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Speaker 1: You're listening to a Muma Mia podcast.

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Speaker 2: Mom and Mayor acknowledges the traditional owners of land and

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Speaker 2: waters that this podcast is recorded on.

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Speaker 3: I am pregnanty.

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Speaker 1: Welcome to Hello Bump.

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Speaker 2: We're making pregnancy less overwhelming and hopefully more manageable. I'm

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Speaker 2: Grace Rubray, I'm pregnant for the very first time and

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Speaker 2: my belly starting to look like an alien.

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Speaker 4: I'm young A Pittman, I'm a former Olympian mother of

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Speaker 4: six and obstetrics and guyany registrar.

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Speaker 2: Each week, Leana and I will be holding your hand

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Speaker 2: week by week through the mysterious, perplexing and very unfamiliar

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Speaker 2: miracle that is pregnancy, all the way from a poppy

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Speaker 2: seed to a pumpkin.

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Speaker 3: Week thirty five and how big a cantalope? Your baby? Apparently?

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Speaker 1: Is that a melon?

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Speaker 3: It's also a pumpkin? Is that better? Is a pumpkin?

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Speaker 4: Yeah? Better?

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Speaker 3: Honey, jew melon?

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Speaker 1: Yeah, we're definitely melons. Yeah, I've got a rabbit.

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Speaker 3: Yeah, that's it.

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Speaker 4: We can go with this sort of Aussie introduced, but

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Speaker 4: we see a lot of the inn Australia. There's a

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Speaker 4: lot of their mother a huge, huge variation in real size. Okay,

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Speaker 4: we're saying like we're talking a kilo difference between some

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Speaker 4: people's babies by this point, so the average is around

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Speaker 4: two point five to two point seven kilos.

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Speaker 1: Wow.

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Speaker 4: So like my babies, as you know, we're born last

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Speaker 4: week at two point eight kilos and they were only

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Speaker 4: thirty four weeks, so you can see they're on the

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Speaker 4: bigger side of a nomine or a twins. So there's

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Speaker 4: a huge, huge variation. Forty six centimeters long.

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Speaker 1: That's that's quite big because long, that's very long lod log.

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Speaker 1: And what have they developed?

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Speaker 4: Ongoing maturity. The kidneys are now getting more mature, so

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Speaker 4: they'll be swallowing more and making more amniotic fluid, which

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Speaker 4: I think is really lovely. And I mean people say

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Speaker 4: I say love and peag God. Yeah, that means my

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Speaker 4: baby's winging inside me or that's when you do the

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Speaker 4: whole you know, there's a doodle inside me and all

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Speaker 4: that kind of conversations. But yes, your baby's kidneys are

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Speaker 4: now starting to really work. Well, this is when we

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Speaker 4: start really looking at is your baby up or down?

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Speaker 4: Is there a bottom presenting or is the head presenting?

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Speaker 4: So you might find between thirty five and thirty six

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Speaker 4: weeks you get a bedside optra sound with your midwife

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Speaker 4: if you aren't having one of those formal ones booked in,

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Speaker 4: because we're tracking bubby's growth and so at this stage

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Speaker 4: we'll start really looking at that spinning baby's website to

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Speaker 4: make sure we try and convince Bobby that a head

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Speaker 4: first is the right way, and if not, you might

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Speaker 4: find in the next week or two you get booked

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Speaker 4: in for what's called an ECV if your baby is

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Speaker 4: bum first at this point, and ecvs where we actually

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Speaker 4: put our hands on your belly and we try and

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Speaker 4: manually from outside. So an external Catholic version is to

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Speaker 4: try and turn your baby to be head down.

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Speaker 1: Is that and it's completely safe to do that.

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Speaker 4: Look, we make sure there's the right baby, So the

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Speaker 4: baby has to be within a certain weight range. We

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Speaker 4: don't want teeny tiny babies, we don't want really big babies.

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Speaker 4: Baby has to be well so not growth restricted, which

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Speaker 4: is obviously the size, but also with normal fluid around

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Speaker 4: baby and no things like gastroskeecies or any anatomical problems

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Speaker 4: with your baby. So they're quite strict on which ones

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Speaker 4: are suitable for that. And then the biggest thing comes

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Speaker 4: down can them tolerate it? So I've done I don't

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Speaker 4: laugh at me. I've done htcvs in my life, so

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Speaker 4: not a huge amount, but I'm very lucky. I train

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Speaker 4: with an incredible doctor who does them all the time

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Speaker 4: and is training me in that space.

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Speaker 1: When you say tolerate, is that because it's painful?

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Speaker 4: That's right, Yeah, and that's what I say. So out

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Speaker 4: of the ones that I've done, three or four women

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Speaker 4: had to stop just because it was so uncomfortable. And

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Speaker 4: this is the ones that I've done, more than eight

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Speaker 4: successful ones that didn't work, But the main reason for

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Speaker 4: stopping was that she just couldn't tolerate the discomfort on

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Speaker 4: the tummy.

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Speaker 2: And it's a discomfort part of that also the anxiety

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Speaker 2: of they feel like it's doing something to the child

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Speaker 2: or it's just like that uncomfortable that it's painful.

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Speaker 3: Look, I think if.

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Speaker 4: They're committed to be in the room, they're usually you know,

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Speaker 4: they've left a lot of that anxiety at the door.

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Speaker 4: So I think a lot of the women do really

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Speaker 4: try because obviously there's ops you to have a cesarian section.

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Speaker 4: You do not have to try and turn your baby.

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Speaker 4: There's also the option to actually have a vaginal breach birth,

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Speaker 4: so particularly at certain hospitals that facilitate that, and I'm

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Speaker 4: very lucky that I work at one that has lots

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Speaker 4: of breach babies born, so you don't have to be there.

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Speaker 4: So it's very committed women that want that vaginal birth

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Speaker 4: and are prepared to give it a go.

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Speaker 1: Right, So people still do have breach babies absolutely imaginally.

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Speaker 4: Yeah, well I've done not many, probably three or four,

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Speaker 4: but I've been present in the room for at least

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Speaker 4: another ten, which is amazing. So again, we have a

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Speaker 4: particular obstitution. I'm sure he won't mind me saying. His

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Speaker 4: name is doctor Andrew Bissets. He's about one of the

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Speaker 4: best obstetricians in Australia. But I've also met an amazing

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Speaker 4: obstution out at Westmead whose names are doctor Andrew Pesh

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Speaker 4: who used to do breach birth. He's starting to retire

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Speaker 4: unfortunately for care. But both of them have been the

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Speaker 4: almost the godfathers of bringing back breach birth because many

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Speaker 4: years ago we used to have lots of breach berths

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Speaker 4: and then there was an inquiry in the early two

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Speaker 4: thousands that really scared a lot of women, and so

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Speaker 4: a lot of the main reason is a lot of

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Speaker 4: obstutions detrained in that space, so they just didn't have

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Speaker 4: the skill set to do it, and that's resurging now.

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Speaker 4: So I think the bottom line is if you've committed

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Speaker 4: to it and it's safe. In other words, again, your

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Speaker 4: babies are normally grown size. It's not a huge baby,

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Speaker 4: it's not a tiny baby, it's not struggling. And you know,

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Speaker 4: particularly if you've had babies before and you know your

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Speaker 4: pelvis is able to birth vaginally, it's definitely worth having

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Speaker 4: a discussion with your obstitution around whether they would be

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Speaker 4: comfortable doing a breach.

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Speaker 2: Birth and you considered high risk. If you're a breach

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Speaker 2: birth I vaginally, it's.

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Speaker 3: Not considered high risk.

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Speaker 4: I mean, the statistics show that a cesarean rate is

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Speaker 4: a one in a thousand chance of severe morbidity to

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Speaker 4: the baby. A vaginal birth with a head down is

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Speaker 4: two in a thousand, between one and two, and a

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Speaker 4: breach vaginal birth is another percent, so between two and

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Speaker 4: three percent chance of a problem. I think the biggest

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Speaker 4: thing if and again I'm very junior guys, so this

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Speaker 4: is just my evidence from what I've listened to doctor

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Speaker 4: Bisits and other obstecutions in this space is if the

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Speaker 4: if the labor is progressing well and you're dilating beautifully

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Speaker 4: and the bum's coming down and it's a bottom presenting,

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Speaker 4: not feet, and everything's going smoothly, it's a good chance

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Speaker 4: it's going to go well. It's if things aren't going

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Speaker 4: well and you know you're not dilating well enough and

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Speaker 4: you're really pushing that envelope and you want something so badly,

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Speaker 4: and there's lots of writing on the wall and the

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Speaker 4: baby's not coping with the labor. In other words, a

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Speaker 4: breach will either go well or it won't go at all.

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Speaker 2: What what's happening to me and what's happening to our bodies?

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Speaker 4: That has our body's goodness back to the real of

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Speaker 4: what we're here today? Do you know? I think at

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Speaker 4: this point it is just you're continuing to grow. We

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Speaker 4: say it every week, but we've got a harp on

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Speaker 4: looking at symptoms. No headaches, blurry vision, we're not having

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Speaker 4: any itchy feet, We're feeling well in ourselves. This is

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Speaker 4: around when the the time you'll have that last blood

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Speaker 4: test to make sure your iron levels are up. To

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Speaker 4: where they need to be, and if they're not, we

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Speaker 4: would be starting to consider that iron infusion. So there's

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Speaker 4: just a few, like tick box things that need to

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Speaker 4: be done at this point in pregnancy.

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Speaker 1: Is this normal?

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Speaker 3: Is it normal?

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Speaker 2: This normal is wanting to talk about bad outcomes. And

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Speaker 2: I haven't wanted to or wanted to engage in any

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Speaker 2: type of podcasts birth stories or anything like that because

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Speaker 2: everything's felt too overwhelming. But I think the further on

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Speaker 2: that I've gotten, you've got more data and it doesn't

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Speaker 2: seem as scary like you're in it.

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Speaker 1: So it's going to happen either way.

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Speaker 2: So I know that there's a few things that we

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Speaker 2: have spoken about off Mike, like hemorrhaging, shouldered dustocia, dastocia,

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Speaker 2: and one that's been in the news recently, which is.

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Speaker 3: The amnotic fluid embolism. Yes, are very rare.

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Speaker 2: But yeah, so all of these things that are very rare,

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Speaker 2: I guess I want to ask if teams are always.

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Speaker 1: On the look at for that stuff one, even if

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Speaker 1: you're low risk.

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Speaker 4: Yes, we are, and we get trained in simulation centers,

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Speaker 4: we get trained in real life birth centers when we're

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Speaker 4: quite junior doctors like for example, my whole first year

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Speaker 4: of training, I had a very senior obstitution with me

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Speaker 4: for all births in case that sort of thing happened.

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Speaker 4: And so even in a public hospital where you're being

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Speaker 4: trained with trainees like myself, we're all very aware when

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Speaker 4: to push that red button and bring the room in.

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Speaker 4: So I think you got to remember that even though

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Speaker 4: it'll feel like you're alone in that space. So that's

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Speaker 4: the thing to be aware of, is that when they

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Speaker 4: see an emergency, your room will be full of people.

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Speaker 4: And that might seem daunting, but it's actually great because

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Speaker 4: it means very senior people are coming in that'll be

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Speaker 4: able to support whatever is required to make sure you

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Speaker 4: and your baby are safe.

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Speaker 1: And is that regardless of whether you're going through a

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Speaker 1: midlife program or all ondred percent through public private obstitutions.

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Speaker 2: It's just everyone knows warning signs and there's a big

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Speaker 2: red button to locate in the street that.

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Speaker 1: You know it will be pressed.

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Speaker 3: Yes, And that's exactly right.

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Speaker 4: So which is why the whole birth in Australia is

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Speaker 4: I can't say birth is one hundred percent safe because

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Speaker 4: it's not. It is one of the more dangerous things.

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Speaker 4: It's why my whole career exists is because it isn't

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Speaker 4: as beautiful as we wish it would be, where it

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Speaker 4: just everyone going to breeds, a baby out, cops.

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Speaker 3: And the dove is born.

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Speaker 4: That doesn't happen like it's so rare that that happens.

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Speaker 4: But midwives and Australia are trained so beautifully and they

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Speaker 4: are protectors in that birth space. But if they're scared

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Speaker 4: and they know there's something wrong, they ninety nine point

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Speaker 4: ninety nine nine percent of the time will pick it

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Speaker 4: and escalate it to an obstetric doctor. Where it becomes

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Speaker 4: a little more challenging is if you're at home. But

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Speaker 4: again they have those systems and checks in place. It's

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Speaker 4: always second midwife. If you're home birthing, there is the

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Speaker 4: ability to call an ambulance. They call it early if

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Speaker 4: there's a concern, and they escalate to the hospital. So

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Speaker 4: they're all very trained in that birth space and in

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Speaker 4: particular for emergencies. So and we practice again every week,

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Speaker 4: again and again and again, and then when the real

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Speaker 4: thing happens, it's an almost autonomous way to deal with it.

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Speaker 1: Do you have patients who get quite anxious about this stuff.

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Speaker 4: All unbelievably and grace. The hardest thing in my job

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Speaker 4: is women who don't want us to come in the birthroom.

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Speaker 4: Like I love this job, like it's my favorite thing

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Speaker 4: to be there with women. And the reason I went

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Speaker 4: and became a midwife initially and even before that, as

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Speaker 4: Adula was I remember my first birth thinking, this is

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Speaker 4: the most extraordinary thing I've ever done, This pregnancy of stuff,

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Speaker 4: the Olympics.

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Speaker 3: The Olympics is great, but.

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Speaker 4: I love pregnancy and birthing and women. So it has

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Speaker 4: been a twenty year passion of mine. I mean, who

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Speaker 4: would go and become an obstitucian with six kids, Like

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Speaker 4: it's just the most ludicrous thing ever. And majority of

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Speaker 4: us in that space are the same. We love being

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Speaker 4: present for women in birth. And so when we see

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Speaker 4: something abnormal happening, like the ct G, which is the

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Speaker 4: monitoring of the baby, is showing babies stressed, or mum's

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Speaker 4: not progressing, she's been four cenemies and she's four cenemies

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Speaker 4: and she's four centimeters, or there's you know, bloodstained like

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Speaker 4: call which is the amniotic fluid coming out, we get

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Speaker 4: really stressed and we want to come in and help you,

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Speaker 4: and I can tell you a bad high risk woman

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Speaker 4: is the like as in not idn't mean she's bad,

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Speaker 4: but as in, a high risk woman who's having a

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Speaker 4: really difficult labor is so much easier because she knows

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Speaker 4: we're going to come in.

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Speaker 3: And that really low risk woman.

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Speaker 4: Who hates doctors because she's afraid of us and it's

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Speaker 4: my hardest day on the birth unit is trying to

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Speaker 4: convince her to just let me come and have a chat.

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Speaker 4: And so I changed the whole narrative. A few months ago,

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Speaker 4: I heard this incredible midwife down in Melbourne wh's actually

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Speaker 4: doing her PhD in the birth trauma space, who said

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Speaker 4: we need to change it. We need women to demand

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Speaker 4: to meet the doctor. In other words, take the reins

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Speaker 4: back and say I don't want some foreign person walking

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Speaker 4: into my room when stuff hits the span. I want

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Speaker 4: to know who the midwives are. I want to know

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Speaker 4: who the head of the military team is, and I

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Speaker 4: want to know who the doctor on call is, so

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Speaker 4: that that way there's no foreign faces if and when

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Speaker 4: I require them to come and help me.

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Speaker 1: And what's on the toolkit this week?

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Speaker 4: So we'll take it back to something nice, hard conversation.

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Speaker 4: Create your birth song list. We started this early, and

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Speaker 4: you remember a very very vacuum like week, say at eleven,

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Speaker 4: we started adding songs.

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Speaker 1: You should have quite a few.

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Speaker 3: I've got to be on that list.

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Speaker 4: But we're getting closer, Like I don't want your labor

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Speaker 4: to start for two weeks, I when you're thirty five weeks,

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Speaker 4: but it could happen. There's definitely a higher propensity of

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Speaker 4: women to go into labor at around this time, and

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Speaker 4: babies you're really well, you know, thirty five weeks. Certainly

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Speaker 4: at my hospital. It's a bit different if you're in

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Speaker 4: rural hospitals. If they weigh over two point four kilos,

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Speaker 4: often that stay with mummy. So we're really approaching a

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Speaker 4: very wonderful time where if baby does well post birth,

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Speaker 4: they can often go home, just like if they were

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Speaker 4: a full term baby. Now, some of course need a

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Speaker 4: little bit of help with feeding and they drop their

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Speaker 4: sugars and they get a bit jaundice and things. But

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Speaker 4: the bottom line of that is have your car seat,

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Speaker 4: have your birth plans, and have your song list because

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Speaker 4: it could happen tonight.

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Speaker 2: This is my toolkit. Funnily enough, is a car seat.

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Speaker 2: I had it. I don't know if this is the

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Speaker 2: nesting hormone that's now suddenly been about the baby instead

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Speaker 2: of me. Is that I went, we just need a

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Speaker 2: car seat, and we need it this weekend, like literally

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Speaker 2: the weekend that's just gone.

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Speaker 1: I was like, we just need to yeah, because that's.

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Speaker 3: The only thing you can't do with that. It's everything else.

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Speaker 1: Yeah, they'll let you leave, yep, unless you have it, Like.

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Speaker 3: They don't let you leave, do not let you leave

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Speaker 3: until you have a car seat in the car.

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Speaker 2: So I went to baby Bunting and picked a car

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Speaker 2: seat and they were like, oh, you just have to

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Speaker 2: wait two weeks for it to come in and then

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Speaker 2: you've got to come back for installation. And I just went,

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Speaker 2: thank goodness that it's thirty three weeks. I went, we

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Speaker 2: need to do it now, because what if we waited

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Speaker 2: until I was on maternity.

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Speaker 4: I'll let you in a little story, most most hospitals

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Speaker 4: have one in their car park yet, so like, just

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Speaker 4: just in case, because you amount a bearers the dome,

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Speaker 4: do it And they're like, oh, I haven't had it

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Speaker 4: done at City in the garage. I've had it for

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Speaker 4: a few weeks, but it's not installed, and the last

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Speaker 4: thing we want you to do is drive around with

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Speaker 4: an unsafe car seat. So find out if you if

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Speaker 4: you end up going into labor early, give the job

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Speaker 4: to your partner or your mother in law to source

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Speaker 4: where the hospital does their car installation, because it's very

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Speaker 4: common that most hospitals have one on site.

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Speaker 1: Do you remember your first drive home.

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Speaker 3: Kilometers an hour? It was I still vividly the other

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Speaker 3: because he.

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Speaker 4: Was so tiny and he looked so small in that seat,

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Speaker 4: and I literally drove like a matter.

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Speaker 1: Or did one of you sit in the back seat?

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Speaker 3: No, I don't know why, but I was driving.

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Speaker 4: I don't know if he'd gone home to set something up,

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Speaker 4: because this is like twenty years ago and my oldest

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Speaker 4: is eighteen now and doing nursing himself. So but I

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Speaker 4: remember someone was in the car. It must have been

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Speaker 4: him saying why are you going so slow? And I'm like,

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Speaker 4: because my baby's in the back.

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Speaker 1: I've got to be there to protect. Yeah, okay, that's normal.

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Speaker 2: We hope you enjoyed this episode of Hello Bump. We

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Speaker 2: have so many episodes of this series filled with tips

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Speaker 2: and stories from women and experts who've been through it

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Speaker 2: all before.

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Speaker 4: You can go back and listen to everything else Hello

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Speaker 4: Bump related in this podcast.

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Speaker 2: Feed, and while you're there, we'd love if you could

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Speaker 2: give us a flying star rating and maybe leave us

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Speaker 2: a review or even shared this episode with a friend.

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Speaker 4: This episode was produced by Courtney Ammenhauser with audio production

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Speaker 4: by Tom Lyon We'll catch you next time.

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Speaker 2: This episode of Hello Bump was made in partnership with

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Speaker 2: Huggies Bye Bye