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I am pregnanty.
Welcome to Hello Bump.
We're making pregnancy less overwhelming and hopefully more manageable. I'm Grace Rubray, I'm pregnant for the very first time and my belly starting to look like an alien.
I'm young A Pittman, I'm a former Olympian mother of six and obstetrics and guyany registrar.
Each week, Leana and I will be holding your hand week by week through the mysterious, perplexing and very unfamiliar miracle that is pregnancy, all the way from a poppy seed to a pumpkin.
Week thirty five and how big a cantalope? Your baby? Apparently?
Is that a melon?
It's also a pumpkin? Is that better? Is a pumpkin?
Yeah? Better?
Honey, jew melon?
Yeah, we're definitely melons. Yeah, I've got a rabbit.
Yeah, that's it.
We can go with this sort of Aussie introduced, but we see a lot of the inn Australia. There's a lot of their mother a huge, huge variation in real size. Okay, we're saying like we're talking a kilo difference between some people's babies by this point, so the average is around two point five to two point seven kilos.
Wow.
So like my babies, as you know, we're born last week at two point eight kilos and they were only thirty four weeks, so you can see they're on the bigger side of a nomine or a twins. So there's a huge, huge variation. Forty six centimeters long.
That's that's quite big because long, that's very long lod log. And what have they developed?
Ongoing maturity. The kidneys are now getting more mature, so they'll be swallowing more and making more amniotic fluid, which I think is really lovely. And I mean people say I say love and peag God. Yeah, that means my baby's winging inside me or that's when you do the whole you know, there's a doodle inside me and all that kind of conversations. But yes, your baby's kidneys are now starting to really work. Well, this is when we start really looking at is your baby up or down?
Is there a bottom presenting or is the head presenting?
So you might find between thirty five and thirty six weeks you get a bedside optra sound with your midwife if you aren't having one of those formal ones booked in, because we're tracking bubby's growth and so at this stage we'll start really looking at that spinning baby's website to make sure we try and convince Bobby that a head first is the right way, and if not, you might find in the next week or two you get booked in for what's called an ECV if your baby is
bum first at this point, and ecvs where we actually put our hands on your belly and we try and manually from outside. So an external Catholic version is to try and turn your baby to be head down.
Is that and it's completely safe to do that.
Look, we make sure there's the right baby, So the baby has to be within a certain weight range. We don't want teeny tiny babies, we don't want really big babies. Baby has to be well so not growth restricted, which is obviously the size, but also with normal fluid around baby and no things like gastroskeecies or any anatomical problems with your baby. So they're quite strict on which ones are suitable for that. And then the biggest thing comes down can them tolerate it? So I've done I don't
laugh at me. I've done htcvs in my life, so not a huge amount, but I'm very lucky. I train with an incredible doctor who does them all the time and is training me in that space.
When you say tolerate, is that because it's painful?
That's right, Yeah, and that's what I say. So out of the ones that I've done, three or four women had to stop just because it was so uncomfortable. And this is the ones that I've done, more than eight successful ones that didn't work, But the main reason for stopping was that she just couldn't tolerate the discomfort on the tummy.
And it's a discomfort part of that also the anxiety of they feel like it's doing something to the child or it's just like that uncomfortable that it's painful.
Look, I think if.
They're committed to be in the room, they're usually you know, they've left a lot of that anxiety at the door. So I think a lot of the women do really try because obviously there's ops you to have a cesarian section. You do not have to try and turn your baby. There's also the option to actually have a vaginal breach birth, so particularly at certain hospitals that facilitate that, and I'm very lucky that I work at one that has lots of breach babies born, so you don't have to be there.
So it's very committed women that want that vaginal birth and are prepared to give it a go.
Right, So people still do have breach babies absolutely imaginally.
Yeah, well I've done not many, probably three or four, but I've been present in the room for at least another ten, which is amazing. So again, we have a particular obstitution. I'm sure he won't mind me saying. His name is doctor Andrew Bissets. He's about one of the best obstetricians in Australia. But I've also met an amazing obstution out at Westmead whose names are doctor Andrew Pesh who used to do breach birth. He's starting to retire
unfortunately for care. But both of them have been the almost the godfathers of bringing back breach birth because many years ago we used to have lots of breach berths and then there was an inquiry in the early two thousands that really scared a lot of women, and so a lot of the main reason is a lot of obstutions detrained in that space, so they just didn't have the skill set to do it, and that's resurging now. So I think the bottom line is if you've committed
to it and it's safe. In other words, again, your babies are normally grown size. It's not a huge baby, it's not a tiny baby, it's not struggling. And you know, particularly if you've had babies before and you know your pelvis is able to birth vaginally, it's definitely worth having a discussion with your obstitution around whether they would be comfortable doing a breach.
Birth and you considered high risk. If you're a breach birth I vaginally, it's.
Not considered high risk.
I mean, the statistics show that a cesarean rate is a one in a thousand chance of severe morbidity to the baby. A vaginal birth with a head down is two in a thousand, between one and two, and a breach vaginal birth is another percent, so between two and
three percent chance of a problem. I think the biggest thing if and again I'm very junior guys, so this is just my evidence from what I've listened to doctor Bisits and other obstecutions in this space is if the if the labor is progressing well and you're dilating beautifully and the bum's coming down and it's a bottom presenting, not feet, and everything's going smoothly, it's a good chance
it's going to go well. It's if things aren't going well and you know you're not dilating well enough and you're really pushing that envelope and you want something so badly, and there's lots of writing on the wall and the baby's not coping with the labor. In other words, a breach will either go well or it won't go at all.
What what's happening to me and what's happening to our bodies?
That has our body's goodness back to the real of what we're here today? Do you know? I think at this point it is just you're continuing to grow. We say it every week, but we've got a harp on looking at symptoms. No headaches, blurry vision, we're not having any itchy feet, We're feeling well in ourselves. This is around when the the time you'll have that last blood test to make sure your iron levels are up. To where they need to be, and if they're not, we
would be starting to consider that iron infusion. So there's just a few, like tick box things that need to be done at this point in pregnancy.
Is this normal?
Is it normal?
This normal is wanting to talk about bad outcomes. And I haven't wanted to or wanted to engage in any type of podcasts birth stories or anything like that because everything's felt too overwhelming. But I think the further on that I've gotten, you've got more data and it doesn't seem as scary like you're in it.
So it's going to happen either way.
So I know that there's a few things that we have spoken about off Mike, like hemorrhaging, shouldered dustocia, dastocia, and one that's been in the news recently, which is.
The amnotic fluid embolism. Yes, are very rare.
But yeah, so all of these things that are very rare, I guess I want to ask if teams are always.
On the look at for that stuff one, even if you're low risk.
Yes, we are, and we get trained in simulation centers, we get trained in real life birth centers when we're quite junior doctors like for example, my whole first year of training, I had a very senior obstitution with me for all births in case that sort of thing happened. And so even in a public hospital where you're being trained with trainees like myself, we're all very aware when to push that red button and bring the room in. So I think you got to remember that even though
it'll feel like you're alone in that space. So that's the thing to be aware of, is that when they see an emergency, your room will be full of people. And that might seem daunting, but it's actually great because it means very senior people are coming in that'll be able to support whatever is required to make sure you and your baby are safe.
And is that regardless of whether you're going through a midlife program or all ondred percent through public private obstitutions.
It's just everyone knows warning signs and there's a big red button to locate in the street that.
You know it will be pressed.
Yes, And that's exactly right.
So which is why the whole birth in Australia is I can't say birth is one hundred percent safe because it's not. It is one of the more dangerous things. It's why my whole career exists is because it isn't as beautiful as we wish it would be, where it just everyone going to breeds, a baby out, cops.
And the dove is born.
That doesn't happen like it's so rare that that happens. But midwives and Australia are trained so beautifully and they are protectors in that birth space. But if they're scared and they know there's something wrong, they ninety nine point ninety nine nine percent of the time will pick it and escalate it to an obstetric doctor. Where it becomes a little more challenging is if you're at home. But again they have those systems and checks in place. It's
always second midwife. If you're home birthing, there is the ability to call an ambulance. They call it early if there's a concern, and they escalate to the hospital. So they're all very trained in that birth space and in particular for emergencies. So and we practice again every week, again and again and again, and then when the real thing happens, it's an almost autonomous way to deal with it.
Do you have patients who get quite anxious about this stuff.
All unbelievably and grace. The hardest thing in my job is women who don't want us to come in the birthroom. Like I love this job, like it's my favorite thing to be there with women. And the reason I went and became a midwife initially and even before that, as Adula was I remember my first birth thinking, this is the most extraordinary thing I've ever done, This pregnancy of stuff, the Olympics.
The Olympics is great, but.
I love pregnancy and birthing and women. So it has been a twenty year passion of mine. I mean, who would go and become an obstitucian with six kids, Like it's just the most ludicrous thing ever. And majority of us in that space are the same. We love being
present for women in birth. And so when we see something abnormal happening, like the ct G, which is the monitoring of the baby, is showing babies stressed, or mum's not progressing, she's been four cenemies and she's four cenemies and she's four centimeters, or there's you know, bloodstained like call which is the amniotic fluid coming out, we get really stressed and we want to come in and help you, and I can tell you a bad high risk woman is the like as in not idn't mean she's bad,
but as in, a high risk woman who's having a really difficult labor is so much easier because she knows we're going to come in.
And that really low risk woman.
Who hates doctors because she's afraid of us and it's my hardest day on the birth unit is trying to convince her to just let me come and have a chat. And so I changed the whole narrative. A few months ago, I heard this incredible midwife down in Melbourne wh's actually doing her PhD in the birth trauma space, who said we need to change it. We need women to demand to meet the doctor. In other words, take the reins back and say I don't want some foreign person walking
into my room when stuff hits the span. I want to know who the midwives are. I want to know who the head of the military team is, and I want to know who the doctor on call is, so that that way there's no foreign faces if and when I require them to come and help me.
And what's on the toolkit this week?
So we'll take it back to something nice, hard conversation. Create your birth song list. We started this early, and you remember a very very vacuum like week, say at eleven, we started adding songs.
You should have quite a few.
I've got to be on that list.
But we're getting closer, Like I don't want your labor to start for two weeks, I when you're thirty five weeks, but it could happen. There's definitely a higher propensity of women to go into labor at around this time, and babies you're really well, you know, thirty five weeks. Certainly at my hospital. It's a bit different if you're in rural hospitals. If they weigh over two point four kilos,
often that stay with mummy. So we're really approaching a very wonderful time where if baby does well post birth, they can often go home, just like if they were a full term baby. Now, some of course need a little bit of help with feeding and they drop their sugars and they get a bit jaundice and things. But the bottom line of that is have your car seat, have your birth plans, and have your song list because it could happen tonight.
This is my toolkit. Funnily enough, is a car seat. I had it. I don't know if this is the nesting hormone that's now suddenly been about the baby instead of me. Is that I went, we just need a car seat, and we need it this weekend, like literally the weekend that's just gone.
I was like, we just need to yeah, because that's.
The only thing you can't do with that. It's everything else.
Yeah, they'll let you leave, yep, unless you have it, Like.
They don't let you leave, do not let you leave until you have a car seat in the car.
So I went to baby Bunting and picked a car seat and they were like, oh, you just have to wait two weeks for it to come in and then you've got to come back for installation. And I just went, thank goodness that it's thirty three weeks. I went, we need to do it now, because what if we waited until I was on maternity.
I'll let you in a little story, most most hospitals have one in their car park yet, so like, just just in case, because you amount a bearers the dome, do it And they're like, oh, I haven't had it done at City in the garage. I've had it for a few weeks, but it's not installed, and the last thing we want you to do is drive around with
an unsafe car seat. So find out if you if you end up going into labor early, give the job to your partner or your mother in law to source where the hospital does their car installation, because it's very common that most hospitals have one on site.
Do you remember your first drive home.
Kilometers an hour? It was I still vividly the other because he.
Was so tiny and he looked so small in that seat, and I literally drove like a matter.
Or did one of you sit in the back seat?
No, I don't know why, but I was driving.
I don't know if he'd gone home to set something up, because this is like twenty years ago and my oldest is eighteen now and doing nursing himself. So but I remember someone was in the car. It must have been him saying why are you going so slow? And I'm like, because my baby's in the back.
I've got to be there to protect. Yeah, okay, that's normal.
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This episode was produced by Courtney Ammenhauser with audio production by Tom Lyon We'll catch you next time.
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