Speaker 1: You're listening to a MoMA Mia podcast.
Speaker 2: Mama Maya acknowledges the traditional owners of land and waters
Speaker 2: that this podcast is recorded on.
Speaker 3: I am pregnant.
Speaker 2: Welcome to Hello Bump. We're making pregnancy less overwhelming and
Speaker 2: more manageable, hopefully. I am Grace Reuvery. I'm pregnant for
Speaker 2: the first time, and I can't walk upstairs slopes or
Speaker 2: speak long sentences without losing my marette without losing my breath.
Speaker 1: Oh, I'm Yanna Pitman. I am a mother of six.
Speaker 3: I had all those babies myself, and now I have
Speaker 3: the privilege of working in a birth unit as a
Speaker 3: training obstitution.
Speaker 2: Each week, Bianna and I will help hold your hand
Speaker 2: week by week through the mysterious, perplexing and sometimes breathless
Speaker 2: miracle that is pregnancy.
Speaker 1: So welcome to week twenty two.
Speaker 2: How big is the baby at week twenty two?
Speaker 1: Babies now about the size of an egg plant. Yeah,
Speaker 1: that's quite big.
Speaker 3: Or a sweet potato, a hair brush, or a defl
Speaker 3: at afl.
Speaker 2: Deflated one, not a full it's a four to one
Speaker 2: full term.
Speaker 3: No, thirty four weeks that I guess twenty eight centimeters.
Speaker 3: Little bubby is now and weighs about four hundred and
Speaker 3: thirty grams, So depending on which hospitals, as you get
Speaker 3: closer to the five hundred grand mark, we're getting closer
Speaker 3: to the time where baby will be viable.
Speaker 1: So only a week away.
Speaker 3: Now, this twenty two week is a really super important
Speaker 3: week medically because if things were starting to happen, if
Speaker 3: you knew you were having getting into pre term label,
Speaker 3: we try very hard and have lots of discussions because
Speaker 3: as of next week you meet the viability age for
Speaker 3: all tertiary hospitals.
Speaker 1: So big hospitals that have a really.
Speaker 2: Good nick use with multiple pregnancies, think, if it's twins
Speaker 2: or true plants, are you starting to look at what
Speaker 2: week you would be looking to get the babies out
Speaker 2: or is it just as long as you can keep
Speaker 2: them in?
Speaker 3: Yeah, great question. I think it depends on what type
Speaker 3: of babies you're having. So there's multiple types of twins.
Speaker 3: I had DCDA twins, so that basically means two percenters
Speaker 3: two separate amniotic secks of the lower risk pregnancy. They
Speaker 3: aim to sort of birth those little ones around thirty
Speaker 3: seven to thirty nine weeks.
Speaker 1: So if it's as long as another other risk factors
Speaker 1: pit prop up.
Speaker 3: Like preclamps Yeah, yeah, MCDA twins, which means there's one
Speaker 3: placenter and two sacks sometimes earlier, and then you save
Speaker 3: you when they have one placenter and they all share
Speaker 3: the same amniotic sacs. So that's your highest risk identical
Speaker 3: twins outside of conjoined twins, because obviously they're twins that
Speaker 3: haven't split completely, so there's variations of different types of twins,
Speaker 3: and they'll be the obstetric team will guide you quite
Speaker 3: closely because things come into play like sometimes they don't
Speaker 3: share the placental flow well enough, or they don't grow equally,
Speaker 3: or sometimes one of them steals all the blood flow
Speaker 3: from the other, which is called twin to twin transfusion.
Speaker 3: So there's lots of complicating things in pregnancy, So definitely
Speaker 3: outside of the scope of this podcast, but it'll be
Speaker 3: really twin pregnancies, even my low risk twin pregnancy will
Speaker 3: be really strongly managed by an obstrition. So that's slightly
Speaker 3: outside the scope of the midwi free grip practice. If
Speaker 3: you end up with doubles, don't get me wrong, the
Speaker 3: midwife is a huge important person and in our obstetric
Speaker 3: department with twins, we have a dedicated MFM midwives to
Speaker 3: make sure the woman doesn't miss out on that wonderful
Speaker 3: midwi free care, which hopefully is in most institutions. But
Speaker 3: they start having lots of frequent ultrasounds, lots of looking
Speaker 3: at the baby's blood flows and and things like that,
Speaker 3: because yes, they are far more they often require preterm birth,
Speaker 3: far more than a single baby or what we call
Speaker 3: a singleton pregnancy.
Speaker 2: And as they are starting to get closer to being viable,
Speaker 2: what have they developed in the past.
Speaker 3: Week, So I think it's a cute one. Well, on
Speaker 3: that note, their lungs is now starting to form those
Speaker 3: little alvole life so those little sacks that will then
Speaker 3: eventually allow oxygen exchange, which is why we're getting close
Speaker 3: to the time where they may survive and may do Okay.
Speaker 3: Brain's now developing the cerebral cortets, so complex thought and
Speaker 3: actions that they will eventually do as starting in that
Speaker 3: process now. And they've even got little retinas in the
Speaker 3: baby's eyes, so yeah, it's amazing. They'll be complete by
Speaker 3: twenty two weeks. And they can now detect light, so
Speaker 3: their eyes remain their eyelids remain fused till about twenty
Speaker 3: six twenty eight weeks. That aren't any color yet, but
Speaker 3: at least they might be able to tell the difference
Speaker 3: between night and day.
Speaker 2: Well, does that affect their sleep at all? They don't
Speaker 2: have any kind of sleep with.
Speaker 3: Not yet the circadian rhythms and stuff come. But that's
Speaker 3: I guess that's what we're going towards.
Speaker 1: Not quite yet.
Speaker 3: A couple more weeks and then they'll have circadian rhythms
Speaker 3: and rem sleep and everything.
Speaker 1: Just like you and I. But yeah, it's a few
Speaker 1: weeks off.
Speaker 3: But at least now their retinas are able to actually
Speaker 3: detect the difference between light and dark inside the uterus.
Speaker 2: What's happening to me? And what's happening to the women?
Speaker 2: What's happening to that? And to me? Tell me what's
Speaker 2: happening to me?
Speaker 3: Constipation is probably at its peak at the moment. You
Speaker 3: might be developing some hemorrhoids. Early hemorrhoids might be starting
Speaker 3: really common in pregnancy. Again, most of them sort of
Speaker 3: go away after birth. It's again increase pressure in the
Speaker 3: rectum so that pregnancy is sitting right there, increased blood flow,
Speaker 3: and with that motility slowing down, you get constipated, you
Speaker 3: push harder, higher chance of hemorrhoids.
Speaker 2: Is this one of the times where you should get
Speaker 2: one of those little stools to put your.
Speaker 1: Proper legs out. Yes, yes, yes, exactly, So go for
Speaker 1: it again. Have you got what I hope? No?
Speaker 2: My pelvic four physio said to get two toilet rolls.
Speaker 2: That's a clever idea if you don't want to buy something,
Speaker 2: so you don't have to buy something new.
Speaker 3: I mean, you're gonna have a baby, it's always having
Speaker 3: a little stool at the end of the baby's going
Speaker 3: to use the toilet train. But I like that just
Speaker 3: a little Yeah I'm doing is literally trying to take
Speaker 3: the pressure off the ground and you know, lift your
Speaker 3: legs up off the so put your feet on toilet.
Speaker 1: Rolls, is what she said. Yeah, I like it. I
Speaker 1: might go and meet your physio. She sounds like is
Speaker 1: it she? Yeah? She excellent?
Speaker 2: Is this normal? Is it normal? Is this normal? Is
Speaker 2: the fact that I am getting out of breath? It's
Speaker 2: just speaking or walking up slopes that I wouldn't even
Speaker 2: call with you anything that requires I've gone back to
Speaker 2: the gym and I've been able to do pilates, but
Speaker 2: I haven't done cardio apart from walking, so I don't
Speaker 2: know how it would go with like a hit class
Speaker 2: at all, because I'm getting out of breath. Why do
Speaker 2: we get out of breath at around twenty two weeks.
Speaker 1: Look nine and nive percent of the time it's normal.
Speaker 3: Okay, Again, your baby's getting hot, bigger, it's pushing up
Speaker 3: and you've got less ability to allow that diaphragm to
Speaker 3: move up and down and take those deep, big breaths.
Speaker 3: You are using more oxygen around your body, so just
Speaker 3: the requirement of the oxygen requirement has gone up. I
Speaker 3: think the thing to consider though, is that breathlessness can
Speaker 3: be one of those red flags just like we've had
Speaker 3: we've talked about before around heart rate going up or
Speaker 3: blood pressure change, you're feeling dizzy. Breathlessness could be could
Speaker 3: be something to do again the risk of a pulmonariabalism
Speaker 3: or a cardiac problem, because if your heart, if you're
Speaker 3: feeling breathless, it means usually you're not quite getting enough
Speaker 3: oxygen around the body. So if it subsequently has breathlessness
Speaker 3: plus chest pain, breathlessness at rest, sitting down, it's time
Speaker 3: to go and see it's doctor.
Speaker 2: One of the things. I've spoken to my mom a
Speaker 2: lot about what happened in her pregnancy, and she's thinking
Speaker 2: back to back in the day and she had something
Speaker 2: that I've not experienced yet. She bled pretty much throughout
Speaker 2: the whole of her pregnancy actually, and then if it
Speaker 2: did stop, it came back at around twenty ish weeks mark.
Speaker 2: What is that a sign of?
Speaker 3: Look, it's really tricky and sometimes we can't work out
Speaker 3: what it is, but it is important to look at that.
Speaker 3: So I think it's a really great discussion for this week.
Speaker 3: Because you've had your morphology hopefully by twenty two weeks,
Speaker 3: we really what I've done before now guys, and look
Speaker 3: for where your placenta is. So sometimes we can get
Speaker 3: what's called a low lying placenta or a placenta previa.
Speaker 1: There's different raids of it.
Speaker 3: So obviously one is just where it's a butting up
Speaker 3: against the cervix and what that basically means. The placenta
Speaker 3: needs to be feeding the baby, so we need it,
Speaker 3: it's essential. But ideally it's up near the fundus, at
Speaker 3: the top of your uterus or on the anterior or
Speaker 3: the posterior walls, so it's somewhere away from where the
Speaker 3: cervix is, and the cervix is obviously the.
Speaker 1: Canal that Levenchy but baby will come out of.
Speaker 3: But unfortunately, in some cases it can actually come really
Speaker 3: close to the cervix. So if it's within twenty millimeters,
Speaker 3: so if you know you're looking atr fingers, it's in
Speaker 3: that sort of period of space, we know there's a
Speaker 3: risk that if that during pregnancy, bleeding may occur, and
Speaker 3: it can be quite significant bleeding, so we monitor you
Speaker 3: more regularly. So if it's just a low lying placenta,
Speaker 3: we then say, look, let's repeat an ultrasound. In the
Speaker 3: third trimester. Most of the time, ninety percent of the
Speaker 3: time that cervix has grown out of the way. It's amazing,
Speaker 3: it's gone. Not even a concern if it's still sitting
Speaker 3: quite close to the cervix, so it's a grade two
Speaker 3: it's sitting like on or just crossing over the cervix.
Speaker 3: Up to a grade four where it's completely covering from
Speaker 3: the front anterior to the back of the cervix posterior,
Speaker 3: that can be quite dangerous because it basically means there's
Speaker 3: no way the baby can come out that placenta is
Speaker 3: crossing right across the exit, and it also means they're
Speaker 3: at much high chance of bleeding. So that's one of
Speaker 3: the big things to know. Where is your placenta. If
Speaker 3: it's low lying, you might be advised to not do
Speaker 3: high impact running for example, or don't or for example,
Speaker 3: reduce intercourse because we don't want to do anything that
Speaker 3: could stimulate or put pressure onto where that placenta is.
Speaker 3: There's also other types of placenta spectrums that you need
Speaker 3: to be aware of. Not for today, but if you
Speaker 3: are someone who has a problem with your placenter, it's
Speaker 3: just really good to get your doctor to explain it
Speaker 3: in thorough detail so that you are aware of what's
Speaker 3: going on. Other things are called bleeding your civix.
Speaker 1: It can bleed.
Speaker 3: It can bleed from contact from intercourse, but I still
Speaker 3: want you to have intercourse as long as your percenta
Speaker 3: is not low lying and you're not having a concern
Speaker 3: is sumportant part of pregnancy. You vagina can bleed because
Speaker 3: it gets dry sometimes and it gets you know, moist
Speaker 3: other times.
Speaker 1: I know probably hate.
Speaker 3: That word, but it's importunately part of the vagina and
Speaker 3: sometimes again back to the placenta, it can lift up
Speaker 3: a little bit on the side. It's more common in
Speaker 3: third semester, but we can get a little bit of
Speaker 3: bleeding from the edge of the placenter called a placenta abruption,
Speaker 3: which is a tiny one and in most cases it
Speaker 3: just sits back down again. It can be a real
Speaker 3: pest bow grace. So some people get this annoying bleeding.
Speaker 3: They don't have a placenta previa, so the placenta nice
Speaker 3: and out of the way.
Speaker 1: And every couple of weeks they do just bleed.
Speaker 3: And these poor women can sometimes be in hospital from
Speaker 3: like twenty five to twenty six weeks till term because
Speaker 3: they bleed. They go home for two or three days,
Speaker 3: they bleed again, they go home for two or three days,
Speaker 3: they bleed again, and they are literally institutionalized for ten
Speaker 3: weeks of pregnancy. The remarkable that they manage to hold
Speaker 3: it together. So I think it's just really important to
Speaker 3: if you do bleed, to try and work out what
Speaker 3: it is. But keep in mind that your doctors are
Speaker 3: probably sometimes standing at the end of your bed going
Speaker 3: I'm really sorry, I have no idea, and often you'll
Speaker 3: get asked, oh can you do an ultrasound to look
Speaker 3: at my placenta, Is it lifting?
Speaker 1: Is it abrupting? Most of the time we can't even
Speaker 1: see it, so it's kind of to proven.
Speaker 3: Otherwise, I'd say more often than not, I can't give
Speaker 3: you a reason, but know that it's common.
Speaker 1: But it's always always a time to go and get help.
Speaker 2: When you talk about the placenta moving. If we for
Speaker 2: a lot of women, the last time they see their
Speaker 2: baby on an ultrasound is that twenty weeks. Can if
Speaker 2: you're low risk, how can you know if the placenta
Speaker 2: has moved? Are there other signs?
Speaker 3: If your percenter is low, that won't be your last
Speaker 3: ultra sound, So it would be strongly against. I mean,
Speaker 3: there's a lot of things we're quite lax with with
Speaker 3: you know, you take our recommendation or you don't that.
Speaker 3: I can't imagine any midwife or doctor or door or
Speaker 3: anyone if you had a low lying percenter a morphology
Speaker 3: that wouldn't say let's repeat it at least between twenty
Speaker 3: eight and thirty four weeks, because we need to know
Speaker 3: ideally the closer to thirty two to thirty four that
Speaker 3: it's moved. It is you have a significant chance of
Speaker 3: a severe postpartum hemorrhage if you don't.
Speaker 2: Is there a chance that if you do have an
Speaker 2: anterior percenter like minds at the front, yep, would it
Speaker 2: move lower or higher? Or if it's an anterior and yeah,
Speaker 2: will it's the other way? No, so because it's not.
Speaker 3: Actually it sounds like the vost is getting a little
Speaker 3: feet and wriggling its way up.
Speaker 1: It doesn't.
Speaker 3: It grows as the muscle and the segment. So you
Speaker 3: actually have what's called your lower segment of your uterus
Speaker 3: in early pregnancy. It's not developed, so there is actually
Speaker 3: an amazing phenomenon where the actual lower segment stretches and
Speaker 3: stretches and stretches are up, and in doing so it
Speaker 3: takes the percenter with it. So the pleasant is not
Speaker 3: physically moving, it's just growing up and away from the
Speaker 3: servix and then it's fine. So if at morphology you
Speaker 3: don't have a low lying placenter, the chances if you're getting.
Speaker 1: One incredibly low.
Speaker 2: Right.
Speaker 3: The other key thing to think about is your cervical length.
Speaker 3: So we talked very early in this series around internal examination.
Speaker 3: So having a trans vaginal which is the probe inside
Speaker 3: the uterus. This is the time we can have a
Speaker 3: look at your cervix and see if it's nice and long.
Speaker 3: If your cervix is super short, in other words, it's
Speaker 3: like only a centimeter long, we would consider at this
Speaker 3: point doing something about it.
Speaker 1: Now not always.
Speaker 3: Some people might say no, thank you, or it might
Speaker 3: be borderline like two centimeters or two point eight, and
Speaker 3: it's just being what we call cervical surveillance, which means
Speaker 3: you have more frequent ultra sounds to check that. But
Speaker 3: ultimately it's what's holding your baby in.
Speaker 1: Once your service.
Speaker 3: Starts to dilate, it's very, very hard to stop labor
Speaker 3: from coming again. I've seen miracles. I thought, there's amazing
Speaker 3: woman with an open service at twenty five weeks. You
Speaker 3: made it to twenty No, it made it to thirty
Speaker 3: four weeks. But it's less common because you know something
Speaker 3: that's the structure is not stable anymore. So if we
Speaker 3: can catch an open cervix or short cervix, I should
Speaker 3: say at twenty weeks, we can usually do something like
Speaker 3: progesterone supplements or even a sicklage. But again that's information
Speaker 3: for your obsoscition to go through with you. But it's
Speaker 3: important when you're saying yay or nay, Do I or
Speaker 3: do I not? Want to have that internal exam It
Speaker 3: would be a reason I'd consider it.
Speaker 2: We've given a lot of advice this episode already, but
Speaker 2: is there anything else that we haven't thought about for
Speaker 2: a checklist this week? For twenty two.
Speaker 3: Weeks monitoring babies movements. Now, let's go into that properly
Speaker 3: next episode, because I think now is the time there's
Speaker 3: patterns will develop, but I think super important to start
Speaker 3: looking and monitoring those.
Speaker 2: My talk itIt for this week is just to stop
Speaker 2: being a hero and if someone love it. If someone
Speaker 2: offers a lift or says, do you want me to
Speaker 2: lift that, Itham, the answer is yes.
Speaker 3: Yeah, perfect take it, including if they want to cook
Speaker 3: your meals and things.
Speaker 2: Yes, oh yes, ay, yes.
Speaker 3: And it also gives them permission to ask you in
Speaker 3: the future. And I think we're so busy not taking
Speaker 3: help because we're want to be heroes, as you perfectly
Speaker 3: said it, but it allows in doing so, them to
Speaker 3: reach back and ask for that when they go through
Speaker 3: prectice in themselves, which makes it a women's club, which
Speaker 3: is exactly what we need.
Speaker 2: Yeah, we hope you enjoyed this episode of Hello Bump.
Speaker 2: We have so many episodes of this series filled with
Speaker 2: tips and stories from women and experts who've been through
Speaker 2: it all before.
Speaker 3: You can go back and listen to everything else Hello
Speaker 3: Bump related in this podcast feed, and.
Speaker 2: While you're there, we'd love if you could give us
Speaker 2: a five star rating and maybe leave us a review,
Speaker 2: or even share this episode with a friend.
Speaker 3: This episode was produced by Courtney Ammenhauser with audio production
Speaker 3: by Tom Lyon.
Speaker 1: We'll catch you next time. Bye.
Speaker 2: This episode of Hello Bump was made in partnership with
Speaker 2: Huggies