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Speaker 1: Welcome to the Kick Your expert led podcast, helping you

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Speaker 1: explore and learn everything about getting pregnancy, birth, and becoming

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Speaker 1: a parent.

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Speaker 2: On the podcast and our online pregnancy program, grow My Baby,

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Speaker 2: we share my experience of helping more than four thousand

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Speaker 2: babies to be born and.

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Speaker 1: Our experience of running a women's health clinic and parenting

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Speaker 1: four boys.

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Speaker 2: We're here to help everyone to feel empowered in pregnancy

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Speaker 2: and birth with real life, practical information.

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Speaker 1: Hello. Everyone, it's Bridget Maloney.

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Speaker 2: Welcome back everybody. I'm obstetrician Dr Patrick Maloney.

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Speaker 1: And this is the Kick Pregnancy Podcast and we're so

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Speaker 1: happy to have you here. This is a question, Pat

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Speaker 1: that we've been asked a lot, and it is should

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Speaker 1: I have a vaginal birth or a cesarean section? Okay,

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Speaker 1: So what we're going to talk about is why someone

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Speaker 1: would ask that question, and then we're going to go

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Speaker 1: through this person actually asked for the pros and cons

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Speaker 1: of both.

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Speaker 2: Yeah, that's a good way of approaching it. Did they

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Speaker 2: mean like for their first baby or for their second

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Speaker 2: or subsequent baby after a previous cason?

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Speaker 1: Look, it wasn't clear. Okay, So actually that's a good

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Speaker 1: point if everybody when you send you questions. We love

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Speaker 1: your background, give.

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Speaker 2: Us some info. Yeah, yeah, because the answer the answer

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Speaker 2: might be a little different.

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Speaker 1: Yes, let's just assume that people might be listening to

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Speaker 1: this that it is their first birth or it's a

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Speaker 1: subsequent birth. We'll talk about both scenarios. Good, All right,

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Speaker 1: So I want to start with Pat, why do you

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Speaker 1: think people ask this question in the first place.

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Speaker 2: I think some people pregnant with their first baby are

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Speaker 2: just to where that there's two ways for that baby

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Speaker 2: to come out and might be just interested in hearing

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Speaker 2: the pros and cons of each approach. And most people

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Speaker 2: have heard of some people, you know, to most people,

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Speaker 2: vaginal birth is the default position and the cease is

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Speaker 2: what you do if something's wrong. But some people have

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Speaker 2: definitely heard of people who would choose to have a

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Speaker 2: caesarian section with no medical indication. Right, I just want

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Speaker 2: that that's what that's my preferred way of having a baby,

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Speaker 2: and it's not because I've got twins or plus enter

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Speaker 2: pre view or whatever. It's just what I want. So

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Speaker 2: then there are also the people who might have some

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Speaker 2: specific medical reason to want to have a cesarian section,

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Speaker 2: might be interested in exploring that, and some of those

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Speaker 2: people that maybe they've had a previous caesarion section and

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Speaker 2: they're exploring the benefits of planned section for the second

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Speaker 2: baby versus vback or in that first birth it was

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Speaker 2: traumatic physically emotionally. There's some people with something called tocophobia,

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Speaker 2: which is fancy way of saying fear of labor. Yep,

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Speaker 2: so they're just super afraid of laboring.

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Speaker 1: We've actually had that question a lot whether we can

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Speaker 1: do a separate podcast on tacophobia.

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Speaker 2: Yeah, I think we, and I think we can, but

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Speaker 2: I think the best thing would be so we're not

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Speaker 2: just pulling our lack of knowledge on it. I think

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Speaker 2: we should do that as a podcast with a mental

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Speaker 2: health professional who can the sort of person we might

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Speaker 2: send somebody to to discuss those fears, work out where

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Speaker 2: they might be coming from, and see whether they can

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Speaker 2: be addressed through therapy rather than just doing a caesar.

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Speaker 2: A common one is fear of tearing. That's really common.

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Speaker 2: Fear of the loss of sexual function or of sexual

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Speaker 2: identity through changes to the chanitols that might come about

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Speaker 2: through childbirth. These are the things we hear about.

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Speaker 1: And see, Yeah, and you did mention at the start,

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Speaker 1: you know it really depends on whether it's their first

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Speaker 1: or their second birth. And I know we do talk

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Speaker 1: about the second birth and generally that they go much better.

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Speaker 1: And somebody who's had a first traumatic birth, yeah, they might.

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Speaker 1: Their thoughts might turn to a plan and I don't

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Speaker 1: know what we can do to help them understand or

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Speaker 1: feel better that perhaps their second birth will be different

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Speaker 1: from them.

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Speaker 2: Yes, well, we can give it a gard that's what

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Speaker 2: we should do. So let's take a few different potential scenarios. Let's,

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Speaker 2: for example, look at somebody who had a baby that

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Speaker 2: was bigger than expected and they got a third degree tear,

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Speaker 2: and the third degree tear required repair and physiotherapy. There's

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Speaker 2: some evidence that the anals think to a problem might

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Speaker 2: only have one good tear in it, okay, and that

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Speaker 2: if it's been significantly torn and repaired expertly to the

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Speaker 2: point where the anorectal function is normal, that we shouldn't

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Speaker 2: mess with that again and risk a second tear from

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Speaker 2: a second vaginal birth. And a lot of people in

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Speaker 2: that situation would elect for a plant, would plan for

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Speaker 2: a plan section for second baby, and I think that's

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Speaker 2: got some validity if we look at the less significant

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Speaker 2: tears well, firstly, they can be expertly repaired, they don't

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Speaker 2: lead to long term dysfunction, and they probably won't happen

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Speaker 2: with the second birth. Everything's more stretchy. Does that make sense? Yeah,

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Speaker 2: So talking to people about the facts and in particular

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Speaker 2: about the very many important ways that the second vaginal

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Speaker 2: birth is different from the first. It's faster, it's more efficient,

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Speaker 2: it's less painful overall, because the painful part of the

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Speaker 2: labor is shorter. The pushing is the pushing phase is

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Speaker 2: way shorter because the tissue around the vagina is more stretchy,

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Speaker 2: so you don't run out of puff. So instrumental births

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Speaker 2: are way less common, and a lot of the significant

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Speaker 2: peranial trauma is related to instrumental births.

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Speaker 1: Yeah, I read even for forceps it goes down from

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Speaker 1: like eight percent down too point seven and second births

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Speaker 1: or absolutely yeah.

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Speaker 2: Yeah, so you just don't get those obstructions at full

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Speaker 2: diletation that need those significant interventions. You know, if you look,

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Speaker 2: even in my practice, I don't mind saying first baby

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Speaker 2: epidural rate fifty second and subsequent five percent. Yeah wow, yeah, Yeah,

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Speaker 2: that's the difference. That's how massively different it is, so

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Speaker 2: we have to be careful that we're not comparing apples,

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Speaker 2: that we are comparing apples with apples, and we're not

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Speaker 2: making the mistake of thinking it's going to be the

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Speaker 2: same again.

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Speaker 1: Yeah, And someone that's it's their first berth and they're

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Speaker 1: thinking about whether they should have a vaginal or a

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Speaker 1: cesarean birth, and they're doing all their listening and research

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Speaker 1: and all the rest, and they hear about all the

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Speaker 1: things people put in place and got the dream vaginal delivery.

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Speaker 1: Often those people are talking about their second berths.

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Speaker 2: Of course they are on the socials in particular. Yeah, yeah, yeah,

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Speaker 2: So I think one of the one of the more

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Speaker 2: frustrating things that we some I'm read on the socials is,

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Speaker 2: you know, I had a complex and difficult and somewhat

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Speaker 2: traumatic first birth, so I got rid of this, got

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Speaker 2: rid of this, got rid of this, change this, change that,

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Speaker 2: change the other, and the second birth went fine, when,

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Speaker 2: of course we know it was always very likely to

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Speaker 2: go fine no matter what you did.

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Speaker 1: Yeah, how like, this is a really tricky question if

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Speaker 1: someone's coming into their birth, either first or subsequent birth,

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Speaker 1: and they've got all these fears around vaginal birth and

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Speaker 1: they're thinking, Okay, so should I have a vaginal birth

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Speaker 1: or a cesarean section? How can we support them?

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Speaker 2: Do you feel I think that there's something we can

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Speaker 2: do even more before then people are going to pregnant.

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Speaker 2: People are going to find enough scary stuff on their

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Speaker 2: own and as their friends and family, we don't need

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Speaker 2: to talk to them all the time about poor outcomes.

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Speaker 2: So I think if you know somebody who is pregnant

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Speaker 2: and you're thinking of sharing the story of a poor

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Speaker 2: outcome that's not other wise relevant to that person, potentially

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Speaker 2: zip it. Yeah, well, at least stop and think why

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Speaker 2: am I sharing this? Is it necessary for me to

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Speaker 2: share this? And have I really thought about the downside

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Speaker 2: of sharing this?

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Speaker 1: And am I sharing it because I haven't healed from

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Speaker 1: my own trauma?

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Speaker 2: Correct? Yeah? Absolutely so. So we don't want to scare

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Speaker 2: people and they're going to find you know, if they

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Speaker 2: want to read about poor outcomes, they're going to find

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Speaker 2: that themselves. They don't need you to tell them that.

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Speaker 2: And the fact that you are telling them that and

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Speaker 2: a bunch of other people are telling them that may

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Speaker 2: just be leading to a confirmation bias in their in

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Speaker 2: their mind that it's more dangerous than it looks.

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Speaker 1: Yeah, and what about at a practitioner level. So I

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Speaker 1: think people have probably guess we're pro choice in terms

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Speaker 1: of a woman's birthing, absolutely right, But they are People

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Speaker 1: tell us all the time that they've been felt pushed

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Speaker 1: in one way or the other from one of their

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Speaker 1: health practitioners. It's very difficult as a person. You can't

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Speaker 1: change that other person's behavior, like you can't change that

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Speaker 1: practitioners behavior. So it's about how you receive the information.

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Speaker 1: So if you have gone, okay, well I'm going to

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Speaker 1: have a plan cesaian, and you're getting pushed back from

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Speaker 1: your healthcare practitioner, what do you think somebody should think

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Speaker 1: or do there?

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Speaker 2: It's interesting. I think it's the job of the health

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Speaker 2: care service, the hospital, the obstecution to make sure people

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Speaker 2: are well informed about their choices. But ultimately, with this one,

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Speaker 2: I believe it's ultimately up to the woman. For example,

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Speaker 2: And this is not available everywhere, not every institution offers

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Speaker 2: this choice. But in my practice, if someone says that

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Speaker 2: they want a plan section without a medical reason per

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Speaker 2: se behind them decision, I'm very keen to explore why. Yeah,

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Speaker 2: and I've sent a few people, not that many people

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Speaker 2: want this off the bat. Not many people say that

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Speaker 2: this is how I want to have my first baby,

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Speaker 2: but the ones that do, I'm very keen to hear why.

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Speaker 2: And a few people I've sent for discussion with a

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Speaker 2: with a clinical psychologist or other mental health worker comfortable

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Speaker 2: with the pregnancy space. Not because I think that person

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Speaker 2: has a mental health problem, but because I think that

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Speaker 2: their concerns need airing so that so that ultimately we

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Speaker 2: can work out that maybe the fears unfounded, or maybe

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Speaker 2: the fears that actually to do with something else. So

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Speaker 2: if the fear really turns out to be a fear

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Speaker 2: of being a parent, or a fear of being a

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Speaker 2: bad parent or something like that, then those things might

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Speaker 2: be addressed in better ways than changing the birth plan.

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Speaker 1: Yeah, Or a fear of something that they've heard about birth, yes,

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Speaker 1: you know, like a fear of getting a needle or

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Speaker 1: whatever it is exactly.

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Speaker 2: Yeah, yeah, so some of these things. There are workarounds

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Speaker 2: to some of these things. But ultimately, ultimately, if someone

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Speaker 2: says I've heard your evidence, thank thank you very much,

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Speaker 2: thank you, I would like the cesarian section, then in

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Speaker 2: my practice, the answers yes.

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Speaker 1: Yeah, yeah, and also, I suppose does it ever go

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Speaker 1: the flip side, So you might recommend to cesarean section

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Speaker 1: and someone's like.

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Speaker 2: No, no, no, this is probably more common.

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Speaker 1: This is more common. Plus also really hard. I would

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Speaker 1: imagine it.

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Speaker 2: Is hard and one of the things that I've found

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Speaker 2: useful in the last in previous episode, we talked about

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Speaker 2: the maternal assisted Caesarien section. I've found maternal assisted sections

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Speaker 2: to be a really great way of a compromise for

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Speaker 2: somebody who understands that they should have a section if

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Speaker 2: they're just looking at risks and benefits, but men they

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Speaker 2: don't want one. Yeah, yeah, and they're upset and they're

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Speaker 2: disappointed and they're ripped off. Then saying well, it could

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Speaker 2: be a maternal assist that has helped a few people

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Speaker 2: get over the line to ultimately make what was a

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Speaker 2: better decision to have a season.

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Speaker 1: It's funny, you know. The question that came from a

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Speaker 1: listener was to explain the pros and cons of natural

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Speaker 1: birth and caesarean section. And I feel that natural birth

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Speaker 1: means no intervention.

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Speaker 2: Well, yeah, that's why we prefer to use the term

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Speaker 2: vaginal birth, don't we, Because the natural to some people

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Speaker 2: means no drugs. It also sometimes carries an unfortunate connotation

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Speaker 2: of being superior.

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Speaker 1: So I think if we're going to go on and

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Speaker 1: do the pros and cons of vaginal and caesarean birth,

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Speaker 1: we're not doing natural birth. I think if we ever

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Speaker 1: were to do that, that would be comparing natural birth

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Speaker 1: and vaginal birth.

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Speaker 2: Yes, we're talking about the real world common practice pros

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Speaker 2: and cons.

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Speaker 1: Yeah, because wow, was it this episode where you said

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Speaker 1: about fifty percent of your first time as would have

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Speaker 1: an epitur but then five percent of your second time

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Speaker 1: is so yeah, natural, we could do that natural versus

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Speaker 1: an emperdural birth, for example, if that ever came to pass.

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Speaker 1: If anybody wanted to hear that does tell.

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Speaker 2: Us in a separate episode, Yah fine, yeah, yeah good.

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Speaker 2: So let's return to the vaginal birth and the things

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Speaker 2: that are said to be better about it.

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Speaker 1: The pro can I say before we do pros and cons?

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Speaker 1: That's still sort of brain work, isn't it. You know,

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Speaker 1: it's all making decisions. It's very cerebral and sometimes this

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Speaker 1: is a gut feel too, So you've got to go

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Speaker 1: with your gut feel.

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Speaker 2: Yeah, yeah, And for most people, the gut feeling at

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Speaker 2: the start, is a preference for vaginal birth for most Yeah.

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Speaker 3: Not all.

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Speaker 2: Yeah, but if we're talking about the headspace pros and cons,

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Speaker 2: what are the risks and benefits vaginal birth in general.

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Speaker 3: Across the globe, with all different levels of medical systems

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Speaker 3: and supports and safety of surgery and so forth, it's

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Speaker 3: probably the safest way to have a baby for most people.

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Speaker 3: It's good for subsequent pregnancies.

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Speaker 2: Vaginal birth. I for your first you're going to go

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Speaker 2: super well for as many more as you want. And

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Speaker 2: that's that's not an optimistic that's not being excessively optimistic.

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Speaker 2: That's just broadly true that the second and subsequent burst

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Speaker 2: will go very well.

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Speaker 1: Like that Russian lady that had sixty nine babies, maybe

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Speaker 1: not that many are very old like in the nineteen hundreds.

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Speaker 2: There's less risks of infection surgical. Yeah, you're not going

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Speaker 2: to get a surgical wound infection from a vaginal birth.

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Speaker 2: You can get an infected paranean, but that's not common.

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Speaker 1: Yeah, what from materia or something, Yeah, exactly.

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Speaker 2: We thought we'd discussed the potential benefits from lactation or

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Speaker 2: on lactation on vaginal birth. Certainly there's some evidence that

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Speaker 2: lactation starts a bit sooner, it's not much sooner, and

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Speaker 2: there isn't really any evidence that that's like delay matters.

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Speaker 1: And maybe if there is a delay, is it because

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Speaker 1: some cesarean babies need to go to the nursery or something.

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Speaker 2: For sure, they might be in it. They might be

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Speaker 2: in a crib in the nursery for the reason that

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Speaker 2: the caesarian section was done in the first place. So

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Speaker 2: these are called confounders. It appears to be one thing

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Speaker 2: or another. But if you but the problem is in

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Speaker 2: the caesar group and the and the vaginal birth group,

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Speaker 2: you might not be comparing apps with apples.

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Speaker 1: And I wonder whether it's a bit of a layover

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Speaker 1: from earlier days where caesareans were thought of as more

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Speaker 1: surgical and like the baby wasn't put on mum's.

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Speaker 2: Chest absolutely, because you used to have to be way

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Speaker 2: sicker to need a caesar. They were rarer, what do

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Speaker 2: you call it, a last resort? Yeah, so I'm not

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Speaker 2: surprised if back in the day the breastfeeding rates from

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Speaker 2: caesar births were really poor because mum and baby may

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Speaker 2: have been really sick. A better comparison would be planned,

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Speaker 2: well woman having planned section versus well woman having vaginal birth.

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Speaker 1: Well this well woman having a planned section, maybe straight

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Speaker 1: on breast feeding, like what ten minutes after the caesar. Yeah,

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Speaker 1: so not sure milk was coming out, just a little

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Speaker 1: bit of.

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Speaker 2: Cho colostrum recovery In most cases are an uncomplicated vaginal

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Speaker 2: birth is going to have a better recovery for the

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Speaker 2: caesar in the initial phases. You know, you've still got

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Speaker 2: the SpineLine aesthetic and you can't even move for six hours,

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Speaker 2: and then you're like one now, it's like one out.

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Speaker 2: It's nighttime, and you're likely to keep the catheter over night,

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Speaker 2: so you're probably not going to get up and have

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Speaker 2: the cathera out and move up and go the toil

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Speaker 2: till the next morning. And then you've got a surgical

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Speaker 2: incision which hurts the vaginal birth cohorts are going to

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Speaker 2: be a lot more mobile, especially in that first day,

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Speaker 2: and have less pain related to movement in the coming days.

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Speaker 1: Yeah, but still a swollen peraneum and absolutely yeah.

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Speaker 2: Yeah, So this is this is where the complexity comes in.

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Speaker 2: If you're unlucky and get a big perennial hematoma that's

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Speaker 2: way worse than a caesarian section.

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Speaker 1: Answer, I don't know what that is.

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Speaker 2: What is that the giant bruise around the vaginant opening

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Speaker 2: way worse than a caesar cup, So it's not always true.

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Speaker 1: And how often do they happen?

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Speaker 2: Oh, that's really rare, But that's what I'm saying. A

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Speaker 2: vaginal birth that goes well is has a better recovery

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Speaker 2: than a caesar, but a vaginal birth that goes poorly

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Speaker 2: does not.

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Speaker 1: These are the unknowns, and I think this is why

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Speaker 1: these questions get asked, Should I have a vaginal birth

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Speaker 1: or a caesarean? Because easy No. Also, it's said that

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Speaker 1: there is a better birth satisfaction with a vaginal birth,

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Speaker 1: but again only if it goes well.

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Speaker 2: Well. I think if it goes well, there's a certain

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Speaker 2: confirmation that my body has worked in the way that

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Speaker 2: it was supposed to or was designed to or I

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Speaker 2: always thought it would. I was built for birth, built

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Speaker 2: for and that that and that would be satisfying. And

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Speaker 2: that's important to some people and not to everybody. Other

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Speaker 2: things things that we some top that we look at is,

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Speaker 2: you know, economic issues, so vaginal birth go home be faster,

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Speaker 2: which in terms of our health resources is good, and

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Speaker 2: the cason is expensive. It's an operation our brain theater,

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Speaker 2: tons of staff, lots of people.

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Speaker 1: We talked in a previous myth or fat though not

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Speaker 1: expensive because the obstration gets paid more.

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Speaker 2: No, no, no, it doesn't change. Doesn't change what I

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Speaker 2: get paid, but changed what the overall think costs.

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Speaker 1: Yeah, for sure. Yeah, every night in our hospital, our

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Speaker 1: public hospital is one thousand dollars and in the public

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Speaker 1: in the private hospital, I think it's something like twelve

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Speaker 1: one hundred dollars a night.

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Speaker 2: Sure, But you know, and that's just the cost to

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Speaker 2: the patient of being in the bed. There's cost to well,

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Speaker 2: the cost of the patient or the patient's health fund.

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Speaker 2: But the cost to the community of running us as

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Speaker 2: are in section.

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Speaker 1: Yeah, the whole theater maybe thousands.

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Speaker 2: Whereas the vaginal birth might happen with you and a

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Speaker 2: midwife in a room and could be very very minimal costs.

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Speaker 1: And what about the respiratory conditions for the babies, Like

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Speaker 1: the vaginal birth is you've said it before that the

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Speaker 1: baby gets squeezed as they move out the birth canal.

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Speaker 2: Yes, so there's some of there might be in general

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Speaker 2: less of a condition called titen or transient tachic near

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Speaker 2: of the newborn, So a baby that's got a temporary

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Speaker 2: high respiratory rate due to fluid in the lungs. And

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Speaker 2: there's less of that, give or take it, vaginal births

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Speaker 2: than there are at caesarean sections. That's normally expertly managed

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Speaker 2: by the pediatricians, and it's one of the reasons why

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Speaker 2: there is always a pediatrician at a caesarean section, but

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Speaker 2: not always a pediatrician at a vaginal birth. So that's

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Speaker 2: a reason.

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Speaker 1: Anymore pros, I'm sure we've missed some. Tell us if

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Speaker 1: you think we've missed a pro of having a vaginal birth,

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Speaker 1: we want to know.

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Speaker 2: We do want to know. You want to move onto

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Speaker 2: the cons Yes it hurts, it.

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Speaker 1: Does, yes, but there is pain medication to help.

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Speaker 2: Yeah, and you know epidurals and tens machines and everything.

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Speaker 1: But you know it hurts and it can be you know,

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Speaker 1: for first time mums. I think it's still not wide

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Speaker 1: enough known that it takes a long time. They could

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Speaker 1: be actually in the thick of active labor for a

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Speaker 1: long time.

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Speaker 2: Yeah, So it's not only painful, but the pain can

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Speaker 2: go on, and especially that first birth, there are some

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Speaker 2: unpredictable things in vaginal births that people find, you know

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Speaker 2: that that can happen in the blink of an eye,

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Speaker 2: things like tearing to the peroneum, postpartum hemorrhage, whereas, by comparison,

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Speaker 2: the cesarian section environment is controlled. Occasionally, you know, we'll

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Speaker 2: get a baby out at caesarean section and and the

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Speaker 2: head causes a slightly bigger tear in the uterus than

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Speaker 2: the whole we've made. But that's you know, that's a

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Speaker 2: couple of extra stitches on our way out. That's not

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Speaker 2: like a bad paranoral tear. So those risks, you know,

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Speaker 2: you can get a postpartum hemorrhage at a cesarian section,

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Speaker 2: just way less common. Some of the rare complications of

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Speaker 2: vaginal job birth, like retain placenta, doesn't really apply to

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Speaker 2: cesarian section because if the placenta's taken too long to

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Speaker 2: come out, we just reach in and reach it in

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Speaker 2: and pull it out. Yeah, you can see it, and

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Speaker 2: you can see it. Uterus is open right in front

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Speaker 2: of you.

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Speaker 1: It's also you know, I think when people are thinking

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Speaker 1: about vaginal birth versus cesarean, I think they really are

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Speaker 1: talking about their parentem they're talking about controlling the situation

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Speaker 1: by knowing when they're going to go into labor, and

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Speaker 1: I think they're talking about how their pelvic flaw is

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Speaker 1: going to function after.

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Speaker 2: Yeah. So I think the long term risk of prolapse

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Speaker 2: and incontinence is probably the big, the big ticket item,

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Speaker 2: and not even this is easy to analyze. A lot

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Speaker 2: of the a lot of the research points to the

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Speaker 2: fact that being pregnant is a risk to your pelvic

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Speaker 2: floor tone and your continents, and it's not all about

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Speaker 2: how the baby gets out.

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Speaker 1: I found a Canadian study and in the non pregnant

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Speaker 1: population ten percent of people had urinary continents in.

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Speaker 2: Continents YEP ten percent, YEP YEP ten.

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Speaker 1: Percent, vaginal birth twenty one percent, and c section fifteen

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Speaker 1: point nine percent. Yeah, so pregnancy is a risk factor.

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Speaker 2: So half the increased risk happened anyway, even if you

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Speaker 2: had a section. Yeah, So that's that's really interesting. There's

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Speaker 2: no doubt that there are a certain there are certain

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Speaker 2: types of vaginal birth that significantly predispose a woman to

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Speaker 2: to surgically relevant prolapse later in life. Labors that take

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Speaker 2: way too long, op labors where the baby comes out

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Speaker 2: looking at the ceiling instead of down at the floor.

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Speaker 2: Forces deliveries and particularly rotational forceps.

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Speaker 1: Deliveries, which aren't done that much now, are they.

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Speaker 2: Not by me? No, there's some sometimes, but not by me.

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Speaker 2: It's my firm belief that the benefit that the that

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Speaker 2: the risks of that are firmly out they firmly outweigh.

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Speaker 1: The benefits they seem to be you know what's happening

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Speaker 1: right then with the birth and not really considering.

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Speaker 2: Forgetting about twenty years later.

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Speaker 1: Yeah. Yeah, that's where I feel like you've got to

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Speaker 1: be careful what to wish for if you if you

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Speaker 1: want a vaginal birth at all.

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Speaker 2: Costs, yes, yes, And you know, this is one of

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Speaker 2: the reasons why we we we look for continuity in

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Speaker 2: our obstetric care, which is easy to get into private

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Speaker 2: sector and harder to get in the public sector. But

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Speaker 2: one of the things that that sort of continuity allows

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Speaker 2: you to do is to turn to a trusted advisor

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Speaker 2: in the thick of battle in labor when things aren't

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Speaker 2: going well and saying, all right, I understand my choices,

438
00:24:10,359 --> 00:24:14,280
Speaker 2: what do you think I should do? Because that's somebody

439
00:24:14,320 --> 00:24:15,720
Speaker 2: you didn't just meet three hours ago.

440
00:24:15,920 --> 00:24:18,639
Speaker 1: Yep, And this is the thing, Like you know, I know,

441
00:24:18,680 --> 00:24:20,720
Speaker 1: we're doing the pros and the cons, and that makes

442
00:24:20,760 --> 00:24:23,240
Speaker 1: it so sort of black and white. I think what

443
00:24:23,280 --> 00:24:28,320
Speaker 1: we're trying to say is it's very muddy. We think

444
00:24:28,320 --> 00:24:31,160
Speaker 1: that if any of the cons have given you heart

445
00:24:31,200 --> 00:24:33,240
Speaker 1: palpitations and you've gone up for sure, I'm not even

446
00:24:33,240 --> 00:24:35,280
Speaker 1: a vaginal birth. I'm going straight for a cesarian section.

447
00:24:35,840 --> 00:24:38,560
Speaker 1: What we suggest you do is go back and listen

448
00:24:38,640 --> 00:24:43,600
Speaker 1: to the assisted birth podcast that we did, the cesarean

449
00:24:43,680 --> 00:24:49,200
Speaker 1: Section podcast, because what we've heard from our listeners is

450
00:24:49,240 --> 00:24:52,600
Speaker 1: that they've gone through their whole labor and vaginal birth.

451
00:24:53,000 --> 00:24:57,159
Speaker 1: And yes they may have had an induction, a failed

452
00:24:57,160 --> 00:25:02,240
Speaker 1: at bidural force its delivery, and then a caesar at

453
00:25:02,240 --> 00:25:05,359
Speaker 1: full dillitation or whatever, but the whole way along, they

454
00:25:05,440 --> 00:25:09,160
Speaker 1: knew how to handle that, how to ask the right questions,

455
00:25:09,440 --> 00:25:10,280
Speaker 1: what was coming next?

456
00:25:10,400 --> 00:25:12,600
Speaker 2: Yeah, they knew what those things were, Yeah, and that

457
00:25:12,640 --> 00:25:15,800
Speaker 2: those things existed. This is what we think is the

458
00:25:15,920 --> 00:25:17,280
Speaker 2: value of knowing more.

459
00:25:17,080 --> 00:25:20,480
Speaker 1: Stuff so that those big cons might to having a

460
00:25:20,560 --> 00:25:23,320
Speaker 1: vaginal birth might diminish a little. Yeah.

461
00:25:23,359 --> 00:25:28,560
Speaker 2: Absolutely, And we you know, there are some people who

462
00:25:28,600 --> 00:25:31,040
Speaker 2: were scared of information and want to take a head

463
00:25:31,040 --> 00:25:34,119
Speaker 2: in the sand approach to childbirth. But I think I

464
00:25:34,160 --> 00:25:38,240
Speaker 2: think most people benefit from knowing a lot more than

465
00:25:38,280 --> 00:25:39,359
Speaker 2: they otherwise would have.

466
00:25:39,480 --> 00:25:42,400
Speaker 1: Yeah, they get to ask the right questions to begin with. Absolutely, good,

467
00:25:42,800 --> 00:25:46,959
Speaker 1: we're talking about vaginal birth or cesarean birth. And now

468
00:25:47,000 --> 00:25:49,640
Speaker 1: we're going ahead, perta, aren't we talking about the pros

469
00:25:49,680 --> 00:25:51,040
Speaker 1: and cons of caesarean birth?

470
00:25:51,080 --> 00:25:51,280
Speaker 2: Good?

471
00:25:51,480 --> 00:25:52,400
Speaker 1: What do you think the pros are?

472
00:25:53,640 --> 00:25:58,119
Speaker 2: Look, there are some obstetric situations where it's definitely safer

473
00:25:58,160 --> 00:26:01,679
Speaker 2: to have a Caesar. Better our from Caesar. So some

474
00:26:01,720 --> 00:26:06,800
Speaker 2: of them are no brainers. Triplets or above three or

475
00:26:06,800 --> 00:26:08,840
Speaker 2: more babies in there? You want, you want a section.

476
00:26:10,080 --> 00:26:16,680
Speaker 2: Some twins are definitely safer with Caesar. Some twin situations

477
00:26:16,720 --> 00:26:21,160
Speaker 2: can be equally safely delivered vaginally a placenta previa. If

478
00:26:21,160 --> 00:26:24,320
Speaker 2: the placenta is covering the opening right across the opening,

479
00:26:24,800 --> 00:26:26,000
Speaker 2: then you must have a Caesar.

480
00:26:26,440 --> 00:26:28,119
Speaker 1: I don't even know how did they do that before

481
00:26:28,160 --> 00:26:29,679
Speaker 1: caess were even a thing.

482
00:26:29,960 --> 00:26:31,800
Speaker 2: Oh the outcomes were very poor.

483
00:26:32,000 --> 00:26:34,560
Speaker 1: Yeah, yeah, and they wouldn't have been even have known

484
00:26:34,600 --> 00:26:36,480
Speaker 1: that there was a placenta previa. That person would have

485
00:26:36,520 --> 00:26:37,399
Speaker 1: just labored and labored.

486
00:26:37,720 --> 00:26:40,520
Speaker 2: Well. Yes, and so if you look back to the

487
00:26:40,760 --> 00:26:45,919
Speaker 2: to the pre medical success rates. That's what you know.

488
00:26:46,359 --> 00:26:50,320
Speaker 2: Those these conditions that are now just routinely avoided by

489
00:26:50,640 --> 00:26:55,960
Speaker 2: caesarian section, like a ruptured placenta previa, those those women

490
00:26:56,000 --> 00:26:59,160
Speaker 2: didn't survive their pregnancy and it used to be really dangerous,

491
00:26:59,359 --> 00:27:04,000
Speaker 2: so that that's not you know, these ones are relative

492
00:27:04,040 --> 00:27:09,440
Speaker 2: no brainers. Yeah, okay, there are some infections. Herpes infection

493
00:27:09,720 --> 00:27:14,800
Speaker 2: is the most commonly encountered one where it's bad for

494
00:27:14,840 --> 00:27:16,560
Speaker 2: the baby to come out through the vagina and get

495
00:27:16,600 --> 00:27:18,959
Speaker 2: the herpes virus on them as a newborn.

496
00:27:19,119 --> 00:27:21,520
Speaker 1: This is herpes in your genitals.

497
00:27:21,640 --> 00:27:24,119
Speaker 2: Yeah, yeah, yeah, if you've got an active infection at

498
00:27:24,160 --> 00:27:24,879
Speaker 2: the time of labor.

499
00:27:25,800 --> 00:27:27,960
Speaker 1: What's an active Well, it's.

500
00:27:27,720 --> 00:27:30,000
Speaker 2: Not just like you're exposed twenty years ago and the

501
00:27:30,080 --> 00:27:32,119
Speaker 2: virus is living inside just somewhere. You have to actually

502
00:27:32,119 --> 00:27:34,960
Speaker 2: have a herpesaw on the on the gentles at the time.

503
00:27:35,280 --> 00:27:36,840
Speaker 1: And would a woman know she's got a.

504
00:27:37,680 --> 00:27:41,160
Speaker 2: It's super painful. Yeah, So you if you knew that,

505
00:27:41,440 --> 00:27:43,040
Speaker 2: you'd bring it to the attention of your caregivers and

506
00:27:43,160 --> 00:27:46,440
Speaker 2: they and they might recommend they would recommend cesarian section.

507
00:27:46,760 --> 00:27:51,000
Speaker 1: How common do you see herpes in labor or in pregnancy?

508
00:27:51,240 --> 00:27:53,960
Speaker 2: Oh, I've seen it several times a year in pregnant people.

509
00:27:54,000 --> 00:27:56,080
Speaker 2: You know, it's a recurrent. It can be a recurrent

510
00:27:56,119 --> 00:27:58,920
Speaker 2: infection in some people. And then once every few years

511
00:27:58,920 --> 00:28:02,760
Speaker 2: that we said, you know, present that term, complicating the

512
00:28:02,800 --> 00:28:07,480
Speaker 2: situation and leading to a season done for that reason.

513
00:28:07,720 --> 00:28:09,520
Speaker 1: Yeah, yeah, what a bummer.

514
00:28:10,760 --> 00:28:13,159
Speaker 2: Well, yeah, that is a bummer for yeah. Yeah, Although

515
00:28:13,200 --> 00:28:16,919
Speaker 2: if you are prone to frequent recurrences, you can go

516
00:28:17,000 --> 00:28:18,400
Speaker 2: on suppressive therapy.

517
00:28:18,480 --> 00:28:19,440
Speaker 1: Even when you're pregnant.

518
00:28:19,520 --> 00:28:21,600
Speaker 2: Yeah, right, and if then if and then if you're

519
00:28:21,600 --> 00:28:23,600
Speaker 2: just on the suppressive therapy, you won't get the outbreak

520
00:28:23,600 --> 00:28:25,000
Speaker 2: of term, and then you don't need the season.

521
00:28:25,080 --> 00:28:25,280
Speaker 1: Yeah.

522
00:28:25,520 --> 00:28:30,240
Speaker 2: As we've covered before, the section is associated with not

523
00:28:30,320 --> 00:28:32,960
Speaker 2: a zero risk of incondents and prolapse, but less risk

524
00:28:33,040 --> 00:28:35,800
Speaker 2: than vagina BA. And of course there are some reasons.

525
00:28:36,359 --> 00:28:38,959
Speaker 2: There are some non obstetric reasons, like if you've got

526
00:28:39,000 --> 00:28:43,080
Speaker 2: a bad heart valve, it's okay, your heart works fine

527
00:28:43,080 --> 00:28:46,040
Speaker 2: if you're just walking around. It may not work fine

528
00:28:46,080 --> 00:28:48,960
Speaker 2: if you're if you're pushing for three hours in labor. Yeah, right,

529
00:28:49,600 --> 00:28:53,640
Speaker 2: that's the sort of exertion that your heart valve might

530
00:28:53,680 --> 00:28:56,360
Speaker 2: not be able to handle. And some people with known

531
00:28:57,200 --> 00:29:04,240
Speaker 2: heart issues might be recommended not to push, and therefore

532
00:29:04,280 --> 00:29:06,240
Speaker 2: they might have the sort of labor where they have

533
00:29:06,320 --> 00:29:10,680
Speaker 2: atment a planned instrumental or just a seater.

534
00:29:11,000 --> 00:29:14,120
Speaker 1: Yeah right, yeah, gosh, can you do a planned instrumental

535
00:29:14,120 --> 00:29:15,960
Speaker 1: that person would have already I was just a pushing.

536
00:29:16,000 --> 00:29:18,880
Speaker 1: It's not the actual contractions during labor that would push

537
00:29:18,880 --> 00:29:19,520
Speaker 1: a heart belt.

538
00:29:19,640 --> 00:29:22,080
Speaker 2: Yes, Let's say someone was going to have a vaginal

539
00:29:22,080 --> 00:29:25,440
Speaker 2: birth but had a was thought to be very poorly

540
00:29:25,480 --> 00:29:27,200
Speaker 2: to a painful labor. You can put an epidural at

541
00:29:27,200 --> 00:29:31,320
Speaker 2: the start labor up painlessly, get to fully, and then

542
00:29:31,400 --> 00:29:33,160
Speaker 2: have a forceps without pushing.

543
00:29:33,280 --> 00:29:33,480
Speaker 1: Yeah.

544
00:29:33,480 --> 00:29:36,040
Speaker 2: Well, yeah, certainly done that a few times.

545
00:29:36,240 --> 00:29:40,640
Speaker 1: Because a person's preference because they had heart disease, No, no, no, Like,

546
00:29:40,840 --> 00:29:42,920
Speaker 1: why wouldn't they choose a cesarean in that situation?

547
00:29:43,000 --> 00:29:44,720
Speaker 2: Oh well, season might have its own risks for them.

548
00:29:44,760 --> 00:29:47,240
Speaker 2: And if they preferred a vaginal birth and just wanted

549
00:29:47,280 --> 00:29:48,840
Speaker 2: it done safely, then that's how you do it.

550
00:29:49,000 --> 00:29:51,840
Speaker 1: There's also you know, we've talked about it previously. It's

551
00:29:52,600 --> 00:29:57,000
Speaker 1: a con might be for some people who perhaps you know,

552
00:29:57,080 --> 00:29:58,800
Speaker 1: have got to the point where they need to plan

553
00:29:58,880 --> 00:30:01,320
Speaker 1: it for their own mental health. They need to have

554
00:30:02,040 --> 00:30:03,800
Speaker 1: the unknowns removed.

555
00:30:03,960 --> 00:30:07,720
Speaker 2: Yes, yeah, and we certainly see that, and that is

556
00:30:07,760 --> 00:30:11,160
Speaker 2: a real mental health issue for some people. This is

557
00:30:11,200 --> 00:30:14,680
Speaker 2: not just you know type as and the people we

558
00:30:14,840 --> 00:30:18,400
Speaker 2: like to make jokes about. This is the lack of

559
00:30:19,080 --> 00:30:21,840
Speaker 2: confidence that it will go well, or that it will

560
00:30:21,880 --> 00:30:24,520
Speaker 2: happen on time, or that they'll get to the hospital

561
00:30:25,000 --> 00:30:28,240
Speaker 2: is a real source of anxiety and fear for some people.

562
00:30:28,960 --> 00:30:31,760
Speaker 1: And we've mentioned it before, but that term tocophobia, like,

563
00:30:31,840 --> 00:30:35,680
Speaker 1: you know, someone's got a big fear. Is it likely

564
00:30:35,720 --> 00:30:39,400
Speaker 1: that they would go on and have a Cesarean.

565
00:30:39,240 --> 00:30:43,200
Speaker 2: Well, potentially yes, although let's say my fear is that

566
00:30:43,240 --> 00:30:44,720
Speaker 2: I won't make it to the hospital. Or you don't

567
00:30:44,760 --> 00:30:46,400
Speaker 2: necessarily have to do a caasy. You could do it.

568
00:30:46,680 --> 00:30:48,960
Speaker 2: You could do an induction, you could just come in

569
00:30:49,000 --> 00:30:52,960
Speaker 2: at term and be induced. But if the pain is laboring,

570
00:30:53,000 --> 00:30:56,760
Speaker 2: if the essence of the fear is labor and vaginal

571
00:30:56,880 --> 00:31:01,440
Speaker 2: childbirth itself, then the various Cycleloge interventions during the pregnancy

572
00:31:01,480 --> 00:31:04,960
Speaker 2: haven't been successful or weren't pursued, then find you can

573
00:31:04,960 --> 00:31:05,480
Speaker 2: have a caesar.

574
00:31:05,680 --> 00:31:08,120
Speaker 1: Yeah, all right, so let's move on to the cons

575
00:31:08,160 --> 00:31:11,960
Speaker 1: of having a Caesarean birth then, because there are few

576
00:31:12,560 --> 00:31:13,120
Speaker 1: there are.

577
00:31:13,680 --> 00:31:16,400
Speaker 2: And this needs to be taken into consideration in the

578
00:31:16,920 --> 00:31:20,280
Speaker 2: big beautiful discussion about how this is going to happen

579
00:31:20,520 --> 00:31:24,600
Speaker 2: between an individual woman and her care providers. Yeah, so

580
00:31:25,840 --> 00:31:30,120
Speaker 2: the cesarean section itself, if done to avoid trauma to

581
00:31:30,160 --> 00:31:33,320
Speaker 2: the pelvic floor, might cause its own trauma. Okay, So

582
00:31:34,080 --> 00:31:39,360
Speaker 2: surgical complications can happen. An emergency caesarean section done with

583
00:31:39,440 --> 00:31:43,520
Speaker 2: lights and sirens can be just scary and traumatic emotionally

584
00:31:43,560 --> 00:31:45,840
Speaker 2: for people. The point I'm trying to make is that

585
00:31:45,880 --> 00:31:50,640
Speaker 2: it's not necessarily the easy way out. Okay, childbirth, whichever

586
00:31:50,680 --> 00:31:52,080
Speaker 2: way the baby comes out, is going to be a

587
00:31:52,080 --> 00:31:52,520
Speaker 2: big deal.

588
00:31:52,840 --> 00:31:56,320
Speaker 1: Yeah, big deal. Yeah. I just think you know that

589
00:31:56,400 --> 00:31:59,600
Speaker 1: we could get if we left, if we were able

590
00:31:59,600 --> 00:32:02,720
Speaker 1: in our common language to get rid of some things

591
00:32:03,120 --> 00:32:06,040
Speaker 1: in terms of pregnancy, then it would help a lot

592
00:32:06,080 --> 00:32:08,560
Speaker 1: of women that feel guilt about how their baby was

593
00:32:08,600 --> 00:32:12,000
Speaker 1: born to be, you know, just not there so things

594
00:32:12,080 --> 00:32:14,560
Speaker 1: like you know, you took the easy option, or your

595
00:32:14,560 --> 00:32:17,200
Speaker 1: body failed you somehow or whatever. I think I think

596
00:32:17,240 --> 00:32:19,200
Speaker 1: that would be good if we if we just stopped

597
00:32:19,320 --> 00:32:23,040
Speaker 1: thinking about it. Both vaginal birth and cesarean birth have

598
00:32:23,160 --> 00:32:24,880
Speaker 1: their equal Yes, I.

599
00:32:24,800 --> 00:32:32,880
Speaker 2: Think those those judgmental comments are particularly unhelpful, and that's

600
00:32:32,920 --> 00:32:35,800
Speaker 2: why I'm trying to confine the discussion to sort of

601
00:32:35,840 --> 00:32:40,920
Speaker 2: proven pros and cons and less no value judgments about

602
00:32:40,920 --> 00:32:45,760
Speaker 2: the decision that's ultimately made. Yeah, so you know, there's

603
00:32:45,760 --> 00:32:47,120
Speaker 2: no doubt for a seas you stay in hospital a

604
00:32:47,120 --> 00:32:51,240
Speaker 2: bit longer. I like that that as a con Yeah,

605
00:32:51,280 --> 00:32:54,280
Speaker 2: well that's right, and it's not for everybody, but it

606
00:32:54,320 --> 00:32:56,320
Speaker 2: is a factor for health economics.

607
00:32:56,640 --> 00:33:00,680
Speaker 1: Yeah, I know, sometimes you do encourage people who have

608
00:33:00,720 --> 00:33:04,400
Speaker 1: got good support systems to go home. So I'm not saying,

609
00:33:04,560 --> 00:33:06,680
Speaker 1: you know that everybody likes staying in hospital, but I

610
00:33:06,760 --> 00:33:07,800
Speaker 1: was just affording the kids.

611
00:33:07,960 --> 00:33:13,000
Speaker 2: Well, that's true. That's the thing. So I think that

612
00:33:13,200 --> 00:33:17,000
Speaker 2: we've got to be careful comparing apples with apples, because

613
00:33:17,520 --> 00:33:22,080
Speaker 2: if you are a pretty healthy person and it's not

614
00:33:22,160 --> 00:33:27,800
Speaker 2: and it's not your first baby, and you're well supported

615
00:33:27,840 --> 00:33:30,680
Speaker 2: at home and your bladder and bowels have started working again,

616
00:33:31,680 --> 00:33:34,000
Speaker 2: go home. If you really think that's right, what's right

617
00:33:34,040 --> 00:33:36,160
Speaker 2: for you, and you're well supported, go Yeah, you.

618
00:33:36,160 --> 00:33:38,560
Speaker 1: Don't sleep very well in hospital, that's that's for sure.

619
00:33:38,680 --> 00:33:40,560
Speaker 2: These are the people I say, you know, my usual

620
00:33:40,560 --> 00:33:42,440
Speaker 2: line is the hospitals for working at it's not for

621
00:33:42,480 --> 00:33:47,040
Speaker 2: being a patient. And and you know, if you're better

622
00:33:47,080 --> 00:33:49,160
Speaker 2: off at home, you don't have to stay longer with

623
00:33:49,160 --> 00:33:53,680
Speaker 2: the caesar. But in general terms, the length of stays

624
00:33:53,720 --> 00:33:54,240
Speaker 2: a bit longer.

625
00:33:54,440 --> 00:33:57,360
Speaker 1: Yeah. They also, you know, a con is that they

626
00:33:57,360 --> 00:34:00,400
Speaker 1: say that recovery is longer. I want to is that

627
00:34:00,440 --> 00:34:01,080
Speaker 1: still the case?

628
00:34:01,440 --> 00:34:03,480
Speaker 2: I think it roughly is the case. If you ask

629
00:34:03,520 --> 00:34:05,600
Speaker 2: someone at three or four weeks after a season, does

630
00:34:05,600 --> 00:34:08,160
Speaker 2: your scar hurt? They might say yes. But if you

631
00:34:08,200 --> 00:34:10,640
Speaker 2: ask a better question, which is is the scar is

632
00:34:10,640 --> 00:34:13,120
Speaker 2: the pain from your scar limiting your daily activities, I'll

633
00:34:13,120 --> 00:34:16,160
Speaker 2: probably say no. So yeah, I guess the recovery is

634
00:34:16,200 --> 00:34:21,360
Speaker 2: a bit longer. But is it meaningfully longer. Perhaps not.

635
00:34:21,920 --> 00:34:26,440
Speaker 1: And you know you should be recovering and doing less,

636
00:34:26,800 --> 00:34:28,280
Speaker 1: you should be looking after your baby.

637
00:34:28,640 --> 00:34:28,839
Speaker 2: Yep.

638
00:34:29,440 --> 00:34:32,200
Speaker 1: And perhaps that's the case if you've had a vaginal

639
00:34:32,320 --> 00:34:35,120
Speaker 1: or a cesarean birth, like you know, people rush around

640
00:34:35,200 --> 00:34:36,279
Speaker 1: and think I'm back at it.

641
00:34:36,680 --> 00:34:39,439
Speaker 2: Yeah, I reckon. If we're talking about recovery, everyone needs

642
00:34:39,440 --> 00:34:42,280
Speaker 2: a friend who's had one of each. That's a person

643
00:34:42,280 --> 00:34:44,399
Speaker 2: i'd take who I would take notice from.

644
00:34:44,480 --> 00:34:44,760
Speaker 1: Yeah.

645
00:34:44,880 --> 00:34:48,840
Speaker 2: Otherwise everybody else's only knows their own experience. The cons

646
00:34:49,520 --> 00:34:54,000
Speaker 2: of section really become more important when we look at

647
00:34:54,040 --> 00:34:57,640
Speaker 2: the pregnancy after that and the pregnancy after that. And

648
00:34:57,719 --> 00:35:01,160
Speaker 2: there are some risks involved in ha next time you're pregnant,

649
00:35:01,320 --> 00:35:03,160
Speaker 2: in having a vaginal birth when you've got a scar

650
00:35:03,239 --> 00:35:06,400
Speaker 2: on the uters from the previous season, and that's the

651
00:35:06,480 --> 00:35:09,600
Speaker 2: risks of vback, And then there's a risk if you

652
00:35:09,600 --> 00:35:11,520
Speaker 2: don't have a vback and you have you've had two seasons.

653
00:35:11,520 --> 00:35:13,160
Speaker 2: Now you kind of stuck with caesars for the rest

654
00:35:13,200 --> 00:35:18,040
Speaker 2: of your obstetric years. Yeah, that has a risk, but

655
00:35:18,080 --> 00:35:20,480
Speaker 2: not until you get to about four or five. Yeah,

656
00:35:20,560 --> 00:35:23,759
Speaker 2: they become a little more surgically complex at those sort

657
00:35:23,800 --> 00:35:26,440
Speaker 2: of numbers, But most people have the two or three babies,

658
00:35:26,560 --> 00:35:29,640
Speaker 2: and at those numbers the risks aren't really important.

659
00:35:29,760 --> 00:35:33,000
Speaker 1: Yeah, And it's not to say that if you need

660
00:35:33,040 --> 00:35:35,560
Speaker 1: four or five cesareans that they can't be done. Like

661
00:35:35,600 --> 00:35:37,000
Speaker 1: there is a bit of a myth saying that you

662
00:35:37,040 --> 00:35:38,760
Speaker 1: can only have a certain amount of caesarians.

663
00:35:38,760 --> 00:35:40,279
Speaker 2: No, you can know as many as you want. It's

664
00:35:40,280 --> 00:35:42,040
Speaker 2: just they get a little bit harder to do and

665
00:35:42,080 --> 00:35:45,839
Speaker 2: the risks go up. Yeah, there's one very significant risk

666
00:35:45,920 --> 00:35:49,200
Speaker 2: of that if you get a placenta previa that covers

667
00:35:49,239 --> 00:35:53,600
Speaker 2: the opening of the cervix and extends up the front

668
00:35:53,600 --> 00:35:56,160
Speaker 2: wall of the uterus such that it covers the scar

669
00:35:57,120 --> 00:36:00,960
Speaker 2: from previous caesarean sections, then it's much more likely to

670
00:36:01,000 --> 00:36:05,040
Speaker 2: be attached abnormally so called placenta a creta, and the

671
00:36:05,160 --> 00:36:08,120
Speaker 2: risk of the of the placenta preview being in a

672
00:36:08,200 --> 00:36:11,680
Speaker 2: creta goes up dramatically the more the more previous seasons

673
00:36:11,680 --> 00:36:14,440
Speaker 2: you've had. And you know, that's probably the most compelling

674
00:36:15,080 --> 00:36:19,000
Speaker 2: argument in favor of keeping uses are in sectional rate

675
00:36:19,360 --> 00:36:25,120
Speaker 2: reasonably under control, is that this is a seriously complicated,

676
00:36:25,800 --> 00:36:31,480
Speaker 2: seriously dangerous diagnosis. And we'll there's no doubt that in

677
00:36:31,520 --> 00:36:34,560
Speaker 2: the future if we keep on, if the number of

678
00:36:34,600 --> 00:36:38,400
Speaker 2: caesars keeps on creeping up, then that's going to stop

679
00:36:38,440 --> 00:36:41,200
Speaker 2: being a once a year diagnosis in a unit like

680
00:36:41,320 --> 00:36:44,000
Speaker 2: mine and become a once a month diagnosis in a unit.

681
00:36:44,520 --> 00:36:47,799
Speaker 1: Yeah, but what about if people like the birth rate

682
00:36:47,960 --> 00:36:51,319
Speaker 1: is declining or per woman is declining, isn't it so

683
00:36:51,400 --> 00:36:53,200
Speaker 1: you know there's not tons of people having four or

684
00:36:53,200 --> 00:36:54,200
Speaker 1: five babies.

685
00:36:54,000 --> 00:36:55,120
Speaker 2: Well, this is true.

686
00:36:55,440 --> 00:36:58,440
Speaker 1: We're are the only ones that had four crazy people. No,

687
00:36:58,520 --> 00:37:03,440
Speaker 1: we're not crazy boys. Speaking of newborns, there is a

688
00:37:03,440 --> 00:37:06,000
Speaker 1: bit of an extra challenge to look after newborns, so.

689
00:37:06,480 --> 00:37:09,360
Speaker 2: You know, a higher a nursery admission rate, in pediatric

690
00:37:09,400 --> 00:37:11,400
Speaker 2: attendance and.

691
00:37:11,320 --> 00:37:15,840
Speaker 1: For the mother, like it's it's physically difficult in the

692
00:37:15,840 --> 00:37:19,040
Speaker 1: first couple of days to actually pick up the baby,

693
00:37:19,160 --> 00:37:22,719
Speaker 1: to maneuver around the baby, like breastfeeding is sort of

694
00:37:22,760 --> 00:37:26,560
Speaker 1: you're managing where you're positioning the baby and your cesarean scar,

695
00:37:27,960 --> 00:37:31,920
Speaker 1: those sort of things. Probably people who have had a

696
00:37:32,000 --> 00:37:34,520
Speaker 1: vaginal birth don't have those things, So that's that's I

697
00:37:34,520 --> 00:37:37,360
Speaker 1: think a con and some people might point to that

698
00:37:37,440 --> 00:37:41,080
Speaker 1: as to how that mum is actually bonding with that

699
00:37:41,160 --> 00:37:43,480
Speaker 1: baby or how breastfeeding started.

700
00:37:44,560 --> 00:37:48,960
Speaker 2: Theoretically, yes, but those type of things might be in

701
00:37:49,000 --> 00:37:53,280
Speaker 2: a list of known colns, but not deal breakers.

702
00:37:53,280 --> 00:37:55,960
Speaker 1: Not deal breakers, that's right. And as we sort of

703
00:37:56,120 --> 00:37:59,840
Speaker 1: talked about already, I think the idea of starting breastfeeding

704
00:37:59,880 --> 00:38:02,080
Speaker 1: for someone that's had a caesarean, because there are more

705
00:38:02,120 --> 00:38:04,879
Speaker 1: and more caesareans, I think that that's moving people are

706
00:38:04,920 --> 00:38:08,600
Speaker 1: starting breastfeeding and thinking, well, you know, this woman who's

707
00:38:08,600 --> 00:38:11,360
Speaker 1: had a cesarean should be giving the best chance to

708
00:38:11,400 --> 00:38:13,000
Speaker 1: start her y let's.

709
00:38:12,760 --> 00:38:15,920
Speaker 2: Try hard to keep her more supported, put the baby

710
00:38:15,920 --> 00:38:17,920
Speaker 2: on the breast more often, do everything we can to

711
00:38:17,920 --> 00:38:18,680
Speaker 2: maximi supply.

712
00:38:20,120 --> 00:38:24,359
Speaker 1: And there's a bit of research between caesarean sections and

713
00:38:24,440 --> 00:38:26,120
Speaker 1: respiratory issues like asthma.

714
00:38:26,320 --> 00:38:30,520
Speaker 2: Yeah, this is an interesting one, isn't it. And I

715
00:38:30,520 --> 00:38:33,239
Speaker 2: think that this is still in them maybe, yeah, it

716
00:38:33,320 --> 00:38:37,479
Speaker 2: might it might be relevant. Research is published from time

717
00:38:37,520 --> 00:38:41,319
Speaker 2: to time where outcome X is divided into people who

718
00:38:41,320 --> 00:38:43,719
Speaker 2: were worn by a vaginal birth and people were born

719
00:38:43,760 --> 00:38:48,080
Speaker 2: by a cesarean section, And sometimes they illustrate a difference,

720
00:38:48,239 --> 00:38:50,840
Speaker 2: say in the rate of asthma among ten year olds,

721
00:38:51,600 --> 00:38:55,120
Speaker 2: but they're not able to illustrate why that. You know,

722
00:38:55,200 --> 00:38:57,440
Speaker 2: what's called a mechanism of action. Why did that happen?

723
00:38:58,320 --> 00:39:00,560
Speaker 2: And you know, we're always getting a little bit suspicious

724
00:39:00,600 --> 00:39:02,320
Speaker 2: if someone says, well, this seems to be a difference,

725
00:39:02,440 --> 00:39:04,160
Speaker 2: but they can't, for the life of them, explain why

726
00:39:04,200 --> 00:39:05,399
Speaker 2: that difference would be there.

727
00:39:05,760 --> 00:39:08,319
Speaker 1: Why they're not taking in those confounders that you can

728
00:39:08,360 --> 00:39:09,080
Speaker 1: talk about, or.

729
00:39:09,080 --> 00:39:11,439
Speaker 2: Well, if you just don't know why the difference is there,

730
00:39:12,040 --> 00:39:16,000
Speaker 2: then then then this little unsatisfying, isn't it. And it's

731
00:39:16,000 --> 00:39:18,799
Speaker 2: a bit hard to think that that might change our

732
00:39:18,880 --> 00:39:21,719
Speaker 2: mind about anything if they've noticed a difference and it

733
00:39:21,760 --> 00:39:26,040
Speaker 2: appears to be statistically significant significant, but goodness knows how

734
00:39:26,200 --> 00:39:29,799
Speaker 2: why the difference is there. Some people think that a

735
00:39:29,840 --> 00:39:32,279
Speaker 2: baby born by sincere in section doesn't come out through

736
00:39:32,320 --> 00:39:35,560
Speaker 2: the vagina, and the baby doesn't come out covered in

737
00:39:35,840 --> 00:39:39,759
Speaker 2: in maternal vaginal bacteria, and the baby's gut doesn't colonize

738
00:39:39,760 --> 00:39:44,520
Speaker 2: with maternal vaginal bacteria, and that that's important for long

739
00:39:44,640 --> 00:39:50,120
Speaker 2: term health. But you know, I watch this space.

740
00:39:50,360 --> 00:39:53,920
Speaker 1: Yeah, that's called vaginal seating, isn't it when someone uses

741
00:39:54,200 --> 00:39:57,080
Speaker 1: secretions in their vagina through the baby's mouth.

742
00:39:57,280 --> 00:40:01,600
Speaker 2: Yeah, you can do that, but no proven benefit at

743
00:40:01,600 --> 00:40:02,279
Speaker 2: this stage. Yeah.

744
00:40:02,320 --> 00:40:05,759
Speaker 1: And isn't the thought that the baby gets those good

745
00:40:06,000 --> 00:40:08,960
Speaker 1: flora and fauna fauna flora when the babies put on

746
00:40:08,960 --> 00:40:10,200
Speaker 1: them on you anyway?

747
00:40:10,239 --> 00:40:13,400
Speaker 2: Yeah, yeah, exactly. Well we'll covered in germs and the

748
00:40:13,440 --> 00:40:15,200
Speaker 2: baby's going to get that. In my view, the baby's

749
00:40:15,200 --> 00:40:16,040
Speaker 2: going to get those anyway.

750
00:40:16,160 --> 00:40:16,359
Speaker 1: Yeah.

751
00:40:16,400 --> 00:40:17,640
Speaker 2: I don't think you have to come out through the

752
00:40:17,719 --> 00:40:18,759
Speaker 2: vagina to get those.

753
00:40:18,920 --> 00:40:23,040
Speaker 1: Yeah. The other one that I wanted to point out

754
00:40:23,320 --> 00:40:27,080
Speaker 1: was that there was a study that showed the higher

755
00:40:27,160 --> 00:40:31,440
Speaker 1: risk of developing type two diabetes for babies born by

756
00:40:31,480 --> 00:40:32,800
Speaker 1: cesarean delivery.

757
00:40:32,880 --> 00:40:36,440
Speaker 2: They always try and control these studies for obvious confounders. So,

758
00:40:36,880 --> 00:40:41,399
Speaker 2: for example, the Caesar group, some of those women would

759
00:40:41,400 --> 00:40:44,000
Speaker 2: have had diabetes, so of course the rospringa might likely

760
00:40:44,000 --> 00:40:47,880
Speaker 2: to get diabetes. Some of those women would have been obese.

761
00:40:48,520 --> 00:40:51,960
Speaker 2: One of the major risk factors in Australia in twenty

762
00:40:51,960 --> 00:40:54,759
Speaker 2: twenty three from an emergency cesarian section is obesity. It

763
00:40:54,840 --> 00:40:56,920
Speaker 2: makes sense that the offspring of a group that had

764
00:40:56,920 --> 00:41:00,000
Speaker 2: more obesity would have more diabetes. So there's an awful

765
00:41:00,120 --> 00:41:04,640
Speaker 2: lot of confounders. There are the explanations that could explain

766
00:41:04,680 --> 00:41:06,920
Speaker 2: the difference other than the way in which the babies

767
00:41:06,920 --> 00:41:09,640
Speaker 2: came out, and the people doing good studies try and

768
00:41:09,640 --> 00:41:10,359
Speaker 2: control for that.

769
00:41:10,600 --> 00:41:14,520
Speaker 1: It's hard, I think, you know, thinking about your newborn

770
00:41:14,560 --> 00:41:17,160
Speaker 1: and the effect that your decision is having or could

771
00:41:17,239 --> 00:41:19,920
Speaker 1: have on your newborn is fraught with a lot of

772
00:41:19,920 --> 00:41:21,440
Speaker 1: emotion as well well.

773
00:41:21,520 --> 00:41:24,080
Speaker 2: Absolutely, and this is why we should first just try

774
00:41:24,080 --> 00:41:26,480
Speaker 2: and stick to the facts, things we actually know, rather

775
00:41:26,520 --> 00:41:29,080
Speaker 2: than things that might be true and might be proven

776
00:41:29,120 --> 00:41:31,480
Speaker 2: in fifty years to be true. So stick to the facts.

777
00:41:31,680 --> 00:41:35,560
Speaker 2: But also we have to we have to confine our

778
00:41:35,640 --> 00:41:39,279
Speaker 2: decision making process I think to the best decision we

779
00:41:39,360 --> 00:41:43,920
Speaker 2: can make today, not the decision we might feel bad

780
00:41:43,960 --> 00:41:47,719
Speaker 2: about in ten years. Yeah. You know, we're called upon

781
00:41:47,760 --> 00:41:51,200
Speaker 2: in life sometimes to make decisions relatively quickly based on

782
00:41:51,280 --> 00:41:53,839
Speaker 2: the best evidence that we had at the time, and

783
00:41:53,880 --> 00:41:56,359
Speaker 2: it's not really fair or useful to beat yourself up

784
00:41:56,360 --> 00:42:00,320
Speaker 2: about that if that later turns out to be unwarmed eyes.

785
00:42:00,360 --> 00:42:02,720
Speaker 2: But you didn't know that outcome in advance.

786
00:42:02,920 --> 00:42:04,640
Speaker 1: Yeah, live in the now.

787
00:42:04,920 --> 00:42:05,480
Speaker 2: Well that's right.

788
00:42:05,600 --> 00:42:08,200
Speaker 1: Yeah, Oh well, there we go. Pat, I like I

789
00:42:08,320 --> 00:42:10,040
Speaker 1: want to leave it there. That's such a good thing,

790
00:42:10,400 --> 00:42:12,440
Speaker 1: you know. Just make the decision. Kind to us, yeah,

791
00:42:12,480 --> 00:42:15,640
Speaker 1: be kind to ourselves. And once you've made the decision,

792
00:42:16,080 --> 00:42:17,520
Speaker 1: just love the decision you've made.

793
00:42:17,800 --> 00:42:22,359
Speaker 2: Yes, yes, yeah, absolutely, no, absolutely, And there's a lot

794
00:42:22,360 --> 00:42:24,840
Speaker 2: of second guessing that gos On. Yeah, I love the

795
00:42:24,880 --> 00:42:27,360
Speaker 2: decision you've made and talk about it like it was

796
00:42:27,400 --> 00:42:31,000
Speaker 2: a decision that was right for you in your circumstances.

797
00:42:31,080 --> 00:42:34,320
Speaker 1: Yeah. Good, All right, everyone. That's the end of the

798
00:42:34,360 --> 00:42:38,640
Speaker 1: podcast and episode, and we hope that you've had a

799
00:42:38,680 --> 00:42:42,760
Speaker 1: really in depth discussion. I heard it in depth discussion

800
00:42:42,760 --> 00:42:46,320
Speaker 1: about the pros and cons of vaginal and caesarean birth

801
00:42:47,600 --> 00:42:50,080
Speaker 1: and until then right now we've got to move on

802
00:42:50,120 --> 00:42:56,319
Speaker 1: to myth all fact al right, Dr pat this is

803
00:42:56,360 --> 00:43:00,480
Speaker 1: still about cesarean sections. So once you've had your and

804
00:43:00,560 --> 00:43:04,760
Speaker 1: you're recovering, do you bleed less after a caesarean section

805
00:43:04,920 --> 00:43:06,520
Speaker 1: compared to a vaginal birth.

806
00:43:07,080 --> 00:43:09,120
Speaker 2: Oh, you don't mean at the time of birth, you

807
00:43:09,200 --> 00:43:11,839
Speaker 2: mean during the recovery. It's about the same.

808
00:43:12,080 --> 00:43:12,839
Speaker 1: It's about the same.

809
00:43:13,719 --> 00:43:16,040
Speaker 2: So what we do, you know, the bleeding that you

810
00:43:16,160 --> 00:43:19,560
Speaker 2: get from a you know, in the up to six

811
00:43:19,600 --> 00:43:24,239
Speaker 2: weeks afterwards, is just bleeding from the uterus, and it's

812
00:43:24,239 --> 00:43:28,560
Speaker 2: often fairly steady and gets a bit irritating, and then

813
00:43:28,640 --> 00:43:31,000
Speaker 2: it tends to disappear about a week before. We see

814
00:43:31,000 --> 00:43:33,480
Speaker 2: people at the six week check and they say, yeah,

815
00:43:33,680 --> 00:43:36,800
Speaker 2: just just gone. And it's coming from the inside the

816
00:43:36,920 --> 00:43:40,200
Speaker 2: uterus itself. And what we do at a caesarean section,

817
00:43:42,120 --> 00:43:45,080
Speaker 2: even if the cervix is closed, is coming down from above.

818
00:43:45,080 --> 00:43:46,720
Speaker 2: You go off and put your finger in the cervix

819
00:43:46,760 --> 00:43:49,040
Speaker 2: from above and give it a little stretch and just

820
00:43:49,040 --> 00:43:51,280
Speaker 2: make sure that there's some way of that blood getting

821
00:43:51,280 --> 00:43:54,960
Speaker 2: down the cervix and out the vagina. So the uterus

822
00:43:55,000 --> 00:43:58,279
Speaker 2: doesn't know whether whether the baby came out vaginantly or

823
00:43:59,080 --> 00:44:01,680
Speaker 2: through a surgical INTI and the bleeding's about the same.

824
00:44:01,960 --> 00:44:07,000
Speaker 1: Wow, I my first cesarean. I was shocked with this.

825
00:44:07,280 --> 00:44:09,400
Speaker 1: I thought, because you're in there with your little sucker,

826
00:44:09,800 --> 00:44:13,239
Speaker 1: that you'd sucked up all the blood. Really surprised at

827
00:44:13,360 --> 00:44:13,960
Speaker 1: us bleeding.

828
00:44:14,480 --> 00:44:16,680
Speaker 2: Well, we suck up the blood that's there that day, yeah, yeah,

829
00:44:16,680 --> 00:44:18,279
Speaker 2: but not all the blood that comes all the other days.

830
00:44:18,360 --> 00:44:21,359
Speaker 2: Yeah yeah, not the future blood. Not the future blood.

831
00:44:21,440 --> 00:44:21,600
Speaker 3: Yeah.

832
00:44:21,680 --> 00:44:24,880
Speaker 1: All right, good, Thank you, Pat, and thank you everyone

833
00:44:24,920 --> 00:44:29,080
Speaker 1: for listening. We enjoy these podcasts so much, and we

834
00:44:29,200 --> 00:44:31,640
Speaker 1: enjoy just it's about the main time you and I

835
00:44:31,680 --> 00:44:33,520
Speaker 1: get to sit in the same room together, Pat, isn't.

836
00:44:33,320 --> 00:44:38,520
Speaker 2: It in this little room. It's fantastic. We're we're having

837
00:44:38,560 --> 00:44:40,160
Speaker 2: a lot of fun with it. And thank you for listening.

838
00:44:40,360 --> 00:44:44,200
Speaker 1: Yeah, and if you love our podcast, please rate us

839
00:44:44,280 --> 00:44:48,920
Speaker 1: five stars, share it with a friend. I know we're

840
00:44:48,920 --> 00:44:50,760
Speaker 1: wrapping up, but I've got a really funny story about

841
00:44:51,080 --> 00:44:56,480
Speaker 1: someone who was an air hostess flight attendant and they

842
00:44:56,560 --> 00:44:59,920
Speaker 1: ground the flight attendants at a certain time, and they

843
00:45:00,080 --> 00:45:02,000
Speaker 1: put them all into the same room as every other

844
00:45:02,200 --> 00:45:06,280
Speaker 1: pregnant woman. And she'd listen to the kick Pregnancy podcast

845
00:45:06,280 --> 00:45:08,279
Speaker 1: and she'd go to work, and she'd tell all the

846
00:45:08,320 --> 00:45:10,759
Speaker 1: pregnant women all of what she'd learned in the Kick

847
00:45:10,800 --> 00:45:11,719
Speaker 1: Pregnancy podcast.

848
00:45:12,760 --> 00:45:14,680
Speaker 2: I have fantastic friends.

849
00:45:14,760 --> 00:45:16,920
Speaker 1: Good all right, everyone, have a great week. We'll see

850
00:45:16,920 --> 00:45:24,719
Speaker 1: you next week for works by now Hey. Even though

851
00:45:24,760 --> 00:45:27,279
Speaker 1: doctor Pat is well a doctor and we get lots

852
00:45:27,320 --> 00:45:30,200
Speaker 1: of other doctors and other experts on our podcast, I

853
00:45:30,440 --> 00:45:33,160
Speaker 1: just need to remind you that this podcast is for

854
00:45:33,280 --> 00:45:38,239
Speaker 1: informational purposes only. We share lots of medical insights and experience,

855
00:45:38,480 --> 00:45:41,840
Speaker 1: but everything we talk about is general in nature and

856
00:45:41,920 --> 00:45:46,200
Speaker 1: may not apply to your specific situation. Please always consult

857
00:45:46,239 --> 00:45:50,040
Speaker 1: with your own healthcare provider for your individual medical advice.

858
00:45:50,160 --> 00:45:51,240
Speaker 1: When you grow your baby,