Joey Wahler (Host): They provide medical guidance and treatment before and during pregnancy. So, we're discussing the role of an OB-GYN. Our guest, Dr. Peter Filozof. He's an OB-GYN provider with Memorial Health System, Ohio.

This is Memorial Health Radio with Memorial Health System, Ohio. Thanks for joining us. I'm Joey Wahler. Hi there, Dr. Filozof. Thanks for being with us.

Dr. Peter Filozof: Hey, Joey, how are you, sir?

Host: Good yourself.

Dr. Peter Filozof: Not bad. Good to talk to you.

Host: Same here. So first in a nutshell, what do you think a woman should look for when choosing an OB-GYN?

Dr. Peter Filozof: I think it's really important that she's comfortable not only on the interpersonal level with her doctor, but also knowing that her doctor went to training that is sufficient to take on even simple medical issues, but as well as complicated issues as well.

Host: And so, what can a patient expect during their first visit?

Dr. Peter Filozof: I think it's important at their first visit to establish a rapport with the patient, and that helps them to go over their medical history, which may or may not impact the outcome of the pregnancy.

Host: And we'll talk a little bit about that in a moment, but first, regularly checking things like blood work and blood pressure becomes more important during pregnancy, right?

Dr. Peter Filozof: Well, and when it does, I mean, most people have heard of preeclampsia, which is where blood pressure can skyrocket towards the end. And it can be life-threatening to both the baby and the mother. So, it's very important to get a baseline blood pressure and to trend that throughout the course of the prenatal visits to see whether or not that's going to remain normal or become dangerously high.

Host: How about the importance of having ultrasounds, and what's an anatomical ultrasound?

Dr. Peter Filozof: Well, an ultrasound saved my first baby's life, quite honestly. And an ultrasound uses sound waves to make a picture of the structures of the developing baby. And so, anatomic survey is a set of things we look for at the time of the ultrasound. That's usually done about 20 weeks of pregnancy or about the halfway point to see if there's any kind of structural anomalies that we could possibly find that may require referring out to a higher level type of hospital or provider.

Host: Now when you say one of these saved your first baby's life, you mean personally or professionally?

Dr. Peter Filozof: Now, personally, we worked hard to get pregnant, finally got pregnant, and everything was going fine. And towards the very end, some measurements of the abdomen were incorrect. This prompted an ultrasound which demonstrated no fluid around the baby and that required an emergency C-section. So, it literally saved her life.

Host: So, your message there for one thing being, it's not just to see the developing features of the baby's face like many associate it with, right? There's a real practical value in it.

Dr. Peter Filozof: Well, you make a great point. I'm so glad you said that, because most people think that it is some cute pictures that you can put on the fridge with some magnets at mom and dad's house. And that's true, but we can also look at other parameters regarding the growth of the baby or the well-being of the baby. In other words, we can see if the baby is performing activities that it should be doing at a gestational age, which implies that it's doing well inside the mother.

Host: Gotcha. So, what's the purpose of prenatal vitamins and they're taken even before pregnancy, right?

Dr. Peter Filozof: It's important that we take folic acid, because folic acid helps lower our risk of what we call neural tube defects. And many people have heard of spina bifida. And folic acid helps lower the risk of that unfortunate anatomic anomaly. So, it's probably really important to try to make sure those things are being taken prior to pregnancy and not waiting until the baby's already developed.

Host: Understood. Genetic testing, so crucial for a woman, prenatal. So, tell us, doctor, when is that done and what does that entail?

Dr. Peter Filozof: This is an exciting time to be pregnant because there's a lot of newer technologies that are being offered to patients of all ages that are somewhat safer than the older tests, such as what we call an amniocentesis, actually inserting a long needle into the maternal abdomen to extract some fluid from around the baby. So now, patients come in early in pregnancy and they can do what we call cell-free DNA testing, a simple blood test that will look for things like Down syndrome or other genetic anomalies and also will tell the gender of the baby, which is really, really neat.

Something else that we're also able to offer, we're able to look for carrier screening to see if a mom or a dad carries something that could be transmitted to the baby, for example, cystic fibrosis. So, very simple testing, but it does improve outcomes. It's essentially no risk to the mom.

Host: Now, I know from personal experience that these genetic tests, while very Impressive in their detail, can sometimes be very confusing to parents. So, what do you think your role is in trying to kind of sift through that for the patient to make sure that they have a layman's understanding of all that information they're getting? Because sometimes that's a lot, right?

Dr. Peter Filozof: Well, I think it is a lot, and each and every day it seems like technology gets even better. So, it's almost more overwhelming. I mean, back in the day, you could stay dumb and happy. Because if you didn't know something was abnormal, you couldn't worry about it. But now, we can screen for carrier status or underlying genetic anomalies that may or may not be transmitted to the baby. And you do have to kind of put that in perspective to the patient and her spouse to make sure they understand what it is we're actually testing and what the long-term implications could be, both good or bad.

Host: Because sometimes, for instance, just simply put, the genetic testing may show that you have, I don't know, let's say a one in a million chance of passing something on to a baby. And that's when I guess the OB-GYN like yourself needs to say, "Listen, don't lose any sleep over it," right?

Dr. Peter Filozof: Oh, well, absolutely. And it's hard, because we're talking about living, breathing humans. We can't just treat them like a statistic, but we have to use statistics to help in our counseling. But things like this, if it is a small chance, but it's never going to be zero, it also helps the patient pass that information along to the pediatrician. So, maybe if later in life, in the child's life, something pops up that could be related to the testing, it gives the pediatrician something to go on.

Host: Gotcha. So, switching gears, once pregnant, how often does a woman typically see OB-GYN?

Dr. Peter Filozof: So in the initial first several months, seven months, we come about once every four weeks. Once we get to about 28 weeks, or about seven months, we come about every two weeks. And as we're approaching the end of the line, they're almost ready to have this baby, we start coming about once a week between 36 weeks and the due date.

Host: And so, what are some of the things that are being ramped up or more closely looked at during those final weeks?

Dr. Peter Filozof: That could be a factor of maternal medical conditions, as diabetes, high blood pressure, smoking, things like that, because that could actually affect the functioning of the placenta, which passes all the nutrients, oxygen, and blood to the baby. If a person had those risk factors, we'd certainly want to observe the infant closer as the weeks went closer to the due date. So, those things can happen even without maternal risk factors. So typically, that's why we come once a week.

Host: Women also have to be tested for gestational diabetes. Tell people what that is, please. And if it's present, how is that addressed?

Dr. Peter Filozof: Diabetes, unfortunately, in America is becoming rampant, even in non-pregnant people. So, family history increases a patient's risk of having diabetes, and as family history goes up, so does the risk to the patient. So, if a patient has risk factors for gestational diabetes, we typically have them drink a really sweet sugar drink early in pregnancy, and draw some blood to see if the levels are below a certain threshold. If they pass that test, great. But we still have to recheck them at about seven months of pregnancy to make sure. And that's people with no risk factors at all, just normal folks who still want to always be checked at about seven months.

Host: As a woman's due date approaches, doc, from your standpoint, anything most important she should keep in mind?

Dr. Peter Filozof: We try to ask them to continue monitoring fetal movement, because if fetal movement were to decrease unexpectedly, that could be a sign of an impending poor outcome. We always ask them to watch for bleeding or if they think their water bag breaks, anything like that, that could put the baby at risk. And if they did notice anything like that to, as quickly as they can, come to labor and delivery so we can assess them in a timely fashion.

Host: What about the OB-GYN care that's needed after the baby's delivered?

Dr. Peter Filozof: I always say, it's service after the sale. So, at any time after delivery. Well, it's true, any kind of goofy question, whatever they think it is, we always make sure the patient understands that we are here to answer that. We want to watch for things like postpartum depression. We want to watch out for things like bleeding or any kind of anatomic problem. We like to help with breastfeeding if there's questions or concerns about that. If it's a surgical delivery, that being a C-section, we want to make sure we can see them. So, just to make sure that the incision's healing with no sign of infection. And then, usually we'll see them at the six-week point after delivery. And at that point, folks usually want to talk about some kind of birth control.

Host: Absolutely. And finally, in summary here, doc, I've got to ask you this. When you're delivering a baby and that baby actually emerges in that moment, what is that like for you?

Dr. Peter Filozof: I keep coming back, every day is a new day. And, you know, people will ask me, "How many babies have you delivered?" Well, who cares? It's not about number. I haven't delivered your baby yet. And this is a unique human that's manifesting upon this world. And I literally can't think of anything more exciting than that, that moment of excitement. And so to me, it's not even really a job. Sometimes it's hard to believe you actually get paid for something. It's so amazing. And I always tell women that is their superpower. That is their superpower.

Host: That's awesome to hear. So, it never gets old then.

Dr. Peter Filozof: Not to me, it doesn't. No.

Host: It's funny that you said people often ask how many of you delivered, because I asked that of our doctor that delivered our baby. And you know what he said? "Probably about 2000." He said, "I've delivered the babies of the babies at this point." And we thought, "You know what? I think we're in the right hands." I just thought it was interesting that you said, you know, what's the difference what the number is, he was like, "Oh, about 2000."

Dr. Peter Filozof: Well, we definitely do the grandkids of the kids. And I thought I was going to maybe slow down when that happened, but I'm way past that point.

Host: Gotcha. Well, that's great to hear as well. Folks, we trust you're now more familiar with prenatal care. Dr. Peter Filozof, a pleasure. Thanks so much again.

Dr. Peter Filozof: Sir, we really appreciate it. Thank you so much for having me on.

Host: And for more information and to get connected with a provider, please visit mhsystem.org/womenandnewborn. Again, that's mhsystem.org/womenandnewbornn. Please remember to subscribe, rate, review this podcast and all the other Memorial Health System podcasts. If you found this one helpful, please do share it on your social media. I'm Joey Wahler. And thanks for listening to Memorial Health Radio with Memorial Health System Ohio.