Speaker 1: You're listening to a MoMA Mia podcast.
Speaker 2: Mom and Maya acknowledges the traditional owners of land and
Speaker 2: waters that this podcast is recorded on.
Speaker 1: I am pregnanty.
Speaker 2: Welcome to Hello Bump. We're making pregnancy less overwhelming and
Speaker 2: more manageable. I feel like it's more manageable already. I'm
Speaker 2: Grace Roobrain, I'm pregnant for the first time.
Speaker 1: And i'man A Pippin. I am a mother of six now.
Speaker 1: I am a former olympian and an obstetric trainee. I've
Speaker 1: had many many first Romessa's greens, so you know we
Speaker 1: can pretty much go anywhere with that.
Speaker 2: Each episode, Jana and I will be holding your hand
Speaker 2: week by week through the mysterious, perplexing, and sometimes overwhelming
Speaker 2: miracle that is pregnancy.
Speaker 3: Week twelve. What objects are we A plum?
Speaker 1: A plum baby's the size of a plumb or a
Speaker 1: small egg.
Speaker 3: A jelly doughnut hole, yes, exact?
Speaker 1: Or passion fruit. I mean you go with lots of fruits.
Speaker 1: There's a lot of fruits.
Speaker 3: This it's very fruit based in the first trimestery.
Speaker 1: Fruit based, and then animals in the last. Fromesser I've noticed,
Speaker 1: we'll get there.
Speaker 3: What have they developed in the last week.
Speaker 1: So their little kidneys are starting to make you ryan,
Speaker 1: which is actually amniotic fluid. Guys, your babies are swimming
Speaker 1: around in their own WII and drinking it and then
Speaker 1: peeing it out again. So it's around this time the
Speaker 1: baby starts to swallow that amniotic fluid and then it
Speaker 1: sort of moves through the body and then they pass
Speaker 1: it out. You can now often see or hear that heartbeat.
Speaker 1: When we talked about ages ago, you couldn't hear it.
Speaker 1: You can now hear that heartbeat, and even on an
Speaker 1: external doppler, So when you go and see your midwife,
Speaker 1: they can often not away, so don't be worried if
Speaker 1: they can't hear it. It also does depend a little
Speaker 1: bit on our body, on our size of our tummy,
Speaker 1: but they can often hear it externally, so you can
Speaker 1: hear what the little ones baby sounds like.
Speaker 3: I did hear it for the firty time I did.
Speaker 1: Just beautiful as it.
Speaker 2: Yeah, I can say that even though I felt so sick,
Speaker 2: like I'm not a monster, I love hearing the heartbeat
Speaker 2: like it is something that's really beautiful to beautiful.
Speaker 1: But on that note, there are a lot of dopplers
Speaker 1: you can buy outside of the home, and we sort
Speaker 1: of touched on this earlier. There's definitely a crazy women
Speaker 1: would love to be able to listen to their baby
Speaker 1: at home. Now, if you are going to buy one,
Speaker 1: because like you and I love listening to a baby's heart,
Speaker 1: that's fine, But there is never a time I want
Speaker 1: you to use it if you're worried about the baby's heartbeat,
Speaker 1: because the placenta sounds different to the fetus, and most
Speaker 1: untrained ears won't be able to differentiate both.
Speaker 3: Would so pick up your own heart.
Speaker 1: Yes, So unless you're really really sure what you're listening to,
Speaker 1: and for example, if it's decreased fetal movements, you need
Speaker 1: to come and see us. Anyway, even a midwife would
Speaker 1: not be happy just using a handheld doppler. They'd send
Speaker 1: you in for sixty minutes. You know you need a
Speaker 1: little bit longer to work out what the patterns of
Speaker 1: the baby's heart are. So it's absolutely not something for
Speaker 1: you to be using. I have seen horrible outcomes where
Speaker 1: someone has thought it was okay, but it was the
Speaker 1: it was not. So it's just a fun thing at
Speaker 1: home to listen in a lovely way. It is not
Speaker 1: something I want you to use to look after your pregnancy,
Speaker 1: and let us do that.
Speaker 2: One question I do have about all these tests is
Speaker 2: you have to go in with a full bladder?
Speaker 3: Yes?
Speaker 2: Yes, Is that because it makes the baby more visible?
Speaker 2: Or I've actually had no idea why we have to
Speaker 2: drink a bunch of way because it's.
Speaker 1: Very bothersame pregnancy, isn't it Because you get there and
Speaker 1: you're busting, You're like, can a little a little bit out,
Speaker 1: but I probably don't have enough blooder.
Speaker 3: Control a little it is all going to go out.
Speaker 1: We actually use the bladder as a window, so it
Speaker 1: actually it's the way the ultrasound works is it sends,
Speaker 1: you know, the ultra sound beams through and we use
Speaker 1: the bladder to actually to highlight the different black and
Speaker 1: dark colored structures of the baby and the fetus behind it.
Speaker 1: So if there's an empty bladder, two things you can't
Speaker 1: use that as a window. And the second thing is
Speaker 1: that lifts the uterus out slightly. So you can imagine
Speaker 1: the bladder sits in front of the pregnancy and as
Speaker 1: with a full bladder, it just lifts the pregnancy up
Speaker 1: a little bit more so you can actually scan it
Speaker 1: more easily.
Speaker 2: This is probably a dumb question. But none of it
Speaker 2: goes into their sack.
Speaker 1: To the urine.
Speaker 3: No, no, no, the water. It doesn't go into their amniotic
Speaker 3: fluid or anything like that.
Speaker 1: I mean, there's the theory is not now Later in pregnancy,
Speaker 1: you know that if your baby, if you have low
Speaker 1: amniotic fluid, the midwife might say go and drink more
Speaker 1: and hopefully the fluid levels will increase on the next pregnancy. Ultimately,
Speaker 1: whatever you feed through the baby, if your dehydrated, your
Speaker 1: baby may often move less and therefore have less fluid,
Speaker 1: less intake in, take output. But no, right before an
Speaker 1: ultra sound that a cute thing is not going to
Speaker 1: make any Okay, okay, yeah.
Speaker 3: What's happening to me? And what else is happening to
Speaker 3: our bodies?
Speaker 1: At week twelve, again from last week, it's getting worse
Speaker 1: with that laxicity. You're feeling more and more floppy, I
Speaker 1: think is the way you can feel it. Some people
Speaker 1: now do find they have almost a bit of an
Speaker 1: obstruction when it comes to their bladder, so difficultly difficult
Speaker 1: passing urine because that baby is literally sitting right where
Speaker 1: that bladder is soon it'll come up and get out
Speaker 1: of the pelvis. But you're right on that cusp where
Speaker 1: it doesn't.
Speaker 2: Feel like the stream is as free well yeah, free flowing,
Speaker 2: or it's just not as even though you feel busting.
Speaker 3: It's like trickles out exactly.
Speaker 1: You've pretty much nailed it perfectly. But that's the baby, unfortunately,
Speaker 1: pushing against that bladder and just causing restriction of the urethra.
Speaker 2: And that's because of the position that It's not that
Speaker 2: they're it's so big, it's just the position of where
Speaker 2: your uterus.
Speaker 1: Is because the baby's quite small still, but it's literally
Speaker 1: if you think about your pubic bone, which is a bone,
Speaker 1: so there's nowhere for the bladder to go up and
Speaker 1: a ways the bladder will fill upwards towards your belly button,
Speaker 1: but that's where your useress is literally sitting and cramping
Speaker 1: in that space, so it can actually you can actually
Speaker 1: there is a condition where you can actually get full
Speaker 1: bladder obstruction. So it's another red flag. We're going to
Speaker 1: start calling the red flags as we get through this podcast,
Speaker 1: where things that are really bad you need to see
Speaker 1: a doctor straight away. So the first red flag in
Speaker 1: the past was that ectopic pregnancy we were talking about
Speaker 1: before bleeding, And this is another one. If you find
Speaker 1: you can't pass you urine in pregnancy, it's time to
Speaker 1: go straight to either the birth unit or your or
Speaker 1: your ED. And now before twenty weeks, guys, that is ED,
Speaker 1: So you go to ED up until twenty weeks or
Speaker 1: e GP. After twenty weeks you call the berthing unit
Speaker 1: you're planning to deliver it.
Speaker 2: A lot of the time people might think that symptoms
Speaker 2: of not being able to pass urine is feeling like
Speaker 2: a uti.
Speaker 3: How do we know the difference several hours?
Speaker 1: So if you have an obstruction, you'll need you'll you'll
Speaker 1: find you can't pass more than dribbles for hours and hours.
Speaker 1: Whereas I mean, urine retract infections in pregnancy can present
Speaker 1: in so many different ways. And just like the thrush
Speaker 1: we talked about before, really common and asymptomatic urine retract
Speaker 1: infections are really common too. Why because we drop arou
Speaker 1: immune system because we're pregnant. So I know, another fun thing,
Speaker 1: but basically you know we have we don't want to
Speaker 1: have any problems from a rejection perspective with the baby.
Speaker 1: And you're also taking on a lot, your nutrition's going
Speaker 1: somewhere else, you're not sleeping as much, you're uncomfortable. There's
Speaker 1: lots of reasons our immune systems reduce, and so therefore
Speaker 1: symptoms of urine. We probably all know of them, burning, stinging,
Speaker 1: funny odor. Back pain is a big one, and we
Speaker 1: can often mask.
Speaker 3: Oh i've got a pregnancy coming.
Speaker 1: I've got a bit of back pain, but definitely worth
Speaker 1: getting it checked, color change in the urine, any concern
Speaker 1: is really easy to pee in a little cup that
Speaker 1: you can get from your GP and they can send
Speaker 1: it off. Is this normal? Is normal?
Speaker 3: I have a few questions for is this normal?
Speaker 2: Because I've just gone through these the first trimester screening
Speaker 2: and the NIPT. I want to know if the nipt
Speaker 2: I got the sex revealed.
Speaker 3: To me because she's a girl, So I want to.
Speaker 2: That's what I wanted, and my partner said that that's
Speaker 2: what he wanted as well. I don't know that if
Speaker 2: that was real, but anyway, we're both both happy. The
Speaker 2: names are easier, I think, so I want to know
Speaker 2: how accurate that test is at this stage. And then
Speaker 2: I also want to know about I sort of said
Speaker 2: to the sonographer when I was in there, or is
Speaker 2: everything looking fine or is everything healthy? And they sort
Speaker 2: of said their wording around it was as much as
Speaker 2: we can tell, yes, and they wouldn't sort of give
Speaker 2: any kind of clarity answers because they said.
Speaker 3: It's still too small exactly.
Speaker 2: I guess what are they specifically looking for in these
Speaker 2: tests to go it's viable or whatever, and what could
Speaker 2: potentially still develop that could make it a non viable
Speaker 2: pregnancy or have problems later on.
Speaker 1: It's a hard discussion around abnimalodies and pregnancy chromosome or
Speaker 1: genetic abnimalodies or structural abnormalody. So as we sort of
Speaker 1: discussed before the NIPT is the blood test, we still
Speaker 1: strongly recommend to have an ultrasound as well because the
Speaker 1: NIPT does miss things like triplody, pregnancies and things that
Speaker 1: aren't tested. So it's ninety nine percent sensitive for Down syndrome,
Speaker 1: pertousyn drome, and Edward, which are three more common disorders
Speaker 1: that it can pick up, whereas the combined first tromester screen,
Speaker 1: which is the government fund and run, is around sort
Speaker 1: of the eighty five to ninety percent, so it's still
Speaker 1: very good. It has about a four to five percent
Speaker 1: false positive rate. But again both of them do, so
Speaker 1: I think it's really hard, and I get a lot
Speaker 1: of women actually asking should I have both, Like you know,
Speaker 1: I can afford it, Should I have the government one
Speaker 1: and the NIPT? And some I know, I have a
Speaker 1: lot of an amazing bosses that I work for who
Speaker 1: obviously training me to be an obstecution and some of
Speaker 1: them are on the fence with it. So some of
Speaker 1: them say yes, get both. Why not? Others say no,
Speaker 1: that's just overuse of you know, government funds and medicare.
Speaker 1: But having had, as I said close friend in the past,
Speaker 1: you went through that and ended up having a terribly
Speaker 1: unwell baby that didn't survive at fourteen weeks with a
Speaker 1: normal nipped you can see why women do it. So
Speaker 1: perhaps the agreement really is that you do NIPT if
Speaker 1: you can afford it, but also have your structural study.
Speaker 1: And there's lots of other things that come out of
Speaker 1: that screening as well, with the blood tests around the
Speaker 1: hypertension and the potential for gross restrictions. So the bottom
Speaker 1: line is, though you may find something you don't want
Speaker 1: to know, and then you have to decide what to
Speaker 1: do about it. It's a really tough conversation to have
Speaker 1: with yourself because some people will continue apprenticeing no matter what.
Speaker 1: I want to reassure you that if you are in
Speaker 1: that position, because a lot of women are, you'll have
Speaker 1: thorough genetic counseling. You'll meet with the Maternal Fiddle Medicine
Speaker 1: Department which work with this space really really well, council
Speaker 1: women around this all the time you have time. So
Speaker 1: in Australia we are really lucky that there are hospitals
Speaker 1: that will support your decision till very late in gestation.
Speaker 1: Now we may not all like that ethically, but some
Speaker 1: women take couples, I should say, take ten weeks to
Speaker 1: make a decision around a baby that may not have
Speaker 1: a good life trajectory. So there are people who will
Speaker 1: support your decision no matter what you make, and many
Speaker 1: decide I don't want to have the invasive testing. I'll
Speaker 1: wait for morphology because morphology the baby is bigger and
Speaker 1: it's the most accurate time we can look at brain, heart, liver.
Speaker 1: What side is the heart is the body on? Are
Speaker 1: there any funny abnormalities with the kidneys? Are there cysts
Speaker 1: on the kidneys? Are there two kidneys so there's all
Speaker 1: these really amazing things that can sometimes indicate chromosomal ABNAML
Speaker 1: that aren't the standard three that we look at with
Speaker 1: the NIPT, and that's what those structural ultra sounds do.
Speaker 1: But it is hard you only look at major things
Speaker 1: at the twelve to thirteen week mark, like are there
Speaker 1: four chambers in the heart? Does it have a brain?
Speaker 3: Yeah?
Speaker 1: You know, is it obviously you know, got kidneys and
Speaker 1: a normal that they measure that sounds are silly, but
Speaker 1: the length of the legs to the size of the hedge,
Speaker 1: like those kind of things you say are there because
Speaker 1: they're telltale signs. Some of the major chromosomeal abnormalodies often
Speaker 1: have really abnormal sized legs and arms compared to its
Speaker 1: its brain and it's utical.
Speaker 3: Yeah.
Speaker 2: So all they've sort of told me was, well, it's
Speaker 2: got two arms, two legs, a heartbeat, and a head
Speaker 2: and that's all we're looking for. And I was like, okay,
Speaker 2: you're sort of I don't know if there's if there
Speaker 2: are people who listening who are quite anxious pregnant people,
Speaker 2: I guess I was surprised there wasn't more reassurance, But
Speaker 2: then I don't know what I was looking for.
Speaker 3: Yeah, with that reassurance.
Speaker 1: I think it's hard and it's a hard topic to
Speaker 1: touch on, but it's because you can't give a result
Speaker 1: and then a mother or a father later comes back
Speaker 1: and said, well, I was told at my first tremester
Speaker 1: ultrasound that it was all normal. They can only give
Speaker 1: to the best of their ability of what they can see,
Speaker 1: and that's why we always say, well, if you concerned,
Speaker 1: have that morphology done, even potentially a little early, because
Speaker 1: we recommend the morphology be sort of between eighteen and
Speaker 1: twenty two weeks. Have it earlier if there's a concern,
Speaker 1: or go and see the genetic counselor and discuss whether
Speaker 1: you want a more invasive tests which can give you
Speaker 1: a far stronger probability of whether this baby is affected.
Speaker 3: And one of the things we can do.
Speaker 2: Because you're tested for pre eclampsia multiple times throughout your pregnancy,
Speaker 2: this is the first time that you are tested. What
Speaker 2: if your tests come back and your high risk at
Speaker 2: this point at twelve weeks.
Speaker 1: Lots of obsertcutions will recommend you're starting aspirin at this point.
Speaker 1: They know that it can help. You might have already
Speaker 1: been on aspirin. To be honest, if you've had preclamps
Speaker 1: here in your last pregnancy, it would be something that
Speaker 1: your obstetution will start pretty early. But if you come
Speaker 1: back with a high risk screening at this point, a
Speaker 1: whole combination of that algorithm with the papa A and
Speaker 1: all different mechanisms of related to this test, but they
Speaker 1: might suggest some ways to try and reduce it, which
Speaker 1: is starting on aspirin, and it's important we start that
Speaker 1: as early as possible too, as in after this, so
Speaker 1: now ten weeks, eleven weeks, twelve weeks, not twenty two
Speaker 1: tis twenty three to twenty four weeks to try and
Speaker 1: change because it actually helps. Well, the theory is that
Speaker 1: it helps with the way the placenter is developing, so
Speaker 1: the way the arteries and the spiral arteries that actually
Speaker 1: feed the placenter and the maternal interface develop, which is
Speaker 1: where there's lots of theories around what preclamps here is.
Speaker 2: But what one of the theories is that And as
Speaker 2: we go along, we'll talk about preclams here a lot
Speaker 2: more because there are so many other different ways that
Speaker 2: it can be picked up.
Speaker 3: So I have a lot of questions for you, which
Speaker 3: I'm sure we'll get into.
Speaker 2: My talkit this week is something that we talked about
Speaker 2: weeks ago or episodes ago. Is because I cleared all
Speaker 2: my tests. For me, that was a moment of this
Speaker 2: is real. Yes, so I went and bought my first item.
Speaker 3: It's perfect. Yeah, I love it.
Speaker 1: I'm not going to add anything that I think it's
Speaker 1: the perfect time.
Speaker 2: To do it. Hope, we hope you enjoyed this episode
Speaker 2: of Hello Bumb. We have so many episodes of this
Speaker 2: series filled with tips and stories from women and experts
Speaker 2: who've been through it all before.
Speaker 1: You can go back and listen to everything else Hello
Speaker 1: Bumb related in this.
Speaker 2: Casp and while you're there, we'd love if you could
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Speaker 1: This episode was produced by Courtney Ammenhauser with audio production
Speaker 1: by Tom Lyon.
Speaker 3: We'll catch you next time.
Speaker 1: Bye.
Speaker 3: This episode of Hello Bump was made in partnership with Huggies.