Franziska Haydanek: I think times have changed with the level of misinformation online. And so I did go through a period of time where if a patient came in and said, I don't want any hormonal birth control, I might just say, okay, and then we wouldn't discuss anything else. But now with the level of misinformation that's coming through, I'm starting to feel like it's also my job to kind of ask why. And being on social media has helped me kind of understand what disinformation is out there. And so sometimes I can even preempt it a little bit with my patients. Welcome back to I Did My Own Research. I'm Dr. Fran, and today I'm joined by Dr. Sarah Neal. Dr. Neal went to medical school at the University of Michigan, completed her obstetrics and gynecology residency at William Beaumont Hospital in Metro Detroit. She then completed a complex family planning fellowship at Harvard Medical School and obtained a Master's of Public Health from Harvard THAN School of Public Health. She currently works as an assistant professor in obstetrics and gynecology, as the associate program director of an OBGYN residency program. And is the course director for a medical student elective and complex family planning in Boston, Massachusetts. Online, she posts at Sarah OBGYN where she discusses her job, medical misinformation, and complex family planning. Dr. Neil, welcome to I Did My Own Research. Thank you so much. I'm so happy to be here. You know, I've really loved following you because you've given such an interesting glimpse into not only the life of an OBGYN, which I obviously know, but also as someone who does complex family planning. And the majority of these listeners are not gonna understand what that is. So could you go a little bit into your training and then what the role of a complex family planning doc is and what your day looks like? Absolutely. That's a great question. And I actually find that even people in medicine, especially outside of OBGYN, may not know what complex family planning is. So complex family planning is a subspecialty of obstetrics and gynecology. And it is a accredited specialty, meaning there's a ⁓ boards that we have to take to be a CFP or complex family planning specialist. And what I did is in addition to medical school and then the full four years of OBGYN residency, I then went on to do a complex family planning fellowship. And folks might want to know, well, like what exactly does that entail? And the field of complex family planning really encompasses developing a deep clinical expertise in abortion care. contraception or birth control care and pregnancy loss care. And of course, some of this is taught in general OBGIN residency, although less and less for abortion care. And in Complex Family Planning Fellowship, we go deeper and develop kind of a subspecialist expertise. Yeah, I'm so thankful for our complex family planning docs that I work with because when I have a patient who so for example patients who've had multiple PEs and then have also had complex pelvic surgery, And but need contraception and you know, there's just complexities to their care that I'm so thankful to have a fellowship trained complex family planning doctor in my system because you know, I don't often have to use them, but when I do I'm so thankful because these patients really are desiring and needing, you know, sub specialized care and are so complex that I need someone who really understands all of their options. So I'm just so thankful for the care that you provide. Outside of abortion care, which is obviously so incredibly needed as well. I'm very thankful that I live in a state that really supports abortion care. Really is, you know, it's written into our like state constitution. So we're very protected. But I trained in Ohio, which was much less open and receptive to patients having all their options for them. So grateful where I work now, but I definitely fear for the places that don't have the options that my patients do. Absolutely. And similarly, Michigan's getting a little bit better, but I trained in Michigan and At the time there were many restrictions on abortion care. And I remember I would sit with the maternal fetal medicine specialists, the high risk doctors, and we would just give someone like a horrible, terribly sad diagnosis about their very desired pregnancy. And then we'd give them their options. But in Michigan, their options were If you want to end the pregnancy, you still have to have a waiting period of twenty-four hours. And by the way, insurance isn't gonna cover it. And then when I moved to Massachusetts for my fellowship training, I was actually blown away by how when those barriers were removed, care felt much more patient-centered. It felt much kinder and it was just the right thing to do. So, like you, I I do feel very lucky to live in a state that currently supports abortion care. Yeah, I don't think people realize when patients are in those situations, the those barriers that you're talking about add such an additional level of emotional turmoil for patients. You know, I'm in like our private Facebook groups where doctors are looking for places where patients can get care and it's like some of them have to go states away. I'm like, Can you imagine packing up and driving three states away to get health care? You know, it's really I feel so much for these patients because it's so much to go through. So I just am thankful for the work that you do. Can you go a little bit into like what a normal like work week looks like for you? I am just so interested in this. I normally don't ask this, but I just like find I'm sure that your week is very varied. So I'd love to hear about it. It is. And I think that's one of the great things about being a specialist. I always tell the residents, like, being a specialist is fun. You should consider it. ⁓ But with complex family planning, my I do have a lot of different facets of my job. So in a typical week, although there really is no typical week, I may spend a couple days in what we call our family planning clinic. And that's a in-person clinic where we do abortion care, miscarriage care, and contraception care. So I might see a patient who had an early miscarriage and give her medications or do her procedure. I might see someone who's coming in to end an early pregnancy. And then I also might see someone who Has an IUD and they're having problems with it, and maybe their PCP tried to help and couldn't quite get it. And so then they refer them to me for kind of a more specialized assessment. I also do speaking on the ⁓ kind of complex patient side, we do do telehealth visits for complex contraception patients. And I find that this telehealth piece is really helpful for patients because a lot of times these are people who have so many appointments in the system. They might have a neurologist, a cardiologist, their primary OB, their PCP. And it takes a lot of pressure off them to be able to talk to a specialist via telehealth. So I might do that. I also do a lot of teaching. So I work with our residents in their general OBGYN clinic, which I love doing. Our residents are just so amazing. And then I do still work on labor and delivery because I really believe that abortion care, pregnancy loss care, and obstetric care are really all in one. And so it's important for me to still continue doing the obstetric piece. Yeah, I think that's so interesting because not all subspecialists do that. You know, some are once they get into more of the GYN sub specialties, they will let OB go. But I do love that the multifaceted care that you're providing. And because a lot of that care is care that we provide on labor and delivery. So it's not always just happy full term babies that we're, you know, that's who we're taking care of. We have a lot of complexities in the patients that we see inpatient. So it's nice to have your expertise there. I'd love to s you know, go a little bit into what we're seeing online because that's how you and I met. And, you know, you probably more than even me at this point see the misinformation online, both about contraception, obviously, but also abortion care. So I'd like to go first into just a little bit in about birth control. Obviously, you and I probably see a lot of the same misinformation and disinformation about birth control. But what's coming across your page right now? What are you seeing a lot of? I have seen a lot of, you know, the balancing your hormones. And then something that's come up like concurrently online and with patients is that I've started hearing more patients say, well, birth control makes your body think it's pregnant. And being on birth control is like being pregnant for many years in a row. ⁓ and I was surprised to hear that because as you and I know, that is it's actually very incorrect. Actually, it's like the opposite. Yes. The one that I've been seeing a lot of recently, I don't know if someone made one video and then everyone, all the wellness grifters, saw it and saw all the views it got and they all repeated it, but it's all exactly the same video. It's like one video of someone just like doing something not related to the topic and then saying, like, Isn't it interesting that we all got put on birth control when we were fifteen? Now the IVF you know, complex is a fifty billion dollar industry. And they all made the same video. There I there's a girl who like shared all of them and it was like 15 and they were all exactly the same because they all got millions and millions and millions of views. Because, you know, I think it's very common for many of us to start birth control in our mid teens. Logically, for me, my parents were like, let's prevent pregnancy. Love them. Thanks, mom and dad. You know, so I think it's a very common experience that many of us get put on birth control for either contraception or dysmenorrhea. And it's also very common for people to have infertility, especially as we're delaying childbearing. You I think the average age of the first baby now in the United States is thirty. That's quite a bit longer than it used to be, right? And that's wonderful because people are really getting to choose what they are doing with their lives and choosing to delay childbearing so they can pursue their education or travel or whatever they want to do. But with delaying childbearing comes delaying fertility and a long and luckily we now live in a time and place where we can have things like IVF. To help people have the families that they want. And I hate that people are like mixing those two up, right? Like you are mixing that two up and you're putting it purely on saying that birth control when you were 15 is causing your infertility at 36. And it's like, no, you delayed your fertility, and birth control doesn't cause infertility. So that's what I see a lot of, and I just hate it so much. How do you like address that? Like I think we all have like slightly different approaches to that. Yeah, there's so many. parts of misinformation that are coming through. And I think we know categorically from lots of research that's been done is that birth control does not impact people's fertility. So I do, I do will just tell patients that and sometimes I'll show them some of the studies if they're concerned. And then on the one that's been a little bit newer and kind of like trending for me, mostly in person, but also seeing it online, which is the, you know, pregnant ⁓ birth control is like being pregnant for years and years and years in a row, I will say that I think times have changed with the level of misinformation online. And so I, you know, we all go through evolutions in our roles as doctors and who we are as doctors. And I think I did go through a period of time where if a patient came in and said, I don't want any hormonal birth control, I might just say, Okay, and then we wouldn't discuss anything else. But Now with the level of misinformation that's coming through, I'm starting to feel like it's also my job to kind of ask why and of course a respectful and partnered way with the patient. And and so recently with one of the residents, we did this together, you know, there was a patient who came in She had some conditions in which hormonal contraception probably would have really helped her. Though they were actually her primary complaints. But her one of her criteria for whatever treatment she had is that she didn't want any hormonal contraception. And the resident had kind of taken the approach that I used to take, just being like, Okay, it's off the table. But I decided why don't we go in with a little bit more curiosity and see if she'd be willing to kind of tell us why? And once we talked about it, she then again said the thing about being afraid of being in a pregnant l pregnancy like state for For many years, if she was on birth control. And we were able to debunk that and talk about how hormonally birth control really quiets the signal from the brain to the ovary, where in pregnancy a whole new organ develops, the placenta, and puts out massive amounts of hormones that are like 30 times what you would get in a birth control pill. And after we had some of those conversations, she was much more open to pursuing some treatments that probably could have really helped her. And we're gonna meet with her again after she's had some time to think about it. I love that. And I think it's really important for clinicians to hear that because I agree. It's we want to be very like patient centered and don't want to push people. And so we're like, ⁓ okay, yep, sounds good. But w sometimes digging a little deeper in a very like kind and calm and not accusatory way will really allow you to understand where patients are coming from. When you were telling that story, I was thinking about a lot of times when patients come in for IUDs. And a lot of times, you know, they come and say, I want the copper IUD. I'm like, okay, why are like, what are we hoping to do with the IUD? And they're like, well, I have heavy bleeding. I'm like, okay, so let's talk about with a copper IUD and what it's really, really great for and what some you know, side effects of it are. And I'm also gonna tell you about the hormonal one just so you really have all your information to make the right choice for you. And I would say more often than not, once they've heard it from someone who really says what You know, the risks and benefits of both options are people say, like, ⁓ maybe I wasn't making the right choice for myself initially because I didn't have all the information. Not that I needed them to make one choice either one way or the other. It affects my life zero. But I felt that I they weren't making they weren't given all the information. And that's the problem with online, I think, is that people think that they're informing themselves when in reality they're disinforming themselves. They're getting misinformation. And I think the internet can be used in a way where As a patient, you use it to educate yourself and then you take it to your clinician and say, Hey, I'm thinking about getting a copper IUD for these reasons. I'd like to avoid hormones for whatever reason, but I also have these problems. And then your clinician can say, based off of you and your medical history and your needs, let's talk about all the options so you can make the right one for you without just like, you know, some chiropractor telling you that copper I's are the only thing you should ever use. Yeah. And I think You know, social media is really powerful because I think our brains, like we like hearing stories from people. That's how our brains are set up. So I think it's really compelling whether it's misinformation or disinformation. It's actually really hard to disentangle that when like there's like a person's face telling you this big dramatic story about their birth control experience. So it definitely has made our jobs a little bit more interesting. And being on social media has helped me kind of understand what disinformation is out there. And so sometimes I can even preempt it a little bit with my patients. So that's been a little pretty helpful. I think that has been very helpful for being a physician who consumes social media, is that I have a much better understanding of where patients are coming from. My husband is a family. medicine doctor, he does not have a singular social media account. And he'll be like, he'll come in from work and be like, are people talking about ADHD a lot right now? I'm like, they sure are. And if you saw the videos, you would be more prepared for those conversations. So I agree with you that being a physician has really opened my eyes in so many ways to ⁓ taking care of the patients and really finding patients where they're at rather than you know the little time that we get to spend with them. You know, they're spending hours. I mean I spent hours on my phone. So you know They are too, so I can see how it affects them. Switching a little over to abortion care. Obviously, one, this is a hard topic to make social media content for. One, it's very ⁓ not regulated, but people like the algorithms push down that content. Have you found that to be true? Yeah. And and I've just decided that it's important enough that It's okay if those videos get less views. You know, even if the video gets 500 views, that's 500 more people than I would have been able to talk to about abortion just sitting at my desk. So I have found when I make videos about abortion, even if they get really high engagement, which typically would then prompt the algorithm to push them out farther, the overall reach is a little bit more limited, but it's w it's worth it to me. Yeah. Do you ever find yourself having to use like other words for it? You know, a lot of times we say like, Going camping and those kind of things, but then I fear that it's not a searchable video where people who are needing that video and looking for it aren't gonna be able to find it. Yeah, I sometimes in the written word I'll change it a little bit. So I might put a little like emoji or icon for one of the letters. I'm I'm not sure that's helped. Obviously, TikTok is super secretive about their algorithm and it's only on always changing. But in general, I just say the word abortion because, like you said, I don't want my patients or people online to be confused about what I'm talking about. And I also think It's important to normalize saying the word abortion because abortion is very common. We know that one in four women by the time they reach their forties will have had an abortion in the United States. So I feel like it's a little bit of my responsibility to kind of name it and say it even on social media. Yeah. I hate that we are so censored in the words that we're out to say, you know, especially in our field, like we can say over uterus fallopian tube, but if you say vagina or vulva, you will be censored. Like you will not you will be so suppressed. in your views just by using anatomical words. So I am not surprised at all that saying things like abortion also highly are censored online. Do you find that our one app is a little bit more forgiving than the other? Like Is Instagram a little bit more okay with things versus TikTok which censors it more or is it kind of all the same? Yeah, I'm just on TikTok right now. So I'm on TikTok and Substock. I'm not sure, you know, about my plans to branch out to other social medias. On Instagram, it's just my personal Instagram. So I'm not doing a lot of ⁓ physician educating on Instagram at the moment. Yeah. What are you doing on Substack? Sometimes I realize that a topic that I cover on TikTok really deserves more. And obviously we can't post like a twenty minute video where we're kind of going on and waxing poetic about a certain topic. So For a few topics, I've written a r a really short, just like two to four paragraphs essay, if you will, to go along with the topic, something that deserves a little bit more in depth consideration. So that's how my sub stack and my TikTok ⁓ interact right now. Yeah, I love that. There are several science and medical content creators who do the same. I know Dr. Jessica Nurik does that, Jen Gunther does that. And it's a great resource I use them all the time. Like whenever I know that ⁓ Doctor Gunther wrote something and I know I need to go look it up, I like go to her Substack because I know it's there and it's like what I'm looking for. So I'm so thankful for those of you who can put those thoughts to electronic paper and have it be a resource for people. Yeah. And you know, TikTok is at times an unstable environment, right? We don't know is it gonna be banned? Is it not gonna be banned? So I think that's why a lot of content creators, like you mentioned, will be cr ⁓ cross posting on on other avenues like Instagram. And for me, some of the content I like to document it on Substock. Yeah. No, I think that's a really great idea, especially for those people who are listening who maybe don't want to be in every single space because it is very overwhelming. It's a lot of work. It's you may not want to it's just not your people. Those are all like very valid things but finding ways to be online. You know, I gave a talk recently to the Buffalo Medical S O we G Y N Medical Society and I was saying like not everyone has to be like Dr. Fran with a camera in front of your face making a video. There are many different ways that you can combat misinformation. It doesn't have to be TikTok, it can be Substack, it can be a blog, it can be a newsletter, you know, there are so many different ways that you can up get to people that make sense for you. just because it worked for me this way doesn't mean you have to do it. But I think a lot of people, you know, are so interested in the things that they do and want to help people that there's ways that you can do that. Absolutely. I mean, there's so many options and they're only increasing over time. So I and I do think we have a little bit of a responsibility to kind of like be out there with our patients, right? I a hundred percent agree with you. Do you ever, you know, abortion care especially is highly politicized. We have seen Physicians be killed over the work that they do. Do you ever fear for yourself in that way online? Because now you are publicly talking about it. Yeah, that's actually what held me back for quite some time. I I started kind of becoming a consumer of TikTok and that type of social media during the pandemic, as many people did. And I started seeing creators like you and other folks pop up. And whenever I thought about sharing anything online, I I thought it's too risky. It's too risky to out myself. quote unquote as to what I do. And and I I don't know if I want to invite that level of transparency into my life for just the public to see. But then after the 2024 presidential election, I realized that I needed to be more open about kind of what I witness, right? I like sit in this really unseen space where people are coming for their kind of most difficult or intimate types of reproductive health care that has huge implications for their life, but they might not go talk to their neighbors about and So I thought I actually have a responsibility to be out here talking about abortion, miscarriage, and and contraception. And so far, you know, I don't want to invite any haters, harassers, or crazy folks. So far, I haven't gotten a lot of harassment just related directly to my social media or TikTok, but it is definitely a risk of my job. Yeah. I did think about that when I was preparing for our interview about how in the twenty twenty-four election debates, I remember when Donald Trump said, you know, they're poor performing after birth abortions. And I don't make a lot of abortion content because I was not trained in it and I my hospital system has the resources that I don't have to perform them. So I feel I'm less of an expert to be able to speak on that. But I had to make a video on that because I knew that wasn't true because those words were being said on a national stage. You know, millions and millions of Americans were watching our former president and now future president say that OBGYNs are performing after birth abortions. And I was like, this is like I the platform that this misinformation now has is absolutely astronomical. And so y someone has to be you know, they weren't fact checking it in real life and the fact checking is never as ⁓ gets as many views or gets the platform that the misinformation does. We see that on a national platform as like the debates, but also on social media, like you said, the videos that have the most information get the most views because they're they're emotional, they're people in, they get people like worked up. The boring videos of saying like we don't perform afterbirth abortions, like that's not a very exciting video because that's the truth. And the truth is pretty boring sometimes. Yeah. And you know, I think that's a good example of not only misinformation, but disinformation. Information that's actually designed to be destructive. And I don't believe I don't know him, but I don't believe that Donald Trump thought that we were doing afterbirth abortions. I think it was purposeful disinformation. And What really upsets me about the purposeful disinformation is I think about women's health and reproductive health care for people over time and how kind of underfunded, neglected it has been. And I think this disinformation and misinformation means now we have to put so much of our resource just to getting back to the truth, not necessarily advancing reproductive health care. And so that really I find frustrating. We should be putting all of our efforts into making reproductive health care. as amazing and great as possible for everyone who needs it. But instead we're kind of like backpedaling and trying to correct these kind of purposeful harms that people are doing by putting this ridiculous information out into the public sphere. Yeah. We're really focusing on all of our energy on like correcting the most basic misinformation of our most basic medical things that we have rather than focusing our energy on trying to figure out the next thing. And that's really hard because When it comes to like OBGYN care, we are we have been chronically underfunded. And like we all know that to be true. So we're working with the best that we have. And to then attack the best that we have is very frustrating, especially when it's for the people who are trying to make money off of it. Like that's the part that makes me upset, which does kind of pull me back into real life because I wanted to talk a little bit about ⁓ pregnancy crisis centers with you. Because I've seen this a lot online too about, and then I see it in real life where people go to like pregnancy crisis centers. So could you walk us through a little bit like what those centers are and what they are not? Yeah. So people will call them CPCs, crisis pregnancy centers. Other people will call them fake abortion clinics. And what they are is they appear to be independent, but most of them are actually part of a coordinated network with the same financial backers. And they are not real medical clinics. They are establishments that will advertise things like pregnancy tests, ultrasounds, options counseling. Free diapers, things like that. And and they'll say, if you're pregnant or if you think you're pregnant, come in and we'll help you. They're also often purposely put like down the street from an abortion clinic to try and funnel patients away from actually getting to abortion clinics. And so these crisis pregnancy centers or fake clinics are really their goal. Again, they're all funded by anti-choice backers. So their goal is to convince people not to get an abortion, which of course I think is. really disrespectful to the person because the person is in charge of their life. The person knows whether they need to end or continue a pregnancy, but their whole goal is to try and convince them to continue. Yeah. Do you see a lot of videos come across your FYP for that? Because I do. I see a lot of videos of people saying, like, are you pregnant? We're here to help. Come here. Like, don't listen to this. We have, you know, like the post-abortion, like reversal pills and those kind of things. That's interesting that it comes across your feed. I wonder if they've detected that I'm not gonna like that very much. And it doesn't come across my TikTok feed, but it does come across like me in real life. So even just a few weeks ago, we had a patient call. She was wanting to get abortion care. She said she had gotten an ultrasound. And when our scheduler asked her where the ultrasound had been, she stated the name of the place and it was a crisis pregnancy center. We asked her if she'd mind sending in the ultrasound so we could confirm how far along she was in pregnancy and help give her her options and set up her appointment appropriately. And she actually said that she would not send it, that she didn't feel comfortable sending the ultrasound. And so I didn't know if now. CPCs are coaching people not to share their ultrasounds because there was a lawsuit in Massachusetts maybe ab about a year ago about a mystic topic pregnancy on an ultrasound from a crisis pregnancy center. So I'm wondering if they're getting coaching. And then in the past I've also seen patients bring in the ultrasound from the crisis pregnancy center. And the first thing I saw when I saw one of these is like, this is the worst ultrasound I've ever seen. Like who did this? Who did this? Like at first I thought it was coming from a real medical clinic and I was like, I need to speak with them because this is not meeting any of the standards for an early pregnancy ultrasound. And then I realized it was just like a f an an ultrasound from a crisis pregnancy center where people don't even really have to be trained to do the ultrasound. So I do see it quite a bit in real life. And I think the algorithm has detected that I'm not gonna like the CPC content on my feeds. ⁓ my God, it's like the one time that the FYP is working to your advantage. That's what my burner account is for. I go start searching it and like teach it that I wanna see the ⁓ misinformation videos because yeah, I've had my TikTok for ⁓ like six years, but I've been posting for five years and initially and I realized this recently on Facebook is because on Facebook it knew that I was like into women's health and it immediately only started showing me like pro life videos, like on like the FYP of Facebook. And I was like, Cup and be don't show me this, don't show this. Show me it. Never showed me any sort of like balance. It was all like pro-life people. And I was like, this is crazy. And that's how my initial my TikTok F like page was too. And then through me blocking people, I'm sure many people blocking me. I now it's such an enjoyable experience because it's so like tailored to me. But it means for content creation, I'm not seeing those crazy videos. So I have to like once in a while go to my burner account and put in a couple like keywords for searches so that the FYP thinks that I'm looking for like why birth control is bad for you. Yeah, that's a good point. Maybe I I need to look up some CPC info on a different account. Yeah, you should see what it shows you. Okay, I wanna get into a little rapid fire with you. What is your favorite form of birth control? Ugh. So first I'm gonna give this standardized family planning answer. And this is true. Standardized OBGN answer for a patient. My favorite birth control is the one the patient likes. That's the most important to me. Personally. My favorite form of birth control is the Libra Nergestral IUD. So example brands would be Morena or Liletta because they do an excellent job preventing pregnancy. And for most people, they reduce or take away the menstrual period. And I found that in my own life to be transformative. So that's my own personal favorite. Yes, I also love my Morena sitting tight in my uterus. My next question is, what is your favorite way to help with the breakthrough bleeding of an IUD? Yeah. So there's a few different approaches and it kind of depends on the patient. ⁓ obviously, as you know, sometimes things get better with time. So I will sit with a patient and say, like, how much is this bothering you and how much are you having breakthrough bleeding? And sometimes a couple cycles is all it takes. Other times I might offer patients something like a course of NSAIDs or anti-inflammatory medications, or even a short course of birth control pills. And then probably my favorite, but this is actually for people with heavy bleeding, is using tranexamic acid. But that's not for all comers. That's just for the folks who maybe have fibroids and really heavy bleeding issues. Yeah, I do love TXA. And I find that patients are really like when you say it's like this is non-hormonal. They're like, ⁓ okay, I like that. And I did, I also I had a V t very TMI for all the listeners. I had daily breakthrough bleeding for like the first two months of my IUD. And I took a five day course of TXA and it completely stopped. So incredible. And a and my my personal anecdote is that it worked very well for me despite having those conditions that you talked about. So I do like a T XA course for patients. Okay, what is the most unhinged birth control claim that you have seen recently? The mo well, the one that I see a lot in the comments, so I do get this comment a lot on my videos is that birth control ruined my life. ⁓ no. Right. So I think that's that feels pretty unhinged to me. And I think that that sounds quite extreme. I think about all the ways that like something else could ruin your life, like a pregnancy with a partner that you don't want, ⁓ you know, a bad partner, having to be pregnant during graduate school or trying to finish college or graduate high school pregnant. And I have a hard time believing that the birth control itself ruins someone's life. So I think that's kind of the most outlandish one that I get. Yeah, that is a great way to think about that. Because I think that's always the thing that people aren't talking about when they talk about like the negatives of birth control or like when people say like, well, birth control increases your risk of blood clots. That is true. But also what increases your risks of having a blood clot even more is pregnancy. And so that tends to be forgotten in those outlandish and quick claims. Okay. And then my last question, who are your three favorite creators that you're following right now? They do not have to be medical. ⁓ yes. Some favorites are Shirlena Bobe. She is a cardiologist and a romance novelist. ⁓ yes, yes. I love her. I just find that so incredible. I'm reading one of her romance novels right now and I just find her like gumption and How she's doing all these different things, super inspiring. So she's one of my favorites. Doc Rachel is another family planning content creator, and we did like a social media session together at the Society of Family Planning annual meeting. So she's a big favorite of mine. And I'm trying to think of a third. Having trouble coming up with a third, but I am loving like the bedsider.org. So that's not a person but an organization. So I've noticed that bedsider.org, which is like a great contraceptive resource for patients and clinicians. hosting a lot more about birth control and abortion. So I've really been loving what they've been doing. I love what they do too. They are so active. Like their social media team, I think, is small but mighty. And they are like out there trying to like make the videos. They like repost our videos. They're like in our comments. Like they're a great example of really again meeting like Not consumers, but like, you know, trying to find the people that you're trying to reach online and really knowing what your audience is looking for and being there for that. I think that was a great example. Dr. Neil, for the people who aren't following you already, where can everyone find you online? Yeah. So you can find me on TikTok at Sarah O B G Y N. So it's S A R O B G Y N and the same handle for my Substack. Thank you so much for being here. Of course, happy to.