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I am pregnant.
Welcome to Hello Bump. We're making pregnancy less overwhelming and more manageable. I'm Grace Rubrey, i am pregnant for the very first time, and my throat is on fire.
I'm young a pitman.
I'm a former Olympian, mother of six babies, and an obstetrics and guyiny registrar.
Each week, we'll be holding your hand, week by week through the mysterious, perplexing and sometimes quite uncomfortable miracle that is pregnancy.
Welcome to Week twenty three. What size is our baby? A squash? We've got back to a burrito again, but I'm not sure.
I'm pretty sure maybe it's a fact burrito this time because we had a burrito in the past.
Fool Buredo.
As someone who's had a lot of goodsman and go mas, you can get a like a mini one, So we're a regular one now, not the mini, not the media anymore.
And we're going to animals as sugar lighter so ozzy animals, sugar a little bit more lug Oh, I love that.
I do too.
So twenty nine centimeter, it's almost a rulele length inside you at twenty twenty three weeks and five hundred grams, which also marks what we call, for most hospitals, the viability. So five hundred grams is what we need a baby to be. We know has good outcomes from us from a size perspective.
And what else are they growing? What else is making them closer to that viability?
Well, I think that's what it is. This is the most important week really in pregnancy. I mean there's other Obviously, full term is probably the most important because that's where maybe's exit strategy has to start being planned. But medically it's a significant week because for our guys there's a big caveat around here. It depends where you birth, it depends on your risk factors, it depends on your baby.
There's lots of factors that it comes down to. But in most major hospitals worldwide, we consider resuscitation from now, so as soon as you're twenty three weeks in one day, in fact, we even start talking about it at twenty two weeks and six days that we give you steroids to mature baby's lungs and magnesium sulfate for baby's brains. So there's medications that we will be asking you do
you want to consider now. For the vast majority of people listening to this, this won't be a conversation you need to have because you're going to be pregnant for a lot lot longer than today. But I think it's a really important topic because there will be one or two of you who this will happen to in the next few weeks, and I think it's nice to have information because you have to make the most difficult decisions you're ever going to make, which is is it a
yes or is it a no? And it's still in a window where you can say no if you don't want or don't like the risks that are associated to this. Now, if you were if you were birthing in a tiny rural hospital and there was no time to move your baby to a tertiary center, you might be a no because it hasn't had a chance to have the steroids.
You haven't got a big unit with neronectologists that can look after and put your little baby on a respiratory respirator because they need to be intubated, they need to be fed around the clock with a nasal gastric tube. They need their monitoring really well. They sometimes need a blood transfusion. They often need antibody. So there's a lot of things this little guy's going to need to survive. So that's a long conversation. The great thing is, though,
it will happen. In other words, a doctor will come in, usually one of myself, an obstetrician in training, or a consultant will talk to you from our perspective what birth looks like. And the neotologist will come as well and say, right, so these are your chances. So they might say something
along the probabilities. So the probabilities at twenty three weeks is your baby has about a twenty to forty percent chance of survival, with a disability rate of around fifty percent in those that do survive.
So it's stilly percent. It's like it's getting better.
Yeah, some centers say up to seventy to eighty percent already at this gestation. But again, weird things that determines, like is your baby coming out head first? Is it a vaginal birth, is it a cesarean section? And some people think okay, no, I want this baby at all costs. It's had steroids. I want a cesarean section because it's
the best chance for my baby to survive. The problem is you then get left with a scar on a transverse incision, so on a what we call a classical incision, which means it's up and down like the old school how people used to do Cesaian sections many years ago.
But it can cause significant problems for pain, but it also causes problems for future pregnancy and problems of placenta are is where where the placenter actually grows and gets stuck or covers you us again, like we were talking about last week, the placenta spectrum disorders.
It's a massive.
Conversation to have, and I think it's just going in with an open mind with you and your partner that probably at some points won't be on the same page, but being aware that this is around the time the conversation happens, and the hardest time is this week because at twenty four weeks the survival rate goes up to forty to sixty percent, and then at twenty five weeks sixty to eighty percent, and then the twenty six weeks seventy five to eighty percent, and where you are now,
you're sitting at eighty five to ninety to ninety percent survival rates. So it's the hardest when those odds are really low.
What hap what's happening to me?
If everything is going well? What are some of the things that verns and mother can be expecting it at this moment?
Any symptoms?
Nothing?
This is the lovely part of pregnancy. This is the time.
Hopefully baby's wriggling around and you're feeling it a little bit. You're not too pregnant, you can't do things, you know, your heartburn is still horrible. Let's be honest. Hopefully nauseous disappeared. So it is the well for me, certainly, it was the loveliest part and pregnancy on the planet because you feel fantastic and you're starting to feel real because the
baby's moving enough and your tummy is big enough. So yes, So if you're if you are out one of our lovely low risk women, Let's be honest, most of us are. This is the best time in your life. Is this normal? Is it normal?
Is this normal? Is about babies movements? Because all of the pamphlets, all of the apps. Everything says to start figuring out the pattern, but what's about I don't know what the pattern is, so I have started My placenta is anterior at the front yep, which meause you don't feel as much. So I don't feel as much, and I don't I rarely feel anything in the center. It is on the sides. In terms of starting to figure out when she's moving, I'm not quite sure how to
pick up on those patterns. And then one of the things that the apps say is make sure it's like ten movements every hour or ten movements every two hours, which is quite a stressful thing to count. What is the in your experience as both someone who's had six children and also speaking to very anxious pregnant people, what are we looking for?
This is probably the most common conversation I have every week, because everyone comes in with what we call decreased feedal movements. Even now at twenty three, twenty four weeks, we get women coming in. Now, guys, we will not be putting a CTG, which is the continuous monitoring on your baby.
It's too early. We start that hunt around.
Twenty four weeks, so next week, but we can't tell you the answer. I would love a Crystal Wald to be able to say what it means and what it's going to do. Every baby is its own little person and has its own little movements, so it's literally trying to work out what is normal for her. So what does she do? Is she a night kicker? Is she a day kicker? Is she not a particularly big kicker? And when you notice a change, that's when you need
to call us. And I think the biggest thing here is it's never wrong to call the unit if you're concerned. You know that we are, especially if it's a public hospital. We're a twenty four to seven servants. We're paid to be there, so it's completely okay. And it's also really nice. Think about it from a flip sid perspective. I deliver some crappy news pretty regularly.
I have to be in pretty high risk, sometimes really horrible outcome situation.
It's really nice to reassure a mum her baby's perfect and fine and send her off with a smile. So it's fine if you come in, just for us to at least allow you to go, yes, I'm good. I saw my baby on the ultrasound. The heartbeat looks great, I'm reassured, I'll go home.
This might be a dumb question or one that's hard to answer, but what other type of movements are there? Because there's kicks and there's butterflies, but what other things could be happening that you.
Might not know is a movement? So sure, that's a good questions. Hiccups another one. Mum's feel that tummy just like regularly feels a little hick you feel. Kicking obviously is the main one. Now, one of the funny things is if your baby is feet down, you might feel increased bladder. Like I said, it's jumping and having a party on your butter So you'll feel your movements wherever
your baby's limbs are sort of pointing. And that's what also can change when you've got an anteria placenters, you do feel them like laterally is you said, on the outsides or in different areas and not expecting. But movements are just that. Most of the time, it starts off as flutters and then it gets stronger, and then it gets stronger sort of twenty eight to thirty four weeks,
it's pretty regular, big strong movements. I'm rolling over towards later pregnancy though, that don't have as much room, so if the frequency and intensity should still be the same, but you might find they're not as giant. They're more like a whack on mum here, I am all my god, that hurts, but not quite as huge, big rolling movements because we don't you know, once baby's head down, we kind of like them to stay there.
What is something we can do this week? What's on our checklist or to do list?
Probably this time of the pregnancy is time to start thinking about what type of anti enatal classes you'd like to do. So we're early, obviously, got plenty of time another fifteen weeks or so, but I think again, if baby was to have another agenda and come a little earlier, it's nice to have, you know, your tool kit started. So we have lots of options. You have great things like calm birthing classes, she birthing classes.
I'm a big fan of hypno birthing.
As I've said before, all of them are strategies to help you through your later.
What is the difference between she birthing and hypno birthing or active birth or I mean.
They're all pretty similar.
They'll give you strategies to Actually, it's a lot of things and it's good to chat. They give you how to have a conversation with your medical team. Will start thinking what you'd like for birth. What is you know, what are your priorities in terms of pain relief, in terms of not having an interventional birth. I mean, sometimes
we can't help it. We are going to say, do you we recommend a cesarean for example, But you can start thinking about what you would like your birth to look like, and also teaching you to breathe, teaching you about what labor is, what things to expect, What are the scary things because you need to know them versus what are the normal things? My answer, that are not much normal about labor. It kind of is very different for everybody, and there's lots of variations of what is
normal and what's not. But at least it arms you with information.
My toolkit this week is actually about booking classes and that the hospital that I will be giving birth, that they offer newborn care, breastfeeding, early breastfeeding rate, and also baby CPR.
Oh that's fantastic, which it terrifies me.
But I would have no idea what to do if a baby was choking or I'm not sure blue, or yeah, if this goes into a CID's territory or something like that, because that's just a.
Whole scary but it arms you. It's all about with information, isn't it. So I mean I don't have that, but I would definitely say, if you can find a first aid course for your baby before being parents, that's fantastic.
Grandparents too. Ideally, Mmmm, that's awesome.
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This episode was produced by Courtney Ammenhauser with audio production by Tom Lyon.
We'll catch you next time. Bye.
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