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I am pregnanty.
Welcome to Hello Bump.
We're making pregnancy less overwhelming and more manageable, hopefully. I'm grace through very I'm pregnant for the first time and things are getting exciting.
Because you're a full term at thirty seven weeks.
It's amazing. I'm Jana Pittman, I'm a former Olympian, I'm a mother of six, and I'm training to be an obstetrician. And it is really exciting because thirty seven weeks is a massive milestone for any woman full term.
Each episode, Yonder and I will be holding your hand week by week through the mysterious, perplexing and exciting miracle that is pregnancy, all the way from a poppy seed to a pumpkin.
Week thirty seven, I've got that our baby is a leak. But that feels that's small fair, Yeah, but I mean I guess if it's long, it's lots. Okay, We'll go with the length of a lace kith.
And the size of a watermelon, yes, or a throw pillow. I do just feel like that. You know, mums when you're a kid used to shove the pillow up your tummy. Yes to baby's look pregnant, and it comes through.
Yeah, I like that.
Baby's about two point nine to three kilos on average, and so yes, full term is important, but it doesn't mean baby's ready to come. So we get a lot of mums at this point that really go, oh, I'm so jack of pregnancy. Please induce me. And we're gonna talk a bit about induction. I know today because I've got some questions for you and you can have something from me. I'll try and answer them the best of my ability. But it's not time yet. There's still a
lot of growing and development for baby to do. So it's laying down the fat, it's the brain maturity and things like that. So we know that all the research says that up until thirty nine weeks, there's still as long as mum's safe and there's no medical reason it's better to stay pregnant. Ironically, though, after thirty nine weeks it's more about mum's comfort and baby has done all it's growing, it will do equally well on the outside as it went on the.
So it comes about us. Now that's nice.
Yeah, so exactly I had the whole friend, it's been a bear and then now it's about mum. So it is a question that people get, is why is wise term thirty seven weeks? Well, baby's really beautifully developed at this point, but there's still a great benefit to keeping them inside for two more weeks if we can. And what's happening to our bodies, Well, you can't predict when labor's going to start, but at some point you're going
to start feeling changes in your body towards labor. So things obviously the Old wives tales like you start getting dire every year and things like that. But your cervix will start to come anteriorly. So at the moment it SIT's really right up near your back passage. We call it a posterior cervix, which means it's holding your cervix closed. It'll start moving forward, it'll start softening. You might find you have a lot more mucous at this point in pregnancy.
You're starting to pee even more than last week. Don't know how that's possible, but it is, and it's very normal to have even more anxiety because birth is approaching and you don't know what it's going to be like.
Is it rare for the placenta to move down? I can't remember what it's called when it, Oh, if low lying? Will it ever become low lying at this point as you get closer.
Not that I've ever heard of. So we know the placenta goes the other way. So hopefully if you had a low lying placenta, found it morphology, So that's around the twenty week We should have importantly done an ultrasound around the thirty four week mark to rule it out. Most placentas actually move up, so as you're the lower segment of the uterus is created, so basically as your whole uterus change of shape and grows up towards your diaphragm,
this placenta usually gets dragged with it. So it's very rare for percenters to stay down. But there are a whole what we call a creative spectrum, so all different types of placentas. Some of them are butt the offs, which basically is where the baby comes out from where the cervic starts. Some of them are a centimeter or two away, and some of them cross completely. Sometimes vessels run across the cervix. So there's all these different and
all of those things. Guys, by now at thirty seven weeks, you don't have it if your old doctor hasn't spoken about it, So it's a little irrelevant.
You go checked, you're fine.
But if you look at your yellow card now which most of us have, or your white card, depending on what hospital you're at, and it says low lying placenta and someone hasn't checked, you've just saved your baby's life. Go and get an ultrasound now in triple check that placenta is out of the way. That does not mean if it doesn't say anything, you have to go and get it. If you have an ultrasound, now it's just for fun. Ninety nine percent of the chance will have
picked that up at a much earlier stations there. Now, is this normal? Is normal?
Now?
My?
Is this normal? Is about interventions?
Okay, Well, it's something that I first learned about in the birth courses, and that an intervention statistically leads to other interventions like epidurals, forceps.
Vacuum cesarean sections, pain like yell everything, yeah.
Yes, So why do we induce such a loaded question?
It is a loaded question than some pausing me not saying something is do you know again? We have already said this a few times. And I think the hardest situation here is women that feel forced into a decision. I don't know any obstetricians that force someone to make a decision unless they're really scared. Now our midwife, and I know most of my friends are midwives more than doctors. To be honest, say, well, doctors get too scared. You know,
birth is a very physiological process. It will happen, give it time. All the statistics that you know are about a particular woman. Every woman's different. You can't lob her in with the same statistics as others. But ultimately, birth's
been happening for a long time. There's a lot of research in this space, and so we know there's certain parameters and certain diseases in pregnancy where a baby could have a terrible outcome if we push pregnancy too long, and so an induction is often offered to women with
certain risk factors. So it might be, for example, you have a very small baby and you have preeclampsia or you have diabetes, and we know the risk of still birth around that thirty six week mark is real and women with type one diabetes, we know that babies that are very, very big, you know, in the ninety fifth to ninety eighth centile do have a risk of shoulder dustotia or peranial trauma, and so that it be offered. Now, that's a circumstance where a woman might say, no, I'm
okay with having a tear. I'd prefer a vaginal birth, even if I have a fourth degree. That's her choice, but the recommendation has to be given that this is what we would do or this is what the recommended research would say is the safest way for mum and baby to come out of this with a positive experience. Now that's where it gets tricky, is that if a doctor offers it to you, ask questions. You know, it is your right to know why, what is the research?
Why you saying this is the right thing for me and the one that I struggle with.
But I know the reason.
I know I've got to get in trouble for this work. But I am an ama mum, as I I am an old woman, I had lots of babies, and often women get asked or recommended to have an induction at thirty nine or forty weeks when they're over forty years of age, because we know the placenta is more likely to get tired and we don't want a baby to pass away. So where what we're afraid of is still birth now.
Id is it's not delivering nutrients an exactly.
It's running around gas. Yeah, so it's no longer feeding your baby the right way. And people will say, well, I had an ultrasound at thirty six weeks and it was normal. Baby looked great, But we have an ultra sound on you in the last week or two, so we don't know that hasn't changed. So again, fetal movements and all that kind of come into play, and that's where it's really tough. And there's lots of research saying that, you know, you have to do a thousand inductions to
save one baby's life and things like that. You know, there's all that sort of stuff, But you have to decide what's right for you and what kind of risks you're prepared to sit with. So they're the difficult inductions. Whereas if I'm telling you need an induction for college stasis, that has a really high chance of stillbirth. So therefore there's preaclance that's the itching, but it's not just itching.
It's actually related to your liver and you've got liver function and all these different reactions within the body that we don't want that we know are linked.
To still birth.
And so when there's certain risk factors that we say, this is the reason we think you should have an induction of labor, and they're very strongly backed research. It's a bit different. But again, the older age woman, the IVF pregnancy, So definitely women have an IVF pregnancy. You know, we say it's a very wanted pregnancy, So is every pregnancy.
You know, there's no pregnancy that's well not every pregnancy, but most people getting to that point in wanting to protect their baby, and it's equally as valuable as someone who went through ten rounds of IVF. But there's that tendency to think, well, why did that woman need IVF, and therefore would you consider an induction. Now, my hospital doesn't do it for IVF, for example, So you'd have to have multiple risk factors like being forty two years
of age, IVF pregnancy in a small baby. There's a real spectrum of when we would offer an induction. The difficult ones, though, grace, are the ones that are women are having a maternal or crest induction. So that is, are we doing an induction because the woman has just decided she doesn't want to continue with pregnancy. Now, that might be for social reasons, it might because she's really uncomfortable.
It might because she has one or two of the softer risk factors, and you know, there's her decision, is that let's.
Have this baby.
They're the harder ones because yes, absolutely, induction of labor, we know, leads to higher rates of evy dural which means you're stuck on the bed, which means it's harder to push, and it can lead to higher rates of instrumental delivery, not caesareans, Funnily enough, although there is some new research showing that there may be a slight increase of caesarean rates too, But the moment, we don't counsel that.
Can I ask about the induction to having an appy zurule. Why does that increase? Is it because labor stalls? Oh no, no, it's so I've done it. So obviously again I can step out of my doctors and into my mum's shoes here. My second labor was an induction of labor, and it just came on so fast. And like you know, we're not thinking of tattoos in pregnancy, but I always think if you have it. I don't know anyone who's had a tattoo. I've got a few from.
Sport and limp and rings and things. But when it first start help, it hurts so badly, but then you get accustomed to it. So in labor, if you go into spontaneous labor, you have a contraction every two or three hours, and then then they're in every hour, and then there are two or three and now, and then your body builds up those contractions. The studies show that after six centimeters the pain is no worse. So it's in the discomfort or the surge, or however you want to
label your pain. It doesn't get worse. It's just becomes more frequent. But you can cope with it. But when you go from zero to sitting here like you and I are, now, I stiff could drip on your arm
and I thump the sintocinin through. Your contractions come on fast and thick, and that labor I had an epidural, and it was the best thing I ever did, to be honest with you, because it meant it meant that I was able to just actually concentrate on my birth, whereas before that I was climbing the walls and in so much discomfort. And so that's where it comes from. So the induction causes the contractions to come on quickly, but you've got to remember that we're only mimicking what
your body does. We're not going to put you into fifteen contractions in a minute. We're trying to replicate exactly what your natural body is doing. The arguments come about, well, sometimes there's more babies that are posterior, for example, because we've started a labor before the babies decided it wants to come. But it comes back to grace. We're doing
it for a medical reason. If it's a maternal request that's different, then you really need to look at the risks of induction and are you happy to have an epidural. And a lot of the time these women are like, I don't really care if I have a season yan I'd be great. If I have a vaginal birth, wonderful, But if it ends up with a season, I don't really care. So I get it, You're like, it's all
about maternal choice. But if there is a reason why I'm really worried about your baby so that I've said to you, I think an induction is the best thing for you, then you're sitting with the risks of a potential epidural, a potential requirement for a vacuum assisted birth, or a baby that's really compromised. That's when you have to make these decisions more difficult, and that's when it's really hard when there's a lot of language out in social media at the moment sort of saying you know,
doctors are forcing inductions on women. No, we're recommending inductions. You could always decline. You can say no to everything. That's what I think women need to remember is you don't have to say yes to anything, but do understand that there's a consequence if you don't, and that has to be on the person making that decision.
In terms of when you've been in labor for a certain amount of time, there is a point where you probably can't be rushed to an emergency c section because the baby's already in the birth.
Yeah, it's a bit different.
That's when the vacuums in the forest.
When the vacuum and the forceps, because you know, you see on TV where they're like, quick, let's go to an emergency C section, but the baby's crowning.
I don't know.
Well, no, look, and this is where I want to ask you. The question of you is what are you more afraid of? The cesarean section or an instrumental birth.
That's a very good question, both cesarian.
I'm I am worried about being in the operating room and not being out of feel like my legs and panicking and what that would. But I think I worry about that panic. My husband is terrified of blood and things like. I know that they'll be the little thing, but I worry about needing a support person and him not being able to do that for me. I'm sure they'll be a nurse that'll hold my hand if he goes white and passes out. And I'm sure he won't be the first person.
To be I've had plenty of several patients in the room, let's say.
But then when it comes to forceps in vacuum, I worry about pro labs, the damage.
To the baby's head with the vacuum with.
The vacuum, like, there's something that in that course I learn about force ofs. My brain's just gone, don't hod onto that. That's where I went, Oh, I'm okay with an episiotomy. It was the best scenario, And I think I liked the idea of trying not to do it with an epidural because then you'd be able to feel it.
But then there was also a woman in the class who said her labor stopped progressing and she was a pelvic floor physio, so she actually got an epidural because her labor stalled and she got it and then her cervix did dilate the rest of the way. So I was like, oh, okay, I see the point. But I think I do have a lot of anxiety about intervention. And it's no judgment on pain relief. I'm not woo woo namastae. Shouldn't women squat it in fields? Oh my god, I'm.
Not like that at all. I'm like, I'll have gas can I who has?
But there's just I guess there's some anxiety around, you know, TOUCH would have been very lucky to not be in an o R. And I don't know what my anxiety will be in like in that room.
I think it's very I'm sure there's lots of people listening that will feel exactly the same. And I think the thing is that everybody's experience and thoughts and feelings around this are going to be very different. And part of it is actually acknowledging what are those fears, because if you can have a discussion with your birth team around what those fears are, we can hopefully help you
reduce some of those. And if you end up in that space, it might be that we need to keep the drapes up a little bit more, that we don't drop the when Bobby comes out, because it's a bit more blood in that setting. And can we put some music on? Can we educate you on different things? Is there a real hard no on some of the options that we're offering in birth, because I think there's a few big points in the birth scenario. Is that epidriols are not just for pain. You kind of mentioned just then.
We often use them for women with type pelvic floor as well, and so for example, we might be eight centimeters and just not quite getting there. It actually relaxes her whole pelvic floor and lets it open up. We
give it for prolonged labor. Someone who's been laboring beautifully like a queen for two days, who's absolutely smashed and needs a break for a few hours to be able to lie down and actually recover, and in that time her whole body relaxes and she pelvic opens up, baby rotates into a great position and she has a beautiful birth. If you need an instrumental birth, and epidurol is much easier because you don't feel the application. Again, I've done lots of for steps and back in birth. That's what
my job is as an obstetrician. I don't love doing them. I don't go into work saying today I want to do five four steps. That's what I've signed up for. I get tickled pink when I come into the room and they don't need me, and I just get to watch a beautiful birth like that, to me is the highlight of my day. Is that the woman as a queen and a power. But they're there for a reason. We use them when your baby is sick. So if we notice on the CTG, on the measuring that their
little heart rate is dropping really low. If you're pushing and you're pushing, and you're pushing, and you're pushing. The prolats risk comes from a baby sitting on that perineum
for too long. And so we do a disservice to you if we let you push for three or four hours, because that baby and that pressure and all those peranial muscles and all the pelvic floor of your pelvic diaphragm, not the harbor diaphram, the one in your whole pelvis get stretched and stretch and stretch and stretched and stretched. There's also a massive increased risk of bleeding afterwards. When that uterus is what we call a tonic, it just
sits open. It's contracting for hours and hours and hours and hours, and so there is a It's so hard because giving all this information scares women, but there is reasons why we expedite birth, either for mum or for baby. But I can wholeheartedly tell you that none of us do it without a lot of consideration beforehand. You just have to again make sure you know the doctor in the room, because it's only doctors that do the midwives don't do the instrumental births. Be confident that that person's
got your back. And when you lock eyes with them, which is what I do with my women. I hold her hand and I say I need to do this to help you and your baby, and she's like okay, and we do it together. I like, look at her and we go and I grunt with her and I count with her, and we're in it. We're like a full team in that space. Well, that's what I think it's about. That's what birth is is. It's the woman doing the work, but just there you're there to support her.
I've just got a quick one for my tool kid, which is a new mantra that I learned from a friend, which is you can do anything for sixty seconds.
I love it. I can't beat that. Just it's gonna.
Be sure to be yeah, but you can do anything for sixty seconds.
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