Ep. 35: Interview with Pediatric Geneticist Susan Winter

March 4, 2019

Listen Now:

Laura and Shanna talk baby genes, newborn screening, NIPTs and more with special guest Susan Winter, who is not only a pediatric geneticist but also Laura’s mom! Also, Laura discusses getting fancy for a baby photo shoot, and Shanna disturbs everyone with talk of rodents. Shanna’s baby is seven weeks old, and Laura’s baby is three weeks old.

https://www.instagram.com/p/BumQpA-ABAZ/?utm_source=ig_web_copy_link

 

Show Notes:

This episode's sponsors:

Episode Transcript

[Music]

Shanna Micko: Hi. Welcome to Big Fat Positive with Shanna and Laura. On this week’s episode, we have our weekly check-ins, we have a very special interview with pediatric geneticist, Susan Winter, and we wrap things up with our BFPs and BFNs. Let’s get started.

[Music]

Shanna Micko: Hey, everybody. Welcome to episode 35 of Big Fat Positive.

Laura Birek: Welcome.

Shanna Micko: Hey, Laura.

Laura Birek: Hi, Shanna. How are you doing?

Shanna Micko: I’m good. Good. Good. Good. All right. Let’s start off with our weekly check-ins. What do you have going on?

Laura Birek: Well, you know what? I actually forgot to check in about something ridiculous last week that I want to make sure I talked about mostly, because I want to post the pictures on Instagram and give some context.

Shanna Micko: Oh, okay.

Laura Birek: You remember how a couple weeks ago my BFP was Rent the Runway, because they had maternity styles?

Shanna Micko: Yes.

Laura Birek: So I fucked up and I forgot to cancel it in time.

Shanna Micko: Uh-oh.

Laura Birek: I had an extra month that was ending last week and they have maternity styles. They don’t have like post C-section styles.

Shanna Micko: Is that not a big market for the designers?

Laura Birek: It’s not really. So I didn’t know what to do and then I had this idea, which was I was going to go on Rent the Runway and I was going to rent the most expensive dress and jewelry I could get and take an insane photo shoot with my newborn baby.

Shanna Micko: I love that idea. Oh my gosh.

Laura Birek: The photo shoot I guess wasn’t so insane, because it was like the baby’s happy for two seconds, let’s take a photo. But I do think it’s ridiculous, because I’m sitting in my kind of messy nursery and I have this like $1,200 dress on that was actually pretty gorgeous.

Shanna Micko: Can you describe it for us?

Laura Birek: Yes, it was like a silk brocade and it was dark greens and blues and it was a very deep V and I couldn’t quite zip it up all the way in the back, but you can’t tell in the photo.

Shanna Micko: Photo magic.

Laura Birek: It’s a deep V, which really has helped when you’re breastfeeding. The deep V works when you’re breastfeeding is what I’m saying. You got the cleavage there.

Shanna Micko: Yes, it’s appropriate for a baby shoot.

Laura Birek: It is. It was pretty good, pretty fun and I got to wear it for like five minutes and then send it back, but I think it’ll be worth it and we’re going to post it on our Instagram so you can see what it looks like.

Shanna Micko: Awesome. I’m excited.

Laura Birek: That was last week and then this week’s been pretty much just business as usual. Corey went back to work though. So that’s been interesting. 

It hasn’t been that hard though, because I have my mom here, which we will talk about more in detail in a couple minutes, because she is our special guest for the second segment. So I haven’t had to be fully thrown into the fire of parenting alone all day yet. We’ll see what happens next week, but otherwise, we’re doing that thing where we sleep and we eat and we sleep and we eat and we don’t sleep and we eat.

Shanna Micko: I’m glad you’re getting the eating in. That’s important.

Laura Birek: Well, he’s getting the eating in. Sometimes when I get the eating in, I eat a lot.

Shanna Micko: You mean the baby?

Laura Birek: Yeah.

Shanna Micko: I was just imagining you guys just freezing pizzas then taking a nap and Chinese food.

Laura Birek: I told the baby that he doesn’t eat if I don’t eat.

Shanna Micko: Good point. You get those extra calories. That’s what I keep telling myself.

Laura Birek: I should say he was three weeks this week. I forgot to say that at the beginning.

Shanna Micko: Do you have any follow-up on how his sleep, because I know last week your BFN was sleep and you were struggling with that?

Laura Birek: Correct. It’s been all right. Here’s the thing. He’s been sleeping fine in his bassinet the first two times you put him down and then like the third time he’s done with it. So I have been following the safe sleep guidelines until about 5:00 a.m. and then throwing them out the window and doing my best what do we need to survive and have a baby that’s rested and having me that’s rested. So I kind of childproof the bed a little bit as best I can. I took off the memory foam topper off our bed to make it a nice firm surface and got rid of our big duvet. So about two hours a night, he’s joining me in the bed, which I know is controversial. But it might not last very long, because we have a SNOO coming on Sunday.

Shanna Micko: You do?

Laura Birek: We do. I jumped on that. When you told me last week where to rent it from and that you were actually liking it now, I decided it was worth a try.

Shanna Micko: Cool. Cool. Cool. Stick with it because like I said, I had a BFN with it at the first week. But it’s come around and she’s really enjoying it and I need to knock on wood so hard right now. But I want to tell you that the last two nights she slept five hours in a row.

Laura Birek: What?

Shanna Micko: Then gotten up to eat and then we put her back down.

Laura Birek: That’s awesome.

Shanna Micko: It’s been wonderful about these last few nights. So fingers crossed it helps you guys too.

Laura Birek: I really hope so. Anyway, I’ll check in with that when there’s more to check in about. What’s new with you?

Shanna Micko: My baby is seven weeks old and I just feel like there have been so many things that happened this week, but I’m only going to check in on a couple of them. First remember I was taking that prescription Reglan to increase breast milk.

Laura Birek: The galactagogue.

Shanna Micko: Yes, the galactagogue prescription. I had said back then that one of the side effects is possible depression, because it’s a dopamine blocker or something like that. So I was keeping my eye out for that and I never had a deep depression or anything. But I was starting to just feel I don’t know if I’m as connected to my baby as I was kind of hoping or as much as I was to my first kid at this point and feeling just a little bit despondent and stuff. I was like, I feel like breastfeeding’s going a lot better and I’m going to try to quit this medication and just see how it goes. So I weaned off it after three days or something and I just feel great.

Laura Birek: Good.

Shanna Micko: I feel really happy and my love connection with my baby came back instantly. I think it was worth it to take it for a few weeks, because it increased my supply and got my baby gaining weight, which is what I really needed. So the side effect of mild depression was worth it, but I do feel better. I just wanted to report that I’m off my galactagogue. Here we go.

Laura Birek: That’s cool you graduated. I feel like also not having any sleep, it’s so hard to separate depression as a side effect from depression, because you’re not getting any sleep and your baby isn’t gaining weight and all that stuff. You know what I mean?

Shanna Micko: Yes, that is true. Also, it reminded me of something our friend Jen has always said. When she was in the thick of it, a friend reminded her the first six weeks are awful. That’s just how it supposed to be with a baby. The first six weeks are really, really hard and then you kind of come out of the fog, the baby starts smiling and things get better. It’s almost like clockwork. I don’t know if it lined up with the Reglan getting off it or just that timing or like you said, the sleeping. It all just kind of lifted a little bit this week. I feel like I’m coming out of the fog a little bit and I feel good.

Laura Birek: That’s great.

Shanna Micko: I feel good not for one.

Laura Birek: Yay! Oh my God, you deserve it. It’s been a long time coming I feel it.

Shanna Micko: It’s true. It’s just really challenging in the beginning, but there is a light at the end of the tunnel and it is so lovely to have that baby smile and laugh at you and that gives me life.

Laura Birek: My guy is starting to kind of look like he’s smiling at you, but we haven’t gotten a confirmed smile. It all could be coincidence, but it is really fun when he smiles even if it’s just gas.

Shanna Micko: Exactly. Bring on the gas smiles. All right. Well, that’s it for me. Should we move on to our interview?

Laura Birek: Yeah, let’s do it right after this quick break.

[Music]

Laura Birek: Our special segment this week is actually a guest interview and it’s a very, very special guest interview for me because it is my mom. It’s Dr. Susan Winter is what other people call her. She is a pediatric geneticist amongst many other things, which she can tell you and she’s been here with me for a month as I’ve been saying and she’s leaving me on Sunday.

Shanna Micko: That went fast.

Laura Birek: I know.

Dr. Susan Winter: Very.

Laura Birek: I know it went really, really fast, but I’ve been very grateful to have her here. But anyway, we’re here to ask about not just her expertise in my baby and her adorable grandson, but her expertise in all babies, especially ones who are not genetically challenged. So welcome mom, Dr. Susan Winter.

Dr. Susan Winter: Thank you for having me.

Laura Birek: You’re welcome.

Dr. Susan Winter: I’ve just wanted to say that it’s been delightful to hear the podcast and I’m so proud of my daughter and I love my grandson.

Laura Birek: Aww.

Dr. Susan Winter: But basically, I thought I should talk about some things relevant to all of you listening with your little babies. When you have them at the hospital, there’s a little blood test they do on them. They take them off and they stick their heel and they get some blood.

Shanna Micko: I remember that.

Laura Birek: It can be a little traumatic. I think I knew what was going on. It’s called a newborn screening test and for people who have recently had babies or had them in the last… What would you say?

Dr. Susan Winter: The first newborn screening test started around the late sixties, 1964, in California.

Laura Birek: Wow.

Dr. Susan Winter: But just for two diseases at that time.

Laura Birek: Would you know what the diseases were?

Dr. Susan Winter: Yeah, phenylketonuria, which is a disease where children can’t handle protein well.

Laura Birek: Also known as PKU.

Dr. Susan Winter: The other one is galactosemia where mom’s milk with the lactose in it is poisonous to the baby. They can’t handle the galactose and it makes them deadly ill.

Laura Birek: Wow.

Shanna Micko: That would be terrible.

Dr. Susan Winter: When we get a presumptive positive, what happens is your baby gets tested usually before six days of age that’s the law and the baby has to be at least 12 hours old. All the tests in California go to a state laboratory that runs the studies every day of the week and should there be abnormal results on any of the tests, results are called immediately to the newborn screening centers. So the newborn screening tests that they do is to detect diseases that could cause a life threatening situation or long-term problem with general health or intelligence. The test went from two diseases in the 60s to more than 60 diseases now.

Shanna Micko: 60?

Dr. Susan Winter: Yes.

Shanna Micko: Wow.

Dr. Susan Winter: Because what’s happened is since the 1960s, we’ve learned a lot about the causes of for instance, SIDS. Over 5% of the sudden infant death children were found to have a fatty acid oxidation defect, which means that when they were hungry and not getting enough food, they break down fat and that fat can’t fully break down. 

That product that’s basically the ash of unburnt food is toxic and can cause these babies to pass away. So this was a big push by many geneticists and pediatricians across the country to get testing for these fat oxidation defects so that we wouldn’t have kids with SIDS. That resulted in the ability to test for a whole lot of diseases because of the technology. So we test for a lot of defects in the way a baby takes regular milk and uses it to grow. There can be a glitch in any one of the steps all along the way and those glitches each have a unique disease with them and many can be life threatening. The other thing the blood test is used for is to detect sickle cell anemia and other anemia diseases like thalassemia, which afflicts Mediterranean people. Then there is also testing for severe combined immunodeficiency, the so-called bubble babies. We’re also testing for diseases that have storage problems where over time a chemical doesn’t break down in the body and it builds up and can cause damage that’s gradual and we can now treat those diseases. So we’re testing for those and the list of diseases that are tested for are growing every day. The amount of patients that are helped is very, very high. The most common disorder is hypothyroidism where the thyroid is not formed in the baby and that disorder is completely treated with just a simple amount of thyroid every day and those babies are all perfectly normal.

Shanna Micko: Wow.

Dr. Susan Winter: So we’re preventing diseases from killing or hurting children, and it’s a very rewarding practice. The hard thing is you have a young mom who just gave birth to a baby or an older mom, doesn’t matter what age and dad and you call the family up and you tell them your daughter could have a rare disease, a fat oxidation, and they don’t know what you’re talking about and they have to bring the baby to you usually at three or four days of age. 

My center in Fresno covers the central valley from Sacramento all the way down to Bakersfield and we have to see these babies. The families just had a baby and they have to get in a car and they’re panicked and crying and it’s a very, very stressful time for the families. So our goal was to make them relaxed, to tell them how wonderful the newborn screening is that it picked the disease up before, the babies used to get a life threatening disease and now we can have a healthy baby. We spend hours in the clinic with them. Often, they have to go home with a special formula. The galactosemic babies can’t drink mama’s milk, so we stop them right away. When we get a positive result, we call the mother and tell them to stop breastfeeding. It’s very hard. One out of every 10 turn out to be really positive. So a lot of people are put through a lot of grief for no reason.

Laura Birek: So only one in 10 are affected?

Dr. Susan Winter: Basically, about one in 10 are really affected. Of the ones that are called to me, we’re refining that. We’re doing the normals better. It’s getting less, but still you have a lot of people where you can tell them at the end of it, “Your baby doesn’t have the disease,” which is reassuring. But you’ve also created a real stressful situation during a time of stress already.

Laura Birek: It seems like it’s better to over catch than under catch though the situation, right?

Dr. Susan Winter: The worst mistake would be a false negative.

Laura Birek: Because it seems like before all these diseases were being tested for, what would happen was you would end up seeing a baby depending on the disease much later down the line when they were becoming symptomatic and maybe had already had brain damage or life threatening.

Dr. Susan Winter: Right. Generally speaking, before newborn screening, I practiced for many years before they began screening for the fat oxidation defects and the other metabolism problems. I would be in the ICU every day almost seeing a one-year-old or a two-month-old in severe life threatening crisis often not making it. My job was to try to figure out what the disease was, which oftentimes I could figure out. But instituting treatment after a child has had a major decompensation in other words, a major illness from the disease, usually their IQ, their intelligence is about half what it would’ve been.

Laura Birek: That’s amazing.

Dr. Susan Winter: We are preventing a lot of intellectual disabilities and these diseases are now becoming livable. The parents have children, although very fragile and still needing to come to clinic all the time and eating special foods, the children are developing like all the other children in their lives and having the ability to go to school and run and play. So it’s extremely rewarding to have a program like the California Newborn Screening Program.

Laura Birek: Is it across the country?

Dr. Susan Winter: Newborn screening is done in every state. 

Each state has a separate jurisdiction over it so they can decide different diseases. There was a national committee set that is now recommending what screening tests should be on a screening panel and most states are now going with the recommendations of the national panel. That’s panel genetics, pediatricians, metabolic specials to all are making sure that we’re screening for diseases that do have a treatment and where the treatment makes a difference.

Shanna Micko: Are these things that are different that would show up on the noninvasive prenatal test?

Dr. Susan Winter: They’re very different. The noninvasive prenatal test is looking at the chromosomes. Your chromosomes are in your cells and in the nucleus there’s 23 pairs and they have all your nuclear genes. So each chromosome has about a thousand genes on it. Those tests are looking for extra chromosome material and missing chromosome material.

Shanna Micko: Okay.

Dr. Susan Winter: The genes themselves are not being looked at. So what I was talking about with newborn screening is every one of those disorders are due to a single gene mistake and so very often they’re due to the mother carrying a gene with a mistake in it and the father carrying a gene with a mistake in it. They match on that one gene. There’s 23,000 genes or more and they just happen to match on that same gene and the baby gets it in a double dose. The mom and dad are fine, because they have a normal gene partner. The diseases come about when both genes are not normal. There are other forms of inheritance, but this is the commonest form. It’s called autosomal recessive inheritance. People will come and say, “But there’s no genetic disease in my family,” and I say to them, “You carry and I carry and everybody in this world carries at least 30 abnormal genes with mistakes or mutations in them and those mutations, if they’re in the same gene pair, you get a disease.”

Shanna Micko: Is there a way for the parents to test themselves ahead of time if they’re worried about having a baby?

Dr. Susan Winter: Yes, there is. So as you mentioned, the noninvasive prenatal screening that was chromosomes. But you can also get carrier screening for diseases and there are many, many prenatal panels. Laura did one.

Shanna Micko: I did one.

Dr. Susan Winter: At the time it was the biggest. It’s now been usurped.

Laura Birek: Of course.

Shanna Micko: The minute a company says they’ve got the most diseases, another one comes on. But up to 300 diseases are looked at for carrier status. Looking for diseases that both mom and dad are carrying the same disease, Corey and Laura had the testing. Although we found some of the genes that they carry, fortunately, Corey’s gene mistakes didn’t match Laura’s. For sure, Laura’s little boy is probably carrying some of those genes, but we know before they had him that he didn’t get a double copy of some of these bad genes. Now, these panels don’t look at all your genes, but they look at the most common ones and especially looking at the ones on newborn screening panels. So they’re another way to reassure yourself. Not all insurance companies will pay for it. But certainly if there’s a family history of any diseases, you should always ask to have a genetic counselor or a geneticist be consulted for, and you see them and you talk over what tests are options.

Shanna Micko: I have a question. Why is it that the noninvasive prenatal test is generally given to women over age 35? What happens that makes them more susceptible to problems I guess?

Dr. Susan Winter: Exactly. Well, it’s always been known that Down syndrome, for instance, which is an extra number 21 chromosome, that disorder has a much higher incidence in mothers who are over 35 years of age. The older the mother gets, the higher the risk of having a down syndrome. So the question then comes, why? The reason probably relates to the fact that women have all of their eggs formed ready to go when they’re inside their mother at 16 weeks gestation.

Laura Birek: Wow. It’s amazing.

Shanna Micko: Wow.

Dr. Susan Winter: Those eggs not only are they ready, they’ve already duplicated their DNA and are ready to make what’s called the first mitotic division and they stay stuck with spindles holding them together, ready to split, but frozen at that time.

Laura Birek: Just a little background for people who don’t remember their high school bio class. You have 23 pairs of chromosomes and you get one half from each parent. So you get one number one chromosome from your mom, one number one chromosome from your dad and then if you have down syndrome, there’s been a mistake where you’re getting two from your mom probably and one from your dad so you have three of them.

Dr. Susan Winter: Yes, it could be from either parent. It’s much more common from the mom. So these spindles are holding these chromosomes waiting to make the egg with one of the pair sets and the actual split does not happen until the sperm enters the egg.

Laura Birek: Oh, wow. I didn’t know that.

Dr. Susan Winter: So then there’s two divisions to make eggs. You end up with four eggs. Three are called polar bodies and one’s the egg that becomes the baby. All of that happens after the sperm enters the eggs. So if the egg is old, the older the egg, the more likely there’s going to be some mistakes. Those spindles, which are tiny little like hairs that contract are what pulls it apart and they’re attached to the sides of the cell. If they break down, the chromosomes will all go to one pole and not split. In that situation, you end up with either an extra whole set of chromosomes, which you can do and I’ve seen babies born with a complete extra 23 chromosomes.

Shanna Micko: Wow.

Laura Birek: So they’re trisomy of everything.

Dr. Susan Winter: They’re trisomy. They’re called triploidy for three of the sets. Down Syndrome’s the most common, because the 21st chromosome is the tiniest and it’s probably the lightest. So it goes to the pole. It’ll not separate as easily, because it’s so light. The older you are, the more likely you’re going to have one of these problems where the split won’t happen correctly and that is when you would offer a special test and so we have to pick the families. Initially, we were doing amniocentesis years ago

Laura Birek: That’s where you take a long needle and stick it into the embryotic.

Dr. Susan Winter: Into the abdominal cavity, take off the fluid, grow it over a week or two and then do the actual chromosome study looking at the chromosomes under the microscope to see if they’re all the right number. When I was pregnant with Laura, I had an amniocentesis, because I was 35 and fortunately, she didn’t have any problems.

Laura Birek: Tell them what you did with that for mother’s day. Was it mother’s day or Christmas?

Dr. Susan Winter: Pardon me?

Laura Birek: Who you sent the chromosomes to. You don’t remember? 

I’m remembering you told me that, that’s how you announced your pregnancy to grandma Anna.

Dr. Susan Winter: Probably your father sent them.

Laura Birek: You sent a picture of the chromosome.

Dr. Susan Winter: Your dad did.

Laura Birek: Which is a little different than how I announced my pregnancy to my mom.

Dr. Susan Winter: Laura sent me a strip of where her urine test had been positive. I said, “What is this? Oh, she’s pregnant.”

Laura Birek: But of course, they were the cheap Amazon ones. So I actually hid it behind a photo in a frame and told her to look behind.

Dr. Susan Winter: That’s right.

Laura Birek: So that I could hear her reaction. I said, “Look behind. I put another photo in.” She goes, “What am I looking at? Oh.”

Dr. Susan Winter: That was fun. The reason why you want to do the NIPS, the blood test, in older women is, because they’re at higher risk.

Shanna Micko: I see.

Dr. Susan Winter: You could do it in any age, but you’re doing it on groups that are not at high risk. Whenever you do any test in medicine, there’s a chance of a false positive and that creates emotional trauma to the individual who gets a false positive result from any test. So we make recommendations when it’s appropriate to do them and when it’s not appropriate to do them based on risk assessments.

Shanna Micko: Okay. So you’re saying you might not suggest a younger person do it, because then they might get a false positive, and it’s not worth it to go through that since they’re not at risk.

Dr. Susan Winter: Exactly. If a younger person has an abnormality detected by either the blood screening tests that the state does, or by ultrasound, we will then offer it to them.

Laura Birek: That’s something in like the 20 week anatomy scan they’re looking for a lot of the mothers.

Dr. Susan Winter: The detailed fetal ultrasound is done between 18 and 20 weeks. If there’s abnormality seen, we will offer either an amniocentesis, which is more accurate, because you actually have baby cells you’re looking at as opposed to DNA that’s chopped up in the mother’s blood that’s baby origin. So it’s more accurate to do an amnio at that point. 

But very often the moms don’t want to do an amnio. They’re afraid of the needle and they’re afraid of the risk of one in 200 miscarrying. So they very often will opt for the noninvasive prenatal screening and very often, it will give them the answer that they need. That can be any age, of course, because that’s a family or a pregnancy that’s been picked out due to screening tests that are abnormal.

Laura Birek: I feel like there’s a lot of people who say, well, I don’t want any of these tests, because there’s no way I would terminate a pregnancy no matter what, which is their choice. Say that you have a pregnant woman who has their 20 week scan and there’s abnormalities and she says, it doesn’t matter, because I’m not going to terminate either way. Would you say it still might be worth it to get the test so you can be prepared? What would you say to a mother like that?

Dr. Susan Winter: I think first of all, you offer all the options to the mother. You try not to influence her thinking, but you do point out to them the advantages of knowing. For instance, say you would not terminate a child with a chromosome anomaly, but knowing ahead of time about it will prepare you for the baby’s birth. Baby’s neonatal period might be handled differently. If the baby has a disorder that predisposes them to heart disease, you’ll be checking the baby’s heart. So knowing is almost always better than not knowing. The option of terminating or not terminating you offer, but you certainly allow them to make that decision. The family is always going to make that decision themselves. But the thing that I point out to them is that I’ve had many, many mothers who had a baby with down syndrome who knew beforehand and said they were able to read books about it, they were able to meet other mothers with children with down syndrome and they felt that it was a blessing to know ahead of time. I do share that with them. We’ll offer them to talk with parents who’ve had a similar situation. We try to give them whatever guidance they want. But if they don’t want to know, that’s their option.

Laura Birek: Man, I wish we could talk for like five hours, but I think that episode might be super long. Right, Shanna?

Shanna Micko: Yeah.

Laura Birek: So I think we’re going to move on to our final segment just after this quick break.

[Music]

Shanna Micko: All right. We are back and we’re going to wrap up this episode with our weekly BFPs and BFNs, big fat positives and big fat negatives. Laura, why don’t you start us off?

Laura Birek: Yeah, so I’m going to do a BFN, because I feel like it’s been just BFP for weeks and you got to balance things. My BFN is actually the co-sleeper that we have, that we registered for. It’s the Arm’s Reach Versatile Co-Sleeper and it’s fine like I said.

Shanna Micko: Is that like a bedside bassinet?

Laura Birek: It’s a bedside bassinet.

Shanna Micko: So it’s not something that goes in the bed on your mattress.

Laura Birek: Correct. It sits next to the bed.

Shanna Micko: Okay.

Laura Birek: It was really well rated and I thought it was going to be great and I’m really grateful that my mother-in-law Sherry got it for us. Don’t take this the wrong way, Sherry. I know you listen. I love you. It’s just that I didn’t know what I need. It’s first baby, so you don’t really realize sort of how things are going to functionally work and it was a blind spot on my part. The problem is that the bassinet is fine, but it has a rigid side all the way around. A lot of other bassinets will have a soft part or a part that’ll fold down so you can stick your arm in and comfort the baby.

Shanna Micko: Yes.

Laura Birek: This doesn’t have that and it doesn’t go low enough to be lower than my bed. So in order for me to reach over, it’s called the Arm’s Reach Co-Sleeper, right?

Shanna Micko: Arm’s reach at an awkward angle is what they can call it.

Laura Birek: But in order to reach my arm out to touch my baby, I have to reach over the hump and it’s very hard on my shoulders. It’s funny because the company, Arm’s Reach, actually all the rest of their co-sleepers have the panel that moves down. I just happened to get the one that doesn’t. So that’s my fault.

Shanna Micko: So where’s the baby sleeping now?

Laura Birek: He’s been in there. It’s a pain in the ass. You have to sit up completely to get him in and out of it. It’s just a little bit of a blind spot on my part.

Shanna Micko: When you get that SNOO, you’re not going to have to work, because that SNOO is going to take care of that baby for you all night like a night nurse.

Laura Birek: That’s right. Nightmare is cheaper than a night nurse. How about I ask my mom? Mom, do you have a BFP or a BFN for us this week?

Dr. Susan Winter: I have a BFN.

Laura Birek: Okay.

Dr. Susan Winter: This is my first biologic child who has had a baby and I’m just so thrilled that she is such a good mother.

Laura Birek: But that would be a BFP I hope. That’s a positive.

Dr. Susan Winter: It is. Of course, I’m sorry. Wait, let me start that over. I have a BFP. My BFP is seeing my daughter being a mother.

Laura Birek: It’s very sweet.

Shanna Micko: Aww, that’s so sweet.

Dr. Susan Winter: She is such a good mother.

Laura Birek: Except for right now I’m overfeeding my son, because I want him to stay quiet during the podcast. That’s sweet, mommy. Thank you, mommy. I learned from the best. Then Shanna, what about you? Is it me? Am I your BFP too? Just kidding.

Shanna Micko: Yes, you’re always my BFP, Laura.

Laura Birek: You too, Shanna.

Shanna Micko: I have a BFN.

Laura Birek: Aww.

Shanna Micko: That is dead rats in my baby’s closet.

Laura Birek: Whoa.

Shanna Micko: Oh my God, you guys like a couple weeks ago, we’d heard like crazy screech scratching in our exhaust fan over the stove and we’re like, oh my God, I think we have a rodent. So we called the exterminators and they came out and just did our whole house: set traps in the attic and did all this stuff. They didn’t find that critter in the exhaust fan over the stove.

Laura Birek: Gross. Gross. Gross.

Shanna Micko: I know. We should do a content trigger warning for this section. So they didn’t find the guy during their inspection. So he must have gotten in the attic because I don’t know if you guys know, but lately I’ve been recording in my baby’s closet. I set up my mic and hang blankets around and everything. So I’m not recording in there today, because I opened the closet door and it smelled like death.

Laura Birek: No.

Shanna Micko: I didn’t know what it was and I was like, “Steve, can you smell this?” He’s like, “I don’t know. Maybe it’s just these musty clothes.” I’m like, “You have a terrible nose.”

Laura Birek: Sorry, my mom is now off to burp the baby. I’ve just fed for way too long. I don’t know about you, but I still have the pregnancy super smell. 

Anyway, but so you smelled it. Gross.

Shanna Micko: I was like, that does not smell right. I’m like, what did I put in here? Did a dirty diaper get in here, because this was a couple weeks after the exterminator? So it wasn’t even on my mind. I left this ride for a few days, Laura. Thank God it was rainy and cold here, so that thing did not decompose more. But finally, I had my mother-in-law come in. I’m like, “That smells wrong. Huh?” She’s like, “Yes, let’s call the exterminators.” So they came out yesterday and found two dead rats in the attic above her room.

Laura Birek: Oof.

Shanna Micko: Good times. But they’re gone now and I’ll air things out. Next week maybe I’ll be back to my very fancy recording spot.

Laura Birek: Unfortunately, I know that smell well, because we also had rats in our attic a couple months after we moved in, but now we have monthly exterminator services.

Shanna Micko: It’s well worth it. On that note, why don’t we wrap things up?

Laura Birek: Let’s wrap things up. Thanks everyone for listening. We’d love to remind you to leave a rating and a review on iTunes or whatever podcast app you listen in. We would be very appreciative of that.

Shanna Micko: We would love to hear from you any questions or comments or what your BFPs and BFNs are. Laura, where can they find us?

Laura Birek: We’re on Twitter, Instagram, and Facebook at BFP Podcast. We also have a website, bigfatpositivepodcast.com, where we post our show notes and direct links to episodes.

Shanna Micko: Big Fat Positive is produced by Laura Birek, Shanna Micko and Steve Yager.

Laura Birek: Thanks for listening.

Shanna Micko: Bye.

Laura Birek: Bye.

[Music]