Obstetric Hospitalist: Trenia

Show Notes

In Episode 4 of No Referral Required, Mandy, Courtney, and Lara sit down with OB-GYN Dr. Trenia, who made the leap from full-scope obstetrics and gynecology to working exclusively as an obstetrics hospitalist. Dr. Trenia explains what hospitalist and laborist roles look like in practice, how shift-based work has transformed her career and personal life, and why high-volume specialization makes her a better surgeon and clinician. The conversation dives into the realities of meeting laboring patients for the first time, the unique challenge of caring for two patients simultaneously, and the art of counseling patients whose wishes may conflict with medical recommendations.

The hosts and Dr. Trenia also tackle some of the biggest conversations shaping modern obstetrics: the rapid pace of evidence-based changes in C-section care, the growing distrust fueled by social media misinformation around drugs like Pitocin, the rise of unassisted "wild births," and the increasingly popular debate over whether OB and GYN should split into separate specialties. Through it all, Dr. Trenia's passion for her work shines — from her commitment to resident education to her daughter's budding interest in medicine. The episode wraps with a lively speed round covering labor and delivery superstitions, dream careers in homicide investigation, and why you should never wear a red shirt on the labor floor.

Transcript

Lara [00:00:08] As a reminder, this podcast covers sensitive and sometimes difficult medical topics. Listener discretion is advised.

Courtney [00:00:17] Hey, everybody. Welcome to episode four of No Referral Required. We’re all here. We’re all here. This is Courtney. Hi, it’s Mandy. And it’s Lara. And we’re back with episode four. So excited to be here. And we have a great guest with us today. Somebody I am fascinated by what you do, because I haven’t done it in a while. Things change. I know, right?

Lara [00:00:37] We’ll find out. Let’s find out what. Yeah, we are here with Trenia, who’s a native Tennessean and an OB-GYN here in this area and started her career doing what we call full scope OB-GYN, seeing patients in clinic, seeing patients on the labor floor, doing GYN surgery. But in the last few years has changed course a little bit with what she’s doing. And we would love to hear from you. Tell us a little bit about how your career has changed over the years.

Trenia [00:01:07] Yeah, I started out in full scope obstetrics and gynecology about 17 years ago, and I did that for about 13 years. And about six years ago or so, I decided that I wanted to specialize more in just obstetrics. So now I’m doing obstetrics hospitalist work, which is much more of where my passion is.

Courtney [00:01:33] What does that mean? What is an obstetrics that does hospital?

Trenia [00:01:39] There’s two different types. There is a laborist and there’s a hospitalist. A laborist just works on labor and delivery and works with delivering babies in different fashions. C-sections, vaginal deliveries, takes care of women who are in labor. A hospitalist can still include gynecology in their scope of practice as well. A hospitalist covers women’s health care, I guess you would say, when other people aren’t around. So I will do obstetrics if there is an ectopic pregnancy, I might cover that as well. For me myself, I work in a large academic center, and so there are most of the time gynecologists nearby, so most of my practice is in obstetrics.

Lara [00:02:26] Okay, interesting. So what does this look like for your life? So you used to have clinic where you’d go in in the morning, see patients all day, and then you’d maybe have a call shift at the hospital. How do things look different now?

Trenia [00:02:39] So for me, it’s probably a lot different than other places because I’m the only hospitalist at the practice that I work at. And there are full scope obstetric and gynecologists that work there. I’m the only hospitalist. So I’m the only one that only covers on labor and delivery. My weeks are very different. I don’t really have a set schedule. I do have one day that is a set schedule for me, and that’s that I work every Sunday night. But every week looks a little different for me. Some weeks I might work three nights a week. Some weeks I might work two days and one night a week. So my schedule does change, but that’s… Depending on the patients that need care.

Mandy [00:03:26] Or the other doctors.

Trenia [00:03:28] It’s more dependent on the other doctors. I fill in gaps when people are on vacation. I think this is new in our practice and so we’re trying to add more hospitalists. I think it’s hospitalist obstetric work is new across the country and it’s growing and it’s becoming very popular. It’s nice because there are people that can do just the obstetrics part and people that can do more of the gynecology part. So instead of doing full scope practice, you can specialize a little bit more on what your passion is.

Mandy [00:04:10] So Trenia, you’re doing shift work. I do shift work, 12 hour shifts. And you do three of those a week, four of those a week?

Trenia [00:04:16] I would say on average, three to four a week.

Mandy [00:04:18] Okay.

Trenia [00:04:19] Some weeks I might do five, some weeks I might do two. It just depends on it, but on average it comes to about four, three to four a week.

Mandy [00:04:27] And your practice requires flexibility so that you can fill in the gaps essentially for all the other people that cover.

Trenia [00:04:32] Until we get, if we get a full scope of five hospitalists, we can get more of like a set schedule, but for now with just me, I fill in more gaps, so it’s more variability.

Courtney [00:04:41] So that would be the goal, would be to have five? Is that based on the number of people that come in, I’m assuming? Or how did five become the number?

Trenia [00:04:50] Well, I think four or five is the number. I think it’s just based on how big the practice is. We work in a large academic medical center and so we’re very busy. Right now the obstetrics and gynecologists providers cover labor and delivery with us but in the future the hope is that more coverage is covered by just the hospitalists.

Lara [00:05:14] How do you feel about this? How does this work in your life, kind of in your personal life? Has it been better? What are your thoughts on family life?

Trenia [00:05:24] So much better. I have always loved medicine. I have always loved science. I’ve always loved being a doctor and doing what I do. , I, very much had more of a passion for OB and working with obstetrics than I did gynecology. I liked gynecology. I was good at gynecology, but I Deep down inside, when I would wake up in the mornings that I was going to labor and delivery, there was an excitement in me. And I didn’t always feel that with gynecology. And- It’s the opposite for me and Lara. Right, exactly.

Lara [00:06:04] Exactly. I go to walk by L&D and I’m like, shy away. Shy away.

Trenia [00:06:09] That’s what the world makes you work around. We’re all in our right place. Yes, yes, good. We need all of us. Thank God for you, Trenia. That’s right. But that’s, I forgot where we’re going with that.

Lara [00:06:19] So you feel like you’re living your passion a little bit more.

Trenia [00:06:25] Much more. I think trimming away things that I was not as passionate about has been much better for me. I no longer do as much clinic, which I didn’t enjoy as much. I have less things to follow up on in my life. Results and messages and questions and things like that, which sort of took over my life for a long time and felt like a burden. I no longer have that. So a lot of that has been lifted off of me. And it’s like Mandy said, it’s shift work. I get up in the morning, I pack my lunch, I go into work, I know I’m going to get off. in 12 hours, and I’m going to sign my patients out. And it’s, sometimes when I did clinic work and gynecology work, I felt like I took that home with me a lot. And I always wondered, am I doing the right things? Am I following up the way I should? And sometimes, frankly, I was just so busy that I felt like I might be missing things. And the beauty of the world I live in now is I go, I do my 12 hours, I have patients on the board, I sign them out to the next person and I know that person’s going to take care of them until the next time that I come in. And so that’s, for me, a huge weight lifted off.

Mandy [00:07:43] That’s awesome. How has, so obviously this is great for you as a provide, I don’t, should I say provider? People have strong feelings about the word provider.

Courtney [00:07:53] Why, what are the feelings about provider?

Mandy [00:07:55] Oh, we’ll put a pin in that. I’ll get back to that. That’s a big thing. Yeah, that’s a whole thing. So I’ll just move on and say physician, but that it works very well for you and just mental health and all of the things. And I can totally see that. How have the patients reacted to that? Have you noticed any hesitancy or any concern or do they?

Trenia [00:08:18] I haven’t noticed any concern at all. And what I will say, and I feel like I am on obstetrics and labor and delivery more than anyone else’s. And my knowledge about obstetrics has grown dramatically just being there. My skills as a surgeon in obstetrics has grown dramatically. My ability to perform some of the procedures that we do in obstetrics like forceps and vacuums and repair of high-level perineal tears after vaginal deliveries, I would call myself an expert in that and I feel like my confidence is there. So for me, I think that it’s been very well received. I know that the nurses always recommend me as far as who would you want to do your surgery who does more than anyone else and that that’s going to be me because i’m just you’re there they are there yeah malcolm gladwell’s 10 000 hours yeah i was gonna say that the high volume you make such an excellent point that

Lara [00:09:31] the one who’s doing forceps every week is the one that’s going to have the lowest risk of outcomes. I could see with the change of the old model where you saw your own doctor in clinic all the time and then your own doctor delivered you and there’s some nice things about that but Also, there’s some nice things about having the high volume person doing your delivery.

Trenia [00:09:54] There’s a lot of things that I feel very comfortable doing that other people that aren’t there very often don’t feel comfortable doing.

Courtney [00:10:00] So when you walk into a woman’s room that’s in the middle of labor or whatever and you’re taking over, you’re signing in to her care, walk me through, how do you approach that? Because a lot of these people you’ve never met, right? You’ve never seen them before or how do you, I’m just putting myself in the place of a laboring mom and being like, new face. Who is this? I don’t know. I’m in the middle of the most excruciating, you know, horrible, you know, feelings that I have had hoping that everything goes okay. What do you, what works for you?

Trenia [00:10:34] Well, what I’ll say is I think medicine today and obstetrics and gynecology today is leaning more towards that. I think that the time of I have my obstetrician and that obstetrician is going to deliver me is not as popular in… So people are expecting it maybe more like… I think in our practice we try to introduce people to that, that you are at a large academic medical center, you are probably going to see more than one physician, more than one midwife, you’re probably going to have learners involved, and I think we try to tell people that before they come to the hospital. Hopefully they’re expecting that. We work 12-hour shifts, so I may come in and be with a woman for six hours, and then my shift is over and I have to introduce another physician. But the studies have all shown and supported that 12 hours working on labor and delivery is about as long as you should be there. When you start to get tired and when mistakes start to happen, it comes after the 12-hour mark. So we try to do that for patient safety as well as, like Mandy said, the health of us as well. So it’s a win-win situation in the end.

Lara [00:11:59] There’s so much talk about physicians leaving the field and our specialty and I think more attention on what are the changes we can make that allow people to stay longer and things like 12-hour shift caps.

Trenia [00:12:12] Right, there’s so many studies and so much research over the last five to ten years on the wellness of physicians, which was never looked at in the past. And that’s huge for keeping people engaged and happy and have a good work-life balance.

Mandy [00:12:31] Do you follow this laborist or hospitalist trend? Do you know what’s happening over the years as far as the number of positions that are available or recruiting? Do you see job posts for this frequently? Do you know? I’m curious if you’re aware, like what’s happening? Is it growing exponentially? Is it everywhere that it’s growing? Is it in certain places that it’s growing more than other places?

Trenia [00:12:56] It probably started about 10 years ago and it was a slow start, but it is growing exponentially now. It is the healthy life work balance in the communities is starting to become a priority for people and people are seeing what having a hospitalist at their hospital can do. And more and more and more practices are starting to hire hospitalists. And I would say that it is national now, whereas it was small to begin with, but it has definitely grown exponentially. And I think it’s growing. even more now. I think it’s becoming bigger and bigger and bigger.

Courtney [00:13:34] Sure. So if you if you were entering med school today and wanted to go down this path now that it it’s something that can be you know gotten to you know and in your education what do you do? Do you do anything differently or do you have to practice regular OBGYN first?

Trenia [00:13:54] It can be a little bit different. Now you have to train as an obstetrician-gynecologist. The residency program is OBGYN. And so you train both. Now there is a fellowship that is fairly new over the last few years that is OB Hospitalist Fellowship. And it’s usually a one or a two-year fellowship and it is just to train as an OB Hospitalist.

Courtney [00:14:20] Is that very rare or is that across the country? Like lots of… How many are there?

Trenia [00:14:24] Do you know how many fellowships there are? I don’t know how many fellowships there are. I know it is growing. There… I don’t know how many there are. But it is growing, but it is something that people are becoming more and more interested in, and even I work with residents now, and I do have residents that express a desire to do that. More and more, I see it more and more.

Courtney [00:14:50] You’ve persuaded me that it’s good. Because my initial reaction is like, What? I want my doctor to, you know, be the one to carry this through. But now the more that you say it, I’m like, okay, yeah, no, that makes more sense. I want the most qualified person taking care of everything. And my doctor follow up, you know, you go and see them after and all that kind of stuff. So you do know, I think I heard you say you do no follow up after the fact. Like you don’t, you know, the six week post all that stuff, a patient would just go back to their regular OBGYN. Okay, okay.

Trenia [00:15:23] No, I actually do have one clinic that is called a perineal clinic. So I do follow, , patients that I do the higher level, , tear repairs on. And so I will follow those in clinic, , which is kind of a new concept and it’s been great to follow those patients as well. I think it’s been good for me cause I’ve learned a lot on how, , those repairs do over time and what they should look like and immediate feedback, you know, almost correct. And then it’s also been nice for the patients because I see so many of them that I can tell them things that they should do and things that they shouldn’t do and things that they should expect.

Mandy [00:16:02] I always thought there should be someone who specialized in what we call the fourth stage, which is the postpartum time, and just did that as their focus and saw women and talked about all the things that we just run through in 15 minutes, which really need probably an hour, you know, mood and breastfeeding and sleep and intercourse and birth control and, you know, healing of lacerations and just all the things that, you know, back to normal screening and expectations and all pelvic floor PT, all the things that get completely glossed over.

Trenia [00:16:44] I will say this, I think there has been interest in that and I think that we used to see people at six weeks postpartum And that was the first time you saw him. And I think recently we’ve started adding three week visits for people. And for just that, to go about like, how are you doing? How is your mood? How are things feeling? How is your family handling this? How’s breastfeeding going? And to hit all those earlier on. And it helps to decrease some of that postpartum depression and some of that anxiety that people may not know they should ask those questions. What a time to be alive here.

Lara [00:17:27] It’s amazing. You’ve seen a lot of change in the field of OB-GYN. We talked about several changes just now, but what are some of the other big things that you’ve seen a shift in, in OB-GYN?

Trenia [00:17:39] So, well, I started my practice in obstetrics and gynecology, but I’ll focus more on obstetrics. What I will say is I think that when I first started practicing for probably the first five or six years, most things didn’t really change. Or slow was very change. Change was very slow. I think that over the last 10 years, that change has become a lot faster. And I would say even over the last three to four years, sometimes it feels like things are changing all of the time. I think change is good. I like to try new things. I like to try new ways to do things. I am a perfectionist and I want, when I give care to a patient, I want that to be a perfect experience. And nobody’s perfect, and I know that, but I always strive for that. And I think doctors are, for the most part, what we used to call type A personalities and want things to be as good as they can be. And I think that the research that we’re doing and the studies that we’re doing and the data that is being thrown at us now are changing things very dramatically, but for the better. I’ll just give you an example. Just use C-sections as an example. I would say that we probably, and research is looking at every single aspect of care prior to that C-section, care during that C-section, and care after that C-section. And for example, what I mean is, we’re looking at should people not have anything to eat or drink prior to a c-section? Should they have a protein drink two or three days prior to that c-section? Will that help them heal better? Will that help their albumin, which is their protein levels, be higher? We look at, they do research and studies on Do you shave an area that you’re going to make an incision on? How do you shave that area that you’re going to make an incision? Do you use a razor? Do you use an electric clipper? Can you do that in the OR? Should that be done an hour before, two hours before? What type of incision are you going to make? How long are you going to let the prep dry? What kind of antibiotics are you going to use? What kind of suture do I use? What kind of stitch do I use? Do I put two stitches there? Do I put one stitch there? Would three be better? What are the risks of that? And then even, how long does the Foley catheter stay in? When should they start walking? Should they get physical therapy after? Every single aspect. of patient interaction from the three days prior to the surgery, through the surgery, and then the postpartum or post-op period is looked at intensely all the time. There’s a lot of studies right now on how do you close that C-section scar? Should we use one layer? Should we use two layers? Should we lock that stitch? Should we do just a running stitch? What kind of suture should we use? It’s just looked at over and over and over again in an attempt to perfect that, to prevent infection, to make the hospital stay shorter, to make that care for that patient be the best that it can be. So I think that’s how medicine has changed. It’s more and more research, more and more attention to detail. How can we make all of these interactions better?

Courtney [00:21:22] How quickly are you able to act on those changes? Like you hear something, you know, you obviously get it from a reputable place, does it come from top down? Like, hey, we as a entire academic, you know, institution are going to do it this way? Or is it is it left up to like, doctor discretion in some way? It’s mostly left up to doctor discretion.

Trenia [00:21:45] I will say I work in a large medical institution, which has been great because I’m inundated with all of the data. But I think we are given a very long leash on there’s no one out there saying you absolutely have to do this or not have to do this. Okay. And initially I think there’s a lot of things that you can use your discretion on whether you want to. Well and like your skill set.

Courtney [00:22:07] Do my hands work? I’m just thinking about like the stitches like you know like functionally can I do this better than I can do this other stitch and they end up about the same you know on the on the other side so.

Trenia [00:22:19] Okay, that’s interesting. Sometimes there’s studies that come out that are absolute, like you really need to give this antibiotic, and that comes down from the top. Okay.

Mandy [00:22:29] So yeah, ones that are proven and have significant safety effects. Right, right. That’ll come from top down. Okay, yeah. On that note, what is the scariest trend in birth that you’re seeing right now?

Trenia [00:22:43] Just the scariest trend? Say wild birth, come on, say it. So I’m gonna go a little deep on this. I think that there’s a lot of distrust in the medical community and in healthcare providers today, unfortunately. And I think probably the scariest trend I see is people shying away from getting medical care.

Courtney [00:23:19] She said wild birth, she just didn’t say it.

Trenia [00:23:23] There are definitely, I think if you want to go to saying home births and being away from facilities that have health care providers, I think that’s definitely the scariest trend. And I see the worst of the worst happen. I think a lot of people don’t understand When it’s good, it’s great, but it does not always happen that way. And unfortunately, sometimes we see some really bad things that come out of decisions to not have medical people involved.

Lara [00:23:58] I find it so heartbreaking when you, to know people are afraid of us, you know? And we’ve spent so many years just wanting outcomes to be better for people, just wanting the best. Going home at night and worrying about patients and thinking about them long after our interaction has ceased.

Courtney [00:24:18] The mental load that you carry with all of this. We always ask about that, but like, you just mentioned, you know, you’ve seen scary things, you worry, you think about, you know, outcomes and stuff. How, how does that affect you? Did it affect you more in your previous role or does it affect you now? Because you sometimes are called into like worst case all the time. You know what I mean? How, what does that feel like to you?

Trenia [00:24:46] Yeah, I’ve been doing this a long time. I am very, I couldn’t survive in this field if I took it home with me and if I took this all on my own shoulders. I think I see a lot of bad things happen. I see a lot of great things happen, but I do see a lot of bad things happen. I see a lot of bad outcomes. I have learned that the only way that you survive doing this for a long time is that you have to stay to yourself or I have to say to myself, I did everything that I could do. And if I can say that, then I can go on. I can sleep that night and I can go on the next day. If I took things home with me and I took that on every time, I would never survive in this field. But, and I do feel that way. If I make a mistake because I’m not perfect, I do perseverate on that for a long time and it tears me up inside. But when bad things happen and I am there, as long as I am there doing the best job that I can do and trying to figure out how to fix things the best that I can, then I’m okay with that. Because that’s all I can do, because I’m just human.

Mandy [00:26:08] So we interviewed someone who works with you a lot, an anesthesiologist recently. And she mentioned AI as a tool that you guys are using to predict hemorrhage, potentially, on the labor and delivery unit. They’re probably looking at it maybe a little bit closer than you might be looking at it. What other tools do you think AI is going to bring about in the obstetrics? Have you thought about that at all? I haven’t thought about that at all. I mean, we use models, right? You’re already using models, VBAC predictors, success predictors, and things like that. No? You’re just flying by the seat of your pants over there, Trenia? Screw AI.

Trenia [00:26:53] I’m trying to think of how AI could help in what we do.

Mandy [00:26:57] AI doesn’t have hands. Not yet.

Lara [00:27:02] That is the thing about obstetrics. It’s a very tactile field. You have to have good hands.

Trenia [00:27:08] I mean, I think it all would be based on looking at predictions of what is the risk that this person might have an infection. You can look at many, you can put them in all different types of models of what’s their BMI, how long were they in labor, when did their water break, all those things. could eventually go into some type of program to predict what’s their chance of infection. I think we have a calculator that we use that’s called a VBAC or a TOLAC calculator, and we put in what’s their… You said TOLAC. I’m sorry, I have to interrupt you. What is that?

Mandy [00:27:54] after cesarean.

Trenia [00:27:55] Right, it’s someone who wants to have a vaginal delivery after they had a prior c-section and we have a calculator that we put different factors into like how long ago was their c-section, why did they have their c-section, what’s their BMI, different things like that and it will give us a number, a prediction of how successful their vaginal delivery will be. Although I will say I take and why I kind of hesitate on that AI question is because there are so many different variables as to why things happen to certain people. I think, I’ll go deep again, I think in having a baby is such an emotional emotionally charged process, and it is a life-changing event for people. And I think a lot of people come into that process with an idea in their mind about how they want their birth process to go. And what they don’t understand is that there’s a lot of variables that go into that. And they may have had they may have had a cousin that they’ve known for years that had a birth experience and they tell them, well, this is what happened to me. And they come in and they’re like, well, why didn’t that, why did I get an infection? And what they don’t understand is there’s a thousand different things that may lead to the outcome that you have having a baby.

Courtney [00:29:22] Which is why you need a doctor who can know all those things.

Trenia [00:29:27] And it’s hard for us to even tell you about those things. These are things that have been studied for years and years and years. And that we try to perfect, but we don’t have the ability to perfect them. But that’s my worry about AI. AI doesn’t always understand that there are other variables to that.

Mandy [00:29:46] Yeah, that’s a great point. What about social media and the internet? We’ve talked a little bit about that with just the fear of medicine and obstetricians in general. But even positive sides. I don’t really have any positives. Anything that you have to work around? Any specific phrases you have to say over and over?

Trenia [00:30:17] Speeches that you have to combat social media? Social media has been extremely detrimental to the medical field and to healthcare. The trust, the mistrust that’s out there. And I think I’ll say my personal opinion is that a lot of that comes from the inaccuracy of postings that people will put on social media. And I don’t know that it’s necessarily always inaccurate because of an intentional inaccuracy. I think a lot of times it’s just a misunderstanding or not understanding fully. And just like I just said, some people, they have an idea of how things should go, and if it doesn’t go that way, sometimes they don’t always understand why it didn’t go. And we can stand there and say a thousand different reasons why. Why did you have to have a C-section? Why did my cousin not have a C-section and I had to have a C-section? Well, how was the baby positioned in your abdomen? What’s the shape of your pelvis? And what type of tissue do you have? How much collagen do you have?

Courtney [00:31:24] And 20 years ago, all you would have known about was your cousin. But now you know about people all over the world. So you can compare that way, which I’m sure is just one more thing to wade through, right?

Trenia [00:31:37] I think that back on the social media, I think a lot of things that people put on social media, just like anything else is always, the good side of it, I think a lot of people will see they have their makeup on and there’s the pretty baby there and everything looks good and they don’t post the 12 hours of the screaming and no makeup and the pain and some of the things they go through. So I think a lot of that might be misleading. I think there’s also a lot of misunderstanding. A lot of the drugs we use in social media are trampled and they’re actually drugs that have been tested for years and years and years and there’s a large distrust for we’ll just say Pitocin and I can say that your body makes Pitocin and some postings will say I don’t want you or some people will say I don’t want you to use Pitocin because that’s going to harm my baby but that could be no farther from the truth. Like I would never give you a medicine that could harm your baby. Or they’ll say Pitocin leads to C-sections. Well, Pitocin doesn’t lead to C-sections. Pitocin leads to contractions. And sometimes contractions get very strong and fetal heart tracings may not look as good when your contractions are strong. And there’s many things that lead to C-sections. The drug alone is not the cause. So I think a lot of it’s social media has opinions that are not always accurate. And I think that they lead people to believe things that are not always true. And I think sometimes that leads to a distrust of medical people.

Courtney [00:33:22] Yeah I think one thing that I have picked up just in doing these episodes so far, I think Lara you said it, was like if you watch something on social media make sure you watch all the way to the end and see what they’re trying to sell you because they might be telling you something at the beginning that you’re like oh that makes sense okay okay but then when you get to the and you can learn more in my downloadable tutorial on blah blah blah blah then you got to go oh okay like it may not be untrue what they said but it also it’s not an unbiased yes you lose your credibility right when you have a product right which like you know social media is a lot of cases a business and it’s how these people are supporting themselves so it’s like this dance you have to do, which is why you should have a doctor that you trust that you can say, I saw this. What does that mean? You know what I mean? And I feel like y’all are very, the ones we’ve met are very good to be like, I understand you saw that. Here’s what you need to know, you know? And so that’s just a little PSA. If somebody’s selling something. Just think twice. It’s a helpful filter.

Mandy [00:34:27] It’s like an age old advice. Trenia, your field is unique in that you have two patients simultaneously. It’s really hard to imagine any other field like this where you’re monitoring two. Two monitoring, two that you’re protecting, and then at times two that you’re rescuing. And they’re not always going the same direction at the same time. Walk us through that a little bit.

Trenia [00:34:54] I’ll say when a woman comes in in labor or comes in in a trauma, I think that there’s always more anxiety from many of the other specialists, especially like if there’s a trauma, the trauma surgeons. There’s a lot of heightened anxiety around that because there are two patients. I’ve done this for years, so I’m used to that. But it does change the dynamics dramatically because you have to think of a pregnant woman, her physiology is actually different than someone who’s not pregnant. So you have to understand the physiology of it as well. And you have to also understand that there’s a fetus that you have to protect as well. It does heighten anxiety when someone comes in that is pregnant in any type of medical emergency. You have to always consider mom and you have to always consider baby.

Courtney [00:35:55] Is that the scariest? Is that when you get scared? Do you ever get scared when you’re in those situations? I know you present as a very confident. I know that’s what I’m saying.

Trenia [00:36:04] You present very confident, which is great, but like, I try to teach the residents that it doesn’t matter what situation you’re in, you never let them know you’re scared. Sure. But are you really?

Courtney [00:36:17] Okay, that’s all I need to know.

Trenia [00:36:20] There are definitely situations that are really scary.

Courtney [00:36:25] Like, if I’m trying to take care of two living children at the same time, that gets scary, because I’m like, I don’t know which one, you know, if like with my two children, like, I can’t even imagine it being a true, like, life and death situation. That’s 10,000 times what I have to do.

Trenia [00:36:41] I think sometimes you have to turn that off, though. I think you just have to figure out how do I make this better? What do I need to do? And you have to look at it through the medical eyes and say, What are we going to do now? What do we do next? How do we stop this bleeding? That’s what our anesthesiologist said.

Courtney [00:36:58] Do the next right thing.

Mandy [00:36:59] That’s what your training gave you. What about when the speaking patient makes a decision that would threaten potentially the patient that is not able to speak for themselves. Wow, that’s crazy.

Trenia [00:37:17] So I do encounter this quite often. I think the way that we approach it is counseling, counseling, counseling.

Courtney [00:37:28] Is it usually they don’t want you to intervene in some way? Correct. And they think it’s because this reason it would be better and you know that that’s not the truth probably. Sometimes it’s cultural.

Trenia [00:37:41] Okay, sure. There are, we see people from all different places over the world and sometimes there’s cultural issues that come into play. Sometimes it’s fear, sometimes it’s ignorance. Exhaustion. Sometimes it’s exhaustion. Like I said, having a baby is a very emotionally charged event and I think I would say probably just like an example of telling someone you need to have a C-section and they say, I don’t want to have a C-section. I can’t do a C-section on that person. That’s assault. So what I tried, I don’t want to give all my secrets away. What I will say that what we do and what we teach the residents to do is you go talk to that patient and you try to find out what their fears are. and you try to connect with them in an emotional and just as a person and a human like I’m here to help you tell me what you’re scared of and why don’t you want to do this and you tell them the risk and I tell them I’m not trying to scare you and I don’t want to upset you, but I want you to understand this. And then I usually give them some time, and I say, look, just talk amongst yourselves, and I’m not gonna force you to do anything that you don’t wanna do, that’s not what I’m there for. I’m there to take care of people, I’m not there to make them do things that they don’t wanna do. So we talk to them, and I tell the residents, you talk to them, and you give them the risks and you respect what their decision is. And I can’t make someone do something. And at the point that the fetus is inside of the mom, I can’t make her do what I think is best all the time. And then we go back and then we talk to them some more. And then we go back and we talk to them some more. And in most cases, eventually after, if they think maybe I will change, my cervix will change some more, or things will change, and I will sometimes bargain with them a little bit, and I’ll say, okay, I hear what your desires are, I know what you want, and I try to connect with them, and I say, look, let’s… I’ll give you one more hour, or I’ll give you 30 minutes. Let’s give it another 30 minutes and see how things look. And what are your thoughts if we give it some more time? And I think sometimes you’re trying to just meet them halfway. And that’s all you’re asking from them. I know that coming to where I want you to be is a long way to get there sometimes, right? , and, , so if you can just bring them a little closer and then bring them a little closer. So a lot of it is just talking and going back and talking and going back. And most of the time we meet in the middle at some point. Okay. That’s good to know.

Mandy [00:40:42] Yeah. All right, I’m gonna ask you a political question, but only in the obstetrics world, OBGYN world. All right, so our specialty, Lara and I know this, Courtney may not know this, that there’s a lot of discussion about training because we’ve become very super specialized, and Trenia’s an excellent example of that, where she let go a part of it and focuses, and Lara and I did the same thing, where we let go part of it, And so as we’ve progressed in our subspecialization, there’s a lot of talk about splitting OB and GYN into separate fields. So from the get-go, you only do one. Yes, from the get-go. And so I’m curious what Trenia thinks about that.

Courtney [00:41:28] If you want to weigh in, you don’t have to.

Mandy [00:41:35] No, you have to. Weigh in.

Trenia [00:41:40] I may not be very popular amongst some of my peers, but I would be in full support of that.

Mandy [00:41:47] Of splitting?

Lara [00:41:48] Of splitting.

Mandy [00:41:48] Oh, interesting.

Lara [00:41:49] That is interesting. What about you, Lara? Oh, I’m there too. Splitting? Oh, I think it’s past time. Oh, I’m the opposite. I’m keeping it together.

Mandy [00:41:55] Really? Yes.

Courtney [00:41:56] I think it’s past time. The reason is… What would you do as a patient? This is my question. I would like… You have to go two times a year? Oh my word. No, you would only see the obstetrician when you’re pregnant.

Mandy [00:42:06] You would only see the obstetrician when you’re pregnant. And then you would see the gynecologist the rest of the time. Yeah, so we would truly do split. Ooh, I have thoughts about that. Let’s hear them. OK, yeah, we’ll hear Courtney’s thoughts. So my thought, here’s why. There have been so many things that I needed to do during a GYN surgery that I was so glad my hands had the tactile learning that they did during obstetrics, placing IUPCs and fetal scalps and feeling It’s own education of your hands that you don’t even realize is happening when you’re doing those hundreds of exams on laboring women and putting in those things around a fetal head that you’re trying to be very careful. So now I can put in an IUD by feel if I had to, or a uterine manipulator, or things that are just really difficult sometimes in the operating room, I have a skill set I don’t think I ever would have gained. Because you wouldn’t do it as much. Right, because we just pointed out, having a huge exposure in a short period of time exponentially increases your skill set in something. And I feel like the tactile sensation is one of those things. But I would add a fifth ear.

Trenia [00:43:15] I was gonna say that. I feel like coming from my side of it, and Lara’s on my side just by the way. I’ll be the judge. I feel like the field is too large when you put them together. It’s just too much now. It’s so much. I feel like, and like I said, if you’re paying attention to the things that are changing, that so much is changing so fast it is very hard to keep up with all of that if you’re trying to do both obstetrics and gynecology for me it was overwhelming trying to keep up with all of the changes when things are changing sometimes monthly, multiple things changing monthly. So I just feel like the fields are so large that splitting them into a gynecology side where it’s just women’s health, annual exams, birth control, menopause, perimenopause, sexual health, that field in and of itself is ginormous. And then obstetrics is becoming that way. Obstetrics is also, it’s a different world. An obstetric patient is very different than a gynecological patient.

Courtney [00:44:40] And then I’m thinking back to what you were talking about, about how you’re seeing patients at three weeks instead of six weeks, and you can talk more about the postpartum, you would have more room I mean, not that you’ll have all the room, but you know what I mean? You’d have more room on that if you were an OB specialist person, whatever, obstetrician only, then you would have more room to go into those things with patients. I don’t know what to choose. I have known, here’s what it is. I have known women get pregnant, planned and all the things and have such a hard time getting in to see. She was with, you know, cause I have doctors that after a while they were like, nope, I’m not delivering any more babies. I am done with that. And so that’s who she was going to and whether or not that was a good choice for someone of her age, I don’t know. Cause she had not yet had children. So like in the front end, like you need to make sure, but if you’re having to, she had to wait, I think she didn’t even see a person until, like three months I don’t know it was so it was in my mind I was like this so far into it and so that would be my only concern is that you would delay care if you had to wait to get into an obstetrician so I don’t know how to make it to where Because when I had, I was going to an OB-GYN, I got pregnant, called them, they said, come see us at six weeks. I was already an established patient, it wasn’t a hard thing to get into there. Yeah, that would be my only question.

Trenia [00:46:16] I would say if you took away the gynecology part and the annual exams, OB would have more appointments. Okay, it’s a valid argument. Because they’re no longer using their time to do

Courtney [00:46:30] It feels like obstetrics is happening. I’m jumping up and down in my seat. It’s like, you know, there’s always something going on. There’s always something going on. But if you’re a gynecologist, it’s not as… I don’t know.

Lara [00:46:40] It’s not as… We’re just sitting in our rocking chairs. That’s me every day. Here’s the exam.

Courtney [00:46:46] Here we go. Yeah. So that’s… Yes. Okay. Okay. Well… You’re very perceptive. I can see it. I’ve been a patient a few times. So I can see it a couple of ways.

Trenia [00:46:56] I would say availability would come… would grow. But I will say, I mean, I’ll tell you, it’s been obstetrics and gynecology for a long time. This has been discussed for years. This is not an easy decision.

Courtney [00:47:10] Do most people in med school go in thinking, I’m gonna do both because you do both, but this is what I really like?

Trenia [00:47:17] I think probably so. I think probably I think now they meet people like me and they meet people like Dr. Junker and they meet people, when I was going through, I didn’t have that. There were obstetrician, gynecologist. They see a lot more of specialization. So I think that it is more medical students are saying, I would rather be a gynecologist and I don’t like OB. I can’t imagine that. But I also think there are, I definitely have residents that come to me that say, I don’t enjoy gynecology. I would really like to do obstetrics. So I do think that We’re seeing more and more of this. I don’t know if they will ever split the residency. You make a good argument. I think there are good arguments on both sides of it.

Courtney [00:48:10] One I would love for all women, this is another PSA I’m just going to put out there, to go see a primary care physician because so many of us only go see our OBGYN and that is our only doctor that we ever see. And I used to do that too. And I would talk to my doctor about random things and he’d be like, oh, you’re doing fine. And I’m always like. And I was doing fine because I was young, but like, I would have loved a lot more, you know, more depth. Yeah.

Trenia [00:48:38] As much as medicine’s changing, you should definitely have a primary care physician. Yes. Yes. Obstetrician and gynecologist do not keep up with blood pressure correctly. Yes. So that’s too many things. Yes.

Courtney [00:48:51] So that’s why PSA for anyone listening, please make a primary care agree appointment right now.

Mandy [00:48:58] Good for you.

Lara [00:48:59] It’s a good PSA. Okay, we’re coming up on our speed rounds. Okay, so we’re gonna ask some fun questions. These are kind of quick, top of your head answers, okay? I’m not good at those. I might say . It’s okay. It’s all right.

Courtney [00:49:12] My husband told me I said too much too, so I’m trying to. He said and , you need to stop the and .

Lara [00:49:18] Okay, sorry, it’s all right.

Courtney [00:49:20] He’s the editor.

Lara [00:49:22] Number one, are you superstitious? No one is in superstition.

Mandy [00:49:27] Lauren are the only ones. Really? Do you say the Q word when you’re at work?

Trenia [00:49:34] I probably don’t say the Q word. Okay, then you’re in superstition. Mildly superstition. Wait, quiet.

Mandy [00:49:39] Oh, oh, oh, oh, oh. Or the S word, which is? I bet you she doesn’t say either one of those when she’s a witch. I don’t say that.

Trenia [00:49:49] And they won’t let me wear a red shirt either because they say that that makes, if you have hemorrhages.

Mandy [00:49:54] Well, there we are, she is.

Trenia [00:49:55] But I would wear a red shirt. What? They say that if you wear red, the nurses and people that work at Flavor and Delivery, they have a bad hemorrhage. They’re like, who has on red?

Courtney [00:50:07] Oh my gosh. That’s funny. That’s so interesting. I’ve never heard that.

Trenia [00:50:11] So I don’t wear red, but I would wear red.

Lara [00:50:15] Just for local comfort, you’re like, okay, fitting in with the culture. What other specialty do you ask for help the most from? General surgery. Okay. That’s a good one. What’s a word or phrase you end up saying multiple times a day? We all have our little scripts. What do you end up saying over and over again?

Trenia [00:50:35] Oh, wow. I have to think about this one. You didn’t have to think very long. Do you know what? I do a lot of surgery with the residents and I think that I say over and over again, don’t try to be fast, be efficient. That’s a good way, yeah, because that’s how you become fast. I say that a lot, because I see a lot of them trying to go fast, and I go, you’re just slowing yourself down trying to go fast. And then people will tell them, you need to speed up. And I’m like, it’s not about speeding up. It’s about being efficient with your movements. So I say that a lot. Be efficient, not fast.

Lara [00:51:09] That’s good. I like that one. You can use it. I might steal it. I might just steal that one. Who in your inner work circle could you not live without?

Trenia [00:51:19] My nurse midwives. I work a lot with nurse midwives.

Courtney [00:51:23] That’s great. I wish that had been around when I was having children. They’re great.

Trenia [00:51:28] It was still kind of like, oh, what’s that? I’m glad you have a very collegial relationship with them. They’re trained a little bit differently, and they see things a little bit differently. And so they add it. We complement each other very well. Yeah.

Lara [00:51:41] Good meeting of the minds. It’s great. I think it’s a good model.

Trenia [00:51:44] Very good model.

Lara [00:51:46] If you could ask your boss or chair for one thing, what would it be?

Courtney [00:51:51] It can be anything, like Skittles.

Lara [00:51:52] Do you want Skittles?

Courtney [00:51:54] Do you want less air conditioning, more air conditioning?

Trenia [00:51:57] If I could have anything 100% honest, I would love to move labor and delivery closer to the Children’s Hospital and have just a women’s If I could have anything I wanted had all the money in the world, I would have a women’s hospital or a women’s wing.

Courtney [00:52:15] Wow, that would be groundbreaking.

Trenia [00:52:18] It’s a long trot.

Courtney [00:52:21] If you build it, they will come. There’s no shortage of patients.

Lara [00:52:27] What other medical specialties gross you out?

Trenia [00:52:31] Anesthesia kind of grosses me out. It’s the mucus. It’s the secretions. That’s so funny. Courtney is tired of us talking about mucus and secretions.

Lara [00:52:41] We both got one. Would you encourage your children to pursue a career in medicine? 100%. I love it. Tell us more.

Trenia [00:52:50] Are any of them interesting, do you think, or are they going that way? My daughter, I was coming home from softball practice the other day, and I couldn’t make it home, so I said, you have to go to the hospital with me. She’s 13. And she’s always said, I think I want to be a doctor. And I took her to the hospital and took her on a tour, and she is like, she’s sold, bought and sold. She loved everything about it and got so excited about it. And I was telling her about things and she’s like, I have no idea what you just said, but that is the coolest thing I’ve ever heard in my life. And so yeah, I would, I would. I think medicine is a very, very, very emotionally mentally, physically hard route to take, but I have never once looked back. I love what I do and I would do it again in a heartbeat, but it’s hard to get there. So get ready for the battle, but I love what I do.

Lara [00:53:39] I love that. The future of medicine is in good hands. Do you have a joke about your area of medicine?

Mandy [00:53:45] A clean one. Nothing in labor and delivery is clean.

Trenia [00:53:49] That’s gross. I don’t know a joke that I have. I’ll think about it and see if one comes to mind.

Courtney [00:53:56] They’re all dirty. Is there any piece of advice, I feel like we didn’t ask this question, that you would give a patient about their pregnancy? About their pregnancy? Like a pregnant, a woman out there is pregnant right now and she’s listening and she’s wondering what in the world, who’s a, what’s a hospitalist? What is that? I don’t want that. What is it? What would you tell her about labor and delivery or or whatever? What would you tell her?

Trenia [00:54:21] I think My best piece of advice for someone who is pregnant is to have as their one and most important goal to stay healthy and keep have a healthy baby. Don’t focus so much on how you get there. Don’t focus so much on the pregnancy itself of, oh, I have pain here or I have this here. And don’t focus so much on the birthing experience and the birth plan that they envision in their head. Just have as their most important goal to be healthy and to keep their baby healthy. That would be my biggest piece of advice.

Courtney [00:55:05] Okay, now our favorite question. If you could do any job in the world, any job, outside of medicine, and still support yourself, you don’t have to go back to school for it, you just wake up and you’ve got the knowledge, whatever it is, what would you do? Not medicine.

Trenia [00:55:22] I would be a homicide investigator.

Courtney [00:55:26] Do you love like podcasts and stuff?

Trenia [00:55:28] Would you wear red? I would absolutely wear red every day. I absolutely am enthralled and obsessed with crime dramas. True crime or do you like the dramatic ones? You’re not a law and order person. I love Dateline and 2020. I can’t even watch that. I am fascinated by that.

Courtney [00:55:54] If I listen to one, I think everyone’s going to kill me. Like I’d literally be sitting here right now going, which one of you? Which one of you is gonna take me in their closet over there?

Trenia [00:56:03] It’s the quiet ones. No, I would love to be a homicide detective. I don’t think that they would hire me at my age, but I think it would be fun.

Courtney [00:56:15] I think it would be very interesting. It would be interesting. Thanks, Trenia. Thanks for having me. Great job. Yeah, this was great. You did great. It was fun. Yeah, so fun. Well, we want to thank all of you for listening, and we hope that you are following along with us on Instagram, and we’ll be back soon. Bye.

Lara [00:56:31] Bye, everybody. Bye. This podcast is intended for informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. The views and opinions expressed by the hosts and guests are their own and do not constitute medical guidance for any individual case. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or health concern. Never disregard professional medical advice or delay seeking it because of something you have heard on this podcast. By listening to this podcast, you acknowledge that the host, guests and producers are not responsible for any decisions or actions you take based on the information discussed.