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 --> 00:00:16,160 Speaker 2: On the podcast and our online pregnancy program grow My Baby, 5 00:00:16,320 --> 00:00:19,239 Speaker 2: we share my experience of helping more than four thousand 6 00:00:19,320 --> 00:00:20,480 Speaker 2: babies to be born. 7 00:00:20,480 --> 00:00:23,119 Speaker 1: And our experience of running a women's health clinic and 8 00:00:23,239 --> 00:00:24,320 Speaker 1: parenting 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 --> 00:00:30,480 Speaker 2: and birth with real life, practical information. 11 00:00:33,720 --> 00:00:35,760 Speaker 1: Welcome everyone. I'm Bridget Maloney. 12 00:00:35,320 --> 00:00:37,440 Speaker 2: And I'm obstatrician doctor Patrick Maloney. 13 00:00:37,520 --> 00:00:40,040 Speaker 1: And you've probably picked this up because you've already listened 14 00:00:40,040 --> 00:00:45,560 Speaker 1: to part one of cesarean sections increasing If you haven't, start, 15 00:00:46,000 --> 00:00:50,000 Speaker 1: go back listen because we set the scene and talk 16 00:00:50,040 --> 00:00:52,760 Speaker 1: about you know, the data's data about whether they are 17 00:00:52,880 --> 00:00:55,560 Speaker 1: or not. And now I think we should move to 18 00:00:56,280 --> 00:01:01,760 Speaker 1: why are they increasing? So pat we mentioned maternal age. 19 00:01:01,920 --> 00:01:04,040 Speaker 1: Do you think it'd be useful if we start with 20 00:01:05,040 --> 00:01:08,840 Speaker 1: comparing say the nineteen sixty landscape to the twenty twenty 21 00:01:08,840 --> 00:01:10,280 Speaker 1: six landscape. 22 00:01:10,480 --> 00:01:12,680 Speaker 2: Well, I think that's the timeframe that we've been looking at, 23 00:01:12,720 --> 00:01:16,240 Speaker 2: and I think that would be very useful because some 24 00:01:16,280 --> 00:01:20,880 Speaker 2: of this is due to societal changes. And if we 25 00:01:20,959 --> 00:01:25,080 Speaker 2: look at this group. There's no doubt that some of 26 00:01:25,120 --> 00:01:30,040 Speaker 2: the pregnancy problems that we see that are more likely 27 00:01:30,360 --> 00:01:33,080 Speaker 2: to wind up with us recommending us as their insection 28 00:01:33,560 --> 00:01:37,880 Speaker 2: are more common in older mums. Now, before we get 29 00:01:37,880 --> 00:01:41,240 Speaker 2: into too much trouble here, it's just more common. So 30 00:01:41,319 --> 00:01:43,280 Speaker 2: everyone will know someone who was thirty nine had their 31 00:01:43,319 --> 00:01:43,720 Speaker 2: first baby. 32 00:01:43,720 --> 00:01:47,279 Speaker 1: I don't dramas at all, got pregnant, had a vaginal birth, 33 00:01:47,440 --> 00:01:48,480 Speaker 1: like everything's gone well. 34 00:01:48,640 --> 00:01:52,280 Speaker 2: Yeah, But to be fair, we mostly we know some 35 00:01:52,360 --> 00:01:54,200 Speaker 2: twenty one year olds who've had tons of things go 36 00:01:54,280 --> 00:01:56,240 Speaker 2: wrong with them and have had their baby biased as 37 00:01:56,240 --> 00:02:00,360 Speaker 2: their insection. So we're not talking about individual cases, talking 38 00:02:00,360 --> 00:02:05,920 Speaker 2: about across the book. When a woman is older at 39 00:02:05,920 --> 00:02:08,760 Speaker 2: the time of her first baby, she has just been 40 00:02:08,800 --> 00:02:12,160 Speaker 2: on the planet for more years and has clocked up 41 00:02:12,639 --> 00:02:16,320 Speaker 2: a greater number of pre existing health problems. And then 42 00:02:16,360 --> 00:02:19,040 Speaker 2: there are some things in the pregnancy itself that are 43 00:02:19,080 --> 00:02:22,400 Speaker 2: more likely to have happened full stop, just because you are older. 44 00:02:23,040 --> 00:02:24,880 Speaker 2: So not just the things you come into the pregnancy with, 45 00:02:25,080 --> 00:02:27,120 Speaker 2: but the things you might that might happen to you 46 00:02:27,200 --> 00:02:28,000 Speaker 2: while you're pregnant. 47 00:02:28,320 --> 00:02:33,200 Speaker 1: Yeah, well, I'm going to do nineteen sixties bridge. I've 48 00:02:33,240 --> 00:02:36,239 Speaker 1: got a massive, big beehive and a little tiny little 49 00:02:36,400 --> 00:02:39,240 Speaker 1: dress on, and you're looking good, looking good. All right. 50 00:02:39,840 --> 00:02:45,480 Speaker 1: So as a woman, I'm married because most people were, Yes, 51 00:02:46,200 --> 00:02:49,200 Speaker 1: And I'm twenty six point eight years old when i 52 00:02:49,200 --> 00:02:49,960 Speaker 1: have my first babe. 53 00:02:50,480 --> 00:02:54,120 Speaker 2: Yeah. Even that sounded a little old, a little old. 54 00:02:54,240 --> 00:02:58,280 Speaker 1: Yeah, yeah, Well, actually I did look the data. They 55 00:02:58,320 --> 00:03:00,720 Speaker 1: got younger, I think in the nineties seventies, and then 56 00:03:00,760 --> 00:03:02,840 Speaker 1: they got older again, so it was weird nineteen sixties, 57 00:03:02,880 --> 00:03:05,280 Speaker 1: a bit older nineteen seventies, a bit younger nineteen eighties. 58 00:03:06,080 --> 00:03:08,359 Speaker 1: So there's a bit of a dip in the seventies. 59 00:03:08,440 --> 00:03:11,520 Speaker 2: So I was born in nineteen seventy two and I 60 00:03:11,560 --> 00:03:13,960 Speaker 2: think my mum was about twenty three when I was born. 61 00:03:14,200 --> 00:03:16,320 Speaker 2: But I've got two of an older brother and an 62 00:03:16,320 --> 00:03:18,520 Speaker 2: older sister. Yeah. 63 00:03:18,960 --> 00:03:22,960 Speaker 1: I reckon if there's a subset that's like a Catholic subset, 64 00:03:23,160 --> 00:03:26,520 Speaker 1: it would be less in Country Victoria. I wonder if 65 00:03:26,560 --> 00:03:28,880 Speaker 1: it was less because my mum was the same. All right. 66 00:03:29,000 --> 00:03:33,040 Speaker 1: So twenty twenty six, bridget Oh, I've lost a few years. 67 00:03:33,080 --> 00:03:35,520 Speaker 1: I'm only thirty two years old when I have my 68 00:03:35,560 --> 00:03:36,200 Speaker 1: first baby. 69 00:03:36,760 --> 00:03:40,440 Speaker 2: Yeah, so that's a significant difference twenty six to thirty two, 70 00:03:42,120 --> 00:03:46,960 Speaker 2: But those are average figures, and justice back then there 71 00:03:46,960 --> 00:03:51,119 Speaker 2: would have been some people younger than twenty six. There 72 00:03:51,160 --> 00:03:53,160 Speaker 2: are plenty of people much older than thirty two. 73 00:03:54,080 --> 00:03:58,040 Speaker 1: Yeah, that's right. Back in nineteen sixty I probably would 74 00:03:58,040 --> 00:04:01,440 Speaker 1: have had three to four children. I bucked the trend 75 00:04:01,480 --> 00:04:04,400 Speaker 1: in real life. But in twenty twenty six, I'd probably 76 00:04:04,440 --> 00:04:07,200 Speaker 1: have just one or two children. Yes, and in fact, 77 00:04:07,240 --> 00:04:11,120 Speaker 1: the Australian birth rate is one point four eight or something. 78 00:04:11,400 --> 00:04:15,840 Speaker 2: Yes, it's way too low, not just for us front 79 00:04:16,279 --> 00:04:20,280 Speaker 2: for business, but but you know, obviously it's too low. 80 00:04:20,520 --> 00:04:22,400 Speaker 2: Obviously it's not even close to high enough to replace 81 00:04:22,440 --> 00:04:25,680 Speaker 2: the population, which is why I developed countries like ours 82 00:04:25,720 --> 00:04:30,039 Speaker 2: are relying heavily on immigration, which is, you know, what 83 00:04:30,080 --> 00:04:35,520 Speaker 2: we need to keep our population growing. Would have no 84 00:04:35,640 --> 00:04:38,960 Speaker 2: hope if we were relying on people who were already 85 00:04:39,200 --> 00:04:43,000 Speaker 2: here to reproduce at the rate needed to grow the population. 86 00:04:44,120 --> 00:04:49,560 Speaker 2: So if we look at those numbers, the smaller family. 87 00:04:49,760 --> 00:04:54,600 Speaker 2: We spoke last week about about how that the fewer 88 00:04:54,680 --> 00:04:58,440 Speaker 2: babies that you have, the less you have to fear from. 89 00:04:58,480 --> 00:05:03,080 Speaker 2: Cesarean section in terms of genuine complications, so people may 90 00:05:03,080 --> 00:05:07,520 Speaker 2: be more likely to choose it, or maybe more maybe 91 00:05:07,640 --> 00:05:12,839 Speaker 2: more willing to accept it as as as advice. 92 00:05:15,720 --> 00:05:22,240 Speaker 1: In nineteen sixties, BRIGID would have lower medical complexity. Twenty 93 00:05:22,240 --> 00:05:27,039 Speaker 1: twenty six, BRIDGID might have some more morbidity. Is maybe 94 00:05:27,040 --> 00:05:29,360 Speaker 1: you could just explain what comorbidities are. 95 00:05:29,440 --> 00:05:31,520 Speaker 2: Well, that's an interesting one, isn't it, Because in some 96 00:05:31,560 --> 00:05:35,880 Speaker 2: ways people were probably a bit healthier. I think there 97 00:05:35,920 --> 00:05:40,720 Speaker 2: was less obesity, but people smoked their off and so 98 00:05:40,760 --> 00:05:41,800 Speaker 2: that I was I. 99 00:05:41,720 --> 00:05:44,080 Speaker 1: Was totally smoking back in nineteen. 100 00:05:43,760 --> 00:05:49,840 Speaker 2: Sixty all right, you were, yeah, Well, so that was 101 00:05:50,160 --> 00:05:55,279 Speaker 2: that was a lot more socially acceptable normal. So in 102 00:05:55,279 --> 00:05:57,960 Speaker 2: Australia the smoking rates have come down dramatically over that 103 00:05:58,279 --> 00:06:02,560 Speaker 2: time period. So so we've we've doubtless improved some things, 104 00:06:03,440 --> 00:06:06,919 Speaker 2: but a few things are worse. 105 00:06:08,400 --> 00:06:11,800 Speaker 1: Nineteen sixties Bridge no IVF. In fact, when was the 106 00:06:11,800 --> 00:06:12,520 Speaker 1: first IVF? 107 00:06:14,000 --> 00:06:18,039 Speaker 2: Well, start in the seventies, didn't and as an idea 108 00:06:18,160 --> 00:06:22,720 Speaker 2: and it sort of came into into you know, practical 109 00:06:22,880 --> 00:06:25,800 Speaker 2: use in the eighties. So I think that that's a 110 00:06:25,800 --> 00:06:32,440 Speaker 2: really interesting one because the recommendation that certain people who 111 00:06:32,440 --> 00:06:34,359 Speaker 2: have had IVF should have their babies spices are in 112 00:06:34,400 --> 00:06:40,080 Speaker 2: section is based, in my humble opinion on some slightly 113 00:06:40,440 --> 00:06:47,000 Speaker 2: inadequate data, and if you control for all the other things, 114 00:06:47,400 --> 00:06:53,960 Speaker 2: like for example, some people with who have babies through 115 00:06:54,040 --> 00:06:59,640 Speaker 2: IVF have got infertility related to obesity, well, their CAESAR 116 00:06:59,720 --> 00:07:02,039 Speaker 2: risk more likely to be related to their obesity than 117 00:07:02,080 --> 00:07:05,599 Speaker 2: the IVF. This where the stats get a bit complex. 118 00:07:06,320 --> 00:07:07,919 Speaker 2: Some people who might have been trying for a baby 119 00:07:07,960 --> 00:07:10,480 Speaker 2: for fifteen years without success and turned to IVF in 120 00:07:10,520 --> 00:07:13,960 Speaker 2: their very late thirties or forty, and some of their 121 00:07:14,040 --> 00:07:16,800 Speaker 2: risk is related to being forty, not because it's IVF. 122 00:07:17,400 --> 00:07:22,320 Speaker 2: So if you control for those potential confounders then and 123 00:07:22,440 --> 00:07:27,120 Speaker 2: look just at whether the IVF is a reason to 124 00:07:27,200 --> 00:07:30,720 Speaker 2: have a CAESAR, the data gets a little bit loose. There. 125 00:07:31,680 --> 00:07:36,360 Speaker 2: There is some suggestion that the placentas from IVF pregnancy 126 00:07:36,720 --> 00:07:43,360 Speaker 2: might not be as good as from the naturally conceived pregnancy, 127 00:07:43,480 --> 00:07:47,680 Speaker 2: and therefore those babies might be more likely to get 128 00:07:47,800 --> 00:07:52,760 Speaker 2: an abnormal field heart rate trace in labor. But that data, 129 00:07:53,040 --> 00:07:55,880 Speaker 2: once you've controlled for confounders and taken out the people 130 00:07:56,320 --> 00:08:00,840 Speaker 2: who's sees a risk is high for other reasons than 131 00:08:01,520 --> 00:08:05,720 Speaker 2: whether or not IVF couses. This is is up for debate. 132 00:08:06,400 --> 00:08:08,880 Speaker 1: I actually did a bit of an AI deep diving 133 00:08:08,960 --> 00:08:10,400 Speaker 1: and like we were going to have a whole segment 134 00:08:10,440 --> 00:08:12,400 Speaker 1: on an IVF and we will get to it again. 135 00:08:12,920 --> 00:08:18,440 Speaker 1: But AI told me to begin with that IVF pregnancies 136 00:08:18,520 --> 00:08:22,320 Speaker 1: have a much higher rate of caesarian section. And I 137 00:08:22,400 --> 00:08:25,000 Speaker 1: basically said, oh, come on, AI, that's bullshit. Tell me 138 00:08:25,040 --> 00:08:29,280 Speaker 1: something different, use twenty twenty six data with a higher 139 00:08:29,840 --> 00:08:34,800 Speaker 1: caesarean section rate. I get really cranky, AI, and it 140 00:08:34,840 --> 00:08:39,360 Speaker 1: came back and said, actually, you're right, you're right. 141 00:08:39,440 --> 00:08:40,520 Speaker 2: Mistake, my mistake. 142 00:08:40,600 --> 00:08:45,280 Speaker 1: Sorry. It said, when we start looking at the increase 143 00:08:45,480 --> 00:08:48,200 Speaker 1: of caesarean rate to the forty one percent that it is, 144 00:08:49,160 --> 00:08:54,440 Speaker 1: it makes the gap between IVF and general population caesarian 145 00:08:54,559 --> 00:09:00,400 Speaker 1: rate much smaller. Well, it just keept quoting old, outdated comes. 146 00:09:00,960 --> 00:09:06,080 Speaker 2: Yeah, and that's a problem with that technology. All right. 147 00:09:06,600 --> 00:09:11,480 Speaker 1: So nineteen sixties BRIDGID less than five percent chance or 148 00:09:11,520 --> 00:09:15,800 Speaker 1: five percent of pregnancies having cesarian section. Sure, and now 149 00:09:15,880 --> 00:09:19,160 Speaker 1: I just said thirty eight to forty one percent twenty 150 00:09:19,200 --> 00:09:26,360 Speaker 1: twenty six. This one was interesting. Minimal monitoring nineteen sixties 151 00:09:26,400 --> 00:09:29,880 Speaker 1: BRIDGID laboring, I wouldn't have had any monitoring, sure, but 152 00:09:29,960 --> 00:09:31,960 Speaker 1: now I've got continuous monitoring. 153 00:09:32,080 --> 00:09:37,720 Speaker 2: Yeah, so this is well, there's a whole whole new topic, really, 154 00:09:37,760 --> 00:09:41,560 Speaker 2: and something we can discuss again in its in its 155 00:09:41,559 --> 00:09:46,320 Speaker 2: own episode. But electronic fetal monitoring during labor, where we've 156 00:09:46,360 --> 00:09:48,600 Speaker 2: got the strap around of tubby monitoring the fetal heartbeat. 157 00:09:49,640 --> 00:09:54,280 Speaker 2: Doubtless it's indicated babies performing very poorly in labor, not 158 00:09:54,320 --> 00:09:57,079 Speaker 2: getting in our foxygen and so forth go around for 159 00:09:57,080 --> 00:10:03,000 Speaker 2: a section, very very bad outcome for the baby is averted. 160 00:10:03,840 --> 00:10:08,880 Speaker 2: But also over the years some problems with interpretation of 161 00:10:09,360 --> 00:10:15,720 Speaker 2: false positives, and critics would say that the over monitored 162 00:10:15,800 --> 00:10:20,079 Speaker 2: labor is more likely to end in cesarain section, but 163 00:10:21,080 --> 00:10:25,079 Speaker 2: no different too, but won't pick up problems any any 164 00:10:25,280 --> 00:10:30,839 Speaker 2: more reliably than than than less strict monitoring, and that 165 00:10:31,240 --> 00:10:34,280 Speaker 2: after all this time is still is still up for debate. 166 00:10:35,520 --> 00:10:37,800 Speaker 1: And it's hard, you know. I listen to your phone 167 00:10:37,840 --> 00:10:43,360 Speaker 1: calls and I hear you sort of getting a CTG 168 00:10:43,559 --> 00:10:45,440 Speaker 1: in or something, and it's it's showing a spike in 169 00:10:45,480 --> 00:10:50,160 Speaker 1: the baby's heart rate, and everyone's like action stations, but 170 00:10:50,280 --> 00:10:53,959 Speaker 1: it's right at the end, you know, and I hear 171 00:10:54,000 --> 00:10:57,120 Speaker 1: you say, yes, sort of to be expected, let's see 172 00:10:57,120 --> 00:10:59,680 Speaker 1: what it's recovery is like. And you know that comes 173 00:10:59,679 --> 00:11:04,920 Speaker 1: from it experience. But in an over protocolized hospital, how 174 00:11:04,960 --> 00:11:06,640 Speaker 1: do you you know, do you think that's a bit 175 00:11:06,679 --> 00:11:08,600 Speaker 1: of an issue as well when it comes to monitoring. 176 00:11:08,880 --> 00:11:13,120 Speaker 2: Yeah, so a lot of people think that electronic feedal 177 00:11:13,160 --> 00:11:17,440 Speaker 2: monitoring has its place, but if we're going to use it, 178 00:11:17,480 --> 00:11:20,520 Speaker 2: we need to use it properly. And it's in the 179 00:11:20,679 --> 00:11:25,640 Speaker 2: very very careful use of it and the experienced and 180 00:11:25,840 --> 00:11:29,640 Speaker 2: expert interpretation of it that we see good data, good 181 00:11:29,800 --> 00:11:36,000 Speaker 2: good outcomes. So we pick up in a nutshell, the 182 00:11:36,040 --> 00:11:42,320 Speaker 2: problem with the electronic fetal monitoring is they work a 183 00:11:42,360 --> 00:11:46,200 Speaker 2: bit like a smoke alarm in your house. If it 184 00:11:46,280 --> 00:11:50,959 Speaker 2: goes off, most likely your house is not on fire, 185 00:11:52,360 --> 00:11:58,640 Speaker 2: just a burnt toast, and so it says things might 186 00:11:58,760 --> 00:12:02,200 Speaker 2: be wrong and you need to go looking to find 187 00:12:02,240 --> 00:12:06,280 Speaker 2: out exactly what's going on. Because even though the smoke alarm, 188 00:12:06,520 --> 00:12:08,320 Speaker 2: most of the time when it goes off, your house 189 00:12:08,400 --> 00:12:11,679 Speaker 2: is not on fire, you still wouldn't sleep investigating. Yeah, 190 00:12:11,720 --> 00:12:14,120 Speaker 2: you'd get up and have a look. And that's what 191 00:12:14,640 --> 00:12:18,080 Speaker 2: that's what electronic feed on monitoring really, that's probably how 192 00:12:18,120 --> 00:12:24,120 Speaker 2: it should be used. And if we the smarter we 193 00:12:24,240 --> 00:12:25,880 Speaker 2: use it, the better a tool it is. 194 00:12:26,880 --> 00:12:32,320 Speaker 1: I want to talk about, you know, the risk and 195 00:12:32,440 --> 00:12:36,440 Speaker 1: litigation that might be impacting on those decisions. In a minute, 196 00:12:36,760 --> 00:12:41,640 Speaker 1: just remind me, all right, So nineteen sixties Bridged might 197 00:12:41,679 --> 00:12:45,520 Speaker 1: have had her baby die. I don't even know how 198 00:12:45,559 --> 00:12:48,160 Speaker 1: to say this. Pat, So her baby die sixty seven 199 00:12:48,200 --> 00:12:53,079 Speaker 1: times more likely than her twenty twenty six selfs help 200 00:12:53,160 --> 00:12:54,679 Speaker 1: me out there? What am I trying to say there? 201 00:12:54,840 --> 00:12:59,240 Speaker 2: Well, it did use to be riskier to have a baby, 202 00:12:59,800 --> 00:13:06,080 Speaker 2: and there's no doubt that it's less risky now. The debate, 203 00:13:06,480 --> 00:13:11,880 Speaker 2: I guess, is a number of things. For all the interventions, 204 00:13:11,760 --> 00:13:16,080 Speaker 2: has the improvements been worth it? I think yes. Then 205 00:13:16,080 --> 00:13:17,679 Speaker 2: we're going to look and say, well, which one's made 206 00:13:17,720 --> 00:13:20,800 Speaker 2: the big differences? And I think that's where the debate 207 00:13:21,640 --> 00:13:25,960 Speaker 2: probably probably should see it. If you look at something 208 00:13:26,120 --> 00:13:27,680 Speaker 2: like it used to be way less common have your 209 00:13:27,720 --> 00:13:33,319 Speaker 2: labor induced. Certainly back in the day, they knew less 210 00:13:33,360 --> 00:13:36,520 Speaker 2: about the problem that you might have before it happened. 211 00:13:37,200 --> 00:13:43,360 Speaker 2: So it was very, very, in fact, completely routine to say, well, 212 00:13:43,520 --> 00:13:46,200 Speaker 2: coming to labor like everybody else, and we'll see how 213 00:13:46,240 --> 00:13:49,840 Speaker 2: we go. And if you're obstructed force entimeters, weet, we 214 00:13:49,880 --> 00:13:53,200 Speaker 2: can't get the baby out through force centimeters cervix, then 215 00:13:53,760 --> 00:13:55,480 Speaker 2: we'll give you a bit of cento and try and 216 00:13:55,520 --> 00:13:56,719 Speaker 2: push you along a bit, and that doesn't work with 217 00:13:56,880 --> 00:14:00,960 Speaker 2: a section, And that would have been totally routine care. 218 00:14:01,200 --> 00:14:03,720 Speaker 2: And in many ways it still is routine care. It's 219 00:14:03,760 --> 00:14:06,080 Speaker 2: just that if we know about a major problem with 220 00:14:06,240 --> 00:14:11,000 Speaker 2: the uterus or the cervix or the baby itself in advance, 221 00:14:11,080 --> 00:14:13,360 Speaker 2: because we've got a lot of very clever technology that 222 00:14:13,440 --> 00:14:17,720 Speaker 2: helps helps us out with that, then there are plenty 223 00:14:17,760 --> 00:14:20,240 Speaker 2: of occasions in which we might say, the chances of 224 00:14:20,280 --> 00:14:24,080 Speaker 2: this baby being born vaginally, despite your preference for that, 225 00:14:24,240 --> 00:14:26,840 Speaker 2: is extremely low, and maybe you would just want to 226 00:14:26,880 --> 00:14:27,640 Speaker 2: section up front. 227 00:14:28,200 --> 00:14:30,040 Speaker 1: Okay, So the last I want to talk about is 228 00:14:30,080 --> 00:14:33,440 Speaker 1: maternal mortality. And you know, the way that you could 229 00:14:33,440 --> 00:14:35,800 Speaker 1: say it is that I would be twice more likely 230 00:14:35,840 --> 00:14:39,400 Speaker 1: to die in nineteen sixties than twenty twenty six. 231 00:14:39,520 --> 00:14:42,000 Speaker 2: Yes, that sounds way more sounds terrible, That sounds way 232 00:14:42,040 --> 00:14:44,520 Speaker 2: more impressive than it really is. But you know, we've 233 00:14:44,560 --> 00:14:47,360 Speaker 2: halved the rate of maternal debts, but we've been out 234 00:14:47,360 --> 00:14:50,680 Speaker 2: of one hundred thousand people, we've halved them from twelve 235 00:14:50,760 --> 00:14:54,560 Speaker 2: to six. Yes, okay, So the real improvements in that 236 00:14:54,680 --> 00:14:59,360 Speaker 2: happened happened before nineteen sixty, so you know, things like 237 00:14:59,480 --> 00:15:03,440 Speaker 2: washing our a safe way of doing a caesarean section, 238 00:15:04,080 --> 00:15:11,560 Speaker 2: the invention of forces, vaccination, sanitation, all of those things. 239 00:15:11,600 --> 00:15:14,720 Speaker 2: We had these massive improvements in the safety of life 240 00:15:14,760 --> 00:15:21,520 Speaker 2: for everybody, but in particular for pregnant women. And by 241 00:15:21,560 --> 00:15:23,960 Speaker 2: the sixties it was already twelve. Now at six, that's great, 242 00:15:23,960 --> 00:15:27,080 Speaker 2: We're we're really grateful and happy with that improvement. But 243 00:15:28,720 --> 00:15:31,800 Speaker 2: the degree to which doing more sections is responsible for 244 00:15:31,800 --> 00:15:32,520 Speaker 2: that is unclear. 245 00:15:34,480 --> 00:15:37,640 Speaker 1: So that's the comparison. But I now want to hone 246 00:15:37,680 --> 00:15:43,880 Speaker 1: in on the age age related caesareans. And we talked 247 00:15:43,880 --> 00:15:49,800 Speaker 1: a little bit about perhaps general body size, but are 248 00:15:49,800 --> 00:15:52,640 Speaker 1: there any other reasons that we talked about the comorbid 249 00:15:52,760 --> 00:15:55,320 Speaker 1: it is, but you know, some people talk about that 250 00:15:55,360 --> 00:16:02,720 Speaker 1: the late thirties early forty year old woman less that 251 00:16:02,800 --> 00:16:05,840 Speaker 1: her tissue is different, her vaginal tissue is different. Is 252 00:16:05,880 --> 00:16:07,960 Speaker 1: there anything else that we need to be thinking about 253 00:16:07,960 --> 00:16:09,200 Speaker 1: when we're talking about age. 254 00:16:09,560 --> 00:16:13,320 Speaker 2: Well, I think, you know, sometimes I find myself saying 255 00:16:13,320 --> 00:16:18,400 Speaker 2: to women in their late thirties that I would rather 256 00:16:18,520 --> 00:16:22,840 Speaker 2: be looking after a woman in her late thirties who's 257 00:16:22,880 --> 00:16:30,440 Speaker 2: a non smoker physically active and normal body weight than 258 00:16:30,520 --> 00:16:34,560 Speaker 2: someone who was nineteen but an obese and a smoker. 259 00:16:35,960 --> 00:16:38,640 Speaker 2: So I think that to a certain extent, we can, 260 00:16:39,880 --> 00:16:42,440 Speaker 2: you know, we can trade off some of the problems 261 00:16:42,440 --> 00:16:46,320 Speaker 2: associated with aging by being in good in good condition 262 00:16:47,120 --> 00:16:52,640 Speaker 2: and making smart health choices. There probably are some issues 263 00:16:52,720 --> 00:16:58,560 Speaker 2: related to being forty plus that you just have somewhere. 264 00:16:58,720 --> 00:17:04,280 Speaker 2: You know, the tissue is a little different. We've just 265 00:17:04,359 --> 00:17:12,120 Speaker 2: had longer to clock up pre existing health problems. You're 266 00:17:12,160 --> 00:17:15,879 Speaker 2: more likely to have diabetes in the pregnancy, hypertension in 267 00:17:15,920 --> 00:17:19,199 Speaker 2: the brency, preclamsy in the brenzy, and those things have 268 00:17:19,320 --> 00:17:21,560 Speaker 2: a way of increasing your section rate. 269 00:17:22,400 --> 00:17:24,399 Speaker 1: I know that a lot of hospitals do as soon 270 00:17:24,440 --> 00:17:26,919 Speaker 1: as you turn a certain age, they put you in 271 00:17:26,920 --> 00:17:29,040 Speaker 1: a certain bracket and maybe you're not able to go 272 00:17:29,080 --> 00:17:31,439 Speaker 1: into the low risk programs, maybe you go into the 273 00:17:31,520 --> 00:17:37,360 Speaker 1: medium high risk programs. So for someone in individualized practice 274 00:17:37,760 --> 00:17:41,919 Speaker 1: practicing continuity of care, is that how you approach an 275 00:17:42,040 --> 00:17:43,520 Speaker 1: older mom when she's having her. 276 00:17:43,440 --> 00:17:46,480 Speaker 2: Baby, Well for sure, because I can in the private 277 00:17:46,480 --> 00:17:48,879 Speaker 2: practice setting, you know that's not difficult to do. You 278 00:17:48,920 --> 00:17:51,560 Speaker 2: can just say to someone, look, you know, is your 279 00:17:52,000 --> 00:17:55,240 Speaker 2: section rate slightly higher than someone in their twenties. Yes, however, 280 00:17:55,320 --> 00:17:57,960 Speaker 2: you've still got plenty in your favor. And if there's 281 00:17:58,000 --> 00:18:00,800 Speaker 2: no absolute reason we should do be doing a section 282 00:18:00,880 --> 00:18:03,639 Speaker 2: now and you don't want a section, then let's not 283 00:18:03,720 --> 00:18:05,800 Speaker 2: do that. Let's come in too late and see how 284 00:18:05,800 --> 00:18:06,000 Speaker 2: we go. 285 00:18:06,240 --> 00:18:06,480 Speaker 1: Yeah. 286 00:18:06,640 --> 00:18:12,800 Speaker 2: Yeah, And that we think that people who who are 287 00:18:13,240 --> 00:18:15,760 Speaker 2: non starters for vaginal birth like just having a section 288 00:18:15,960 --> 00:18:18,600 Speaker 2: from the get go, there really needs to be either 289 00:18:18,640 --> 00:18:20,960 Speaker 2: a strong maternal preference or a good medical reason. 290 00:18:21,440 --> 00:18:24,560 Speaker 1: Good. So I want to go on to we already 291 00:18:24,560 --> 00:18:27,119 Speaker 1: touched on IVF and I think we've covered that, but 292 00:18:27,200 --> 00:18:33,000 Speaker 1: it can fall into the category of what some people 293 00:18:33,080 --> 00:18:37,359 Speaker 1: term as a precious pregnancy. So for somebody that's waited 294 00:18:37,400 --> 00:18:40,639 Speaker 1: for so long or somebody that knows they're only going 295 00:18:40,680 --> 00:18:43,880 Speaker 1: to have too and so therefore they start making different 296 00:18:44,119 --> 00:18:48,520 Speaker 1: decisions about how they're going to actually birth. Is this 297 00:18:48,560 --> 00:18:50,840 Speaker 1: a myth or like, how do people come to you 298 00:18:51,040 --> 00:18:54,600 Speaker 1: in their late thirties early forties and sort of say, oh, 299 00:18:54,640 --> 00:18:56,160 Speaker 1: you know, I'm a bit old, so I'm definitely having 300 00:18:56,200 --> 00:18:58,119 Speaker 1: a season because I've waited so long for this baby 301 00:18:58,160 --> 00:18:59,720 Speaker 1: to come. And is that a thing? 302 00:19:00,160 --> 00:19:06,480 Speaker 2: It's definitely a thing, Whether it's a whether it's a logical, 303 00:19:06,560 --> 00:19:10,119 Speaker 2: scientific thing, or whether it's evidence based thing or whether 304 00:19:10,160 --> 00:19:16,080 Speaker 2: it's an emotional thing is less clear, but that's definitely 305 00:19:16,119 --> 00:19:19,040 Speaker 2: something people think about at the end of a long 306 00:19:19,640 --> 00:19:28,840 Speaker 2: period with infertility. I think people's allowance for or tolerance 307 00:19:29,000 --> 00:19:36,080 Speaker 2: for uncertainty drops dramatically. So we all have an uncertainty tolerance, 308 00:19:37,240 --> 00:19:44,400 Speaker 2: and if you've been through a lot with fertility, surprises 309 00:19:44,560 --> 00:19:50,239 Speaker 2: aren't welcome. So sometimes the section, for all its ins 310 00:19:50,280 --> 00:19:53,159 Speaker 2: and outs, for all its risk and benefits, it looks 311 00:19:53,320 --> 00:19:58,440 Speaker 2: like a I've got a definite day. I don't have 312 00:19:58,520 --> 00:20:01,720 Speaker 2: to be in labor, wondering whether it's progressing nicely, wondering 313 00:20:01,760 --> 00:20:04,200 Speaker 2: whether wondering whether it's safe, whether the wondering the baby 314 00:20:04,280 --> 00:20:09,720 Speaker 2: is monitoring is normal, or just have a section and 315 00:20:11,000 --> 00:20:12,840 Speaker 2: is it always the most scientific thing in the world. 316 00:20:12,880 --> 00:20:16,800 Speaker 2: Not really, that person might be perfectly safed ever vaginal birth, 317 00:20:17,280 --> 00:20:20,600 Speaker 2: but but ultimately might just be the way the way 318 00:20:20,640 --> 00:20:21,200 Speaker 2: people feel. 319 00:20:22,680 --> 00:20:25,960 Speaker 1: I want to now talk about what we just touched 320 00:20:26,000 --> 00:20:32,560 Speaker 1: on about the risk to the practitioner in continuing with 321 00:20:32,680 --> 00:20:36,480 Speaker 1: a vaginal birth when perhaps call should be made for 322 00:20:36,520 --> 00:20:41,200 Speaker 1: a cesarean section. So how does that impact on your 323 00:20:41,240 --> 00:20:42,040 Speaker 1: decision making? 324 00:20:43,119 --> 00:20:47,000 Speaker 2: I think undoubtedly it does. I think it would be 325 00:20:47,080 --> 00:20:50,919 Speaker 2: naive to say that, Oh no, no, no, I'm just I 326 00:20:50,960 --> 00:20:55,960 Speaker 2: only do science, you know, I only do evidence. There's 327 00:20:56,000 --> 00:20:59,960 Speaker 2: there's a thing. So the longer, you know, as time 328 00:21:00,119 --> 00:21:06,720 Speaker 2: goes by, litigation risk goes up and people's tolerance for 329 00:21:06,800 --> 00:21:10,920 Speaker 2: poor outcomes goes down. So if we're going to have 330 00:21:10,960 --> 00:21:14,960 Speaker 2: one or two babies in our late thirties, we expect 331 00:21:15,000 --> 00:21:19,560 Speaker 2: them both to be well. And so your doctor's not 332 00:21:19,560 --> 00:21:21,880 Speaker 2: a machine. He's a human. He or she's a human being. 333 00:21:22,240 --> 00:21:27,320 Speaker 2: And there's a those thoughts to creep in a little bit. 334 00:21:29,720 --> 00:21:33,399 Speaker 2: Sometimes it's not just performance in labor. Sometimes, you know, 335 00:21:33,440 --> 00:21:37,159 Speaker 2: there have been some some some medico legal cases about 336 00:21:37,440 --> 00:21:40,760 Speaker 2: failure to failure to warn in advance of the risk 337 00:21:40,760 --> 00:21:44,280 Speaker 2: of vaginal birth. And the counter argument would be, well, 338 00:21:45,600 --> 00:21:48,199 Speaker 2: you know, the vaginal birth is the is not a 339 00:21:48,800 --> 00:21:52,320 Speaker 2: it's not a choice, it's the default, and it's not 340 00:21:52,359 --> 00:21:54,960 Speaker 2: a procedure that the doctor did to me. It's something 341 00:21:55,080 --> 00:21:59,960 Speaker 2: it's nature. But there have been a number of important MENA. 342 00:22:00,080 --> 00:22:02,640 Speaker 2: Co Leegal cases about saying, well, hang on a minute, 343 00:22:02,680 --> 00:22:04,920 Speaker 2: you knew this baby was estimated to be four and 344 00:22:04,960 --> 00:22:10,920 Speaker 2: a half kilos on ultrasound assessment and then the baby 345 00:22:10,960 --> 00:22:14,640 Speaker 2: they start coming out with significant neurological damage to the baby, 346 00:22:15,400 --> 00:22:19,840 Speaker 2: you should have done a section. So those things are 347 00:22:20,359 --> 00:22:24,080 Speaker 2: definitely on our mind. And I think anyone in modern 348 00:22:24,080 --> 00:22:27,040 Speaker 2: obstetric practice who isn't troubled by that probably should be 349 00:22:27,119 --> 00:22:30,840 Speaker 2: troubled by that a little bit. It's there. It's a factor. 350 00:22:31,920 --> 00:22:35,520 Speaker 1: I know that you're being completely honest when you're mean, 351 00:22:35,560 --> 00:22:40,160 Speaker 1: You're always honest, but like that's laying yourself bear to criticism. 352 00:22:40,280 --> 00:22:43,320 Speaker 1: You know, people could say, oh, see, that's why obstricians 353 00:22:43,320 --> 00:22:45,840 Speaker 1: are always doing cesareans because they're too worried about getting sued. 354 00:22:46,560 --> 00:22:49,600 Speaker 2: I don't think that is the same thing. You ask 355 00:22:49,640 --> 00:22:52,600 Speaker 2: whether it's on our mind. It's on our mind. Is 356 00:22:53,119 --> 00:22:56,560 Speaker 2: it a reason for doing a section? I don't think so. 357 00:22:56,880 --> 00:22:59,600 Speaker 2: I think I would do sections because I think it's 358 00:22:59,680 --> 00:23:03,399 Speaker 2: good a lot of the time. Let's let's take that 359 00:23:03,480 --> 00:23:06,080 Speaker 2: same example of the baby that's predicted to be very, 360 00:23:06,200 --> 00:23:08,960 Speaker 2: very large. And we've discussed elsewhere in other episodes that 361 00:23:08,960 --> 00:23:11,760 Speaker 2: that that the prediction. The prediction model is hard to 362 00:23:11,760 --> 00:23:15,040 Speaker 2: get right and it can be inaccurate. But let's say, 363 00:23:15,040 --> 00:23:17,040 Speaker 2: for example, the prediction was right and the baby was 364 00:23:17,080 --> 00:23:19,760 Speaker 2: four and a half kilos, then I just think it's 365 00:23:19,800 --> 00:23:23,600 Speaker 2: good care to discuss with that person, would you rather 366 00:23:23,640 --> 00:23:26,240 Speaker 2: have this baby by cesar in section? Here are the 367 00:23:26,320 --> 00:23:28,760 Speaker 2: risks and benefits of doing that, and here are the 368 00:23:28,800 --> 00:23:31,639 Speaker 2: risks and benefits of having this baby or attempting to 369 00:23:31,640 --> 00:23:34,720 Speaker 2: have this baby vaginally, and as a team try and 370 00:23:34,920 --> 00:23:40,359 Speaker 2: try and come to a decision. So that's good care ultimately, 371 00:23:40,400 --> 00:23:43,800 Speaker 2: if the if the woman decides when, when, when confronted 372 00:23:43,840 --> 00:23:46,560 Speaker 2: with the data and the and the and a clear 373 00:23:46,600 --> 00:23:50,159 Speaker 2: explanation of the problem as we see it and the options, 374 00:23:50,680 --> 00:23:54,240 Speaker 2: if she decides to have a section, I would like 375 00:23:54,320 --> 00:23:57,040 Speaker 2: to think, under my care, that's because that was the 376 00:23:57,240 --> 00:24:00,560 Speaker 2: that was the best team decision, not because it was 377 00:24:00,600 --> 00:24:03,200 Speaker 2: the one at least likely to result in litigation. 378 00:24:03,400 --> 00:24:08,399 Speaker 1: Yeah, if people are here and they're listening and going, okay, 379 00:24:08,400 --> 00:24:12,720 Speaker 1: so you haven't addressed whether caesareans are higher in private 380 00:24:14,200 --> 00:24:19,359 Speaker 1: obstetric led care or then say a midway free group care. 381 00:24:21,160 --> 00:24:23,159 Speaker 1: What's what's something that we can say about that? 382 00:24:24,200 --> 00:24:26,240 Speaker 2: Well? I think people maybe should go back and have 383 00:24:26,240 --> 00:24:29,159 Speaker 2: a listened to the to the to the to the 384 00:24:29,200 --> 00:24:32,240 Speaker 2: big private versus public care study that was published in 385 00:24:32,240 --> 00:24:33,000 Speaker 2: Australia last year. 386 00:24:33,040 --> 00:24:34,840 Speaker 1: Oh yeah, we did an episode on that linked to 387 00:24:34,880 --> 00:24:36,720 Speaker 1: the show notes that was that was really good. 388 00:24:36,880 --> 00:24:39,639 Speaker 2: Yeah. Look, it's hard to know we're often not comparing 389 00:24:39,640 --> 00:24:43,520 Speaker 2: apples with apples that the groups, the groups on an 390 00:24:43,560 --> 00:24:48,080 Speaker 2: everyday basis can be hard to compare. What that study did, 391 00:24:48,119 --> 00:24:54,480 Speaker 2: which was which was groundbreaking, was was come up with 392 00:24:54,480 --> 00:24:57,719 Speaker 2: with with with a fair comparison between the two groups. 393 00:24:58,400 --> 00:25:00,840 Speaker 2: So they constantly checked throughout the study that they were 394 00:25:01,000 --> 00:25:05,880 Speaker 2: comparing the same groups under two care models. They were 395 00:25:06,280 --> 00:25:08,359 Speaker 2: it wasn't that one was full of healthy, fit twenty 396 00:25:08,359 --> 00:25:10,320 Speaker 2: one year olds and the other one was full of 397 00:25:10,359 --> 00:25:15,840 Speaker 2: forty four year olds with IVF. So they were constantly 398 00:25:15,920 --> 00:25:18,360 Speaker 2: checking to make sure that it was a fair comparison 399 00:25:18,920 --> 00:25:21,800 Speaker 2: and there were there were some interesting outcomes. Has it 400 00:25:21,840 --> 00:25:24,639 Speaker 2: has it solved the Has it solved the issues? Absolutely not. 401 00:25:24,760 --> 00:25:28,760 Speaker 1: No. It did bring in other parameters about birth though, 402 00:25:28,840 --> 00:25:34,960 Speaker 1: Like you know, it had outcomes for a woman's public 403 00:25:35,000 --> 00:25:38,200 Speaker 1: floor prolapse. So we'll get onto that. 404 00:25:38,160 --> 00:25:38,520 Speaker 2: In a tack. 405 00:25:39,320 --> 00:25:42,399 Speaker 1: All right, So I want to talk about the repeat 406 00:25:42,880 --> 00:25:49,280 Speaker 1: rinseom repeat sea cycle, sea section cycle. So the you know, 407 00:25:49,680 --> 00:25:52,639 Speaker 1: it's likely to get higher when people are having the 408 00:25:52,760 --> 00:25:55,320 Speaker 1: repeat caesarean sections. 409 00:25:54,880 --> 00:25:57,040 Speaker 2: It could do as a percentage. 410 00:25:56,640 --> 00:26:01,440 Speaker 1: As a percentage, So what's happening there? How many people 411 00:26:01,440 --> 00:26:05,080 Speaker 1: are having our planned section after a first section? 412 00:26:05,520 --> 00:26:08,720 Speaker 2: Yeah, this is a really interesting point because this is 413 00:26:08,800 --> 00:26:11,160 Speaker 2: one of the areas where we probably could be doing better. 414 00:26:11,600 --> 00:26:13,760 Speaker 2: You know, I mentioned in the last episode that robson 415 00:26:13,760 --> 00:26:17,960 Speaker 2: criteria where you compare, you're comparing groups of caesars. Yeah, 416 00:26:18,720 --> 00:26:22,680 Speaker 2: and there are some groups that some types of caesars 417 00:26:22,680 --> 00:26:26,600 Speaker 2: that don't really want warrant a comparison because we want 418 00:26:26,600 --> 00:26:29,439 Speaker 2: everyone in that group da have section. But if we 419 00:26:29,520 --> 00:26:35,840 Speaker 2: look at, say the feedback situation, that's seen broadly as 420 00:26:35,880 --> 00:26:39,000 Speaker 2: somewhere that we could be doing better. Yeah. So let's say, 421 00:26:39,000 --> 00:26:43,160 Speaker 2: for example, someone has their first baby for an indication 422 00:26:43,359 --> 00:26:47,480 Speaker 2: that's unlikely to repeat itself. So not someone who obstructs 423 00:26:47,480 --> 00:26:50,160 Speaker 2: at seven centimeters, because if that one has a baby 424 00:26:50,200 --> 00:26:52,159 Speaker 2: the same partner and has another big baby, that might 425 00:26:52,320 --> 00:26:56,080 Speaker 2: much happen again. Right, So we're talking about somebody whose 426 00:26:56,119 --> 00:27:00,439 Speaker 2: first baby, first caesar was done without labor for breach 427 00:27:00,560 --> 00:27:05,680 Speaker 2: or percent of previa, there's two good examples. Then that person, 428 00:27:06,440 --> 00:27:07,679 Speaker 2: you know, their luck would be out if they got 429 00:27:07,680 --> 00:27:10,800 Speaker 2: those things again. So they coming to the second pregnancy, 430 00:27:11,040 --> 00:27:17,120 Speaker 2: neither of those apply. We need to work harder at 431 00:27:17,320 --> 00:27:22,960 Speaker 2: talking up vback for that group because they would have 432 00:27:23,040 --> 00:27:26,280 Speaker 2: high levels of success if there was nothing else going on. 433 00:27:27,440 --> 00:27:30,960 Speaker 2: And the v back success rates, you know, in some 434 00:27:31,119 --> 00:27:34,439 Speaker 2: institutions are terrific. It's just that not enough people come 435 00:27:34,440 --> 00:27:36,960 Speaker 2: to the starting line. But of the people that do 436 00:27:37,880 --> 00:27:40,760 Speaker 2: the majority of those of those women would go on 437 00:27:40,800 --> 00:27:44,760 Speaker 2: to have a vaginal birth, and the ones that wound 438 00:27:44,840 --> 00:27:47,399 Speaker 2: up with a section that seems to happen at a 439 00:27:47,440 --> 00:27:50,200 Speaker 2: comparable rate that anyone would have a section. Yeah, even 440 00:27:50,240 --> 00:27:52,680 Speaker 2: if they had no previous yep, was the. 441 00:27:52,200 --> 00:27:55,200 Speaker 1: First attempt, second baby, but first attempt at a vaginal birth, 442 00:27:55,200 --> 00:27:59,560 Speaker 1: they were the same statistical Yeah. 443 00:27:58,920 --> 00:28:01,440 Speaker 2: And sometimes there's rate is less and you think, wow, 444 00:28:01,480 --> 00:28:05,560 Speaker 2: could that possibly be right? And it's because it's not 445 00:28:05,640 --> 00:28:10,080 Speaker 2: all comers that the people attempting the people attempting the 446 00:28:10,160 --> 00:28:15,080 Speaker 2: v bag are a subset, whereas the first baby section 447 00:28:15,280 --> 00:28:17,080 Speaker 2: rate is a percentage of everybody. 448 00:28:17,200 --> 00:28:19,640 Speaker 1: Yeah, and it might help some people if we put 449 00:28:19,680 --> 00:28:23,960 Speaker 1: some figures around that. So of those that have had 450 00:28:24,600 --> 00:28:29,000 Speaker 1: their first section baby by C section, sixty to seventy 451 00:28:29,040 --> 00:28:31,280 Speaker 1: percent go on and have another planned section. 452 00:28:31,640 --> 00:28:34,760 Speaker 2: Yes, they're the group we're interested in, because that number 453 00:28:34,760 --> 00:28:35,480 Speaker 2: could be smaller. 454 00:28:35,600 --> 00:28:38,640 Speaker 1: Yeah so, yeah, the thirty forty percent are going on 455 00:28:38,680 --> 00:28:39,880 Speaker 1: and attempting a v back. 456 00:28:40,720 --> 00:28:44,600 Speaker 2: Yeah so, so given that most of the v backs, 457 00:28:44,960 --> 00:28:49,480 Speaker 2: if carefully selected, will will have a vaginal birth, then 458 00:28:49,760 --> 00:28:53,320 Speaker 2: the answer would seem to be to do more vbacks, 459 00:28:54,000 --> 00:28:58,000 Speaker 2: to have more people come forward for an attempt at 460 00:28:58,040 --> 00:29:03,240 Speaker 2: a vaginal birth. And the you know, the people who 461 00:29:04,400 --> 00:29:07,240 Speaker 2: attempt that and it winds up with the section, they're 462 00:29:07,280 --> 00:29:10,280 Speaker 2: still fine. And if they'd elected for a section, well, 463 00:29:10,920 --> 00:29:14,400 Speaker 2: one hundred chance you're getting a section. But so the 464 00:29:14,480 --> 00:29:18,400 Speaker 2: vback's worth a try. And some of the reasons that 465 00:29:18,480 --> 00:29:23,680 Speaker 2: people give for not wanting an attempt at vaginal birth 466 00:29:23,720 --> 00:29:26,080 Speaker 2: with a previous section, ah, legitimate, it's up to you. 467 00:29:26,080 --> 00:29:28,160 Speaker 2: You don't have to. But a lot of the time, 468 00:29:28,600 --> 00:29:30,280 Speaker 2: I think the most common thing that I'm told is 469 00:29:30,280 --> 00:29:31,920 Speaker 2: I had a section last time. Wasn't too bad. It 470 00:29:31,960 --> 00:29:33,760 Speaker 2: wasn't too bad. I'll just have another one of those plays. 471 00:29:34,040 --> 00:29:37,640 Speaker 2: That's that kind of devil, you know argument. And I 472 00:29:37,640 --> 00:29:39,640 Speaker 2: guess if that's the way they feel that, that's fine. 473 00:29:39,760 --> 00:29:43,920 Speaker 2: But I often say to people who, well, if someone 474 00:29:43,960 --> 00:29:47,200 Speaker 2: feels ripped off by their first labor and disappointed that 475 00:29:47,240 --> 00:29:49,720 Speaker 2: they had a section. I mentioned v back to those 476 00:29:49,720 --> 00:29:52,640 Speaker 2: people very early while they're still in the hospital with 477 00:29:52,640 --> 00:29:57,200 Speaker 2: the first baby, because I think dangling that possibility of 478 00:29:57,320 --> 00:30:00,960 Speaker 2: vaginal birth next time probably helps with mental health recovery 479 00:30:00,960 --> 00:30:04,480 Speaker 2: from the first baby, where some people feel very disported 480 00:30:05,840 --> 00:30:07,640 Speaker 2: and you say, well, that was the best thing to 481 00:30:07,680 --> 00:30:11,360 Speaker 2: do this time, but next time, whole new story, we'll 482 00:30:11,400 --> 00:30:16,040 Speaker 2: try again, and that that helps some people with the 483 00:30:16,160 --> 00:30:20,800 Speaker 2: with the with the mental for that. So I think 484 00:30:20,960 --> 00:30:23,680 Speaker 2: I think those someone who really really wants a vaginal 485 00:30:23,720 --> 00:30:26,640 Speaker 2: birth should should give it a go, all things being equal. Secondly, 486 00:30:26,640 --> 00:30:31,200 Speaker 2: you've got the group that that feel that that still 487 00:30:31,200 --> 00:30:34,400 Speaker 2: feel despite their section experience with their first baby, that 488 00:30:34,560 --> 00:30:37,560 Speaker 2: their rough preference is to have that baby vachinaly, and 489 00:30:37,600 --> 00:30:39,000 Speaker 2: I think that's a group we could really work on 490 00:30:39,080 --> 00:30:42,360 Speaker 2: get more people over the line. And then then there's 491 00:30:42,360 --> 00:30:43,840 Speaker 2: always going to be a group of people who say, 492 00:30:43,880 --> 00:30:46,360 Speaker 2: look at a section, last time was fine, Just give 493 00:30:46,360 --> 00:30:48,160 Speaker 2: me another one of those, and I only want one 494 00:30:48,160 --> 00:30:49,000 Speaker 2: more baby anyway. 495 00:30:49,120 --> 00:30:49,320 Speaker 1: Yeah. 496 00:30:49,520 --> 00:30:52,000 Speaker 2: Yeah, the people I probably work on the hardest to 497 00:30:52,000 --> 00:30:53,680 Speaker 2: try for a vback it would be someone who wants 498 00:30:53,680 --> 00:30:57,280 Speaker 2: four more babies, because if they have one section and 499 00:30:57,360 --> 00:31:00,520 Speaker 2: four vaginal births, their outcomes will be better than someone 500 00:31:00,520 --> 00:31:01,480 Speaker 2: who has five sections. 501 00:31:02,920 --> 00:31:05,160 Speaker 1: Do you think there's such a thing as a modern birth? 502 00:31:05,280 --> 00:31:10,440 Speaker 1: Like women's ideas and society's ideas about birth changing, you know, 503 00:31:10,480 --> 00:31:12,560 Speaker 1: where they look at their pelvic floor they think, oh 504 00:31:12,560 --> 00:31:15,240 Speaker 1: my god, I've heard about what a vaginal birth could 505 00:31:15,240 --> 00:31:17,600 Speaker 1: do to a pelvic floor, Like you know, is it 506 00:31:17,720 --> 00:31:18,880 Speaker 1: are you seeing that trend? 507 00:31:19,520 --> 00:31:25,200 Speaker 2: Yes? Yes, yes. The question what's a modern birth? It's 508 00:31:25,240 --> 00:31:30,400 Speaker 2: a really really interesting one because these are not discussions 509 00:31:30,680 --> 00:31:36,640 Speaker 2: that were available for people to have in the entire 510 00:31:36,800 --> 00:31:40,080 Speaker 2: history of the world right up until about sixty years ago, 511 00:31:41,040 --> 00:31:43,760 Speaker 2: so and in terms of choosing a section out right 512 00:31:43,840 --> 00:31:50,520 Speaker 2: maybe ten years ago, so that it doesn't surprise me 513 00:31:51,000 --> 00:31:54,680 Speaker 2: that we have not as a community worked out how 514 00:31:54,720 --> 00:31:58,640 Speaker 2: this works, the idea of modern birthing, because because these 515 00:31:58,800 --> 00:32:04,200 Speaker 2: choices are new and the entire history of humanity before that, 516 00:32:04,240 --> 00:32:05,240 Speaker 2: you've got what you were given. 517 00:32:05,880 --> 00:32:09,040 Speaker 1: Yeah, I think it is interesting because actually we're very 518 00:32:09,160 --> 00:32:14,240 Speaker 1: concentrated on looking at cesarean rates as a proxy for care, 519 00:32:15,120 --> 00:32:19,400 Speaker 1: whereas the modern birth and the modern woman they're looking 520 00:32:19,440 --> 00:32:21,440 Speaker 1: preps at different parameters. 521 00:32:22,480 --> 00:32:25,360 Speaker 2: And they may consider the availability of a caesar that 522 00:32:25,400 --> 00:32:27,160 Speaker 2: they choose at a time, that they choose it to 523 00:32:27,200 --> 00:32:30,440 Speaker 2: be awesome care. Yeah, we've got to keep that in mind. 524 00:32:31,320 --> 00:32:36,240 Speaker 2: In some ways, the issue of the modern birth and 525 00:32:36,280 --> 00:32:42,000 Speaker 2: the burden of choice mirrors the mirrors the journey of 526 00:32:42,000 --> 00:32:47,160 Speaker 2: women through through the last three one hundred years in 527 00:32:47,200 --> 00:32:54,160 Speaker 2: other aspects of their life. So it's to me is no, 528 00:32:54,640 --> 00:32:57,280 Speaker 2: it's no more troubling that someone might grapple with this 529 00:32:57,360 --> 00:32:59,560 Speaker 2: information and think what's the right thing to do? Then 530 00:32:59,560 --> 00:33:01,600 Speaker 2: it might be grappling for a young woman in general 531 00:33:01,680 --> 00:33:03,960 Speaker 2: to think how am I going to fit children into 532 00:33:03,960 --> 00:33:10,240 Speaker 2: my career or into the fact that I started my relationship, 533 00:33:10,960 --> 00:33:13,800 Speaker 2: you know, my relationship with children later and all of 534 00:33:13,800 --> 00:33:17,040 Speaker 2: those sort of things. So it's just it's just another 535 00:33:17,280 --> 00:33:23,560 Speaker 2: part of modern life that requires decisions, and it's not 536 00:33:23,680 --> 00:33:26,680 Speaker 2: that amazing to me that those decisions are not always. 537 00:33:26,400 --> 00:33:30,600 Speaker 1: Obvious, especially and we haven't even really touched on it, 538 00:33:30,680 --> 00:33:34,080 Speaker 1: the impact of the different ways of having a birth 539 00:33:34,080 --> 00:33:37,640 Speaker 1: that are so much on display in social media. So 540 00:33:37,840 --> 00:33:40,560 Speaker 1: a young person trying to decide how they're going to 541 00:33:40,560 --> 00:33:43,720 Speaker 1: have a baby now will be clouded by or from 542 00:33:43,760 --> 00:33:45,520 Speaker 1: mine that's just coming in at them. 543 00:33:45,720 --> 00:33:47,920 Speaker 2: Yeah, but for my money. The socials get this wrong 544 00:33:47,960 --> 00:33:51,480 Speaker 2: because there seems to be an over There seems to 545 00:33:51,520 --> 00:33:55,200 Speaker 2: be an undercurrent or sometimes an overcurrent that there's a 546 00:33:55,320 --> 00:33:58,120 Speaker 2: right answer and you just you just don't know it yet. 547 00:33:58,440 --> 00:34:02,200 Speaker 2: And if you follow me or you're the right answer, 548 00:34:03,000 --> 00:34:03,920 Speaker 2: I've got the right answer. 549 00:34:04,600 --> 00:34:06,920 Speaker 1: If you take this supplement or if you do this 550 00:34:06,960 --> 00:34:09,719 Speaker 1: particular thing during your labor, you're going to end up 551 00:34:09,719 --> 00:34:10,640 Speaker 1: with the birth that you want. 552 00:34:11,680 --> 00:34:16,600 Speaker 2: Nobody's got the right answer for you. We think in 553 00:34:16,680 --> 00:34:19,760 Speaker 2: our podcast, in our grow My Baby program that knowing 554 00:34:19,880 --> 00:34:25,840 Speaker 2: more helps, But the right answer is, you know, it's complicated. 555 00:34:25,360 --> 00:34:29,480 Speaker 1: It's complicated and very individualized. You know, if if that 556 00:34:29,600 --> 00:34:33,400 Speaker 1: Monash study that we mentioned earlier about comparing public and private, 557 00:34:33,680 --> 00:34:36,200 Speaker 1: if anything came out of that that people should really 558 00:34:36,360 --> 00:34:38,839 Speaker 1: hold on to, it's continuity of care. 559 00:34:39,840 --> 00:34:45,480 Speaker 2: Yes, that that that was clear. So there is there 560 00:34:45,480 --> 00:34:48,359 Speaker 2: are some no brainers we think. We think continuity of 561 00:34:48,440 --> 00:34:55,320 Speaker 2: care is a great idea. We think give or take, 562 00:34:55,600 --> 00:34:58,640 Speaker 2: having some experts around who can help you with birth 563 00:34:58,680 --> 00:35:01,400 Speaker 2: go suddenly wrong is a good eye dear. I think 564 00:35:01,480 --> 00:35:07,520 Speaker 2: vaccination is a good idea, But in the areas where 565 00:35:07,520 --> 00:35:12,000 Speaker 2: there's genuine choice, so much complexity, so much complexity. 566 00:35:12,719 --> 00:35:17,319 Speaker 1: So for everybody, I hope we haven't further confused. You 567 00:35:18,000 --> 00:35:22,720 Speaker 1: where these two part of episode? But if anyone asks 568 00:35:24,000 --> 00:35:28,959 Speaker 1: you cesarean rates increasing, here's some answers. You can listen 569 00:35:29,000 --> 00:35:31,160 Speaker 1: to both these episodes and you'll have a little bit 570 00:35:31,200 --> 00:35:33,400 Speaker 1: of information at the ready. 571 00:35:33,280 --> 00:35:36,480 Speaker 2: Will at least be well informed, yes, about about what 572 00:35:37,000 --> 00:35:38,080 Speaker 2: we think's really going on. 573 00:35:38,880 --> 00:35:41,760 Speaker 1: All right, if you love our podcast, we would really 574 00:35:41,800 --> 00:35:45,200 Speaker 1: appreciate that you share it with your friends. If you 575 00:35:45,400 --> 00:35:48,759 Speaker 1: rate us on Spotify or Apple podcasts, that helps to 576 00:35:48,760 --> 00:35:51,920 Speaker 1: push it out to other people and get recommended to 577 00:35:51,960 --> 00:35:54,680 Speaker 1: them in their feeds, and all of those things helps 578 00:35:54,800 --> 00:35:59,839 Speaker 1: us grow our podcast listenership, and that also helps us 579 00:35:59,880 --> 00:36:01,719 Speaker 1: know that we're doing the right thing and people are 580 00:36:01,760 --> 00:36:05,439 Speaker 1: really enjoying the information that we're putting out. Okay, until then, 581 00:36:06,080 --> 00:36:08,440 Speaker 1: we'll be back in your ears next week. Keep growing 582 00:36:08,440 --> 00:36:09,719 Speaker 1: those babies, keep well. 583 00:36:09,960 --> 00:36:11,680 Speaker 2: Thanks for listening, everybody, bye for now. 584 00:36:15,960 --> 00:36:19,160 Speaker 1: Hey, even though doctor Pat is well a doctor and 585 00:36:19,200 --> 00:36:21,560 Speaker 1: we get lots of other doctors and other experts on 586 00:36:21,600 --> 00:36:24,400 Speaker 1: our podcast, I just need to remind you that this 587 00:36:24,520 --> 00:36:28,960 Speaker 1: podcast is for informational purposes only. We share lots of 588 00:36:29,000 --> 00:36:32,600 Speaker 1: medical insights and experience, but everything we talk about is 589 00:36:32,840 --> 00:36:36,520 Speaker 1: general in nature and may not apply to your specific situation. 590 00:36:37,080 --> 00:36:40,759 Speaker 1: Please always consult with your own healthcare provider for your 591 00:36:40,840 --> 00:36:43,720 Speaker 1: individual medical advice. When you grow your baby