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I am pregnanty.
Welcome to Hello Bump.
We're making pregnancy less overwhelming and more manageable.
I'm Grace Rubrey.
I'm pregnant for the first time and the rings on my fingers are starting to feel a little tight.
Oh shame. I'm Yana Pittman. I'm a former Olympian mother of six, and I'm training to be an obstetrician.
Each week, we'll be holding your hand week by week through the mysterious perplexing where every day is a whole new symptom, but still a miracle. It is pregnancy all the way from a poppy seed to a pumpkin.
Week twenty eight, How big is our baby?
So we're kind of looking at a baby that's around the size of a coconut.
Now it is a large eggplant, loafe of bread, lofe of bread.
One of those half ones are like a full one. It's a half one.
Yeah, you to compare it to the goga dar a full one feels aggress see it if it was like maybe full term yeah, yeah, that's a full time baby.
Yeah, a big sour dough full term baby.
And an animal from Australia as a potteroo.
What's the potter room? I don't really know. I was hoping you could tell me. I googled that one. It feels like some type of marsupial. That's a right greatly.
Something, but it's about a kilo in size by if you're actually thinking about the measurement per se.
And what's our placenta measuring? Like, wait wise, because if we're starting to feel uncomfortable and like we aren't carrying more weight, if the baby's only one kilo, what's our placenta's sort of way well?
Percenters and will change through out pregnancy depending on how much nutrition is going through and whether you've got preclamps or anything like that. But you've also got the amniotic fluids. You got to think there's a lot more than just your percent to your baby and your own blood volumes. There's a whole lot more changing in your body at this point.
The blood volume, keep your exact blood volume.
Yeah, and how has that baby developed this week?
Baby's growing rapidly at this point, so he or she in your case, she is now starting to develop sleep wake cycles and might even be having rem sleep, which I think is really cute to think that they're actually having those similar cycles that they will when they're a kid in adult and they're now seeing more defined grooves in their brain, so that brain isn't again growing and differentiating.
And this is that theory of like the sleep cycle is every ninety minutes or so, you should probably feel something.
In field movements exactly. And you might find this point if you've gone in with the CREASFIITL movements to the hospital. For example, they'll put on a little CTG where they actually monitor baby's heart rate and we actually can see it on the scan. You can actually see when the baby has like a lower heart rate, when it's actually dropping and not doing very much activity, and then it becomes really active.
And that's what we.
Call those sleepwake cycles. And we do want you to watch that because sometimes if there's no movements, it's a little one sleeping. But if that is going on for too long, then we need to really adjust how we're thinking about our baby's movements and potentially go and see the hospital.
It is a hard one because sometimes if you're busy, you haven't really checked in with your body. I even had it just this morning. I was like, I haven't felt her normally. I feel her when I'm laying down in bed. And then I was busy and I went and had food, and then I came and lay on the couch and I was like, just check in, and then she moved.
I was like, okay, but I.
Think you hit the nail on the head there. So taking some time out is your first step if you think your babies, if you haven't really during the day you think, oh, maybe they're not moving as much, is to just take that twenty minutes time out, have something to eat, drinks and water, because often they do have less movement. When you're a little bit dehydrated, lie down and see if you can check in with your little one.
What's happening, what's happening to me, and what's happening to our bodies.
Well, I think we'll go into this quite a bit, but now your uterus is pushing up very much underneath that rib cage, so there's a lot less movement of that diaphragm and your lung, so you're going to feel a lot more breathless. So and I think women are still trying to do a lot twenty eight weeks and it's starting to get harder. So all bending down, tying your shoelaces, all that sort of stuff is now going to become just that little bit more challenging.
Yes, that's definitely happening for me.
And I wanted to ask about when they're sort of up around your ribs, that you're starting to feel that discomfort. But then one of the biggest things that you hear about preoclampsia is pain underneath the ribs.
It's differentiating.
It's like everything in pregnancy is like a normal symptom or like you should go to the hospital, and it's just whether it's paired with the right amount of things. So how do we figure out the difference between the discomfort and when we should be worried.
That's a tough question to say. Look, I think things like preclamps is obviously related to blood pressure, and that's to do with the way your capsule around your liver is being irritated or swelling. So it's a late stage of preclamps And now that's and I know my fellow obstetric trainees and bosses will go, oh, that's not correct going or it can be the first stage, because there's
definitely different ways that preclamps you can eventuate. But in most cases you leave the fighter baby that's small and ultrasound, and then they look for a reason why, or a woman has increased dema quickly and sometimes unilateral. Sometimes it happens more.
You know, all of us swelling.
Pregnant emma is swelling, Yes, swelling exactly. Sorry, yes, thank you for the non medical deal. But it happens more quickly, so we do expect to see some swelling again, can be normal, can be a problem. Headaches is a big one. Changes in your vision, so any of those kind of things clue us into what's going on. But again, headaches are normal in pregnancy.
Vision changes not so much.
If you have diabetes. It's a really big one when you have to check in with your eyesight because it can deteriorate ord written not with the in pregnancy. But all of those things can be very normal. And that's the hardest part is if you're concerned, that's what a midwife and a doctor's for. Give them a call, tell them what you're symptoms are. They'll either reassure you or tell you to come in for an assessment.
Yeah.
Look, I have made calls to my midwife.
I was sitting at a high bench at a pub and my calves were swollen and I was like, oh my gosh, another DBT or yeahah yeah, and I had a slight headache as well, and I was like, this is it.
It's like it's the end.
And then she I just called and she was like, no, it's sort of be like swelling and it doesn't go down. Yeah, it's like look for your face, your hands, but the hands.
Get itchy too.
Not yet, hopefully in pregnancy if you can get to think called colystasis, which is when you get itchy hens and feet. We actually had a lady this week come in with rip rowing colystasis, and the only symptoms she had was itchy hens and otherwise a completely healthy pregnancy had been It was her second pregnancy, no concerns in the last one, and this one we had to unfortunately birth her earlier because she had significant problems with her liver. Again, liver pain could be a symptom.
Of that as well.
So there's all these different things in pregnancy that can point to different directions of what's going on.
It is that thing of like, every symptom is normal, every symptom is problematic. Potentially sorry, yeah, potential problematic, And it's okay to call.
In fact, we want we want you to. I think the biggest thing that comes out of that is if you're concerned. It's most public hospitals are a twenty four to seven service. So that's why we're there, is for reassurance, but also to occasionally pick up on what mum's intuition is saying, because often it's the thing to go by most.
Is this normal is normal?
Is this normal is about nipples?
Okay?
Sometimes they are a little bit crusty when I take off my bra at nighttime, and I just don't know if that's is that too early for colostrum or what are the changes around this time that we can start to see.
Well, your breasts start changing in first tremester already you notice that the size change yet Okay, sure, think but it's also that the ductal developments. Everything's changing to get you in preparation for breastfeeding. It's not too early. We do have women that have colostrum at twenty eight thirty weeks.
It's normally closer to thirty four and thirty six. We don't want you to stimulate your breasts, ladies, at this gestation, because pre term labor is not something we want to induce, and it's very much an old wives tale, and certainly in countries that don't have sintocin and things like that, where they actually get women to stimulate their nipples in early labor to try and get that labor starting. So we don't want that just yet, but it's usually a
good sign. If you can get some closterum coming naturally, it means that you've got a better chance of being out of breastfeed if that's what you choose to do.
And still even if you are, haven't cost them now. It's not an indication of how well or how easy. It's just a real mix bag. I think one of the things that I've been told by a lot of pregnant friends is how hard breastfeeding is, and they were just not prepared for how hard it was going to be.
And I think that's a lovely message to even be saying now, because there should be no judgment in this space. Yet there is so much judgment, and there's so much on social media, and so many women walk out of that experience feeling like they've let them and their babies down, when ultimately I have breastfed most of my babies. One of them was particularly difficult, and I like the saying
fedti's best. But if you can't, the relationship with your baby could being greatly affected if you push that envelope too hard and it's not working, and it's sometimes just nicer for the entire relationship to say this isn't working. I've sought out all the options, I've tried everything. Congrats, I've done a great job. And stop it earlier than before. You're really hitting a brick wall with it.
And what can we do this week? What are some important things to book in or.
Look that for. I think twenty eight weeks is a really important time because this is when we start actually looking for babies that may be struggling. So we sort of touched on preclamps here, and obviously there's things like diabetes, So around twenty eight weeks is when we first look for signs in your baby via ultrasound. So if you have a higher risk pregnancy, even just being a bit older unfortunately puts.
Through in that categories.
Sometimes we like to do an ultrasound at twenty eight weeks because we actually start looking at babies growth and then compare it at thirty two and thirty six weeks to make sure they're not either becoming too big in the case of diabetes, which is called macrosomia, or becoming
too small in the case of growth restriction. So we also look at dopplers now, so we start looking at the vessels that feed your baby, and the particular vessels for example, in the baby's brain and around their liver, around how they're coping with the pregnancy as a whole.
Well, for my talk kit this week, I wanted to actually ask you a question about iron tablets versus an iron infusion. So I was on iron tablets and just taking them every second day was what I was prescribed. They've redone my iron, hemoglobin and vitamin D and it was mostly fun except my iron had gone down even though I was on iron tablets every second day, and they just said to go well, up your tablets to every day now. But why isn't it going straight to
an iron infusion. Why would we be waiting at twenty eight weeks?
Yeah, great question, now, I think the big thing is I actually learned this only two weeks ago, which shows I'm really.
Still training guys.
Okay, so there's a lot of smarter doctor other than me. But we actually excrete a lot more of the components that make up iron and hemoglobin through the urine when we're pregnant because we've got leakia glamarola. Like basically your kidneys work harder and so you're losing some of that ability to hold onto your iron. Plus the baby takes your iron, Plus you're obviously using it more to create more hemoglobin, which is how you carry oxygen around your body.
So you are definitely going to be depleted. And so ooral ion is fantastic. We don't absorb enough of it, which is why sometimes women all require or they get really constipated, let's be honest, and they can't tolerate taking oral Ion's probably the biggest reason women don't take it. Then we start looking at an infusion. But why do
we want this? It's optimizing birth, So it's actually not about now, Yes, it helps fatigue in things, but you know you're going to lose a bit of blood when you actually have your baby, and so if you go into that space with a low hemoglobe, so a low carrying capacity of oxygen, you're going to feel terrible. So if we do it now, though, it's just a little too early, so unless we think your labor is coming soon.
So if there's some an indication that you've either had a bleed, for example, if you've got an aph, if you're bleeding regularly and your ions dropped significantly and you've got a low, really low hemoglob and then of course we'll do an iron infusion or sometimes a blood transfusion, but ideally we wait till about thirty four to thirty six weeks to make sure the ooral didn't work and that we're giving it close enough to birth that's going to support you when you need it most, which is
in labor and that postpartum period.
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