and I knew this because I was part of the GD community and I had friends that were birthing in Brisbane who were even having to keep below higher numbers than me. They had much higher numbers than me, so I thought, “You're with a private obstetrician and you're getting different information than me,” so I started to clue on that. And then also, when I was doing my readings on my fingers, I would get a different reading on this one to this one, so I started questioning, “If this one's .5 difference to this one, how accurate is this measuring?”Meagan: Yeah, interesting. Very interesting. Ashley: So it was very scary for me to do that because nobody's doing that and every time you're going there, they're like, “Dead baby. There was a woman who had gestational diabetes and her baby died.” And I was like–Meagan: You hear these and you're like, “What?” Ashley: I was like, “How did she die? How did the baby die?” They said, “Oh, we can't disclose that information. You're telling a room full of women with gestational diabetes that a baby died and the mum had gestational diabetes. She could have been hit by a car for all we know and you're using it to fearmonger us, but you're not willing to tell us how the baby died. It could have been negligence on the hospital's part. It may not have been GD related at all.” Meagan: Yeah, she just had it. Ashley: She just had it, so I found that quite disgusting and all of those things started to really add up. The more that I saw in the VBAC community, the more that I saw this was happening around Australia, the more I was determined to advocate and fight which is really hard for a highly sensitive person, but I got a student-midwife. I got the head midwife to come to my appointments. I had a student-doula who was a dear friend of mine and I started to grow a team around me. I refused to see one of the doctors at one point and wanted to speak to the best, most amazing doctor in the hospital, so the midwives set me up with the nicest obstetrician who still didn't support me to have a vaginal birth, but he was nicer to deal with. I mean, I had some crazy conversations with some of the obstetricians during that time. One of them was a junior and she said to me because I didn't want to have continuous monitoring. I just wanted to have the doppler. She said, “You know what my boss says? He says that if you don't have continuous monitoring, then you're basically free birthing in the hospital.” I looked at her and I was like, “You're crazy.” At this point, free birth to me was crazy and she was telling me that because I'm in a hospital and if I'm not doing that, then I'm free birthing. And I thought, “But I'm getting checked with a doppler by a midwife. I'm with obstetricians.” That is absolutely insane, but it goes to show the kind of mentality and the thought process that goes through the fact that they don't know how to be with women. They don't know how to observe and watch a woman. Now, my mindset is the complete opposite way. I see things in a different light than how they would see. They rely on machines whereas they don't rely on that connection. I'm the type of person that relies on human-to-human connection and I've listened to people and I love stories. That's how we learn. We don't learn about humans by watching machines. I started to learn about the inaccuracies of their machines and some of the equipment that they were using. It made no sense to me to have continuous monitoring when I knew that one obstetrician would send me to surgery for the reading whereas another one with maybe more experience who may be older and more chilled would be like, “Yeah, that's nothing.” If the results are at that rate, then that's not beneficial to me because then I'm putting my fate on whether I get a choppy-choppy obstetrician or a chilled, relaxed one on the day. So that was kind of my thinking. I didn't do growth scans this time. I didn't see the point in me having a growth scan to tell me that I was having a big baby. My first was 3.7 at 39 weeks. I knew this one was going to be 4 kilos and I said, “Look, I'm happy to birth a 4.5-kilo baby out of my vagina,” which is almost 10 pounds for your listeners and they just wanted to do Cesareans on 4-kilo babies as well as inductions. It was always about induction and I found out the reason why they wanted to do induction. They wanted to manage me. They weren't a tertiary hospital, one of the bigger ones, and so I found out that the junior obstetricians wouldn't be comfortable doing or maybe confident or capable of doing an emergency Cesarean on someone of my size, so I said, “That's fine. Just send me to that hospital or that hospital. Let's just do this. If it's a staffing issue, I don't want to stretch it out.” They just laughed at me. It can't be a big deal then, can it? If they're not willing to send me to a different hospital. We had so many conversations and it was anxiety-inducing. I would cry on the way to the hospital. I would cry on the way home. I'd have to get my fight on and I even had a conversation with an obstetrician that said to me, “We'll fight about that later.” I said, “That's exactly right though isn't it? It's a fight, the fight.” Meagan: Yeah, we'll fight about that later. That right there. Ashley: He goes, “Oh, I didn't mean fight. I don't mean fight.” I go, “Yeah, but no. You do.” Meagan: But you just said that. Ashley: But you do. Meagan: You're like, “Yeah, I can tell that you're not agreeing with me and you're telling me that if I want something else, I'm going to have to fight with you.” Ashley: And so I'm hearing about this informed consent and I'm like, “Informed consent.” I'm fixated on what would get them to be on my side. I've learned about informed consent. They legally have to support me, right? But that is just the fast in my opinion, in my experience, they wouldn't know what informed consent or working with a woman, it just blows my mind. I didn't realize that at the time, but there were a lot of conversations that were happening about my weight. “You're not going to be able to. It's harder for bigger women like you.” I would leave conversations thinking, “I'm not going to be able to birth my baby out of my vagina because I'm big.” Meagan: They were shaming you. Ashley: Yeah, basically I was told by an obstetrician that, “She's not a fatist, but—.” I was like, “I've never heard someone say ‘I'm not a fatist.'” I don't even know what that means. I had some really interesting conversations because I was asking questions and I was asking questions because I was asking so many questions. Every time I went to an appointment, the obstetrician would say to me, “Ah, I see you're having a repeat Cesarean,” and that would spike adrenaline. Read my book. Read my book. You would know that I'm having a VBAC and then, “Oh, well do you know the risks of VBAC?” Yes, I do. “Oh, you really do know the risks, but we still recommend that you have a repeat Cesarean,” and I would have to go through that every single time. Meagan: So discouraging. Ashley: It was a nightmare. By 36-37 weeks, I had received a phone call and they said, I could feel the smugness and a smile through the phone, “Oh, we're not willing to take the risk. You're going to have to go to a different hospital.” I was just horrified. I was so scared. I've just been kicked out of hospital because nothing has changed with me.”Meagan: But because I won't do what they want me to do and I'm being stern in following my heart. Ashley: Yeah, because I won't submit. I've told you from day one what I'm going to do, but I suppose the rate of success with that tactic is probably 99%, I'm probably the 1% of women who actually says, “No. I actually will not fall for your trickery.”Meagan: Yeah, okay fine. I'll leave. Ashley: I was so determined, so then I went to a different hospital and it was a newer hospital. They had birthing pools. I was hopeful that I might get in a birthing pool. You get your own room in the postpartum. I was excited. They had informed consent signs. The receptionists weren't fighting each other. This first one that I went to was pretty rough down there. They were lovely and polite. I thought, “Oh, this feels nice. Maybe I'm going to have a different response,” and I did. I saw an amazing midwife on entry. She was like, “If they're not going to allow you to do this, you advocate and you can make a complaint. That's disgusting how you were treated.” I thought, “Oh, wow. This is the best thing.” I saw an obstetrician. They were supportive. They wanted to do some of the same things, but they respected me. I felt like I was seen as a human. They would ask me questions and they would go and ask a consultant and the consultant would agree with me. I was like, “Wow, I am ticking boxes here.” I made some compromises because I was vulnerable. I did a growth scan and they found out that baby was about 4 kilos. Meagan: Like you already guessed. Ashley: I knew that at 39 weeks. I said, “That's fine.” “Oh, we recommend induction.” I said, “Yeah, I know you do. I'm not doing it.” That's what caused me the C-section last time. I'm not doing it. We went through the study at 39 weeks. I said, “That doesn't apply to me. It doesn't apply to me. I'm not in that study. It doesn't mean anything to me.” I don't know how you can have a study saying that it's going to work better on someone at 39-41 because you're not doing the same people. You're not doing induction on someone at 39 weeks and then going, “Hey, let's try it again at 41 or whatever it is.” You're doing different people. I don't want to know about it. I don't care about it. They said, “Okay, well I'll talk to the consultant. We'll look at the scan,” and then she came back and said, “Yep, you're fine. There's no fat on the shoulders, so yep. That's fine.” But if I hadn't said that, I would have been booked in for an induction, right? I would have just said, “Let's go, yep.” I sat there on the weekend with my husband shaking like a leaf again having to advocate for myself. It isn't an easy thing to do. Every time I have to raise my voice, I'm putting adrenaline into my body. I'm not raising like screaming, but I'm having to raise my voice. My baby would have been under attack the whole pregnancy essentially. I eventually get to the due date. A week before my due date– it was a couple of days before my due date– my midwife turns to me at the last appointment. She was training in the hospital last time, so I was really grateful that she was willing to come with me and support me even though she wasn't going to get her book signed off for this birth. And on that appointment, she said to me, “Look, my daughter's booked a holiday for me, so I'm going away on your due date. Are you going to have this baby soon now?” I was like, “Oh my goodness. You've just fought with me the whole time and now you've turned into them trying to get me to have my baby before my due date because it suits you.” Yes. I was heartbroken and I was so angry. I decided then and there I was not going to invite her into my birth space even if it was sooner because she had betrayed me on every level. I went into that appointment and the obstetrician didn't recommend it, she said, “Do you want to do a cervical stretch?” A sweep and I said, “No, I don't.” I turned to the midwife and said, “What do you think?” She was like, “Yeah, why not?” Of course, she said that because it gets the baby out quicker. So again, you've got to be careful about who you're with because if you're relying on people who've got a different agenda, you've got to take their advice or their opinion with a grain of salt. But I was a little bit interested myself. I'd never had a stretch or a sweep like that before. I was a bit interested. I was worried that I was going to go over due dates and I was willing to wait for 40+10 and I was getting a bit stressed like, “Oh, what if it goes longer?” You start to freak out at that point. There's a bit of pressure and with what I'd been through, I had the stretch and sweep. She said, “You're 3 centimeters and you're stretchy.” I was like, “Wow. Wow. Last time, they couldn't even– I was closed up.” Meagan: Get a Foley in. Ashley: Yeah. So I was so excited. I started to get some niggles and lose some mucus and a bit of blood and things like that. Two days later, I went into labor. She said to me, “If it does nothing in the next couple of days, then the baby wasn't ready to come. If it happens, then the baby was always going to come,” sort of thing. Now, obviously, what's the point in doing them if the baby is going to come and it does nothing but disturb? I mean, my complete mindset changed and flipped. But yeah, I went into straight labor. I was so excited and so proud of myself. I'm in labor this time. I never knew if my body was broken after all of the fearmongering and talk. I was just so proud of myself. It was exciting. I had adrenaline pumping through me. I was shaking with fear and excitement. I was going to wait the whole day to go in. I was going to essentially go to hospital when my baby's head was coming out. As soon as I went into labor, I was like, “Yeah. I think I should go to the hospital.” I was adamant the whole time I wasn't going in until I was ready to push and as soon as I was in labor, I was like, “Yep. Okay, it's time.” Meagan: Let's go. It's exciting. You're like, “Okay, let's go have this baby.” Ashley: Yeah, and it was fast and hard. When I go into labor, it's not any prelabor, it's just that this is on. I dilate pretty quickly. When I got to the hospital, I was 5 centimeters. They were really surprised at how I was doing because I was quite calm and quiet. They were like, “Oh.” I got eventually into the birthing suite. My doula came and set up the room really pretty. I went into the shower and had a midwife assigned to us. She just sat down and read my birth plan and was happy with everything. She wouldn't let me in the birthing pool of course because I was over 100 kilos even though they've got a hoist for bigger people if they need to. They're just not comfortable with bigger people in the birthing pool. I just did my thing and I said, “I don't any doctors to come in. I don't want anyone annoying me or harassing me.” And I just labored for a few hours until I felt like there were some waters or something I could smell and feel. The midwife said, “Do you want me to check you?” I said, “Yeah. Yeah, we'll see if the waters have gone.” She said, “Yeah, the waters have gone and yeah, this is a little fore bag so would you like me to break that?” I said, “Well, if you think so, okay.” At this point, my education had gone to the point of getting past the induction. If I had gotten into spontaneous labor and I saw a midwife because everything was raving about midwives, I'm going to be fine. This baby's going to come out of my vagina okay. I didn't know anything about birth really. I just knew what not to do. I'm probably not going to have an epidural, but I'm open to it. You shouldn't break the waters, but I don't really understand why. But I wasn't having my waters broken. I was just having a little bit of my waters broken. And then came the tsunami and it was my entire waters. It was all over the bed and it was all warm. I was like, “What is happening?” She had either–Meagan: So your bag never really did break until then. Ashley: No, yeah. Yeah. Yes. And there's some other information. She's like, “Oh, we'll put the screw on the baby's head.Meagan: The FSC, fetal scalp electrode? Ashley: We call it the clip. Meagan: A clip. Ashley: Yeah, some call it the screw. I call it the screw. It's a little clip and it barely hurts. That was one of my compromises from not having continuous monitoring. I said, “If I have that, then I can be mobile.” That was the compromise and negotiation. Then, I found myself locked to a machine by the way because it wasn't mobile at this point. Then as soon as I got off the bed, there was a decel, so I was back on the bed. I was in excruciating pain at this point. I come out of my nest in the shower where I was able to breathe through everything and I was standing upright. Now there was a bit of fear happening because there was a decel that she didn't recover from quickly enough, so then the obstetricians and everyone had to come in. They were kind of like, “Oh, C-section,” talking about it already. I said, “No. I don't want to talk about it. The baby's fine. Just let me do my thing.” “Okay, okay,” and then they hounded me to get a catheter in my arm even though I didn't want one. I said, “No, I don't want one.” It's really painful and I don't want it. She said, “Oh, come on. We'll just get one in.” I said, “Okay, fine. Just do it then. Just leave me alone.” So she put it in and I'm walking around with this thing coming out of my vagina, this thing in my hand and I'm out of the zone and really finding it hard to get back into how I was feeling. Meagan: Your space. Ashley: Yeah, my space. I must have been in there for an hour or two, maybe a bit longer. By this point, they've told me that I'm 10 centimeters on one side, 8 centimeters on the other and there were a couple more decels and maybe one more and they were saying things to me that I don't understand. They were like, “You've got an anterior lip. It's swollen. You're 10 centimeters on this side and 8 centimeters on that side. Your baby's asynclitic. Your baby's up high.” They're looking at me and I'm like, “I don't know.” Meagan: You don't know what any of that means. Ashley: I'm 10 centimeters. The baby is going to come out right any minute. I'm just like, “Is the baby's going to come out soon?” I was starting to feel some pushy pains as well, so my body was pushing a little bit too and then I think I went back into the shower and I called in my husband because he was a weak link and I knew he would do what I said. I was like, “I want an epidural.” And the epidural was there within 10 minutes. I knew that would happen. They wanted me to have an epidural on arrival because of my said. I went to the anesthesiologist appointment and they looked at my back and said, “No, you've got a fine back.” What they're worried about with bigger people is that there can be fat over the spine. I said, “Okay, well I've got a fine back,” which I thought would be fine because I never had any problems with the C-section. They said, “But we still recommend an epidural on arrival.” I was like, “Okay. Well, at least I understand why.” The thing is that I'm trying to get information from them so I can make informed choices, so if it's in my best interest, then I will say yes and I will do it. But if it's in the best interest of you to make your life easier, then I'm not going to do it. I'm not going to put myself or my baby at risk to make your life easier. I understood that an emergency C-section was a higher risk than a planned C-section. I understood that induction was a higher risk. I knew all of the before things and the choices. What I got stuck with is I didn't understand physiological birth. I hadn't done any research on that. So they were talking to me gobbledygook, all of these things were happening. I just never thought that this could happen. I never ever thought this would happen to me. My mom had me in 7 hours. What is happening? What are these things that are happening? Now I'm on the bed. I'm stuck on the bed because I've chosen to have an epidural and now I've negotiated because we have had a couple of decels. I've negotiated for myself what I think is a pretty sweet deal which I realize is actually a really bad deal of vaginal examinations every hour. The normal standard practice is about every 4 hours and I'm like, “Okay. How about if we just check every hour and see if there is any progress?” They're like, “Yeah, that sounds great.” Every hour, they come into me and they're saying, “No change. Baby's up high. No change. We recommend C-section. These are the risks if you wait.” They were talking to me about the risks that would happen in a Cesarean, not about the risks that would happen in a vaginal birth if I wait. So it was very biased. I was like, “Okay, so what happens if I wait to have a vaginal birth?” They were like, “Well, we just recommend a Cesarean.” I feel like I'm in a room stuck with the enemy. I said to my doula, “I don't trust them. I feel like they know what they're talking about, but I don't know any different either.” My doula was a student doula and it's not like I came in there with a midwife who is on my team. I'm looking at the midwife and I'm like, “Are you going to help me?” I'm realizing that she's team obstetrician. I mean, I've never met her before. She was just working there. I'm thinking, “This is not what was sold to me in the VBAC group if I see a midwife. Midwives are amazing, blah blah blah blah.” What I actually missed was that independent midwives that are not working in hospital have more free reign are the midwives that everyone's raving about. I'm thinking it's just random midwives, any midwives are awesome. And not every midwife's awesome because you've got different personalities. You've got different experiences. You've got different passions and every person is different just like you can find an amazing obstetrician. You can find an amazing personal trainer, but they're not going to suit everybody or everyone's needs. And they have a bias against different people based on color, based on gender, based on size, based on the way that you look. If they can identify with you, they are going to be more attached to the story and fight and advocate a bit more. If they're not really into you, they're going to be like, “Oh well. I'm not going to lose my job over this,” sort of thing. I've learned all of these things since. Eventually, after about 6 hours, I had another decel. I think I had about 3 in total. It wasn't a huge amount. Meagan: Yeah, and how low were they? Do you remember? Ashley: I don't remember. The problem was that she wasn't coming back as quickly as they would have liked. Meagan: Prolonged. Ashley: Yeah, it was prolonged. I also didn't know at the time that the epidural also slowed down my contractions too. I only know this from getting the hospital notes which is quite common with epidurals as well. Eventually, I just said, “Okay, fine. I'm fine. I'll go.” After the last one, it felt like my baby was at risk. If someone is coming to you every hour saying, “This is the risk. We recommend that,” eventually, you just give up. I think I had been in labor for a total of 12 hours at that point. The first labor I had ever had and off I went. As I was going out, the midwife said to me, “It's okay. I had a home birth planned, but I ended up in a Cesarean. You'll be okay.” I was like, “See? You never would have been on my team because you hadn't even had a vaginal birth yourself.” I looked at her and I was like, “That was the worst thing you could have ever said to me at that point.” I was like, “Just because you had one and you're okay with it doesn't mean that I'm okay with it.” It was the worst thing. She obviously thought it was really supportive, but I felt so betrayed. So off I went and I had my surgery. Everything started to go downhill. My husband got rushed out of the surgery with my baby and you could just feel that it was intense. I said to my husband, “I love you. Look after the baby. I think I'm either going to lose my uterus or I'm going to die.” Meagan: Were you hemorrhaging? Ashley: Basically, the story that they tell me, I'm not sure if I believe it, but even if it is true, it is what it is at the end of the day. One of the risks that they were worried about is when a baby descends too much, there's a– you know this yourself– there's always a risk of a special scar happening because there's more risk of a tear or them having to cut more. So that's what they were informing me about the whole time. They knew about the risk and they were trying to stop– Meagan: But they kept saying that baby was high, right? Ashley: They told me that baby was high. They said that when the baby came out, she flung her arm up and ripped it down to my cervix. Meagan: Oh, okay. Ashley: Now, how does that happen when a baby is up high? If she's up high, how is she ripping down to my cervix? Now I think about that. How does that happen? Because my cervix was fully dilated. Meagan: Yeah, except on that one side. Did it ever finish? That swelling, that edema, did it go down? Ashley: Not that I know of. What they told me was nothing had changed positioning in that. Then when I looked at the notes when I got the notes, he laid out, “I saw that the positioning had changed.” She had come down a station, but they never communicated that to me. I have a feeling that she was probably down a bit further than they had put because, on the paperwork, they also said I was only 7 centimeters. There was no mention of an anterior lip, so they fudged the papers a little bit and weren't honest. I mean, if you're going to make a few little changes, then obviously, there's a reason for that. It obviously looks better on paper. Meagan: That's what happens all of the time. The patient will hear one thing, then on the op reports, it's a little different. So we always encourage you to get your op reports. It's sometimes hard to read but get your op reports. Ashley: It is hard to read. You know, they put it on the board too here in Australia what you are and at what time, so the information is there for me to look at the whole time while I'm in labor, so it's not that one person just said it, it's literally on the board for you to see. I was quite upset when I saw some of the notes. I went through the notes. I've been through them multiple times now and I was just trying to learn. I was Googling, “What does this mean and what does that mean?” because I don't know the medical jargon. I'm learning all of the things and I'm looking at Spinning Babies. I'm looking at everything and trying to learn after the fact, but essentially what had happened was apparently, she had flung around there, tore my uterus down to the cervix and then they needed to call in a specialized team to come in and resolve that problem that they had created. The surgery went on for a number of hours and it was a very challenging surgery. I wanted to crawl out of my body essentially because I had been laying there for so long. It was just a horrible experience. I was reunited with my baby. She was born at 6:30. I was reunited with them at about 12:00 at night, so I had been in labor from 4:00 in the morning and then I was breastfeeding her because my husband advocated for her to be breastfed. So that meant that she had her sugars checked. They were fine, so they were happy for her to wait for me. I was really, really glad that my husband advocated for me. I was so tired when I got out of surgery and I was back in this hot room. I was sweating profusely. There was no aircon. Some of the rooms, even though it was new, didn't have aircon. I ended up in a room with no aircon and it was so hot. I had to have a midwife stay with me and do observations every 15 minutes to check me. I didn't end up in the ICU, but I lost 3.1 liters of blood. I had blood transfusions in the surgery, all of the stuff in the surgery to keep me awake, and all of that. I really wanted to go under, but they wouldn't put me under because I had been eating. It wasn't a great experience and I came out very traumatized from that experience. I ended up having PTSD with flashbacks. I was crying for months. I felt broken. They told me to never have a vaginal birth again, and that I could have two more babies so that was amazing. I was like, “Well, you must have done a good job if you think I could have two more,” but they must be born Cesarean. I was like, “Okay, no problems.” I was so grateful to be alive after that experience. I was trying to make sense of what had happened. The next few years, that was my mission to try to make sense because I've gone from a space of you're not allowed to have a vaginal birth to what happened, trying to understand what happened, and then planning our future because we wanted four children total. So I almost never had any more children. For 6-12 months, I was done. I was never going to go through that again. I was a broken person. I was really struggling, but I trained as a postpartum doula and I started to want to help women in breastfeeding and the things that I knew that I could support because I ended up breastfeeding that baby for 12 months and I felt like a success at that regard. I learned a lot about breastfeeding. I wanted to share my voice and help women, but I wasn't well enough to help women in the birth space because I felt like a failure. I was trying to learn and I wanted to be in a space where I felt safe. This was trauma and challenges were happening and this was me being able to help people and make a positive out of a negative essentially. And then I found you guys. I found your podcast and I was like, “This is amazing,” because you were the first place that was promoting VBAC after two Cesareans. Back then, nobody was having VBAC after two Cesareans let alone multiple now that we see happening. I think a lot of it has to do with your podcast because when you hear women's stories and you hear the statistics and you can actually hear other women doing it, that was the start of me getting hope and realizing that there was another way. Meagan: Oh, that just gave me the chills. Ashley: Thank you so much for your podcast. Meagan: I have a sweater on right now, but literally it just went up my arm. Ashley: Awesome. It is really nice to know that if I didn't come across your podcast, I probably wouldn't have taken that next step, so it is life-changing to hear other women's stories and have that resource. The fact that you guys had the stats and everything, I was very much in the stats trying to move through special scars. I eventually had gone onto Special Scars, Special Hope. Meagan: Such a good group. Ashley: Yeah, so amazing and started to connect with other women who were having worse scars than me. They were birthing on classical scars. I was like, holy moly. I think it was ACOG or maybe RANZ of New Zealand and Australia. They said it was okay to labor on a scar like mine because I had a vertical scar down to my cervix. That's the low-risk special scar. I was like, “If it's good enough for them, it's good enough for me.” Look at these people saying that. All of the obstetricians that I had spoken to because I had a meeting with an obstetrician. I had met with so many midwives who knew about the system. They said to me, “Look. They are going to be petrified of you coming to the system.” It was really good to get that feedback and from my own experience, they wouldn't allow me to have a VBAC let alone a VBAC after two Cesareans with a special scar and high BMI. I started to really try to uncover, so I met with an obstetrician from that hospital and she basically said to me, “Look, you're a square peg trying to fit in a round hole or a round peg in a square hole.” I looked at her. I didn't understand that. I had never that and I have never been referred to as that kind of person. I quite like doing what normal people do. I was looking at her. I'm like, “What are you talking about?” She just said to me, “Basically, I ended up with this surgery because the surgery who was working had decided that because of my weight, that that was all that I was capable of or that was the path that I was going through.” That was really the first time that I've felt like my weight has actually held me back or I've been discriminated against. When I look back at the fact of how I was treated and the conversations I was having, it was obvious that it was happening the whole way through, I just was so naive to it that it was happening in my face and I didn't even realize it because the thing is that I understand that being of high weight can put you at risk for all of these things. I'm looking at it from their point of view, but I'm not actually sometimes looking at it from Ashley's point of view. I understand their concern and I understood all of the medical stuff because I had listened to them. I had asked questions. I had read their policies for obese people. I understood that it was discrimination. I didn't understand it at the time. I didn't understand that they probably weren't seeing me as a human as maybe they would have if I was a skinny version of myself. We probably would have had a different conversation. They probably would have been cheering me on and holding my hand and saying, “You're an amazing VBAC candidate. We support you. We probably still want to do all of these things to you, but we're not going to kick you out of hospital.” That's the difference when I hear women's stories. Oh, she's allowed to get in the water bath and she's allowed to have a beautiful birth. She doesn't have to bend over backward and do a cartwheel and it's because she looks a certain way or she was really lucky because she got an obstetrician that was amazing. There are all of these things that have to line up. That's what has propelled me on my journey to find home birth as an option. Meagan: Home birth, home birth. So you talked about stats. You were on this mission of stats, so you went out and you found the stats about VBAC after multiple Cesareans, two Cesareans, special scars, found some stuff, said, “Okay, this seems acceptable,” and then you started a home birth. Based off of your own research, for you, you felt completely comfortable starting this journey. Ashley: No, I didn't. Meagan: Okay. Ashley: I didn't. I mean, I had to work through the fears with the stats and I was comfortable with home birth and the idea of home birth. I understood that home birth was as safe as birthing in a hospital and I understood that if I was birthing with a midwife I would have a medical person with me. Now, the next challenge that came for me was that I couldn't find a home birth midwife who would support me. I feel like I leveled up. I was leveling up the whole time. It was like, now you've got a VBA2C. Now you've got a special scar. Let's work through this. What do I feel comfortable with? What am I willing to take on? Okay, okay. That's doable. That's doable. I can work through that. What's the next thing? Oh yeah, the next thing is this. Okay, what am I going to do with that? A home birth. Okay, a home birth feels like a safe option. I can do this. I can do that. I can do that. Okay, that's going to be the best thing for me. I'm not going to go back to hospital. Meagan: I love that you said that. I can do this. I'm comfortable with this. You kind of have to go through that with anything. In life in general, but especially with this birth, you went through it and you were like, “Okay, yep. Yep. Yep. Yep. Yep. Yep. Okay. Now, here I am.” Ashley: Yeah and I was seeing a psychologist at the time for all of the things to help me lose weight actually. My GP, I wanted to lose weight. I've been overweight my whole life. I wanted to lose weight. I went to a nutritionist and she was like, “You know everything. I think it's emotional.” I've got childhood stuff going on. I worked with him and I said, “The way that I feel about the hospital system, is this right?” He's normalizing my experience for me and saying, “You're perfectly normal.” I'm trying to say, “Am I having a trauma response here? I don't want to go into a home birth because I'm having a trauma response,” because the obstetrician said to me, one of them, she's like– she wasn't the best obstetrician for the debrief. She said to me, “You've got a risk of special scar, a 7% rupture rate.” I said, “That's a little bit different from what I found in Special Scars, Special Hope where they are looking at women.” I said, “Have you got any statistics?” She's like, “No.” I'm like, “So how can I trust that what you're saying is correct then?”Meagan: Well then, where'd you get 7%?Ashley: Exactly. She's like, “Look, if you find any doctor who's willing to support you, then they're not the doctor for you. I'm telling you what is the safest thing for you.” I was challenging her because at this point, I'm angry. I'm so done. I'm so done. I've just been through hell because of you people and I want to get information. I don't want to hear your judgments. She said to me, “If you find a doctor, then basically they're not right. They're doing the wrong thing.” I said, “So you're the best doctor in the whole world? You know everything right? You're the best and you know the best then? So if I find another doctor who says yes then they're wrong and you're right, that's what you're saying?” She was just looking at me. She was like, “I just feel like what you're going to do is you're going to keep looking until you're going to find someone and then you're going to put yourself at risk.”I'm like, “That is exactly what I'm going to do.” Meagan: You're like, “Well, I'm glad you feel that way.” Ashley: I should have sent her a postcard after my free birth and said, “I freebirthed. Thank you for driving me to this.” It is amazing the conversations you have when you really do have conversations. You can see where they're coming from and how very different their views are. Some of the fears and worries that they have are not about you and your baby. They are about themselves and their career, but the information I didn't know about her was that she was actually the head of obstetrics and she just lost her title and her job. She'd been bumped down. The reason why I went to her was because she supported breech birth in hospital and she was very vaginal friendly. She did support me. She was the consultant I saw on the paperwork that supported me to have a vaginal birth, but in the timeframe of me organizing to meet up with her, the information that I didn't know that I found out later was that she lost her job because she had supported somebody to have a breech and there was a poor outcome that the parents accepted, but somebody else had basically complained about. The only thing is that breech is so risky they say even though it's not. She's one of the radical obstetricians so she had been punished and so she was coming from a space of where she was. It's really important to know that information. You never know where they are in their career or how they are feeling, so she might have been really bitter at the time and negative and feeling like there was doom and gloom in the world. It was really shameful when I was speaking to my doula friends and they were like, “Oh really? She was so amazing.” I'm like, “Yeah, well maybe she is amazing but not for people like me. Maybe she supports this person because they've got a thin body and because of me, she's like, ‘No. I wouldn't touch you with a 10-foot pole,'” because it's too risky for her and for her job also. They are up against it as well in the system and that's something I have learned. My next mission was that I needed to find a midwife who was going to bat for me, not somebody who was going to be worried about losing their career because they come after the midwives too that are home birthing. So I had gone to the free birth podcast as well and I was listening to their stories. I was like, “They're a bit out there for me. I'm not brave enough to do that. That's a bit radical.” Eventually, my husband was the one that talked me into a free birth when we couldn't have a midwife to support me. It

The last time we talked about GDM, we had no other than Dr. Coustan himself talk to us about it. There have been some updates from the literature since over 4 years ago! We answer some questions. Should we do early GDM screening? Is the 1 or 2 step screening method better? Can patients eat before their 1 hour glucose test?  Twitter: @creogsovercoff1 Instagram: @creogsovercoffee Facebook: www.facebook.com/creogsovercoffee Website: www.creogsovercoffee.com Patreon: www.patreon.com/creogsovercoffee You can find the OBG Project at: www.obgproject.com

Routine, repetitive urine dipsticks (meaning at each prenatal visit) were introduced into prenatal care back in the 1960s and 70s. The idea was to act as an early screen for bacteriuria (ASB), proteinuria as a screen for preeclampsia, and glycosuria as a screen for GDM. That was based more on expert opinion rather than clinical trials. The utility of urine dipstick testing in pregnant women has been debated for years, with studies suggesting minimal use in asymptomatic patients. Urine dips as still integrated into clinical practice mainly out of tradition…But is this evidence-based now? And if it is NOT evidence-based to do this with every visit and with every patient, when SHOULD it be done? What does ACOG have to say? Well, turns out ACOG says a lot- so you'll want to stay tuned until the end of the episode as we cover that and a lot more.

Please Subscribe and Review: Apple Podcasts | RSS Submit your questions for the podcast here News topic du jour: are covid vaccines causing persistent covid? Podcast Questions: 1. Sodium Nitrite [18:20] Dana says: Good morning! I just listened to your episode from 12/23. I have had a long-standing, perplexing question about sodium nitrite/nitrate, and it relates to the recent episode. Since I was 14, I've had a sensitivity to processed meats that contain sodium nitrite/nitrate (ham, lunch meat, salami, hot dogs, etc). It creates a vascular migraine headache with a aura of visual disturbances and sometimes hemiparesis. I can stop the progression with aspirin, so I'm confident it's vascular. The perplexing part, is that it never happens if I eat vegetable high in nitrite/ nitrates, or meats that are cured with celery powder that is high in nitrite/nitrates. Any thoughts on how these are different?   2. High fasted blood glucose/high cholesterol [20:56] Jackie says: Hey there! Long term listener, first time e-mail-er. I've been low carb for the better part of the last 5 years and had some success in maintaining a 40lb weightloss with those eating habits. However, after 2 surrogate pregnancies accompanied with IVF and exogenous hormones over the last 3 years, I'm struggling to get back to my pre-pregnancy weight. Looking for answers I had some labs done, expecting a thyroid issue, to find high fasted glucose levels (99-101) and elevated bilirubin. I'm fine after eating, my glucose sits at about 74-84 2 hours after eating pretty consistently. I'm just not sure why all of a sudden I'm showing poor insulin management in the mornings on an empty stomach? My BMI is 34- which I know isn't ideal and I'm working on it- but after hormones the weight doesn't seem to want to come off. I'm 30 years old. My doctor said “make some lifestyle changes and we'll keep an eye on it.” So much help there! Wondering if that might be attributable to my dis-regulated blood glucose levels. Would appreciate your insight on the matter! Any thoughts as to what I can try to get my blood sugar back to normal before it spirals out of control? I'm debating on a CGM but not sure if it would be of help? Also, my cholesterol came back high at 212. LDL/HDL ratio of 3. Triglycerides are 66. In the low carb world what does this mean, as in the standard medicine world it's not great- not sure if it's the same. Thank you for your time and all the knowledge you bring to optimizing health! You're truly changing the world.   3. Keto Breastfeeding [26:55] Juliana says: Hi Robb and Nikki, I've been listening to your show for about a year now and I love the breadth of topics you cover. I know sometimes you joke that people my age are not interested in what you have to say, but I want to let you know we are very interested. I share your podcast all the time and people my age love it. With my second baby I was diagnosed with GDM and was on my way toward type 2 diabetes post partum. My blood sugar levels were out of control and I kept adding on weight. I found keto and completely changed my life. I lost 40 pounds before getting pregnant with our 3rd baby. With our 3rd baby I was very strict and ate less than 50 carbs/day and had an extremely healthy pregnancy with no GDM this time. I am now 10 weeks post partum of my 3rd baby. After having the 3rd baby I gave myself a ton of freedom (ie any/all carbs). It was a celebration of all my hard work for 2 years. Now at 10 weeks post partum I tried to go back to my very low carb way of eating and within 48 hours I got soo soo soo sick, it very much felt like keto flu. I would like to note that I had an LMNT each day and salt my food generously with redmonds. I got scared because breastfeeding is the most important thing for me. I went back to having carbs to undo the sickness, but I would prefer a low carb way of eating if I could get there. I take magnesium and dessicated liver and vitamin D and LMNT. I also did not restrict calories, I am very familiar with the keto diet and I made sure I had plenty of fat and calories. I'm curious as to what ketosis does to our overall hydration levels and possibly breast milk supply? I know you recommend LMNT for breastfeeding moms, so I was hoping you might have some insight on low carb diets and breastfeeding. I'm willing to suffer through the keto flu but I'm terrified of it hurting my milk supply. I also read that breastfeeding lowers glucose levels and am curious if that may have had an interaction and intensified the keto flu. I forgot to take my morning fasting numbers. I'm a 33 year old female and my weight is totally irrelevant because I just had a baby Thank you for any insight you might have! Thank you, Juliana Sponsor: The Healthy Rebellion Radio is sponsored by our electrolyte company, LMNT. Proper hydration is more than just drinking water. You need electrolytes too! Check out The Healthy Rebellion Radio sponsor LMNT for grab-and-go electrolyte packets to keep you at your peak! They give you all the electrolytes want, none of the stuff you don't. Click here to get your LMNT electrolytes Transcript: You can find the transcript at https://robbwolf.com/2022/12/30/nitrite-sensitivity-trouble-after-hormones-keto-breastfeeding-thrr136/

VIDEOS: The Cost of Denial Clip (17:33) Hang On, Bill Gates and Dr. Fauci just did WHAT? | Redacted with Clayton Morris (21:43) There is nothing constructive about the pot calling the kettle black. – Clare Daly  (1:17) Clinical trial for nicotinamide riboside: Vitamin safely boosts levels of important cell metabolite linked to multiple health benefits University of Iowa Health Care, October 10, 2022 In a clinical trial of nicotinamide riboside (NR), a newly discovered form of Vitamin B3, researchers have shown that the compound is safe for humans and increases levels of a cell metabolite that is critical for cellular energy production and protection against stress and DNA damage. Studies in mice have shown that boosting the levels of this cell metabolite — known as NAD+ — can produce multiple health benefits, including resistance to weight gain, improved control of blood sugar and cholesterol, reduced nerve damage, and longer lifespan. Levels of NAD+ diminish with age, and it has been suggested that loss of this metabolite may play a role in age-related health decline. These findings in animal studies have spurred people to take commercially available NR supplements designed to boost NAD+. However, these over-the-counter supplements have not undergone many clinical trials to see if they work in people. The new research, reported in the journal Nature Communications, was led by Charles Brenner, PhD, professor and Roy J. Carver Chair of Biochemistry at the University of Iowa Carver College of Medicine The human trial involved six men and six women, all healthy. Each participant received single oral doses of 100 mg, 300 mg, or 1,000 mg of NR in a different sequence with a seven-day gap between doses. After each dose, blood and urine samples were collected and analyzed to measure various NAD+ metabolites in a process called metabolomics. The trial showed that the NR vitamin increased NAD+ metabolism by amounts directly related to the dose, and there were no serious side effects with any of the doses. “This trial shows that oral NR safely boosts human NAD+ metabolism,” Brenner says. “We are excited because everything we are learning from animal systems indicates that the effectiveness of NR depends on preserving and/or boosting NAD+ and related compounds in the face of metabolic stresses. Because the levels of supplementation in mice that produce beneficial effects are achievable in people, it appears than health benefits of NR will be translatable to humans safely.” Consumption of a bioactive compound from Neem plant could significantly suppress development of prostate cancer National University of Singapore, September 29, 2022 Oral administration of nimbolide, over 12 weeks shows reduction of prostate tumor size by up to 70 per cent and decrease in tumor metastasis by up to 50 per cent A team of international researchers led by Associate Professor Gautam Sethi from the Department of Pharmacology at the Yong Loo Lin School of Medicine at the National University of Singapore (NUS) has found that nimbolide, a bioactive terpenoid compound derived from Azadirachta indica or more commonly known as the neem plant or curry leaf common in throughout Indian cuisine, could reduce the size of prostate tumor by up to 70 per cent and suppress its spread or metastasis by half. In this research, we have demonstrated that nimbolide can inhibit tumor cell viability — a cellular process that directly affects the ability of a cell to proliferate, grow, divide, or repair damaged cell components — and induce programmed cell death in prostate cancer cells,” said Assoc Prof Sethi. The researchers observed that upon the 12 weeks of administering nimbolide, the size of prostate cancer tumor was reduced by as much as 70 per cent and its metastasis decreased by about 50 per cent, without exhibiting any significant adverse effects. “This is possible because a direct target of nimbolide in prostate cancer is glutathione reductase, an enzyme which is responsible for maintaining the antioxidant system that regulates the STAT3 gene in the body. The activation of the STAT3 gene has been reported to contribute to prostate tumor growth and metastasis,” explained Assoc Prof Sethi. “We have found that nimbolide can substantially inhibit STAT3 activation and thereby abrogating the growth and metastasis of prostate tumor,” he added. Mindfulness training provides a natural high, study finds University of Utah, October 20, 2022 New research from the University of Utah finds that a mindfulness meditation practice can produce a healthy altered state of consciousness in the treatment of individuals with addictive behaviors. Not unlike what one might experience under the influence of psychedelic drugs—achieving this altered state through mindful meditation has the potential lifesaving benefit of decreasing one's addictive behaviors by promoting healthy changes to the brain. The findings come from the largest neuroscience study to date on mindfulness as a treatment for addiction. The study, published in the journal Science Advances, provides new insight into the neurobiological mechanisms by which mindfulness treats addiction. Study findings provide a promising, safe and accessible treatment option for the more than 9 million Americans misusing opioids. Eric Garland is the lead author of the paper and is a distinguished professor and directs the University of Utah's Center on Mindfulness and Integrative Health Intervention Development. Garland's study builds on previous research measuring the positive effects of theta waves in the human brain. Researchers have found that individuals with low theta waves tend to experience a wandering mind, trouble concentrating or they ruminate on thoughts about themselves. Low theta waves result in a loss of self-control as the brain slips into its default mode of automatic habits. In contrast, when a person is focused, present and fully absorbed in a task, EEG scans will show increased frontal midline theta wave activity. “With high theta activity, your mind becomes very quiet, you focus less on yourself and become so deeply absorbed in what you are doing that the boundary between yourself and the thing you are focusing on starts to fade away. You lose yourself in what you are doing,” said Garland. Garland's new study showed it is in this mindful, theta wave state that people begin to experience feelings of self-transcendence and bliss, and the brain changes in ways that actually reduce one's addictive behaviors. Garland's research team recruited 165 adults with long-term opioid use for the study. Participants were randomly placed into either the control group that participated in supportive group psychotherapy or the experimental group taught to incorporate Mindfulness-Oriented Recovery Enhancement (MORE) into their daily lives. Participants showed more than twice as much frontal midline theta brain activity following treatment with MORE, whereas those in supportive therapy showed no increase in theta. Participants in MORE who showed the biggest increases in theta waves reported more intense experiences of self-transcendence during meditation, including the sense of one's ego fading away, a sense of oneness with the universe or feelings of blissful energy and love. MORE also led to significant decreases in opioid misuse through the nine-month follow-up. These reductions in opioid misuse were caused in part by the increases in frontal midline theta brain waves. Garland explained that by achieving “tastes of self-transcendence” through meditation, mindfulness therapy boosted theta waves in the frontal lobes of the brain to help participants gain self-control over their addictive behaviors. Free radicals blamed for toxic buildup in Alzheimer's brains Rutgers University, October 11, 2022. A study reported in Cell Death & Disease revealed a previously unknown mechanism that may contribute to traumatic brain injury and Alzheimer's disease. While a buildup of the protein amyloid-beta has been hypothesized to be the major driver of Alzheimer's disease, the study suggests that another protein, after undergoing oxidation by free radicals, could be a causative factor. “Indeed, scientists have known for a long time that during aging or in neurodegenerative disease cells produce free radicals,” explained lead researcher Federico Sesti, who is a professor of neuroscience and cell biology at Rutgers Robert Wood Johnson Medical School. “Free radicals are toxic molecules that can cause a reaction that results in lost electrons in important cellular components, including the channels.” Dr Sesti and colleagues determined that oxidation of a potassium channel known as KCNB1 results in a toxic buildup of this protein, leading to increased amyloid-beta production and damage to brain function. “The discovery of KCNB1's oxidation/build-up was found through observation of both mouse and human brains, which is significant as most scientific studies do not usually go beyond observing animals,” Dr Sesti reported. “Further, KCBB1 channels may not only contribute to Alzheimer's but also to other conditions of stress as it was found in a recent study that they are formed following brain trauma.” Study: Maternal, paternal exercise affects metabolic health in offspring Ohio State University, October 19, 2022 A mouse study by Kristin Stanford, with The Ohio State University College of Medicine at the Wexner Medical Center, provides new ways to determine how maternal and paternal exercise improve metabolic health of offspring. This study used mice to evaluate how their lifestyles—eating fatty foods vs. healthy and exercising vs. not—affected the metabolites of their offspring. Metabolites are substances made or used when the body breaks down food, drugs or chemicals, or its own fat or muscle tissue. This process, called metabolism, makes energy and the materials needed for growth, reproduction and maintaining health. Metabolites can serve as disease markers, particularly for type 2 diabetes and cardiovascular disease. “Tissue metabolites contribute to overall metabolism, including glucose or fatty acid metabolism, and thus systemic metabolism. We have previously shown that maternal and paternal exercise improve health of offspring. Tissue and serum metabolites play a fundamental role in the health of an organism, but how parental exercise affects offspring tissue and serum metabolites has not yet been investigated. This new data contributes to how maternal or paternal exercise could improve metabolism in offspring,” Stanford said. This study found that all forms of parental exercise improved whole-body glucose metabolism in offspring as adults, and metabolomics profiling of offspring serum, muscle, and liver reveal that parental exercise results in extensive effects across all classes of metabolites in all of these offspring tissues. Regular consumption of fried food before pregnancy increases risk of developing gestational diabetes Kennedy Shriver National Institute of Child Health and Human Development, October 10, 2022 New research published in Diabetologia (the journal of the European Association for the Study of Diabetes) shows that women who eat fried food regularly before conceiving are at increased risk of developing gestational diabetes during pregnancy. Gestational diabetes (GDM) is a complication that can arise during pregnancy, and is characterised by abnormally high blood glucose during the pregnancy (especially in the final 3 months). It can lead to increased birthweight of the child, as well jaundice and other complications. When left untreated, it can cause complications or stillbirth. Women who have GDM are more likely to later develop full blown type 2 diabetes. The authors included 21,079 singleton pregnancies from 15,027 women in the Nurses' Health Study II (NHS II) cohort. NHS II is an ongoing prospective cohort study of 116,671 female nurses in the USA aged 25-44 years at the start of study. For fried food consumption, participants were asked “how often do you eat fried food away from home (e.g. French fries, fried chicken, fried fish)?” and “how often do you eat food that is fried at home?” Both questions had four possible frequency responses: less than once per week, 1-3 times per week, 4-6 times per week, or daily. The researchers analysed fried food consumption at home and away from home separately, as well as total fried food consumption. In addition, they asked the participants what kind of frying fat/oils they usually used at home, with the possible responses as follows: real butter, margarine, vegetable oil, vegetable shortening, or lard. The association persisted after further adjustments were made for varying body-mass index (BMI). After this, the risk ratios of GDM among women who consumed total fried foods 1-3, 4-6, and 7 or more times per week, compared with those who consumed less than once per week, were 1.06, 1.14, and 1.88 respectively (thus an 88% increased risk for 7 or more times per week compared with less than once per week). The authors say: “The potential detrimental effects of fried food consumption on GDM risk may result from the modification of foods and frying medium and generation of harmful by-products during the frying process. Frying deteriorates oils through the processes of oxidation and hydrogenation, leading to an increase in the absorption of oil degradation products by the foods being fried, and also a loss of unsaturated fatty acids such as linoleic and linolenic acids and an increase in the corresponding trans fatty acids such as trans-linoleic acids and trans-linolenic acids.” They add: “Frying also results in significantly higher levels of dietary advanced glycation end products (AGEs), the derivatives of glucose-protein or glucose-lipid interactions. Recently, AGEs have been implicated in insulin resistance, pancreatic beta-cell damage, and diabetes, partly because they promote oxidative stress and inflammation. Moreover, intervention studies with a diet low in AGEs have shown significantly improved insulin sensitivity, reduced oxidant stress, and alleviated inflammation.” When analysed separately, the authors found that there was a statistically significant association of GDM with fried food consumption away from home, but not with fried food consumption at home. The authors say: “Deterioration of oils during frying is more profound when the oils are reused, a practice more common away from home than at home. This may partly explain why we observed a stronger association of GDM risk with fried foods consumed away from home than fried foods consumed at home.”

In 1964, John O'Sullivan published his original research describing abnormal cut off values following an oral glucose challenge in pregnancy. O'Sullivan laid the foundation for screening and diagnosis of gestational diabetes. We have learned a lot since that 1964 publication. In this session, we will review a new meta-analysis coming to print in November 2022 comparing the 1-step with the 2-step oral glucose tolerance test. We will also summarize data on point of care glucometers (capillary blood glucose) for diagnosing gestational diabetes. Is the use of POC testing devices for GDM diagnosis evidence-based? There's an answer for that… And we will cover it.

DJ Ashba joins Ralph Sutton and Don Jamieson and they discuss Ashbaland in the Metaverse and DJ Ashba's background in graphic design, celebrating 9 years of marriage and how DJ Ashba met his wife, creating the new genre of music "GDM" by incorporating guitar with electronic dance music, collaborating with other artists, how DJ Ashba met Nikki Sixx and the creation of Sixx:A.M., DJ Ashba's first concert, first drug and first sexual experience and so much more!(Air Date: March 16th, 2022)Support our sponsors!Mipod.com - Use promo code: SDR for 20% off!YoKratom.com - Check out Yo Kratom (the home of the $60 kilo) for all your kratom needs!ZippixToothpicks.com- Click here to start your healthier alternative to smoking today!The SDR Show merchandise is available at https://podcastmerch.com/collections/the-sdr-showYou can watch The SDR Show LIVE for FREE every Wednesday and Saturday at 9pm ET at GaSDigitalNetwork.com/LIVEOnce you're there you can sign up at GaSDigitalNetwork.com with promo code: SDR for a 14-day FREE trial with access to every SDR show ever recorded! On top of that you'll also have the same access to ALL the shows that GaS Digital Network has to offer!Follow the whole show on social media!DJ AshbaTwitter: https://twitter.com/djashbaInstagram: https://instagram.com/ashbaDon JamiesonTwitter: https://twitter.comrealdonjamiesonInstagram: https://instagram.com/donjamiesonofficialWebsite: https://www.donjamieson.comRalph SuttonTwitter: https://twitter.com/iamralphsuttonInstagram: https://www.instagram.com/iamralphsutton/The SDR ShowTwitter: https://twitter.com/theSDRshowInstagram: https://www.instagram.com/thesdrshow/GaS Digital NetworkTwitter: https://twitter.com/gasdigitalInstagram: https://www.instagram.com/gasdigital/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.