1 00:00:04,080 --> 00:00:07,160 Speaker 1: Welcome to the kick your Expert led podcast, helping you 2 00:00:07,240 --> 00:00:11,639 Speaker 1: explore and learn everything about getting pregnancy, birth, and becoming 3 00:00:11,640 --> 00:00:12,039 Speaker 1: a parent. 4 00:00:12,400 --> 00:00:16,120 Speaker 2: On the podcast and our online pregnancy program grow My Baby, 5 00:00:16,320 --> 00:00:19,320 Speaker 2: we share my experience of helping more than four thousand 6 00:00:19,360 --> 00:00:20,640 Speaker 2: babies to be born and. 7 00:00:20,680 --> 00:00:23,680 Speaker 1: Our experience of running a women's health clinic and parenting 8 00:00:23,720 --> 00:00:24,320 Speaker 1: for boys. 9 00:00:24,520 --> 00:00:27,520 Speaker 2: We're here to help everyone to feel empowered in pregnancy 10 00:00:27,680 --> 00:00:30,520 Speaker 2: and birth with real life, practical information. 11 00:00:33,760 --> 00:00:36,000 Speaker 1: Welcome everyone. I'm Bridget Maloney. 12 00:00:35,600 --> 00:00:37,800 Speaker 2: And I'm obstetrician doctor Patrick Maloney. 13 00:00:38,280 --> 00:00:41,839 Speaker 1: And today, look, we haven't had a fresh episode in 14 00:00:41,880 --> 00:00:44,839 Speaker 1: the can for all those people in podcast land, I 15 00:00:45,000 --> 00:00:47,960 Speaker 1: know what I'm talking about for a little while, because 16 00:00:48,280 --> 00:00:50,840 Speaker 1: you've been concentrating on something else, Pat, have you I. 17 00:00:50,760 --> 00:00:55,000 Speaker 2: Have, I've been. I've been doing my training and initial 18 00:00:55,080 --> 00:00:59,800 Speaker 2: cases learning how to use the da Vinci Robotics system 19 00:00:59,840 --> 00:01:04,440 Speaker 2: for gynocological surgery, which has been absolutely fascinating. 20 00:01:04,840 --> 00:01:07,000 Speaker 1: It's so funny. So when I told my mum, and 21 00:01:07,160 --> 00:01:10,600 Speaker 1: you know, she is eighty three with dementia, so take 22 00:01:10,640 --> 00:01:13,760 Speaker 1: that all into account. When I said, oh, pets learning 23 00:01:13,800 --> 00:01:18,000 Speaker 1: how to do surgery on a robot, thought. 24 00:01:17,920 --> 00:01:19,199 Speaker 2: Was wrong with that? Poor robot? 25 00:01:19,840 --> 00:01:22,279 Speaker 1: That's exactly what she thought. She thought you were actually 26 00:01:22,319 --> 00:01:25,280 Speaker 1: operating on a robot. She ever forbid. 27 00:01:25,560 --> 00:01:27,560 Speaker 2: I'm happy for her to continue to believe. 28 00:01:27,959 --> 00:01:31,640 Speaker 1: Yeah, but maybe because it's going to become more common, 29 00:01:31,680 --> 00:01:34,560 Speaker 1: people are going to start knowing people that have had 30 00:01:34,600 --> 00:01:38,240 Speaker 1: surgery on a robot by a robot before. 31 00:01:38,319 --> 00:01:41,800 Speaker 2: Yeah, I think that's right. So right now, it's still 32 00:01:42,120 --> 00:01:46,640 Speaker 2: kind of reasonably new, certainly in benign gynocology. The gynecological oncologists, 33 00:01:46,640 --> 00:01:48,960 Speaker 2: the cancer guyny surgeons have been into it for quite 34 00:01:48,960 --> 00:01:51,360 Speaker 2: a while, and it's probably getting a bit more common 35 00:01:51,880 --> 00:01:56,760 Speaker 2: for benign gynecological problems like in theometriosis or urine fibroids 36 00:01:57,120 --> 00:01:59,480 Speaker 2: as a way of doing a hysterectomy, taking out over 37 00:01:59,560 --> 00:02:06,880 Speaker 2: his taking ENDO. And it's been limited somewhat by cost. 38 00:02:07,280 --> 00:02:08,440 Speaker 2: The robot itself is very. 39 00:02:08,400 --> 00:02:10,480 Speaker 1: Expensive, millions of dollars. 40 00:02:10,639 --> 00:02:16,880 Speaker 2: Yeah, that's right, but it has some very exciting benefits. 41 00:02:17,040 --> 00:02:21,120 Speaker 2: It's a joy to use. The vision you get is unbelievable. 42 00:02:21,680 --> 00:02:26,640 Speaker 2: The post operative results are extremely good in terms of 43 00:02:26,919 --> 00:02:30,360 Speaker 2: lengths day patient post operative pain, quality of recovery, and 44 00:02:30,400 --> 00:02:33,840 Speaker 2: so forth. But you know, from my point of view, 45 00:02:34,840 --> 00:02:37,840 Speaker 2: it's just a delight to use. The vision you get 46 00:02:37,880 --> 00:02:41,720 Speaker 2: on the console. It's unbelievable. So it's quite a bit 47 00:02:41,760 --> 00:02:45,440 Speaker 2: of a bit of a learning curve that I've done 48 00:02:45,480 --> 00:02:49,760 Speaker 2: thousands of cases of traditional laparoscopy approach to things where 49 00:02:49,760 --> 00:02:52,880 Speaker 2: you're actually standing at the bedside, holding onto the laparoscopic 50 00:02:53,440 --> 00:02:56,560 Speaker 2: instruments yourself. And the robotic platform, of course, is whether 51 00:02:56,680 --> 00:02:59,720 Speaker 2: a robot comes over the top of the operating table 52 00:03:00,040 --> 00:03:04,520 Speaker 2: once you're sleep, the instruments are attached to the robot, 53 00:03:04,800 --> 00:03:07,239 Speaker 2: and then the surgeon sits at a console and controls 54 00:03:07,240 --> 00:03:07,680 Speaker 2: the robot. 55 00:03:07,720 --> 00:03:09,600 Speaker 1: It's kind of quite separate to the patient, isn't it. 56 00:03:09,680 --> 00:03:12,080 Speaker 2: Yeah, you're over in the corner of the room, and 57 00:03:12,120 --> 00:03:13,359 Speaker 2: that takes a little getting used to it. 58 00:03:13,440 --> 00:03:13,680 Speaker 1: Yeah. 59 00:03:13,760 --> 00:03:20,040 Speaker 2: Yeah, Just yesterday I was asking a vaginal assistant to 60 00:03:20,120 --> 00:03:26,040 Speaker 2: move an instrument. I said towards me, And that's a 61 00:03:26,120 --> 00:03:30,840 Speaker 2: traditional laperoscopy sort of instruction, which would mean towards the 62 00:03:30,880 --> 00:03:33,799 Speaker 2: patient's head. But I was not standing towards the patient's head. 63 00:03:34,160 --> 00:03:36,360 Speaker 2: I was sitting in the corner of the room, so 64 00:03:36,400 --> 00:03:38,800 Speaker 2: I didn't mean. I didn't mean towards me. I meant 65 00:03:38,800 --> 00:03:41,080 Speaker 2: towards towards where I would otherwise be standing. 66 00:03:41,120 --> 00:03:43,720 Speaker 1: If we weren't using a robot got all these years, Pat, 67 00:03:43,720 --> 00:03:45,720 Speaker 1: and I didn't. I've never thought about that, So you're 68 00:03:45,720 --> 00:03:48,800 Speaker 1: actually I always thought that you'd be standing towards the 69 00:03:48,960 --> 00:03:50,040 Speaker 1: legs of the patient. 70 00:03:50,320 --> 00:03:52,520 Speaker 2: Now you stand up near the up near the head. 71 00:03:52,600 --> 00:03:54,960 Speaker 1: Why houses I did not know that, God, and so 72 00:03:55,080 --> 00:03:57,520 Speaker 1: did the assistant. Then go hang on a minute. 73 00:03:57,480 --> 00:04:00,240 Speaker 2: Yeah, I think I know what you mean. Yeah, that's 74 00:04:00,280 --> 00:04:02,960 Speaker 2: what I've been up to, and it's been it's been terrific. 75 00:04:02,960 --> 00:04:05,520 Speaker 2: It's going to become really important part of my practice. 76 00:04:05,520 --> 00:04:10,960 Speaker 2: I'm sure I'm now one of a very very few 77 00:04:12,000 --> 00:04:17,560 Speaker 2: gynecologists practicing in regional Australia who have the access and 78 00:04:17,600 --> 00:04:22,200 Speaker 2: now the full training in robotic kynecology. So it's a 79 00:04:22,240 --> 00:04:23,080 Speaker 2: very exciting time. 80 00:04:23,400 --> 00:04:26,000 Speaker 1: I know one of the very first patients that you 81 00:04:26,120 --> 00:04:29,920 Speaker 1: did surgery on and you came home and you said 82 00:04:29,960 --> 00:04:32,880 Speaker 1: to me, oh, well, she was just sitting up in bed, 83 00:04:33,560 --> 00:04:36,280 Speaker 1: like a couple of hours later, she was eating and 84 00:04:36,320 --> 00:04:39,640 Speaker 1: she said, doctor Pat, no shoulder tip pain. Yes. 85 00:04:39,920 --> 00:04:44,120 Speaker 2: Yeah, it has a number of benefits like that, which 86 00:04:44,160 --> 00:04:45,480 Speaker 2: I really have to see to believe. 87 00:04:45,760 --> 00:04:50,880 Speaker 1: It's it's been amazing, and so Pat has been having 88 00:04:51,040 --> 00:04:51,880 Speaker 1: enormous hours. 89 00:04:52,120 --> 00:04:57,960 Speaker 2: So yeah, the training sixty seventy hours. The training on 90 00:04:58,000 --> 00:05:01,159 Speaker 2: the simulator really there in use during the day, so 91 00:05:01,240 --> 00:05:04,719 Speaker 2: to use the simulator, which attaches to the real platform, 92 00:05:05,400 --> 00:05:09,040 Speaker 2: you have to access it after hours. So I've been 93 00:05:09,040 --> 00:05:14,360 Speaker 2: in there in hospital at nighttime practicing on simulations and 94 00:05:14,400 --> 00:05:17,840 Speaker 2: then moving on to a series of what they call 95 00:05:17,920 --> 00:05:23,440 Speaker 2: propted or supervised operations. And then now we're done. 96 00:05:24,640 --> 00:05:28,839 Speaker 1: Well good, we're here making a fresh new episode for everybody. 97 00:05:28,960 --> 00:05:29,159 Speaker 2: Good. 98 00:05:29,480 --> 00:05:33,440 Speaker 1: And we thought, well, the speak pipes have been banking 99 00:05:33,520 --> 00:05:36,839 Speaker 1: up again, and we love all your questions. There's so many, 100 00:05:37,640 --> 00:05:38,880 Speaker 1: I've picked probably six. 101 00:05:39,160 --> 00:05:41,040 Speaker 2: Well, then it's good to hear people's voices. 102 00:05:41,120 --> 00:05:43,440 Speaker 1: It is good to hear people's voices. So I think 103 00:05:43,440 --> 00:05:46,120 Speaker 1: we should just get stuck straight into that, and we're 104 00:05:46,120 --> 00:05:48,400 Speaker 1: going to start with this one. 105 00:05:48,600 --> 00:05:51,360 Speaker 3: Hid apart and Bridget. My name's Lauren. I'm currently twelve 106 00:05:51,360 --> 00:05:53,479 Speaker 3: weeks pregnant. I've started listening to your podcast and I 107 00:05:53,520 --> 00:05:56,719 Speaker 3: haven't been able to stop. I just wanted some advice 108 00:05:56,960 --> 00:06:01,200 Speaker 3: around if I would be a potent or candidate for 109 00:06:01,240 --> 00:06:04,200 Speaker 3: a v back. I tested positive for strap B in 110 00:06:04,279 --> 00:06:09,680 Speaker 3: my first pregnancy. Because of that, they told me I 111 00:06:09,720 --> 00:06:17,040 Speaker 3: needed to be induced, so my waters broke at term, 112 00:06:17,880 --> 00:06:21,720 Speaker 3: I went into the hospital. They induced me with potocin. 113 00:06:22,800 --> 00:06:27,120 Speaker 3: I had the IV, However, I wasn't able to progress 114 00:06:28,440 --> 00:06:33,440 Speaker 3: further than two centimeters, hence needing a emergency C section. 115 00:06:35,000 --> 00:06:38,479 Speaker 3: I'm just wondering this time around if I, yeah, I guess, 116 00:06:38,520 --> 00:06:45,320 Speaker 3: if I test positive again to strap be, will I 117 00:06:45,360 --> 00:06:52,000 Speaker 3: still need the induction and will I still be able 118 00:06:52,040 --> 00:06:59,719 Speaker 3: to potentially progress this time around? Yeah? Any any advice 119 00:07:00,640 --> 00:07:02,040 Speaker 3: would be appreciated. 120 00:07:02,120 --> 00:07:02,440 Speaker 4: Thanks. 121 00:07:03,240 --> 00:07:06,120 Speaker 1: Now, this is my second listening to this, and the 122 00:07:06,279 --> 00:07:08,599 Speaker 1: first time I listened to it, I went in a minute, 123 00:07:08,680 --> 00:07:10,920 Speaker 1: you know, strip B induction. I get it now, though 124 00:07:11,000 --> 00:07:11,720 Speaker 1: I know what you're going to. 125 00:07:11,760 --> 00:07:15,320 Speaker 2: Say, Yes, yes, I think this would be better describe 126 00:07:15,360 --> 00:07:22,600 Speaker 2: as augmentation. So it looks it's it's a technical thing, 127 00:07:22,680 --> 00:07:26,440 Speaker 2: but we tend to describe induction as being when someone 128 00:07:26,560 --> 00:07:30,000 Speaker 2: is not in labor, nothing's happening, and we think that 129 00:07:30,200 --> 00:07:32,800 Speaker 2: baby's better out and the end let's try and in, 130 00:07:32,960 --> 00:07:35,680 Speaker 2: let's try and get that labor up and going, and 131 00:07:36,320 --> 00:07:40,960 Speaker 2: ideally that's for good reasons. And augmentation is typically that 132 00:07:41,000 --> 00:07:44,040 Speaker 2: what the term we use when somebody is in labor 133 00:07:44,160 --> 00:07:48,040 Speaker 2: and we want it to go faster. So when we 134 00:07:48,080 --> 00:07:50,679 Speaker 2: talk about someone with group B streped to coccus. Remember, 135 00:07:50,720 --> 00:07:54,440 Speaker 2: it's not an infection that that group B streptococcus GBS 136 00:07:54,440 --> 00:07:57,600 Speaker 2: belongs in the vagina. It's present in the vagina of 137 00:07:58,960 --> 00:08:02,960 Speaker 2: twenty percent of at any given time. But if a 138 00:08:02,960 --> 00:08:07,520 Speaker 2: baby comes out after a birth with an infection serious 139 00:08:07,560 --> 00:08:15,160 Speaker 2: things meningitis and caphalitis, septicemia. 140 00:08:11,800 --> 00:08:11,880 Speaker 4: The. 141 00:08:13,680 --> 00:08:19,520 Speaker 2: Culprit is often GBS from the maternal vagina, and the 142 00:08:19,560 --> 00:08:22,920 Speaker 2: outcomes can be very serious. Those babies can become sick 143 00:08:23,080 --> 00:08:26,960 Speaker 2: very quickly because once that bacteria gets away from where 144 00:08:26,960 --> 00:08:30,880 Speaker 2: it belongs in the vagina into a baby's bloodstream, it's 145 00:08:31,040 --> 00:08:38,240 Speaker 2: very damaging. So they started a process in the very 146 00:08:38,240 --> 00:08:43,360 Speaker 2: early days of my training to swab for it and 147 00:08:43,400 --> 00:08:45,480 Speaker 2: then if it was there, pushed the labor on a 148 00:08:45,520 --> 00:08:49,200 Speaker 2: bit faster and then give antibiotics in labor as well. 149 00:08:49,720 --> 00:08:55,880 Speaker 2: And since it's been done that way, there's been better results, 150 00:08:56,120 --> 00:08:59,640 Speaker 2: much much better results, a bit like vaccination. We'd treat 151 00:08:59,679 --> 00:09:02,520 Speaker 2: a whole lot of people to save a few, but 152 00:09:02,840 --> 00:09:05,840 Speaker 2: the rates of babies with a thing called early onset 153 00:09:05,920 --> 00:09:09,160 Speaker 2: GBS setsus so straight away come out heavily infected with 154 00:09:09,240 --> 00:09:12,040 Speaker 2: GBS has come right down since it's been done that way, 155 00:09:12,040 --> 00:09:17,400 Speaker 2: and it's generally considered an intervention in the birth process. 156 00:09:17,440 --> 00:09:23,800 Speaker 2: That's worth it. But some women need to have some 157 00:09:23,960 --> 00:09:30,160 Speaker 2: sintocinon augmentation in labor which they otherwise would not have had, 158 00:09:30,640 --> 00:09:34,440 Speaker 2: and occasionally that will lead to cesarainsection. 159 00:09:34,600 --> 00:09:37,280 Speaker 1: Particularly because her water's broke first. Yeah. 160 00:09:37,800 --> 00:09:40,120 Speaker 2: Yeah, So when the waters break, that's when the baby's 161 00:09:40,160 --> 00:09:42,880 Speaker 2: exposed to the GBS in the vagina, and we want 162 00:09:42,920 --> 00:09:48,439 Speaker 2: that period to be pretty brief. Now what happens. Of course, 163 00:09:48,480 --> 00:09:51,560 Speaker 2: in a natural labor, first baby out turned the water's break, 164 00:09:51,559 --> 00:09:54,560 Speaker 2: it can take ages for the contractions to come. So 165 00:09:54,640 --> 00:09:58,600 Speaker 2: if someone's got GBS positive on a swab taken at 166 00:09:58,600 --> 00:10:01,200 Speaker 2: thirty six weeks, that predicts that the GBS will still 167 00:10:01,240 --> 00:10:04,280 Speaker 2: be there a month later when the water's break, and 168 00:10:04,640 --> 00:10:08,520 Speaker 2: that woman is best off getting on with it. So 169 00:10:08,559 --> 00:10:10,320 Speaker 2: we'll use a bit of sintosin to get the show 170 00:10:10,320 --> 00:10:14,200 Speaker 2: on the ride, to get the contractions coming. But occasionally 171 00:10:14,640 --> 00:10:18,880 Speaker 2: an induced or augmented labor will end in cesarean section. 172 00:10:19,600 --> 00:10:21,199 Speaker 2: Sometimes it's hard to tell whether that was going to 173 00:10:21,240 --> 00:10:25,199 Speaker 2: happen anyway, or whether the use of sintosin has actually 174 00:10:25,200 --> 00:10:29,000 Speaker 2: increased that woman's cesarean section risk. And this is typical 175 00:10:29,080 --> 00:10:32,320 Speaker 2: example of obstetrics where we're trying to play off one 176 00:10:32,440 --> 00:10:33,360 Speaker 2: risk against another. 177 00:10:34,240 --> 00:10:38,520 Speaker 1: And she wants to know like whether in a subsequent birth, 178 00:10:38,520 --> 00:10:42,920 Speaker 1: whether she would go ahead and have a vback or 179 00:10:42,960 --> 00:10:46,240 Speaker 1: whether she should And you know you have a plan section. 180 00:10:46,880 --> 00:10:49,760 Speaker 1: And that is the that's the million dollar question which 181 00:10:49,760 --> 00:10:52,040 Speaker 1: has been asked over and over and over in our 182 00:10:52,120 --> 00:10:53,080 Speaker 1: speak pipes. 183 00:10:52,880 --> 00:10:57,640 Speaker 2: Yes, lately, how do I determine if I'm a good jean? Yeah? So, look, 184 00:10:57,679 --> 00:11:02,640 Speaker 2: it's a tricky one. There's nothing about this story that 185 00:11:02,760 --> 00:11:05,880 Speaker 2: I think makes this person a bad candidate for feedback. 186 00:11:06,360 --> 00:11:09,599 Speaker 2: We worry about a different scenario. Well, I'll give you 187 00:11:09,600 --> 00:11:14,679 Speaker 2: a different scenario. A very small, petite woman with a 188 00:11:15,679 --> 00:11:23,079 Speaker 2: seven foot husband, has a four and a half kilogram 189 00:11:23,280 --> 00:11:27,000 Speaker 2: baby and obstructs at four centimeters and has a cesarean section. 190 00:11:27,080 --> 00:11:29,079 Speaker 2: If she rocks up for a fedback, the same thing 191 00:11:29,160 --> 00:11:33,320 Speaker 2: is quite likely to happen again, and she might be 192 00:11:33,440 --> 00:11:36,000 Speaker 2: considered a poor candidate who might be better off with 193 00:11:36,080 --> 00:11:42,680 Speaker 2: a plan section. But in this situation, obstructing it two 194 00:11:42,760 --> 00:11:46,000 Speaker 2: centimeters or developing an abnormal field heart rate to two 195 00:11:46,040 --> 00:11:51,720 Speaker 2: centimeters and needing an emergency cesarean section delivery. Most people 196 00:11:51,760 --> 00:11:57,360 Speaker 2: would consider that that's an unknown candidate and really could 197 00:11:57,360 --> 00:12:00,360 Speaker 2: give feedback a try. What are the things that would 198 00:12:00,400 --> 00:12:02,800 Speaker 2: be nice would be? If it would be if the 199 00:12:02,840 --> 00:12:05,240 Speaker 2: GBS swab at thirty six weeks in the subsequent pregnancy 200 00:12:05,320 --> 00:12:07,360 Speaker 2: was negative. Yeah, which of course it might be. It 201 00:12:07,360 --> 00:12:12,000 Speaker 2: comes and goes, so that you were less there was 202 00:12:12,120 --> 00:12:13,679 Speaker 2: less need for augmentation. 203 00:12:14,400 --> 00:12:19,760 Speaker 1: Yeah, and yes, augmentation not exactly induction. So her ball 204 00:12:19,960 --> 00:12:21,400 Speaker 1: started rolling once her. 205 00:12:21,320 --> 00:12:24,360 Speaker 2: Waters broke, and yes, that's when it suddenly that's. 206 00:12:24,240 --> 00:12:28,120 Speaker 1: Where step strip B became the issue. Yes, but if 207 00:12:28,160 --> 00:12:31,960 Speaker 1: she went along and just had knew that she had 208 00:12:32,000 --> 00:12:34,839 Speaker 1: strap bee, but then went into labor naturally for a 209 00:12:34,920 --> 00:12:37,720 Speaker 1: v back and labored quickly and labored quickly, she wouldn't 210 00:12:37,760 --> 00:12:38,679 Speaker 1: need any augmentation. 211 00:12:38,800 --> 00:12:42,560 Speaker 2: No, that's right. So that so best case scenario would 212 00:12:42,559 --> 00:12:43,480 Speaker 2: be the test negative. 213 00:12:43,600 --> 00:12:43,840 Speaker 1: Yeah. 214 00:12:44,320 --> 00:12:46,719 Speaker 2: Second best case scenario would be to test positive at 215 00:12:46,720 --> 00:12:50,079 Speaker 2: thirty six weeks but labor efficiently a terms, which of 216 00:12:50,080 --> 00:12:51,520 Speaker 2: course might happen second time around. 217 00:12:51,720 --> 00:12:51,880 Speaker 4: Yeah. 218 00:12:52,120 --> 00:12:54,800 Speaker 2: So the water's break, the contractions come quickly, nobody comes 219 00:12:54,880 --> 00:12:59,959 Speaker 2: near you with any sinto and you have essentially a normal, 220 00:13:00,840 --> 00:13:03,080 Speaker 2: non augmented beback labor. 221 00:13:03,280 --> 00:13:07,280 Speaker 1: Yeah. Now, Lauren, We've done lots of episodes that I 222 00:13:07,320 --> 00:13:09,480 Speaker 1: think might help you here. We've actually done a strip 223 00:13:09,520 --> 00:13:14,000 Speaker 1: B episode, We've done a v back episode, and an 224 00:13:14,040 --> 00:13:16,880 Speaker 1: induction episode. So maybe have a listen to all three 225 00:13:16,920 --> 00:13:21,200 Speaker 1: of those. This is where if you're in our program, 226 00:13:21,240 --> 00:13:24,400 Speaker 1: you would you would naturally be presented with that information. 227 00:13:24,559 --> 00:13:26,520 Speaker 1: So you know you're going along in your pregnancy. You 228 00:13:26,520 --> 00:13:30,240 Speaker 1: haven't even thought about what a strip BEE might positive 229 00:13:30,240 --> 00:13:32,520 Speaker 1: test might mean for you. Then in the graw My 230 00:13:32,600 --> 00:13:35,520 Speaker 1: Baby program you're presented with that information, so you sort 231 00:13:35,520 --> 00:13:38,880 Speaker 1: of know that information before you're sitting in your doctor's 232 00:13:38,880 --> 00:13:40,959 Speaker 1: office or your midwife's office, and all of a sudden 233 00:13:40,960 --> 00:13:43,280 Speaker 1: you're presented with the information. You go, hang on a minute. 234 00:13:43,440 --> 00:13:45,040 Speaker 2: These are the questions something to us. 235 00:13:45,080 --> 00:13:49,240 Speaker 1: Yeah, good and good luck. Good luck with all your choices. There, 236 00:13:50,480 --> 00:13:52,280 Speaker 1: Let's move on to our next caller. 237 00:13:53,600 --> 00:13:58,040 Speaker 5: Hi, my name's Rebecca. I would love some advice on 238 00:13:58,200 --> 00:14:02,440 Speaker 5: breach babies. I have a very stubborn breach baby that 239 00:14:02,600 --> 00:14:06,320 Speaker 5: is refusing to turn. Can you talk through some of 240 00:14:06,360 --> 00:14:12,160 Speaker 5: the pros and cons of ACV and particularly weighed against 241 00:14:12,200 --> 00:14:15,360 Speaker 5: the risks and benefits of going straight to a caesar 242 00:14:16,320 --> 00:14:18,840 Speaker 5: and also be good to look at that from the 243 00:14:18,960 --> 00:14:20,840 Speaker 5: mum's and the baby's perspective. 244 00:14:21,320 --> 00:14:22,160 Speaker 4: Thank you so much. 245 00:14:23,240 --> 00:14:26,680 Speaker 1: Now, Rebecca didn't tell us what week she was at. Sure, 246 00:14:26,800 --> 00:14:27,960 Speaker 1: we don't know how pregnant she is. 247 00:14:28,320 --> 00:14:33,200 Speaker 2: Sure, yep, I think we've done an episode on ACV. Yeah, 248 00:14:33,280 --> 00:14:33,720 Speaker 2: good breach. 249 00:14:33,840 --> 00:14:36,600 Speaker 1: Yeah, within the breach episode. 250 00:14:36,240 --> 00:14:38,480 Speaker 2: I think let's assume for a moment people have had 251 00:14:38,480 --> 00:14:40,880 Speaker 2: a bit of a listen to the ECV episode and 252 00:14:40,960 --> 00:14:45,000 Speaker 2: can familiarize themselves with what involves. Basically, it's a technique 253 00:14:45,000 --> 00:14:48,080 Speaker 2: whereby we can come into the hospital with a baby 254 00:14:48,120 --> 00:14:51,040 Speaker 2: in the breach position and under a bit of a 255 00:14:51,080 --> 00:14:56,000 Speaker 2: controlled environment, place our hands on the pregnant woman's belly 256 00:14:56,040 --> 00:14:59,920 Speaker 2: and trying to turn the baby around and look at 257 00:15:00,560 --> 00:15:06,200 Speaker 2: a It's an established and well described technique. I've always 258 00:15:06,240 --> 00:15:09,960 Speaker 2: found it to be a real knack thing, and the 259 00:15:10,000 --> 00:15:12,720 Speaker 2: people who were the best at it, without question, were 260 00:15:12,720 --> 00:15:15,640 Speaker 2: the really old guys who trained me when I was 261 00:15:15,680 --> 00:15:19,160 Speaker 2: at the Royal Women's guys that doubtless by now have 262 00:15:19,240 --> 00:15:22,000 Speaker 2: moved on because they, I mean like moved on to 263 00:15:22,080 --> 00:15:28,000 Speaker 2: moved on past other worlds, celest Jilie, because they you know, 264 00:15:28,400 --> 00:15:31,680 Speaker 2: I think there was a certain era in the medical 265 00:15:31,720 --> 00:15:37,200 Speaker 2: worldhere cases were dangerous. They hadn't nailed the spinal anesthetic. 266 00:15:37,440 --> 00:15:39,440 Speaker 2: They hadn't nailed and before that they had nailed the 267 00:15:39,440 --> 00:15:40,280 Speaker 2: surgical technique. 268 00:15:40,360 --> 00:15:42,440 Speaker 1: No used to be like up and down the belly, 269 00:15:42,440 --> 00:15:42,800 Speaker 1: didn't it. 270 00:15:43,200 --> 00:15:49,560 Speaker 2: So they had more incentive to avoid cesarean section. 271 00:15:50,640 --> 00:15:53,840 Speaker 1: And can I tell a quick story about that? So 272 00:15:54,080 --> 00:15:57,920 Speaker 1: I grew up in a little country town and had 273 00:15:57,920 --> 00:16:02,160 Speaker 1: a very Catholic upbringing where our main community was going 274 00:16:02,200 --> 00:16:06,720 Speaker 1: to church on Sundays. Sure, and the people that always 275 00:16:06,760 --> 00:16:11,520 Speaker 1: filled the front que pews were a family that had 276 00:16:11,560 --> 00:16:13,880 Speaker 1: lots of babies and had lots of babies in succession, 277 00:16:14,280 --> 00:16:17,160 Speaker 1: and she would have her babies by cesarean by the 278 00:16:17,160 --> 00:16:18,960 Speaker 1: time that I don't know, the third game or something. 279 00:16:19,520 --> 00:16:22,880 Speaker 1: And I remember that it was a constant that we 280 00:16:22,880 --> 00:16:27,200 Speaker 1: were always praying for missus Hill and her cesareans. 281 00:16:28,240 --> 00:16:34,440 Speaker 2: I'm sure, I'm sure by then they had achieved significant safety. 282 00:16:34,960 --> 00:16:38,280 Speaker 2: But isn't that funny, like maybe in your mother's mind 283 00:16:38,320 --> 00:16:41,840 Speaker 2: that was still potentially a big issue and a dangerous 284 00:16:41,880 --> 00:16:46,440 Speaker 2: thing worth getting your prayers out. Yeah, that's a cracker. 285 00:16:46,520 --> 00:16:52,240 Speaker 2: So I think that where does ECV standard modern obstetric 286 00:16:52,240 --> 00:16:56,240 Speaker 2: practice in Australia, certainly it's done. I don't do it, 287 00:16:56,280 --> 00:16:58,360 Speaker 2: not because I disapprove of it. I don't think it works, 288 00:16:58,360 --> 00:17:01,000 Speaker 2: but because I don't think I'm good at yeah, and 289 00:17:01,040 --> 00:17:04,200 Speaker 2: I haven't. I don't do nearly enough. But I've got 290 00:17:04,200 --> 00:17:08,160 Speaker 2: some colleagues in Melbourne who do, and occasionally I'll send 291 00:17:08,160 --> 00:17:12,280 Speaker 2: people to them only because I think that if you're 292 00:17:12,280 --> 00:17:14,320 Speaker 2: going to do ecvs, probably should do a fair few 293 00:17:14,359 --> 00:17:19,480 Speaker 2: would be good at it. Yeah, there was so, you 294 00:17:19,520 --> 00:17:23,560 Speaker 2: know the call I set about for mother and baby. 295 00:17:24,800 --> 00:17:26,800 Speaker 2: It's hard to know what a baby's experiencing on the 296 00:17:26,840 --> 00:17:29,280 Speaker 2: on the on the inside, but there are some there 297 00:17:29,280 --> 00:17:31,679 Speaker 2: are some fetal risks involved in doing it, which is 298 00:17:31,680 --> 00:17:35,000 Speaker 2: why it should be done in a hospital where under 299 00:17:35,720 --> 00:17:38,720 Speaker 2: fetal heart rate monitoring, so that if a significant problem occurs, 300 00:17:39,080 --> 00:17:44,520 Speaker 2: you can proceed immediately to cesarean section and then and 301 00:17:44,880 --> 00:17:48,080 Speaker 2: then for the For the mothers, it's a little you know, 302 00:17:48,119 --> 00:17:53,119 Speaker 2: it's unpleasant to get the baby to turn around and 303 00:17:53,240 --> 00:17:56,360 Speaker 2: sort of do a forward role. You need to disengage 304 00:17:56,400 --> 00:17:59,639 Speaker 2: the breach from the palvi. So the baby's bum is 305 00:17:59,680 --> 00:18:03,080 Speaker 2: the brief that's right down in the pelvis in late pregnancy, 306 00:18:03,119 --> 00:18:05,600 Speaker 2: and you've got to push that up out of the 307 00:18:05,680 --> 00:18:09,760 Speaker 2: pelvis and then flip the baby around and then it hurts. 308 00:18:09,880 --> 00:18:12,080 Speaker 1: I would say that would feel quite painful. 309 00:18:12,160 --> 00:18:13,040 Speaker 2: Yeah yeah. 310 00:18:13,080 --> 00:18:14,840 Speaker 1: Are they lying on their back when this happens? 311 00:18:15,359 --> 00:18:15,600 Speaker 5: Uh? 312 00:18:15,680 --> 00:18:20,080 Speaker 2: Yeah, yeah, so you know, so it's it's not that pleasant. 313 00:18:22,440 --> 00:18:25,040 Speaker 2: The other thing I think where ECV kind of sits 314 00:18:25,640 --> 00:18:30,320 Speaker 2: is that once upon a time, people, you know, individual 315 00:18:30,400 --> 00:18:34,560 Speaker 2: woman had more babies than they do now. And I 316 00:18:34,600 --> 00:18:38,159 Speaker 2: think that if you were thinking you might have might 317 00:18:38,160 --> 00:18:41,080 Speaker 2: have had four or five babies and you were trying 318 00:18:41,080 --> 00:18:45,120 Speaker 2: to avoid four or five sections, then an ECV might 319 00:18:45,119 --> 00:18:46,960 Speaker 2: have been worth it if your first baby was in 320 00:18:46,960 --> 00:18:49,960 Speaker 2: a breach presentation, because then you could get that baby 321 00:18:49,960 --> 00:18:52,000 Speaker 2: to flip around, have that baby vaginally and all the 322 00:18:52,000 --> 00:18:56,560 Speaker 2: other babies vaginally. And it's a little different these days, 323 00:18:56,640 --> 00:19:00,080 Speaker 2: especially in my private practice, where people want to do 324 00:19:00,880 --> 00:19:05,919 Speaker 2: and they get started later. And this is not from me, 325 00:19:06,040 --> 00:19:09,920 Speaker 2: this is from my patients that they are less worried 326 00:19:10,920 --> 00:19:13,520 Speaker 2: about having those babies by says their insection. If that's 327 00:19:13,520 --> 00:19:16,280 Speaker 2: what the if, that's if that's what needs to happen. 328 00:19:17,600 --> 00:19:24,560 Speaker 2: So I think that ECV is probably limited by patient demand. 329 00:19:24,880 --> 00:19:26,520 Speaker 2: I don't have a lot of people saying should we 330 00:19:26,560 --> 00:19:31,600 Speaker 2: do this for my patients more often than I recommend 331 00:19:31,600 --> 00:19:34,800 Speaker 2: ECV if they want my recommendation. We often spend a 332 00:19:34,840 --> 00:19:36,680 Speaker 2: lot of time talking to people about risks and benefits, 333 00:19:36,680 --> 00:19:38,760 Speaker 2: but the choice is up to you. But then sometimes 334 00:19:38,760 --> 00:19:40,480 Speaker 2: people will turn around say, yeah, I understand that, but 335 00:19:40,520 --> 00:19:44,040 Speaker 2: what do you think? What would you do more often 336 00:19:44,080 --> 00:19:46,639 Speaker 2: than I recommend ECV, I recommend a section for the 337 00:19:46,640 --> 00:19:49,679 Speaker 2: breach baby and a v back for second baby, and 338 00:19:49,680 --> 00:19:51,880 Speaker 2: that way you get what I think is the safest 339 00:19:51,880 --> 00:19:58,480 Speaker 2: option without but also still experience a vaginal birth with 340 00:19:59,240 --> 00:20:01,960 Speaker 2: v back. And typically a woman having her second baby, 341 00:20:02,000 --> 00:20:04,639 Speaker 2: if she had the first Caesar for breach and the 342 00:20:04,720 --> 00:20:08,440 Speaker 2: second baby is kephalic, and she has that baby by feedback, 343 00:20:08,720 --> 00:20:12,640 Speaker 2: then she would be considered a good vback candidate because 344 00:20:12,880 --> 00:20:16,000 Speaker 2: for all we know she labors terrific. It's just we 345 00:20:16,040 --> 00:20:18,600 Speaker 2: didn't do it. Yes we did it, Caesar, and. 346 00:20:18,880 --> 00:20:21,520 Speaker 1: You know it just so happens, scosh. Things are in cycles. 347 00:20:21,520 --> 00:20:23,680 Speaker 1: But all of that, well not all, but so many 348 00:20:23,720 --> 00:20:27,879 Speaker 1: of our questions in the latest batch of speak pipes 349 00:20:27,880 --> 00:20:32,120 Speaker 1: were about feedback. So you say about people not having 350 00:20:32,160 --> 00:20:35,639 Speaker 1: as many babies, but the cycle comes and goes. Where 351 00:20:35,800 --> 00:20:39,119 Speaker 1: the what's in their heart. What's in people's heart is 352 00:20:39,160 --> 00:20:43,400 Speaker 1: to have a vaginal birth. Yes, and so this cycle 353 00:20:44,240 --> 00:20:46,600 Speaker 1: is that people really do want to experience a vaginal birth, 354 00:20:46,640 --> 00:20:50,200 Speaker 1: maybe feel disappointed or or feel like they didn't have 355 00:20:50,240 --> 00:20:52,919 Speaker 1: that experience that they thought childbirth was in their first 356 00:20:52,920 --> 00:20:57,159 Speaker 1: and are looking for answers about feedback. It's interesting because 357 00:20:57,359 --> 00:20:59,119 Speaker 1: just not that long ago, everyone was asking for a 358 00:20:59,160 --> 00:21:02,360 Speaker 1: plan CESARA. So you know, it's I don't know what happens. 359 00:21:02,960 --> 00:21:08,840 Speaker 2: Things topics come and go in the public's attention. That's true, 360 00:21:09,000 --> 00:21:12,639 Speaker 2: But I think that some trends have emerged over the years, 361 00:21:12,680 --> 00:21:17,680 Speaker 2: and I think one is that supporting v back, encouraging 362 00:21:17,800 --> 00:21:27,000 Speaker 2: v back, and putting and conducting vbacks when it might 363 00:21:27,000 --> 00:21:31,320 Speaker 2: have been easy to do a thesar, all of that 364 00:21:31,520 --> 00:21:35,399 Speaker 2: is really important in maintaining choice. And I think that 365 00:21:35,520 --> 00:21:39,320 Speaker 2: it really helps if I'm recommending for solid obstetric reasons 366 00:21:39,320 --> 00:21:41,800 Speaker 2: that a woman has her first baby by cesare in section. 367 00:21:42,480 --> 00:21:46,760 Speaker 2: I think it really helps to know that I mean 368 00:21:46,800 --> 00:21:49,560 Speaker 2: it when I say that you're likely to be a 369 00:21:49,560 --> 00:21:53,159 Speaker 2: good candidate for vback next time around, and that person 370 00:21:53,200 --> 00:21:55,399 Speaker 2: can say, fine, I'll have this baby by sines are 371 00:21:55,480 --> 00:21:58,840 Speaker 2: in section because it's the wisest decision for today, but 372 00:21:59,280 --> 00:22:02,320 Speaker 2: next time, if it's in my heart to have a vback, 373 00:22:02,359 --> 00:22:02,720 Speaker 2: I will. 374 00:22:02,880 --> 00:22:06,399 Speaker 1: Yeah. And maybe the questions that patients should be asking 375 00:22:06,640 --> 00:22:11,240 Speaker 1: is have you done ACVs? What are the success rates? 376 00:22:11,280 --> 00:22:14,280 Speaker 1: Like you know, what's your experience for that particular practitioner. 377 00:22:14,400 --> 00:22:17,480 Speaker 1: Like we could give you lots of things about ecvs, 378 00:22:17,520 --> 00:22:19,320 Speaker 1: but you know, if you've got a practitioner that's done 379 00:22:19,800 --> 00:22:21,720 Speaker 1: many and I don't even know what would you count 380 00:22:21,760 --> 00:22:24,080 Speaker 1: as many ecvs? What would give you enough experience to 381 00:22:24,119 --> 00:22:25,800 Speaker 1: go yep? I can put my hand on my heart and. 382 00:22:25,760 --> 00:22:29,560 Speaker 2: Say yep, dozens of previous and several years. 383 00:22:29,880 --> 00:22:30,120 Speaker 1: Yeah. 384 00:22:30,320 --> 00:22:32,960 Speaker 2: Yeah, and that's that. It's not me when it comes 385 00:22:33,000 --> 00:22:38,240 Speaker 2: to ECV. Yeah. So I would only want to if 386 00:22:38,240 --> 00:22:41,240 Speaker 2: this was me or you, I would only want. 387 00:22:41,000 --> 00:22:42,400 Speaker 1: To It'd be weird I it was you. 388 00:22:43,000 --> 00:22:46,160 Speaker 2: I would only want to do that if I knew 389 00:22:46,240 --> 00:22:49,800 Speaker 2: that I would only want to take the inherent risks 390 00:22:50,640 --> 00:22:53,320 Speaker 2: if there was a promise of success. Yeah sorry, a 391 00:22:53,359 --> 00:22:55,960 Speaker 2: reasonable likelihood of success. Yeah, otherwise aw a risk and 392 00:22:56,000 --> 00:22:59,280 Speaker 2: I benefit yeap. So I'd be saying I would want 393 00:22:59,320 --> 00:23:02,800 Speaker 2: to be where that could where the success rate was 394 00:23:02,880 --> 00:23:07,359 Speaker 2: known and acceptable to me. Yeah, that would be a 395 00:23:07,520 --> 00:23:09,399 Speaker 2: real part of assessing the risk for me. 396 00:23:09,840 --> 00:23:10,720 Speaker 6: Yeah. 397 00:23:10,800 --> 00:23:12,800 Speaker 1: And the other question I perhaps would be asking my 398 00:23:12,920 --> 00:23:17,399 Speaker 1: practitioner is how many v backs have you attended? How 399 00:23:17,480 --> 00:23:20,919 Speaker 1: many v backs have been successful for you? Yeah? Is 400 00:23:20,960 --> 00:23:25,640 Speaker 1: it something that you have patients for for time because 401 00:23:25,640 --> 00:23:27,480 Speaker 1: it takes sometimes it takes a bit longer, doesn't that? 402 00:23:27,880 --> 00:23:31,840 Speaker 2: And would you consider me on the basis of what's 403 00:23:31,840 --> 00:23:35,440 Speaker 2: happened so far if I have this season now, would 404 00:23:35,480 --> 00:23:40,439 Speaker 2: you consider me a good v back candidate in two 405 00:23:40,480 --> 00:23:41,240 Speaker 2: and a half his time? 406 00:23:41,320 --> 00:23:44,520 Speaker 1: Yeah? And for all the other v back questions that 407 00:23:44,560 --> 00:23:48,000 Speaker 1: we had in the list today, go there is. We've 408 00:23:48,000 --> 00:23:50,720 Speaker 1: got a really great story. One of our patients helped 409 00:23:50,760 --> 00:23:54,240 Speaker 1: us out on the v back episode where she told 410 00:23:54,240 --> 00:23:54,720 Speaker 1: her story. 411 00:23:54,840 --> 00:23:55,080 Speaker 2: Yeah. 412 00:23:55,160 --> 00:23:58,840 Speaker 1: Yeah, and it's really lovely to listen to. Good alrighty, 413 00:23:59,119 --> 00:24:01,199 Speaker 1: we're going to move on nowt. 414 00:24:02,640 --> 00:24:04,879 Speaker 6: Hi Doctor pattern Bridget, I have a two part question. 415 00:24:05,440 --> 00:24:08,160 Speaker 6: I recently gave birth to my first daughter, full term, 416 00:24:08,359 --> 00:24:12,640 Speaker 6: uncomplicated pregnancy other than hyperamesis. She was induced twenty four 417 00:24:12,640 --> 00:24:16,800 Speaker 6: hours after spontaneous rupture of membranes without progression. I ended 418 00:24:16,880 --> 00:24:19,080 Speaker 6: up having a beautiful water birth with four hour and 419 00:24:19,119 --> 00:24:23,080 Speaker 6: twenty minute labor seventeen minute pushing phase. I experienced the 420 00:24:23,080 --> 00:24:25,720 Speaker 6: fetal ejection reflex and did not need to actively push 421 00:24:25,800 --> 00:24:28,640 Speaker 6: except for her shoulders. My daughter then had a full 422 00:24:28,680 --> 00:24:30,800 Speaker 6: resource and a bag of blood due to a hemorrhage 423 00:24:30,840 --> 00:24:33,920 Speaker 6: caused by a shearing injury to the cord, which impacted 424 00:24:33,920 --> 00:24:36,919 Speaker 6: two of the three blood vessels. This was not apparent 425 00:24:37,000 --> 00:24:39,640 Speaker 6: until after the shoulders were delivered and the blood escaped. 426 00:24:40,200 --> 00:24:43,119 Speaker 6: She is now perfectly healthy and happy four month old. 427 00:24:43,440 --> 00:24:46,879 Speaker 6: My first question is how likely am I to experience 428 00:24:47,000 --> 00:24:51,480 Speaker 6: the fetal ejection reflex for subsequent births. Secondly, what is 429 00:24:51,520 --> 00:24:54,639 Speaker 6: your experience with shearing injuries to the cord. We're waiting 430 00:24:54,640 --> 00:24:58,280 Speaker 6: on state histopathology results, and there is limited research on 431 00:24:58,359 --> 00:25:01,720 Speaker 6: the actual causes of sheer injuries from what I can find. 432 00:25:02,400 --> 00:25:05,840 Speaker 1: Thank you to your little baby. Squeak was there. 433 00:25:06,080 --> 00:25:06,679 Speaker 2: I didn't hear that. 434 00:25:06,680 --> 00:25:09,560 Speaker 1: That's nice. I love it. She's she's quite an optimistic 435 00:25:09,600 --> 00:25:13,200 Speaker 1: person because other people would describe the pregnancy and birth 436 00:25:13,800 --> 00:25:14,560 Speaker 1: kind of differently. 437 00:25:15,119 --> 00:25:18,040 Speaker 2: Yes, we need a blood transfusion. 438 00:25:18,119 --> 00:25:21,680 Speaker 1: Yeah, Also that she had a pregnancy with hate hyperamesis 439 00:25:21,720 --> 00:25:24,479 Speaker 1: well yeah, you know, like yeah, that in itself can 440 00:25:24,480 --> 00:25:24,959 Speaker 1: be traumatic. 441 00:25:25,119 --> 00:25:28,520 Speaker 2: Yeah, so that's good. That's a really glass half full 442 00:25:28,560 --> 00:25:31,280 Speaker 2: way of looking at it. So that was a pregnancy 443 00:25:31,320 --> 00:25:36,440 Speaker 2: that did have its issues, but a cracking labor terrific. 444 00:25:36,720 --> 00:25:43,679 Speaker 2: So the the piece of that that I want to 445 00:25:43,680 --> 00:25:46,800 Speaker 2: discuss today is the is this injury to the cord? 446 00:25:47,760 --> 00:25:52,920 Speaker 2: Those are not at all common. And remember the blood 447 00:25:52,960 --> 00:25:57,080 Speaker 2: that's in the cord, that's the baby's blood, and we 448 00:25:57,119 --> 00:26:02,119 Speaker 2: don't want to let it leak out. So it is 449 00:26:02,200 --> 00:26:05,000 Speaker 2: possible to get some sort of shearing forces on the 450 00:26:05,080 --> 00:26:09,119 Speaker 2: cord and then and the cord can break and fetal 451 00:26:09,160 --> 00:26:13,000 Speaker 2: blood comes leaks out, and then the baby can be 452 00:26:13,080 --> 00:26:17,280 Speaker 2: left anemic. And that seems to be what happened on 453 00:26:17,320 --> 00:26:23,359 Speaker 2: this occasion, and maybe needed a transfusion. And often it 454 00:26:23,359 --> 00:26:26,840 Speaker 2: would be obvious that that's what's happened. There's a bit 455 00:26:26,840 --> 00:26:31,960 Speaker 2: of debate about exactly why it happens. I think some 456 00:26:32,040 --> 00:26:35,960 Speaker 2: of them would be due to difficult birth, traumatic parts 457 00:26:36,000 --> 00:26:38,840 Speaker 2: of the of the birth. If the cord was up 458 00:26:38,840 --> 00:26:42,080 Speaker 2: next to the fetal head and forces were used, for example, 459 00:26:42,600 --> 00:26:44,680 Speaker 2: then it could damage the cord. 460 00:26:45,040 --> 00:26:46,600 Speaker 1: The speed of this birth. 461 00:26:47,400 --> 00:26:51,439 Speaker 2: I don't think that's likely to be relevant because fast 462 00:26:51,440 --> 00:26:57,400 Speaker 2: births happen all the time, and and cord shearing injuries 463 00:26:57,400 --> 00:26:58,280 Speaker 2: are really uncommon. 464 00:26:58,760 --> 00:27:01,239 Speaker 1: I can hang on, what is shearing? What does that 465 00:27:01,280 --> 00:27:02,560 Speaker 1: mean that it's sheered off? 466 00:27:02,840 --> 00:27:06,520 Speaker 2: Yeah, like it's just been sort of you know, force 467 00:27:06,560 --> 00:27:11,639 Speaker 2: has been applied to it and it's broken. So I 468 00:27:11,680 --> 00:27:15,080 Speaker 2: guess that it could be explained by some intervention in 469 00:27:15,119 --> 00:27:20,199 Speaker 2: the birth, like forces on rare occasions. But also there 470 00:27:20,240 --> 00:27:26,120 Speaker 2: are some cords that are very thin and fragile, and 471 00:27:26,160 --> 00:27:30,440 Speaker 2: that's typically related to prematurity, although sometimes the term baby 472 00:27:30,440 --> 00:27:32,600 Speaker 2: has a really thin and fragile cord and you go 473 00:27:32,680 --> 00:27:34,200 Speaker 2: to put a little bit of traction on the cord 474 00:27:34,240 --> 00:27:37,560 Speaker 2: to help the percenter come out, and it breaks. Whereas 475 00:27:37,560 --> 00:27:40,200 Speaker 2: we like a cord to be a pretty pretty fat 476 00:27:40,240 --> 00:27:42,640 Speaker 2: sort of thing with lots of that lots of this 477 00:27:43,280 --> 00:27:46,560 Speaker 2: chord protection around it called Wharton's jelly, where the where 478 00:27:46,600 --> 00:27:51,080 Speaker 2: the cord is good centimeter across and it's fat, and 479 00:27:51,160 --> 00:27:53,960 Speaker 2: the vessels inside it are protected by all this jelly 480 00:27:54,560 --> 00:27:58,399 Speaker 2: and less likely to be squished by the head. Yeah, 481 00:27:58,840 --> 00:28:01,960 Speaker 2: so really unco common scenario. But one thing in this 482 00:28:02,000 --> 00:28:04,160 Speaker 2: case that was obviously picked up by obviously the cord 483 00:28:04,240 --> 00:28:06,360 Speaker 2: was noted to be damaged. There was fetal blood coming 484 00:28:06,400 --> 00:28:10,720 Speaker 2: out of it, and they and they dealt with that, 485 00:28:10,880 --> 00:28:14,160 Speaker 2: and the pediatricians arranged a transfusion for the baby. 486 00:28:14,720 --> 00:28:18,520 Speaker 1: Is there any correlation between a pregnancy with hyperremesis and 487 00:28:20,040 --> 00:28:22,720 Speaker 1: the quality of the cord? 488 00:28:22,920 --> 00:28:24,960 Speaker 2: No, not that I'm not that I'm aware of. I don't. 489 00:28:25,000 --> 00:28:28,720 Speaker 2: I don't think that's a connection that's ever been made. 490 00:28:30,040 --> 00:28:34,160 Speaker 2: I think the chords some are fat, some are fat, 491 00:28:34,240 --> 00:28:36,399 Speaker 2: and some are thin, and I don't know if anyone 492 00:28:36,480 --> 00:28:40,320 Speaker 2: really knows the reasons behind that. So I think our 493 00:28:40,360 --> 00:28:42,560 Speaker 2: callers should be confident that this is a super rare 494 00:28:42,600 --> 00:28:45,280 Speaker 2: thing that by virtue of being super rare, is unlike 495 00:28:45,280 --> 00:28:49,560 Speaker 2: that happened again. Yeah, yeah, there may be a tiny subgroup. 496 00:28:49,600 --> 00:28:52,080 Speaker 2: This might have been the research she was looking for 497 00:28:52,760 --> 00:28:55,960 Speaker 2: about whether there's someone who sort of inherently makes chords 498 00:28:56,240 --> 00:29:00,720 Speaker 2: that are prone to damage. I don't belief that's an 499 00:29:00,800 --> 00:29:05,160 Speaker 2: established phenomenon, but someone may be looking into that. But 500 00:29:05,280 --> 00:29:10,719 Speaker 2: I would have thought that the phenomenon was so unlike, 501 00:29:11,240 --> 00:29:16,320 Speaker 2: so rare, that she could confidently have another chinal birth 502 00:29:16,360 --> 00:29:19,840 Speaker 2: and that could be an outcome that could be closely 503 00:29:19,880 --> 00:29:22,080 Speaker 2: watched for. But it's most unlikely to happen again. 504 00:29:22,360 --> 00:29:25,520 Speaker 1: That's the problem. You know, in a lot of pregnancy research, 505 00:29:25,560 --> 00:29:29,640 Speaker 1: isn't it. Sometimes, these super rare things, it's hard to 506 00:29:29,880 --> 00:29:34,600 Speaker 1: get good, robust information research around it because you know, 507 00:29:34,840 --> 00:29:36,920 Speaker 1: how do you even set up a. 508 00:29:36,600 --> 00:29:38,360 Speaker 2: Research Yeah, it's not happening. 509 00:29:41,120 --> 00:29:43,040 Speaker 1: She talks a little bit. Just want to touch on 510 00:29:43,080 --> 00:29:44,480 Speaker 1: the fetal ejection reflex? 511 00:29:44,560 --> 00:29:46,040 Speaker 2: Oh, yes, what is it? 512 00:29:46,680 --> 00:29:47,480 Speaker 1: Does everyone get it? 513 00:29:47,840 --> 00:29:48,040 Speaker 4: Yeah? 514 00:29:48,920 --> 00:29:51,800 Speaker 2: I think that what most people are talking about when 515 00:29:51,840 --> 00:29:56,240 Speaker 2: they talk about a fetal ejection reflex is getting to 516 00:29:56,320 --> 00:30:03,080 Speaker 2: that state where the body pretty much automatically injects the baby. 517 00:30:03,840 --> 00:30:08,000 Speaker 2: And whether that's the same thing as pushing that happens automatically, 518 00:30:08,840 --> 00:30:11,640 Speaker 2: or whether it's like pushing that just happens without you 519 00:30:12,120 --> 00:30:17,160 Speaker 2: thinking you're pushing, yeah, or whether it's a totally different phenomenon. 520 00:30:17,240 --> 00:30:20,560 Speaker 2: I don't know. I don't know whether which of those 521 00:30:20,640 --> 00:30:24,920 Speaker 2: is true, but certainly it's very very useful to get 522 00:30:24,960 --> 00:30:30,960 Speaker 2: to the point where you can't help but push. Yeah, 523 00:30:31,240 --> 00:30:33,840 Speaker 2: And whether you're actually pushing because you can't resist it, 524 00:30:33,920 --> 00:30:36,160 Speaker 2: like doing half a poo, it's hard to stop halfway 525 00:30:36,160 --> 00:30:38,440 Speaker 2: through and just say well, I'm done now. Your body 526 00:30:38,440 --> 00:30:40,959 Speaker 2: wants to keep going. That's where you want to get to. 527 00:30:42,120 --> 00:30:48,800 Speaker 2: And if people, if people women in labor pushing automatically, deliberately. 528 00:30:48,800 --> 00:30:51,200 Speaker 2: I don't think it matters, but it's happening, whether they 529 00:30:51,320 --> 00:30:54,959 Speaker 2: feel like they can control it or not. That's really 530 00:30:55,520 --> 00:30:58,000 Speaker 2: a great place to get to. Lots of the pushing 531 00:30:58,040 --> 00:31:01,760 Speaker 2: that's done before then, where you're choosing to push, it's useful, 532 00:31:01,800 --> 00:31:05,880 Speaker 2: but it's where yourself out. Yeah, and if you start 533 00:31:06,200 --> 00:31:09,600 Speaker 2: choosing to push too early because you've been recommended better 534 00:31:09,640 --> 00:31:14,960 Speaker 2: start pushing, and people have got one or two hours 535 00:31:15,000 --> 00:31:17,600 Speaker 2: of that in them, and then if still babies still 536 00:31:17,640 --> 00:31:21,120 Speaker 2: not out, we can be setting ourselves up for a 537 00:31:21,200 --> 00:31:24,880 Speaker 2: high chance of an instrumental birth. Whereas all things being equal, 538 00:31:24,880 --> 00:31:28,120 Speaker 2: and if there's no rush, there's no concerns about fetal wellbeing, 539 00:31:28,720 --> 00:31:32,280 Speaker 2: and we wait for fidal head to descend further down 540 00:31:32,320 --> 00:31:37,240 Speaker 2: into the pelvis, then then we can reach a point 541 00:31:37,480 --> 00:31:41,760 Speaker 2: where you can't help but push, and that's way more 542 00:31:41,760 --> 00:31:45,800 Speaker 2: efficient and likely to be able to get the baby 543 00:31:45,840 --> 00:31:47,400 Speaker 2: out before you're exhausted. 544 00:31:47,680 --> 00:31:50,560 Speaker 1: Yeah, anyone listening to this and then all of a 545 00:31:50,560 --> 00:31:52,000 Speaker 1: sudden going, oh my god, now I've got to think 546 00:31:52,000 --> 00:31:52,600 Speaker 1: about pushing. 547 00:31:52,960 --> 00:31:53,440 Speaker 2: Guess what. 548 00:31:53,680 --> 00:31:56,800 Speaker 1: We have an episode on that, so we'll put that 549 00:31:56,840 --> 00:31:59,120 Speaker 1: in the show notes as well. And you know, I 550 00:31:59,200 --> 00:32:03,120 Speaker 1: like how you describe, but because sometimes she actually described 551 00:32:03,120 --> 00:32:06,120 Speaker 1: it as she didn't have to push until she got 552 00:32:06,120 --> 00:32:09,760 Speaker 1: to the shoulders. Yes, so, but she has been pushing 553 00:32:09,800 --> 00:32:10,680 Speaker 1: probably beforehand. 554 00:32:10,680 --> 00:32:15,160 Speaker 2: But that's right. And she asked about whether the happened again. 555 00:32:15,400 --> 00:32:19,920 Speaker 2: I think that phenomenon is more common than more baby chef. Yeah, yeah, yeah, 556 00:32:20,000 --> 00:32:24,160 Speaker 2: So you dilate quickly, the head descends quickly, there's less 557 00:32:24,200 --> 00:32:27,960 Speaker 2: resistance to the tissue around the around the birth now, 558 00:32:28,440 --> 00:32:34,640 Speaker 2: and the fetal head arrives near the vaginal opening faster, 559 00:32:35,280 --> 00:32:38,040 Speaker 2: and then there's an overwhelming urge to expel. 560 00:32:38,160 --> 00:32:42,760 Speaker 1: Yeah right, all right, good luck with your research. If 561 00:32:42,760 --> 00:32:45,440 Speaker 1: you find anything, just maybe you could send it to 562 00:32:45,520 --> 00:32:48,920 Speaker 1: us and we'll assess it and maybe even do an 563 00:32:48,960 --> 00:32:50,840 Speaker 1: episode on it and if it is something that is 564 00:32:50,880 --> 00:32:55,520 Speaker 1: a valid research paper to be talking about. Alrighty, we've 565 00:32:55,520 --> 00:32:58,400 Speaker 1: got to repeat caller now, Pat. 566 00:32:59,400 --> 00:33:03,240 Speaker 4: Hi, doctor Pat and Bridgid. I called in December of 567 00:33:03,280 --> 00:33:06,440 Speaker 4: twenty twenty four after I found out that my son 568 00:33:06,560 --> 00:33:10,280 Speaker 4: had CMB at twenty four weeks and we elected to 569 00:33:10,320 --> 00:33:13,360 Speaker 4: terminate the pregnancy. I'm calling back to say that we 570 00:33:13,440 --> 00:33:17,240 Speaker 4: did do IVF again and I had a great seven 571 00:33:17,280 --> 00:33:21,920 Speaker 4: week scan yesterday that shows another healthy baby growing, so 572 00:33:22,000 --> 00:33:25,160 Speaker 4: I wanted to give you that positive update. I wanted 573 00:33:25,200 --> 00:33:28,560 Speaker 4: to ask a question. My first son, I had a 574 00:33:28,600 --> 00:33:31,160 Speaker 4: scheduled see section because of a complete previa, and I 575 00:33:31,200 --> 00:33:36,120 Speaker 4: was very happy with that experience. With my loss and 576 00:33:38,360 --> 00:33:41,240 Speaker 4: delivery of a fetal loss at twenty six weeks, I 577 00:33:41,240 --> 00:33:43,240 Speaker 4: did have a vaginal delivery and had a lot of 578 00:33:43,280 --> 00:33:45,920 Speaker 4: pain and wanted to thank you for your thoughtful response 579 00:33:45,920 --> 00:33:49,160 Speaker 4: to my question. I am planning another repeat sea section 580 00:33:49,520 --> 00:33:53,200 Speaker 4: and was thinking about doing the risk reducing selping jectomy 581 00:33:53,200 --> 00:33:55,680 Speaker 4: because I know this is my last pregnancy and just 582 00:33:55,720 --> 00:33:58,960 Speaker 4: wanted your thoughts on how that adds time to the 583 00:33:59,000 --> 00:34:03,200 Speaker 4: procedure and any potential for delay and initiation of breastfeeding, 584 00:34:04,000 --> 00:34:07,080 Speaker 4: just with adding on that additional procedure, And if you're 585 00:34:07,080 --> 00:34:09,359 Speaker 4: doing in your practice, you know, what are your thoughts 586 00:34:09,440 --> 00:34:13,040 Speaker 4: on women choosing to do this procedure. I'm hearing that 587 00:34:13,080 --> 00:34:15,960 Speaker 4: it can be a good thing to do when you 588 00:34:16,080 --> 00:34:18,080 Speaker 4: know that you're done with children and having another guid 589 00:34:18,120 --> 00:34:20,360 Speaker 4: inclogic procedure. Anyway, thank you so much for all the 590 00:34:20,360 --> 00:34:22,719 Speaker 4: work that you do, and again for your thoughtful responses 591 00:34:22,760 --> 00:34:25,359 Speaker 4: to all the questions you get. Keep doing the good work. 592 00:34:25,440 --> 00:34:28,719 Speaker 1: Thanks so much in that question, what a great yeah, 593 00:34:28,840 --> 00:34:33,799 Speaker 1: CaAl Yeah, and how exciting to be pregnant again after 594 00:34:33,840 --> 00:34:36,040 Speaker 1: all that heartbreak from last time, and how brave to 595 00:34:36,719 --> 00:34:39,239 Speaker 1: come back and tell us like, yeah, thank you. We 596 00:34:39,320 --> 00:34:39,960 Speaker 1: appreciate that. 597 00:34:40,040 --> 00:34:42,680 Speaker 2: Yeah, we appreciate your you know, you're honesty and your 598 00:34:42,719 --> 00:34:48,560 Speaker 2: openness about that tragic medical scenario you went through last 599 00:34:48,600 --> 00:34:54,360 Speaker 2: time and the doubtless extremely difficult decision followed by some 600 00:34:55,239 --> 00:35:01,480 Speaker 2: happiness that you'll do so well done. The the opportunistics 601 00:35:01,480 --> 00:35:04,400 Speaker 2: to help injecting me is a hot topic at the moment. 602 00:35:04,640 --> 00:35:07,080 Speaker 1: This will be brand new to many, many, many many people, 603 00:35:07,120 --> 00:35:09,160 Speaker 1: so we better yeah dive in. 604 00:35:09,239 --> 00:35:14,640 Speaker 2: So let's talk about it. Ovarian cancer is still a 605 00:35:14,960 --> 00:35:19,400 Speaker 2: highly problematic disease. It's reasonably uncommon, but the outcomes for 606 00:35:19,480 --> 00:35:23,560 Speaker 2: people who get that disease in their fifties sixty seventies 607 00:35:24,239 --> 00:35:28,920 Speaker 2: are still quite poor, and the reason is that the 608 00:35:28,960 --> 00:35:32,839 Speaker 2: disease is often advanced at the time of diagnosis, and 609 00:35:32,880 --> 00:35:37,680 Speaker 2: despite surgery, chemotherapy and so forth, five years of survival 610 00:35:37,760 --> 00:35:44,239 Speaker 2: rates for ovarian cancer fully treated still very poor compared 611 00:35:44,280 --> 00:35:47,040 Speaker 2: to the developments that have been made over the last 612 00:35:47,040 --> 00:35:51,520 Speaker 2: twenty or thirty years with other cancers including breast, cholorectal, 613 00:35:51,560 --> 00:35:59,799 Speaker 2: and so forth. So the focus on ovarian cancer is 614 00:36:00,560 --> 00:36:05,920 Speaker 2: on prevention rather than treatment because we're a little bit 615 00:36:05,960 --> 00:36:08,720 Speaker 2: stuck for advances in treatment. Lots of very very clever 616 00:36:08,760 --> 00:36:12,680 Speaker 2: people are trying a different group of very very clever 617 00:36:12,719 --> 00:36:16,080 Speaker 2: people are trying to work out a screening test that's 618 00:36:16,120 --> 00:36:23,920 Speaker 2: proven difficult. But there's an established intervention that can be 619 00:36:23,960 --> 00:36:28,360 Speaker 2: done for prevention and to help to help with prevention, 620 00:36:28,719 --> 00:36:30,840 Speaker 2: and that's to have your tubes removed when you finish 621 00:36:30,920 --> 00:36:37,279 Speaker 2: your family. So if you have. It turns out that 622 00:36:37,880 --> 00:36:41,880 Speaker 2: quite a quite a large number of cases of ovarian 623 00:36:41,920 --> 00:36:46,759 Speaker 2: cancer start in the tubes, and that if you have 624 00:36:46,880 --> 00:36:51,080 Speaker 2: your tubes removed once you finished your family, you significantly 625 00:36:51,120 --> 00:36:53,960 Speaker 2: reduce your overall risk of ever getting over in cancer 626 00:36:54,000 --> 00:36:58,800 Speaker 2: in the first place. Now, your risk would be reduced 627 00:36:58,960 --> 00:37:02,120 Speaker 2: even further if you had your ovaries removed, but that 628 00:37:02,320 --> 00:37:05,799 Speaker 2: in most pre menopausal women causes more harm than good. 629 00:37:06,520 --> 00:37:10,320 Speaker 2: Wind up instantly menopausal, needing to take menopausal hormone therapy 630 00:37:10,440 --> 00:37:13,360 Speaker 2: until you're at least fifty one or so, if not longer, 631 00:37:13,719 --> 00:37:16,880 Speaker 2: and that's that's not considered standard practice. But your tubes 632 00:37:16,920 --> 00:37:21,200 Speaker 2: you can live without they only have a reproductive purpose. 633 00:37:21,280 --> 00:37:26,600 Speaker 2: They don't they're not otherwise ormnently active, and they can 634 00:37:26,640 --> 00:37:29,719 Speaker 2: you can easily live without them. So rather than just 635 00:37:29,719 --> 00:37:33,480 Speaker 2: clip the tubes for contraceptive purposes, we're more likely these 636 00:37:33,560 --> 00:37:37,799 Speaker 2: days to take them out all together. In someone who 637 00:37:37,800 --> 00:37:39,440 Speaker 2: comes along and says I've had enough babies and I 638 00:37:39,480 --> 00:37:44,760 Speaker 2: want permanent surgical contraception. And then there's a different group 639 00:37:44,880 --> 00:37:47,040 Speaker 2: who might not even need the contraception, maybe the husbands 640 00:37:47,080 --> 00:37:49,080 Speaker 2: out of a sectomy, or maybe they've got no you 641 00:37:49,200 --> 00:37:52,080 Speaker 2: there or whatever, but they just want the tubes removed 642 00:37:52,560 --> 00:37:56,799 Speaker 2: for the overi and cancer risk production. And recently in Australia, 643 00:37:57,520 --> 00:38:03,120 Speaker 2: one of my colleagues in coological oncology has has really 644 00:38:03,200 --> 00:38:06,880 Speaker 2: been very active politically in trying to get other surgical 645 00:38:06,920 --> 00:38:09,680 Speaker 2: groups to talk to women about the value of having 646 00:38:09,680 --> 00:38:14,399 Speaker 2: their tubes removed when they have other surgery such as 647 00:38:14,960 --> 00:38:20,239 Speaker 2: gall bladder or a pandix or something. Because while we're 648 00:38:20,239 --> 00:38:22,920 Speaker 2: there all taking tubes off, and there were some practical 649 00:38:23,160 --> 00:38:25,000 Speaker 2: problems with getting that done, we need people to do 650 00:38:25,000 --> 00:38:27,000 Speaker 2: it properly. It's not not quite as easy as looks, 651 00:38:27,719 --> 00:38:31,839 Speaker 2: but you know, it's not a big surgical intervention and 652 00:38:31,880 --> 00:38:34,160 Speaker 2: if you're having another operation for a different reason and 653 00:38:34,280 --> 00:38:38,520 Speaker 2: the surgeon had capability of taking tubes off, or they 654 00:38:38,560 --> 00:38:41,120 Speaker 2: had a capability of bringing a gynecologist to quickly do it, 655 00:38:41,480 --> 00:38:47,360 Speaker 2: then great. So one of the most obvious times to 656 00:38:47,440 --> 00:38:51,640 Speaker 2: do a contraceptive procedure has been at the last birth. 657 00:38:51,680 --> 00:38:54,080 Speaker 2: If that birth this by cesarian section, because you've got 658 00:38:54,120 --> 00:38:55,960 Speaker 2: the tummy open and the tubes are sitting right there, 659 00:38:56,600 --> 00:39:04,320 Speaker 2: and it's quite technically straightforward in most cases to remove 660 00:39:04,440 --> 00:39:08,640 Speaker 2: the tubes pretty quickly. They can bleed, but we've got 661 00:39:08,640 --> 00:39:13,120 Speaker 2: ways around that, a technique that prevents most bleeding, and 662 00:39:13,200 --> 00:39:15,200 Speaker 2: rather than just putting two quick clips on the tubes, 663 00:39:15,239 --> 00:39:17,359 Speaker 2: that just take them off altogether, and then that woman 664 00:39:17,400 --> 00:39:21,200 Speaker 2: gets the benefit of permanent contraception and ovarian cancer risk reduction. 665 00:39:21,960 --> 00:39:24,800 Speaker 2: It doesn't add a It adds an extra ten to 666 00:39:24,840 --> 00:39:27,400 Speaker 2: fifteen minutes to the caesar, but that's not a problem. 667 00:39:27,480 --> 00:39:29,759 Speaker 2: It can still be done under the same single shot 668 00:39:29,800 --> 00:39:34,760 Speaker 2: spinal anesthetic and it doesn't add a particularly problematic increase 669 00:39:34,800 --> 00:39:39,480 Speaker 2: in time. That's not going to translate to post operative problems, 670 00:39:40,239 --> 00:39:45,640 Speaker 2: interrupt the bonding process, change breastfeeding results, anything like that. 671 00:39:46,760 --> 00:39:49,520 Speaker 1: So if this is being offered to this woman, you'd say, 672 00:39:49,880 --> 00:39:51,480 Speaker 1: if that's what you want to do, go for it. 673 00:39:51,600 --> 00:39:54,799 Speaker 2: Yeah. Yeah, in skilled, experienced hands. That might add ten 674 00:39:54,840 --> 00:39:55,800 Speaker 2: minutes to the season. 675 00:39:56,320 --> 00:39:59,759 Speaker 1: We've got to I just want to test because so 676 00:40:00,080 --> 00:40:03,719 Speaker 1: here in Balarute, we've got a Saint John of God 677 00:40:03,800 --> 00:40:06,880 Speaker 1: so religious based hospital. 678 00:40:06,760 --> 00:40:10,040 Speaker 2: Yes, Catholic church owned hospital. Yeah, who haven't previously been 679 00:40:10,080 --> 00:40:13,400 Speaker 2: that keen to have contraceptive procedures done in their hospital, 680 00:40:13,680 --> 00:40:16,960 Speaker 2: but are happy for the tubes to be removed if 681 00:40:17,000 --> 00:40:21,320 Speaker 2: the primary purpose is a very cancer risk production. 682 00:40:21,800 --> 00:40:24,360 Speaker 1: Well, but I think that's all we've got time for today. 683 00:40:24,840 --> 00:40:27,600 Speaker 1: Are good, They're all good. Yeah, they're always good, They're 684 00:40:27,600 --> 00:40:28,080 Speaker 1: always good. 685 00:40:28,160 --> 00:40:28,359 Speaker 3: Yeah. 686 00:40:28,400 --> 00:40:31,360 Speaker 1: We look about audience. You guys are very clever people, 687 00:40:31,400 --> 00:40:34,200 Speaker 1: and and you know you're clever because you're asking, you're 688 00:40:34,239 --> 00:40:38,360 Speaker 1: asking the right questions, and you're wanting your seeking the answers. 689 00:40:38,800 --> 00:40:41,239 Speaker 1: We hope that we're always here to give you those 690 00:40:41,280 --> 00:40:44,200 Speaker 1: answers that you're looking for. You can just tell us. 691 00:40:44,440 --> 00:40:47,080 Speaker 1: If not, just get into our DMS and say, hey, 692 00:40:47,120 --> 00:40:50,200 Speaker 1: the way that you answered blah blah, I've that was wrong, 693 00:40:50,320 --> 00:40:53,440 Speaker 1: that was wrong. I've had it on very good authority 694 00:40:54,000 --> 00:40:55,760 Speaker 1: aka chat GBT. 695 00:40:56,400 --> 00:40:59,480 Speaker 2: And and we'll record and we'll talk about it. 696 00:40:59,520 --> 00:41:03,279 Speaker 1: Yeah, good, all right until next week, everybody, we hope 697 00:41:03,280 --> 00:41:06,279 Speaker 1: that you're having a very lovely week weather, and if 698 00:41:06,280 --> 00:41:09,600 Speaker 1: you're aiming to get pregnant, that happens for you this week, 699 00:41:09,600 --> 00:41:11,600 Speaker 1: wouldn't that be great? Like there we go, got a 700 00:41:11,640 --> 00:41:15,879 Speaker 1: baby dust. Until then, keep growing your babies and we'll 701 00:41:15,880 --> 00:41:16,919 Speaker 1: be in your ears next week. 702 00:41:16,960 --> 00:41:17,960 Speaker 2: Thanks for listening, everybody. 703 00:41:18,000 --> 00:41:26,680 Speaker 1: Okay, bye for now. Hey, even though doctor Pat is 704 00:41:26,760 --> 00:41:29,160 Speaker 1: well a doctor and we get lots of other doctors 705 00:41:29,200 --> 00:41:32,000 Speaker 1: and other experts on our podcast, I just need to 706 00:41:32,040 --> 00:41:36,160 Speaker 1: remind you that this podcast is for informational purposes only. 707 00:41:36,760 --> 00:41:40,280 Speaker 1: We share lots of medical insights and experience, but everything 708 00:41:40,320 --> 00:41:43,319 Speaker 1: we talk about is general in nature and may not 709 00:41:43,360 --> 00:41:47,600 Speaker 1: apply to your specific situation. Please always consult with your 710 00:41:47,640 --> 00:41:51,560 Speaker 1: own healthcare provider for your individual medical advice when you 711 00:41:51,600 --> 00:41:52,360 Speaker 1: grow your baby