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A Nest Collaborative Seminar: The Covid Vaccine: Questions Answered for Pregnant Women and Young Families

Watch Dr. Jane van Dis, (OBGYN, Medical Director at MavenClinic and Advisor to Nest Collaborative) answer Nest mom’s questions about the Covid vaccine as it relates to pregnancy and breastfeeding.

SPEAKERS:

Dr. Jane van Dis, Amanda Gorman, Anna Zornosa

TRANSCRIPT:

Dr. Jane van Dis – “Thank you, Amanda. And thank you, Anna as well. I’m really excited to be here. As someone who focuses on maternity and postpartum care, what you guys do and the services you offer are essential. Having said that, so is knowledge about COVID and the vaccine, so I’m here to answer answer all of your questions.”

Dr. Jane van Dis – “What I what I want to say before we start with the questions is just to give a little overview of the news that that hit the airwaves this morning, which was the announcement that the FDA was going to be suspending the J&J vaccine while they investigated the clinical scenario around the six women who were diagnosed with thrombus. And if you’re wondering, is this similar to the AstraZeneca news? Where in some of those participants had a thrombus as well? The answer is, yes. So what this is, it’s called the vaccine immune mediated thrombotic thrombocytopenia. So it’s a little bit strange, because it’s a small blood clot that forms in the setting of diminished platelets, so decreased platelets, and platelets actually usually help to form a clot. So if you’re thinking, wait a second, wouldn’t having fewer platelets mean that you would bleed more easily? The answer is yes. It’s a little bit of a mind tease that way. But what what we want to say is that actually, this news is not surprising. We know that different people react differently to the vaccine, immune systems have very specific reactions. I had a fever of 101 when I got my Pfizer vaccine, some people have no fever at all. So it really runs a very large gamut in terms of the reactions. But let’s talk about the numbers because these numbers don’t scare me for one second, and here’s why.”

Dr. Jane van Dis – “What we’ve learned today is that six women had this small blood clot. And the risks of this blood clot were one in a million. So a million people would have to get the J&J vaccine for one person to have a blood clot. And so we’ve seen six people with this blood clot. Let’s talk about some other risks for blood clot because as an OBGYN, this is something that I think about and I’m cautious about all the time. So for instance, the risks of getting a blood clot when you take an oral contraceptive, combined estrogen progesterone pill is about one in 3,000. So you’re going from one in 1 million to one in 3,000. The risk of getting a blood clot in pregnancy, which is actually more common than you think is around one in 500. So again, comparing one in 1 million to one in 500. And then lastly, the risk of having a blood clot if you have COVID is one in five.”

Dr. Jane van Dis – “So compare one in five to one in a million. And that really should frame how you’re thinking about the risk of this blood clot. Of course, when it hits the media, it makes it feel like it’s like, danger, danger, danger. But it’s really, really important to focus on those numbers. So one in a million for the J&J vaccine. As of today, that number could change, versus one in five, for those with those people who had COVID. And what we saw in the pregnant population during COVID, and what we’re obviously still seeing because it’s not eradicated, is that pregnant women who get COVID, also, at very, markedly increased risk for blood clot as well. So that can be devastating to the mom to the baby to both in pregnancy. So COVID is actually the most dangerous thing still out there. And I’m not worried about this risk from the J&J vaccine at all. So that’s my little opener about the the news today. But I’m here to answer all your questions.”

Anna Zornosa – “Great. And Jane, you know what, I’ll start with just a couple questions that were sent to us in advance. I want to encourage our guests who are on the call to enter questions via chat. So I’ll I’ll ask a few that were sent in advance, but I’ll check over and see if we’re getting any in chat to make sure that your questions are represented as well. So Jane, we had a lot of questions about the COVID vaccine related to pregnancy. The first one is, is it safe to get before you’re pregnant/while you’re trying to get pregnant? And is there anything to suggest that it would actually prevent pregnancy?”

Dr. Jane van Dis – “Oh, that’s such a great question. The answer to that question, is it safe to get the vaccine at any point. It’s safe to get the vaccine while you’re thinking of getting pregnant, it’s safe to get the vaccine on the day you conceive, it’s safe to get the vaccine, seven days after you conceive, it’s safe to get the vaccine in every trimester. We have not determined that there is any period of the pregnancy that puts the pregnancy at risk by having received the vaccine at that point in time.”

Dr. Jane van Dis – “What we know from the research that’s been done regarding COVID, but importantly, the research that’s been done prior about vaccines in pregnancy, which is that maternal antibodies that are stimulated by the vaccine, so when mom gets the vaccine, she creates antibodies. What we know is that those antibodies have have been able to be passed to the fetus while the mom is pregnant. So just like we recommend moms in the third trimester, get the Tdap vaccine, because pertussis is an infection that that affects infants in the first six months of life specifically, and the infant cannot get the vaccine in those first few months. So getting those passive antibodies from mom, while the baby is in utero is actually a preventative way to help protect the baby by vaccinating mom. And the same is true for the COVID vaccine. So moms who are getting the COVID vaccine are actually able to be passing antibodies to their fetus, to help protect that fetus once it’s born.”

Anna Zornosa – “Excellent. Jane, you were so thorough in that answer but we have a lot of questions related to pregnancy. So I’m going to come back in at the risk of you being a little bit redundant because this person asked specifically, if there’s any chance that the COVID vaccine could have side effects for the baby like a learning disability, or childhood cancer, or could there even be less scary effects, like an early delivery or an effect on birth weight?”

Dr. Jane van Dis – “We definitely have not seen the birth weight or the early delivery. I checked the CDC website before I came on this webinar, and over 86,000 pregnant women have received the COVID vaccine. I often times will talk to moms and they’ll be like, but we don’t know anything about this vaccine. And I’m like, well, actually, we know a lot. When we launched the vaccine in December, we had about 23,000 people in the Pfizer trial and 23,000 people in the Moderna trial.”

Dr. Jane van Dis – “We launched that for our nation and now we have four times that number of pregnant women who’ve had the vaccine. And we’re not seeing any changes or effects on the course of pregnancy or increased complications of pregnancy. Basically, what the statisticians see is that all the things that normally potentially can happen during pregnancy, are happening at the exact same rates for those women who get the vaccine. So we’re not seeing any changes or alterations in risk for moms who get the vaccine when they’re pregnant. As far as long term sequelae, for children who are born to mothers who had the vaccine in pregnancy, I would be lying if I said, I know the answer to that question, because obviously, we don’t have that data yet. Having said that, I will say that we do rely on the technology that we know a lot about, which is that we’ve been vaccinating pregnant women for decades and decades. Pregnant women, in addition to the Tdap vaccine, also commonly get the flu vaccine if they are pregnant during flu season. And so we’ve had decades and decades of research giving those two vaccines in pregnancy without any deleterious or long term effects for children.”

Dr. Jane van Dis – “What I find in a lot of the questions that I get is, you know, genuine fear. And I think that that fear needs to be acknowledged, and it needs to be listened to. Having said that, as a scientist, my next thought is, is there a mechanism for harm? Is there a way scientifically, biologically, that this vaccine could cause the things that you named, learning disability and cancer? And the fact of the matter is, is that there is no reason to think that there is a mechanism of harm that these vaccines could cause that outcome. The reason being for the Pfizer and Moderna vaccine, these are vaccines that are transported into the cell via an mRNA, a messenger RNA, and that messenger RNA actually disintegrates. It disappears very quickly after your immune system recognizes it and starts building antibodies against it, it doesn’t linger, it doesn’t stay in your cell. Someone described it as the Snapchat of vaccines. And that’s a wonderful analogy, because it’s there, and then it actually disintegrates and disappears. The J&J and the AstraZeneca vaccine are a little bit more stable. And they are not using that mRNA technology, they are using a very common technology that we’ve known about for a long time, which is hitching a ride on an adenovirus piece of molecular tissue.”

Dr. Jane van Dis – “But the bottom line is, in order for there to be those deleterious effects, we’d have to have a mechanism by which we could plausibly say, if this happened, and this happened, and this happened, then this happened. And guess what? We don’t have that mechanism.”

Anna Zornosa – “Great. Hey, Jane, I’m gonna stay on the question of pregnancy for a while. And we had someone who wrote in a question in chat, that she actually had COVID last year. And so she is wondering whether or not the antibodies that would be in her body because of COVID would be giving her her protections. And and whether or not the baby might have some of those protections, because she had COVID, prior to conceiving?”

Dr. Jane van Dis – “Yes, that is such a great question. And the answer is that yes, we would suspect that the antibodies that her body formed in response to having COVID would be passed to her fetus as well. The difference, however, is that we have seen really incredibly variant rates of antibody formation, in response to having had COVID. And as you might know, from having watched the news over the last year, some people their immunity to COVID, after they’ve had COVID, wanes or disappears. And we’ve also heard reports of people getting COVID a second time. In order to get COVID a second time your body did not create a robust immune response, and you were vulnerable to COVID. Again, so really the question about antibodies for those moms who have had COVID, the answer is probably yes, you will have a good antibody response and probably yes, you will be transmitting those antibodies to your fetus in utero. Having said that, it is still the recommendation of OBGYNs and scientists, that if even if you’ve had COVID, that you still get the vaccine and the reason there is that the vaccine actually causes a more robust response across the board in people than actually having had the infection. I know that sounds counterintuitive, right? But that’s what the science bears out. So we know right now, and this is really hard, right? Because we’re doing science in real time. We know right now that Pfizer and Moderna have said that their immunity so far is good for six months. We don’t know yet if the immunity for the vaccines is good for a year or two years, we don’t have the answer to that question we will find out in real time.”

Dr. Jane van Dis – “So if you were to ask me, do I think at some point, all of us will be recommended to get a COVID booster? My answer is yes, I do, in the same way we get a tetanus booster. In the same way I recommend my moms get a Tdap booster. I think that we will all end up getting a COVID booster. So this will not be our first time around with the COVID vaccine. Right now, we just don’t know how long that immunity is good for. But yeah, great question.”

Anna Zornosa – “Awesome. We have more questions about antibodies and babies and things like that. But I’m going to flip right now and go to a topic that’s really near and dear to a lot of the women on this call, which is breastfeeding. So we have lots of questions about breastfeeding. The first one is, if you are a breastfeeding mom, should you have any concerns about getting the vaccine? ”

Dr. Jane van Dis – “That is my favorite question of all because this is the question where I say a thousand, a million, ten million percent yes. There is no harm to moms who are breastfeeding in getting the vaccine. And I was really, really disappointed that lactating moms were not included in the clinical trials. Because again, there is absolutely no mechanism of harm for moms who are breastfeeding to get the vaccine. In fact, there is a potential upside, which is that we know that IGG and IGA which are the antibodies that form against the COVID vaccine are present in breast milk within seven days of having received the vaccine. So we know that there’s an upside for breastfeeding moms to get the vaccine and there’s no mechanism of harm. And it’s not just me. The authority on this for me is the Academy of Breastfeeding Medicine. And this is the the world’s best scientists around breastfeeding medicine. And they came out immediately when the Pfizer and Moderna vaccines were released and said, stop the presses. breastfeeding women should not be lumped in with pregnant women. They’re totally totally different. There’s no potential mechanism for harm with breastfeeding moms. Absolutely, breastfeeding moms should get the vaccine. And if you have any questions or you’d like to read for yourself, I always encourage moms to go directly to their site, it’s wwwbfmed.org. And they have a ton of resources there about COVID. But lots of other breastfeeding information as well. So put that on your browser and bookmark it because they are a great source of information. Excellent.”

Anna Zornosa – “Excellent. So Jane, now we get to could the antibiotics and breastfeeding help milk help others? So we have a question here wondering whether or not, if you express your breast milk, instead of have the baby latch, will you still transfer the antibody? So if the baby’s getting the milk, but from a bottle will you still get antibodies? And then the second one I’ll tee up to so that you can have them at the same time is, if a woman does have antibodies, she’s breastfeeding, she’s had the vaccine, should she be giving some of that milk to her three year olds and five year olds?”

Dr. Jane van Dis – “That’s a great question. Let’s answer the first one first, which is that the antibodies are circulating in the maternal body. And it really doesn’t matter if that baby gets the milk via a bottle or via latching on the nipple. The antibodies will be there all the same as those of you who are experts in breastfeeding. Now there are some bacteria on the skin skin flora that are helpful to babies. So there are some benefits not related to COVID for having a baby latch on the actual breast as opposed to pumping and bottle feeding. But in terms of the COVID antibodies, they’re going to be the same.”

Dr. Jane van Dis – “And the question about feeding breast milk to other members of the family. The answer to that is that right now what I’ve read from the scientific literature, is that the scientists have so far determined the presence of antibodies in breast milk. The second half of that question is, is it enough to provoke an immune response, robust enough for the size and weight of a baby versus the size and weight of a three year old? That is a question that I haven’t seen answered yet. But here’s what I will say, I don’t think there’s any harm. There’s not any harm in giving that breast milk to the to the three year old. So, scientifically, I feel like I can’t answer the question with great accuracy. But again, I don’t see any I don’t see any harm in doing that.”

Anna Zornosa – “Awesome. Thank you. I have a feeling that we’ll have more questions about breastfeeding and COVID vaccines, and more questions on other topics as well. So if you’re on the call, feel free to put a question in the chat. And we’ll try to catch it and make sure that Dr. Jane gets a chance to answer that as well.”

Anna Zornosa – “Jane, I’m going to go back to another question. Because you were very, very clear that from your perspective, having the COVID vaccine would not endanger your baby. But we have questions about if you know about trying to get pregnant, and it’s coming up again. So forgive me if this is a little redundant, but it’s so important to people. They have heard that if they’re trying to get pregnant, they should wait, that the COVID vaccine might actually keep them from getting pregnant. Have you heard anything like that?”

Dr. Jane van Dis – “I’ve heard it when I’ve seen my colleagues. One of my favorite colleagues is Dr. Feinberg. She’s a reproductive, endocrine and infertility specialist at Northwestern University, so great academic institution. And she wrote a column a couple of weeks ago actually debunking all of the myths surrounding the COVID vaccine and that period of trying to get pregnant. So maybe women who are going through an IVF cycle, going through an IUI cycle, trying to conceive naturally, and say the first few weeks of pregnancy because that’s the area of clinical care that reproductive endocrine and infertility specialists take care of right. And so she wrote a great article debunking all of the myths that associate the COVID vaccine, with infertility with miscarriage. If you have the opportunity to talk to a reproductive endocrine and infertility specialist, at least all the ones that I know, they say get the vaccine as soon as you can, as soon as it’s available, because you know, what does impact potentially the outcome of fertility and a pregnancy? COVID. We know the harms of COVID. And we have not seen any harms associated with taking the vaccine. Like I said earlier on the day of conception, three days after conception, the first two weeks of conception, there just isn’t any data to show that anything changes statistically in those women who get the vaccine at that point in time of their reproductive cycle.”

Anna Zornosa – “Excellent. Jane, such an awesome job answering everyone’s questions. And let me just remind people who are listening that if you have a question, you can put it in the chat and we’ll make sure that it gets answered. We had a really interesting question Jane, about the different types of vaccines. So this questioner says, J&J, of course, uses an adenoviral vector, excuse me on that one. Are there other vaccines of this type given to pregnant moms? Just wondering if there’s a theoretical possibility that this type of vaccine is safer than an mRNA vaccine, which is the Moderna and Pfizer type?”

Dr. Jane van Dis – “Yeah, we do have some other vaccines that are using the killed or the dead adenovirus as the vector to carry the virus into the cell. So we do we do have some other data about that. This was not a novel technology, in the same way that the mRNA vaccine was a novel technology. Having said that, the scientists had been working on the mRNA technology for 30 years prior. In fact, I love the article that I saw circulated again yesterday about the woman scientist who came up with the mRNA technology and, her struggles to get people to listen to her and believe her 30 years ago, when when she postulated that this might be a way to administer vaccines. But given the fact that we know how tenacious women are, and how smart they are, thank goodness she kept at it and was able to continue her research. So really the technology is is 30 years old. It’s not, it’s not brand new in 2020. It was just ready to be released in 2020.”

Dr. Jane van Dis – “I have have read the stories about how the mRNA technology came about. And it’s just absolutely astounding. You know, we also have the flu vaccine, which is something that is given to pregnant women all the time as well. And that’s not exactly the same as the J&J. But it is more similar to the J&J than it would be to the Pfizer or Moderna. And that is a small piece of inactivated influenza particle.”

Dr. Jane van Dis – “But you know, the fact of the matter is, is that we have been, we’ve been vaccinating pregnant women, as I said, for you know, we started with polio, back in in the 60s. And I have an interesting story about polio, actually, which was that in the 70s, you know, polio is an active virus, right? The MMR vaccine is measles, mumps, rubella, and those are active viruses as well. And typically, we don’t give active viruses to women in pregnancy, because of the theoretical possibility that even the tiny little bit of activity of that virus could have deleterious effects on the fetus. And what I found in some historical research that I did was that back in the 70s, actually, there was a huge cohort of women who didn’t know they were pregnant, and they were getting these live viral vaccines. What was interesting was, is that of course the researchers track them, and even these women who got live viruses still did not have any deleterious effects on the pregnancy or on the children, they obviously follow that those children for a long time. And so what I find interesting is that I feel like in a way, because of some of the things that have happened in healthcare, not related to vaccines, we have sometimes outsized imaginations about what threats or harm could potentially be. But the fact of the matter is, is that the vaccine science has actually been super, super safe. So even in this cohort of women who got live virus, there was still no evidence of harm. So when I think about these other technologies, where we have dead or an activated or in the mRNA case, you know, bioengineered piece of spike protein that disappears within a couple of days, what I see is absolutely the intellectual just a miracle of vaccine science, you know, here saving so many lives today. So, I as a person, I’m so thankful for that.”

Anna Zornosa – “Right. Great. Thank you, Jane. This is an interesting question. What about high fever as a side effect of the vaccine? Couldn’t that be harmful to the baby?”

Dr. Jane van Dis – “Yeah. And that question has been looked at a lot. I’ll be honest with you. We, you know, we do talk about the possibility of fever in pregnancy, potentially causing harm. What we’ve seen with the COVID vaccine, though, is that the fevers that happen for those women who get the vaccine, it’s about somewhere between 15% to 18% of women will have either, you know, a low grade or high grade fever if they get the vaccine. Even in those women, what’s important about that temperature is that it’s very transitory, right? It might last for eight hours, it might even last for a 36, maybe even 48 hours, but it isn’t long enough and it isn’t high enough to really cause any harm that we’ve that we’ve seen with pregnancies. If anything. I’ll be honest, the scientists have looked at as well at sperm, and actually the sperm are more sensitive to fever than than the egg is or then then pregnancies are. So sperm is actually a more fragile being. Having said that, studies show that the sperm recovers as well, that there are no long term effects on the sperm, you know, from the higher fevers, and so I’m not worried about that. I do recommend if you have a fever, you can absolutely take, if you’re not pregnant, you can take either Motrin or Tylenol. And then if you are pregnant, I recommend the Tylenol. When I had my fever, I just I took some Motrin and I drank a lot of water, and I just kind of laid in the bed.”

Anna Zornosa – “We have one participant who observes that Duke University is starting to study if timing of vaccine provision during pregnancy impacts the antibody load for the baby. Are you seeing any early data on that?”

Dr. Jane van Dis – “Yeah, I did see some data showing the researchers postulated that potentially vaccine administration in the second trimester did produce the highest antibody load. But again, that was one study. I feel like, we probably will need additional studies to show us that that the second trimester is the best time. We do typically recommend the Tdap vaccine in the third trimester. Of course, the influenza vaccine can be any trimester depending on the timing of the year. So it’s it’s too soon to say whether the timing is ends up being clinically relevant, right, or the amount of antibodies that you produce in the first and the third trimester sufficient to produce an antibody protection in the fetus. And therefore the higher number of the second trimester doesn’t really matter clinically, we still have yet to answer those questions. But that’s what I’ve heard is that the second trimester might produce the most robust response.”

Anna Zornosa – “Great, thank you so much. We also wondered, we have someone who picked up on your statement that having COVID recently could impact a woman’s ability to get pregnant. Could you elaborate on that? Oh,”

Dr. Jane van Dis – “Have I heard or seen data showing that having COVID could affect one’s fertility? Is that is that what the question? What I have seen recently that’s come out is that there are some reports and scientists writing papers about the effects of the COVID on the menstrual cycle and and the potential inflammatory response of the lining of the uterus, the endometrium. So I have I have seen some reports that women are having, are reporting some irregular menstrual cycles. The data is a little bit hard to tease out right now because the data so far show that some women are having shorter cycles, and other women are having longer cycles, some women are having lighter cycles, some women are having heavier cycles. So I feel like it’s hard to say that any one thing is true other than we are seeing that there are some alterations in the manner by which COVID infection can affect the menstrual cycle. So I think it’s really too soon to say. I hadn’t heard that there was a robust enough study showing that there were a sufficient number of people to say that COVID infection affected fertility. What we know from studies so far is that it’s not adversely affecting the eggs themselves. But in terms of the whole process of the egg implanting in the endometrium, I think there’s still more to come. Right.”

Anna Zornosa – “Great. I’m gonna take one more question now and then I’m going to revisit that provocative thing that Amanda said at the beginning of the call is that she had an invitation for people on this call. While we do that, we’ll just give you last call on questions. And we’ll just do one last circle back to the Dr. Jane, after Amanda speaks to see if you have anything else. But in the meantime, there is a question here, Jane, are there timing concerns when getting the COVID vaccine and Tdap vaccine? Would you do one before another or wait a certain amount between the vaccines?”

Dr. Jane van Dis – “Well, if it were me, I get the COVID first. I would get the COVID first, and you do have to wait two weeks between administration of vaccines. So let’s say you got the Tdap last week, you need to wait another week before you could get the COVID or vice versa. But I would prioritize the COVID given what we know are the deleterious effects for both mom and baby of COVID infection in pregnancy. So that that would be my advice there. Excellent.”

Anna Zornosa – “Excellent. So anybody who has a final question, reflect on it, on everything that you heard from Dr. Jane. And if you’ve got a question, go ahead and put it in the chat box. For right now, Amanda, tell us about that thing you said you said special announcement and some special invitations.”

Amanda Gorman – “Yeah, so we’re super thrilled, really to have the opportunity to offer a new and additional service offering opportunity for new moms from Nest Collaborative. Really, after the work we’ve done over the last three years with moms and babies we really realized that there was another space that that we needed to fill and that was giving moms an opportunity to have more time with our lactation consultants for more preventive information sharing and an opportunity that we’re missing for them to be with one another. I think reflecting on all of our experiences as moms ourselves, and lactation consultants listening to the moms we’re seeing, we know how valuable community and and listening to other moms and their experiences and their questions and their, their goals, how valuable that is for women listening to one another. So what we’re offering newly this year 2021, we are now announcing that we are launching the Latch Lounge. And this is really a a virtual space of virtual salon if I could say, an opportunity for moms to get together and a small group a small cohort with one of our IBCLCs, one of our lactation consultants, to really hit upon what’s going on for them right now in a more proactive and preventive venue. So right now, we are just launching the first two versions of our Latch Lounges, and they are coming out next week. So I’m really actually super excited that we have some moms here who have been nest clients and patrons and understand their services. And then we have some who might not be familiar with what we do. So right now we’re launching the first two versions of Latch Lounge. You’re your arms or newbies. And”

Amanda Gorman – “We specify that because just because you have been a mom before doesn’t mean that this new baby is like first. And so that’s really geared at babies who are somewhere between two to four weeks in or outside. And these are small group visits with one of our lactation consultants to really talk about what they should be expecting what is normal versus needs concerns, and an opportunity to ask more proactive questions. And really not wait for the problems to occur. Our one on one, the heart of what we do at Nest Collaborative are these one on one visits where moms come to us kind of with their issues, their concerns and their problems. These are a way to more proactively engage with moms and really head off those problems, give them the information they need about what they should be experiencing now and what they should be expecting in the in the weeks to come. The second cohort we’re offering is what we call Settling In. And this is for moms with babies in the six to eight week range. And this is talking about getting into those schedules, we all know that there’s a plethora of books out there guiding moms towards certain theories and schedules. So this is talking about naps and feeding schedules versus being able to really get to know your baby, who they are, what their personalities are, how to you know, engage with them as they’re emerging. And then getting back to normal getting back to yourselves your coupledom your, your relationships, getting back to sex. And so we’re launching these next week for the very first time. And what we’re doing tonight is really inviting anyone here who’s present with our seminar with Dr Jane to, to sign up if they’re in one of those two slots, or know anyone who they think might be a good fit. We’re really, really thrilled to be offering the second offering from Nest Collaborative and and I’m thrilled to invite you to sign up. So what you can do is go to www.nestcollaborative.com. You can go ahead and book now to identify that you might be one of those cohorts, you want to sign up, of course, you can put something in the chat right now. And we’re happy to get you settled and signed up on our on our side. Or feel free to email at info@nestcollaborative.com with any questions you have. But But I want to actually”

Anna Zornosa – “I actually know something, which is that the first 50 women who grab a seat at the lounge, are actually going to get a little gift from us, we’re going to pop in the mail to them a refrigerator magnet all about quantities of breast milk and what they equal etc. So just a little thank you for the very first women in the lounge. Well listen, I am looking right now into the chat to see if there are any further questions. And it looks like there are not. So I think what we get to do is wrap up and say tremendous thanks.”

Anna Zornosa – “Dr. Jane that was just amazing. I want to tell you that I’ve been doing zoom calls for a long time. And I’ve rarely seen as many people at the beginning of the call as at the end, which just has to do with the amazing, amazing quality of information that you serve up to our guests tonight. Thank you so very much.”

Dr. Jane van Dis – “Thank you. It’s great. I’ve been trained well. I I once did a one hour zoom webinar and I answered 60 questions in 60 minutes.”

Anna Zornosa – “That that training actually came through. So thank you so much. And Amanda, thank you so much for taking a break from your vacation to come and join us tonight and to and to to share a little bit about where it’s been and where it’s going. I think you’ve added so much to this evening and I thank you so much. Everybody else, thank you for joining us. We’ll be doing sessions like this again in the future. We’ll make sure that everybody who joined us tonight is the first to hear about those. It was a pleasure to spend some time this evening with you and thank you so very much. Bye all!”

Amanda Gorman – “Bye everyone. Thank you so much.”

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