1 00:00:03,960 --> 00:00:07,040 Speaker 1: Welcome to the kick your Expert led podcast, helping you 2 00:00:07,120 --> 00:00:11,520 Speaker 1: explore and learn everything about gettingant, pregnancy, birth, and becoming 3 00:00:11,520 --> 00:00:11,959 Speaker 1: a parent. 4 00:00:12,280 --> 00:00:16,040 Speaker 2: On the podcast and our online pregnancy program grow My Baby, 5 00:00:16,200 --> 00:00:19,959 Speaker 2: we share my experience of helping more than four thousand babies. 6 00:00:19,640 --> 00:00:22,239 Speaker 1: To be born, and our experience of running a women's 7 00:00:22,239 --> 00:00:24,200 Speaker 1: health clinic and parenting for boys. 8 00:00:24,440 --> 00:00:27,400 Speaker 2: We're here to help everyone to feel empowered in pregnancy 9 00:00:27,560 --> 00:00:30,400 Speaker 2: and birth with real life, practical information. 10 00:00:33,600 --> 00:00:35,760 Speaker 1: Welcome everyone, I'm Bridge Maloney. 11 00:00:35,479 --> 00:00:37,760 Speaker 2: And I'm obstetrician doctor Patrick Maloney. 12 00:00:38,240 --> 00:00:41,160 Speaker 1: And guess what, Pat, We've got another Q and a nice. 13 00:00:41,200 --> 00:00:42,440 Speaker 2: I love Q and a good. 14 00:00:42,640 --> 00:00:44,960 Speaker 1: So we've got a lot of questions to get through. 15 00:00:45,320 --> 00:00:48,800 Speaker 1: Let's see how we go, and as we usually do, 16 00:00:48,840 --> 00:00:53,240 Speaker 1: we're going to get straight into it perfect good. Pat's 17 00:00:53,280 --> 00:00:56,080 Speaker 1: fresh off operating this morning and he's got to get 18 00:00:56,080 --> 00:00:58,960 Speaker 1: back to work and operate more in about half an hour, 19 00:00:59,000 --> 00:01:01,440 Speaker 1: so we'll see what we can manage. All right, let's 20 00:01:01,440 --> 00:01:01,880 Speaker 1: start here. 21 00:01:02,880 --> 00:01:06,560 Speaker 3: Thanks so much for your podcast. My name's Jess. My 22 00:01:06,760 --> 00:01:11,560 Speaker 3: question relates to getting pregnant again. I've got an almost 23 00:01:11,680 --> 00:01:16,000 Speaker 3: two year old girl, but I'm wondering how my history 24 00:01:16,040 --> 00:01:21,600 Speaker 3: would apply to a next pregnancy. So at my twenty 25 00:01:21,640 --> 00:01:25,080 Speaker 3: week scan with my first baby, I had a short 26 00:01:25,120 --> 00:01:30,800 Speaker 3: cervix of twenty four millimeters from memory, and I took 27 00:01:31,440 --> 00:01:37,399 Speaker 3: daily progesterone pessaries up until thirty five and six. When 28 00:01:38,000 --> 00:01:41,480 Speaker 3: I went into labor, a foot came out and I 29 00:01:41,600 --> 00:01:46,000 Speaker 3: ended up having an emergency sesari and with her. I 30 00:01:46,040 --> 00:01:48,680 Speaker 3: guess my question is if I had that in the 31 00:01:48,760 --> 00:01:52,920 Speaker 3: first pregnancy, would I be likely to have it again, 32 00:01:53,120 --> 00:01:59,960 Speaker 3: both the short cervix and a breach baby or potential 33 00:02:00,120 --> 00:02:03,440 Speaker 3: we could? That mean I could try for a beedback. 34 00:02:04,120 --> 00:02:07,400 Speaker 3: Thank you so much. I'm thirty five at the moment, 35 00:02:07,600 --> 00:02:11,760 Speaker 3: so time is picking and I'm aware of that. Thank you. 36 00:02:12,880 --> 00:02:17,000 Speaker 2: What a great question. Yeah, well done on that first 37 00:02:17,320 --> 00:02:18,400 Speaker 2: berth and all of that. 38 00:02:19,240 --> 00:02:22,080 Speaker 1: Excitement and wanting to go again like that's. 39 00:02:21,880 --> 00:02:26,720 Speaker 2: Impressing, fantastic. So there's a few there's a few parts 40 00:02:26,760 --> 00:02:30,000 Speaker 2: of the question, aren't there. The first one is about 41 00:02:30,639 --> 00:02:37,440 Speaker 2: where the SAVI call shortening runs in subsequent pregnancies, and 42 00:02:37,840 --> 00:02:40,040 Speaker 2: I think the answer to that is yes, if someone's 43 00:02:40,040 --> 00:02:43,840 Speaker 2: had cervical shortening, then they would be considered at higher 44 00:02:43,880 --> 00:02:47,000 Speaker 2: than average risk of it happening again. And that's okay. 45 00:02:47,120 --> 00:02:51,239 Speaker 2: The outcome for this caller was terrific, wasn't it. She 46 00:02:51,720 --> 00:02:55,800 Speaker 2: went into a program of cervical surveillance. They watched the 47 00:02:55,840 --> 00:02:59,560 Speaker 2: cervix carefully, and when it seemed to be getting a 48 00:02:59,560 --> 00:03:02,280 Speaker 2: bit too sh short, they used some vaginal progesterones, which 49 00:03:02,560 --> 00:03:06,840 Speaker 2: certainly helps. And when she did eventually labor, it was 50 00:03:06,919 --> 00:03:09,440 Speaker 2: right out in the third trimester. The pregnancy didn't go 51 00:03:09,520 --> 00:03:11,760 Speaker 2: as long as we'd like, but it went pretty long. 52 00:03:12,400 --> 00:03:15,560 Speaker 2: And that's a terrific outcome. So if we looked at 53 00:03:15,639 --> 00:03:19,799 Speaker 2: all of the people who had cervical insufficiency, that that 54 00:03:19,960 --> 00:03:22,799 Speaker 2: term that used to be called cervical incompetence, but that. 55 00:03:23,080 --> 00:03:24,519 Speaker 1: We thankfully got rid of that. 56 00:03:25,160 --> 00:03:27,640 Speaker 2: The incompetence bit sounded a bit like it might have been, 57 00:03:27,720 --> 00:03:30,120 Speaker 2: like it was the patient's fault, so so they replaced 58 00:03:30,120 --> 00:03:35,839 Speaker 2: it with civical insufficiency. Of all the people with that, 59 00:03:36,480 --> 00:03:39,200 Speaker 2: this is one of the people would be least worried about, 60 00:03:39,280 --> 00:03:42,400 Speaker 2: because they, yes, they've got the condition. But the cervix 61 00:03:42,440 --> 00:03:46,120 Speaker 2: responded world to progesterone and in facts stayed closed to 62 00:03:46,240 --> 00:03:50,360 Speaker 2: within a few weeks of the end of the pregnancy, 63 00:03:51,840 --> 00:03:55,440 Speaker 2: a few weeks of the due date. The worst case scenario, 64 00:03:55,480 --> 00:03:57,600 Speaker 2: of course, is when the cervic springs open way too 65 00:03:57,640 --> 00:04:01,600 Speaker 2: early and the tradition or the tech book finding of 66 00:04:03,280 --> 00:04:07,520 Speaker 2: a painless second trimester labor whether where the cervix just opens, 67 00:04:08,320 --> 00:04:11,320 Speaker 2: the baby comes out very quickly, and it's way too 68 00:04:11,360 --> 00:04:14,920 Speaker 2: soon for the baby to survive. So our usual advice 69 00:04:14,960 --> 00:04:17,760 Speaker 2: to this person would be to one hundred percent be 70 00:04:17,760 --> 00:04:20,520 Speaker 2: back in surveillance, so she could have some first trimester 71 00:04:20,600 --> 00:04:22,960 Speaker 2: surveillance of the length of the cervix. They could have 72 00:04:22,960 --> 00:04:24,680 Speaker 2: a look on a thirteen week scan to make sure 73 00:04:24,720 --> 00:04:28,200 Speaker 2: a baby didn't have any hard or spinal abnormalities, and 74 00:04:28,360 --> 00:04:31,000 Speaker 2: start measuring the cervix nice and early. Do it again 75 00:04:31,040 --> 00:04:33,320 Speaker 2: at twenty weeks like they did last time as part 76 00:04:33,320 --> 00:04:37,400 Speaker 2: of that twenty week morphology scan. Nice long cervix long 77 00:04:37,480 --> 00:04:40,200 Speaker 2: closed four and a half centimeters great or if it's shorter, 78 00:04:40,920 --> 00:04:44,080 Speaker 2: then we give the progesterones. Then we enroll in a 79 00:04:44,120 --> 00:04:47,479 Speaker 2: cervical surveillance program where we keep on looking and we 80 00:04:47,560 --> 00:04:51,560 Speaker 2: want to make sure that it either stabilizes or if 81 00:04:51,600 --> 00:04:55,440 Speaker 2: it's getting properly short, we put in a stitch. Now, 82 00:04:55,440 --> 00:04:58,320 Speaker 2: would we just put a stitch in this person anyway? 83 00:04:59,080 --> 00:05:01,920 Speaker 2: Some people might Some people might not that it'll be 84 00:05:01,960 --> 00:05:05,400 Speaker 2: worth discussing with your care team at the start in 85 00:05:05,520 --> 00:05:07,680 Speaker 2: favor of putting in a stitch. At the start would 86 00:05:07,720 --> 00:05:09,560 Speaker 2: be that, yes, this does seem to be a genuine 87 00:05:09,640 --> 00:05:12,440 Speaker 2: case of short cervix. On the other hand, the outcome 88 00:05:12,520 --> 00:05:17,680 Speaker 2: last time was extremely good. Yeah, the breach is unrelated, 89 00:05:18,560 --> 00:05:20,880 Speaker 2: and that's just a bit of bad luck that you 90 00:05:20,960 --> 00:05:24,080 Speaker 2: had both of those things going on. There probably are 91 00:05:24,160 --> 00:05:27,400 Speaker 2: a very small number of people who are prone to 92 00:05:27,600 --> 00:05:30,680 Speaker 2: recurrent breach pregnancies, and it might have something to do 93 00:05:30,720 --> 00:05:33,000 Speaker 2: with the shape of the uterus. But in the majority 94 00:05:33,040 --> 00:05:34,640 Speaker 2: of cases we think it's a new role of the 95 00:05:34,640 --> 00:05:38,599 Speaker 2: diceage time. But whether the baby is bump first or 96 00:05:38,640 --> 00:05:41,760 Speaker 2: head first is mostly fetal behavior or in this case 97 00:05:41,760 --> 00:05:45,000 Speaker 2: food first, yeah, well foot first, Yeah, it's mostly fetal behavior. 98 00:05:45,200 --> 00:05:48,039 Speaker 2: And the the baby next time doesn't know that the 99 00:05:47,520 --> 00:05:50,800 Speaker 2: baby the baby last time was breach. So it's probably 100 00:05:50,839 --> 00:05:53,719 Speaker 2: in most cases a brand new role of the diceage time. 101 00:05:54,800 --> 00:05:58,560 Speaker 2: So let's say, for argument's sake, that the next baby 102 00:05:58,680 --> 00:06:00,840 Speaker 2: is head first that has been shown to be consistently 103 00:06:00,880 --> 00:06:04,440 Speaker 2: head first in the third trimester, then feedback, all things 104 00:06:04,480 --> 00:06:07,440 Speaker 2: being equal, would definitely be on the table. Yeah. Good. 105 00:06:07,760 --> 00:06:12,360 Speaker 2: And in fact, someone with a cervix that was going 106 00:06:12,400 --> 00:06:14,600 Speaker 2: to come open a little bit earlier and a little 107 00:06:14,600 --> 00:06:18,880 Speaker 2: bit faster, you know, theoretically, would be an efficient laborer. 108 00:06:18,960 --> 00:06:20,880 Speaker 2: And as long as there's enough pregnancy under our belt 109 00:06:20,880 --> 00:06:23,719 Speaker 2: by then we'd be grateful in a feback setting for 110 00:06:23,760 --> 00:06:24,920 Speaker 2: a cervix that open quickly. 111 00:06:25,080 --> 00:06:28,400 Speaker 1: Yeah good, right, Well, good luck with your firstly getting 112 00:06:28,400 --> 00:06:31,360 Speaker 1: pregnant and your pregnancy planning. You sound like you're all 113 00:06:31,360 --> 00:06:34,560 Speaker 1: over it. All right, let's move to this one. 114 00:06:34,560 --> 00:06:38,640 Speaker 4: Pad Hi, doctor Padon bridget love your podcast. This is 115 00:06:38,680 --> 00:06:43,320 Speaker 4: my third time listening for my second pregnancy. I just 116 00:06:43,400 --> 00:06:48,479 Speaker 4: have a question about skin irritation, specifically on the face. 117 00:06:49,120 --> 00:06:54,640 Speaker 4: Is that common during pregnancy. I've just hit my second 118 00:06:54,760 --> 00:06:59,400 Speaker 4: trimester and I have a persistent rash around my mouth 119 00:06:59,600 --> 00:07:03,640 Speaker 4: area that's raised and dry, which won't go away, and 120 00:07:03,760 --> 00:07:05,680 Speaker 4: I just wanted to find out if there's anything I 121 00:07:05,680 --> 00:07:08,960 Speaker 4: can do about it and if it is common or not. 122 00:07:09,360 --> 00:07:09,960 Speaker 5: Thanks guys. 123 00:07:10,720 --> 00:07:14,400 Speaker 1: You know these people that say pregnancy glow, it's not 124 00:07:14,440 --> 00:07:16,280 Speaker 1: always like that. It's always the case. 125 00:07:16,880 --> 00:07:19,880 Speaker 2: No, So the glowing pregnant woman is a second trimester 126 00:07:19,920 --> 00:07:24,960 Speaker 2: phenomenon somewhere between the spewing and and the big proper 127 00:07:24,960 --> 00:07:28,520 Speaker 2: pregnant lady, that's hard to you know that everything hurts, 128 00:07:29,560 --> 00:07:32,720 Speaker 2: and some people are lucky enough in the second trimester 129 00:07:32,880 --> 00:07:37,480 Speaker 2: to have a period where they feel unusually well reasonably energized, 130 00:07:37,920 --> 00:07:41,760 Speaker 2: and they the skin looks good, and that's unfortunately is 131 00:07:41,760 --> 00:07:48,080 Speaker 2: not always the case. So this dry, patchy rash is 132 00:07:48,200 --> 00:07:52,880 Speaker 2: usually one of the great big, long list of pregnancy 133 00:07:52,880 --> 00:07:57,000 Speaker 2: phenomena that you know, it's a list we're familiar with. 134 00:07:57,240 --> 00:07:59,680 Speaker 2: It's just that not often talked about. So people know 135 00:07:59,720 --> 00:08:02,640 Speaker 2: about the you know, the nausea and volmiting in a 136 00:08:02,680 --> 00:08:05,000 Speaker 2: first trimester, but I think we've done an app before 137 00:08:05,440 --> 00:08:08,760 Speaker 2: about a great big one this. Yeah, so some some 138 00:08:08,760 --> 00:08:13,240 Speaker 2: some skin irritation is one of those, and we haven't 139 00:08:13,240 --> 00:08:16,480 Speaker 2: seen a picture so without without knowing your specific circumstances, 140 00:08:16,480 --> 00:08:20,520 Speaker 2: it'd be worth speaking to local doc about whether it 141 00:08:20,520 --> 00:08:23,120 Speaker 2: could be something else, something treatable. But if it's just 142 00:08:23,200 --> 00:08:27,200 Speaker 2: part of the pregnancy picture, then few things that can 143 00:08:27,240 --> 00:08:33,559 Speaker 2: be done. Moisturizing might help, something like plain sorble and cream, 144 00:08:33,679 --> 00:08:36,520 Speaker 2: a fair bit of putting up with it. If it's 145 00:08:36,559 --> 00:08:39,640 Speaker 2: if you're reassured that it's a harmless thing, then maybe 146 00:08:39,640 --> 00:08:43,560 Speaker 2: that maybe we'll just leave it alone. And then I've 147 00:08:43,559 --> 00:08:46,640 Speaker 2: had some people use one percent hydrocordizone cream like a 148 00:08:46,679 --> 00:08:52,959 Speaker 2: dormade cream on various dermatitises in pregnancy, and as a 149 00:08:53,080 --> 00:08:56,480 Speaker 2: cortizone dose goes, it's tiny, not much of it as 150 00:08:56,720 --> 00:08:59,920 Speaker 2: is absorbed systemically from the skin, and it's generally considered 151 00:09:00,000 --> 00:09:01,240 Speaker 2: a reasonably safe thing to do. 152 00:09:02,160 --> 00:09:03,960 Speaker 1: It is annoying, though, like you know, you sort of 153 00:09:05,400 --> 00:09:06,920 Speaker 1: you don't know how your body's going to react. I 154 00:09:06,960 --> 00:09:09,040 Speaker 1: remember having a little bit of a dermatitis patch on 155 00:09:09,240 --> 00:09:12,360 Speaker 1: my cheek during my pregnancies. I can't remember which one, 156 00:09:12,360 --> 00:09:15,400 Speaker 1: but you know, it's a bit annoying. You just you think, 157 00:09:15,440 --> 00:09:16,480 Speaker 1: oh god, what else? 158 00:09:16,640 --> 00:09:20,200 Speaker 2: Yeah, what else exactly? But I think I think we 159 00:09:20,240 --> 00:09:23,600 Speaker 2: could It might just settle by itself and it'd be nice. 160 00:09:23,600 --> 00:09:26,760 Speaker 2: But is it an indicator of serious underlying disease. Absolutely. 161 00:09:27,880 --> 00:09:29,439 Speaker 1: And it just goes to show how long we've been 162 00:09:29,440 --> 00:09:32,480 Speaker 1: doing the podcast for now, Like this is her third listen, 163 00:09:33,080 --> 00:09:36,000 Speaker 1: and she's had two pregnancies, so I presumably like one 164 00:09:36,080 --> 00:09:39,280 Speaker 1: was pre pregnant and then two pregnancies and here we 165 00:09:39,320 --> 00:09:42,160 Speaker 1: are coming back for the next one. So that's really great. 166 00:09:42,200 --> 00:09:46,880 Speaker 5: Good luck Hybrigitt and pat. So my question is, as 167 00:09:46,920 --> 00:09:49,640 Speaker 5: the first time mum, I feel really uneducated about birth, 168 00:09:50,000 --> 00:09:52,800 Speaker 5: and I'm really scared about losing control and advocating for 169 00:09:52,880 --> 00:09:57,000 Speaker 5: myself in my birth experience. My fears include things like 170 00:09:57,160 --> 00:10:00,880 Speaker 5: being pressured in decisions out of fear like early induction, 171 00:10:01,120 --> 00:10:04,480 Speaker 5: having my waters broken too soon, unnecessary vaginal checks to 172 00:10:04,480 --> 00:10:07,320 Speaker 5: see how dilated I am, or being told to push 173 00:10:07,440 --> 00:10:10,880 Speaker 5: my body doesn't feel ready. I also worry about them 174 00:10:10,880 --> 00:10:13,840 Speaker 5: taking the baby out of the room after birth, and 175 00:10:13,880 --> 00:10:18,000 Speaker 5: I also fear of being pressured into formula or bottle 176 00:10:18,040 --> 00:10:20,679 Speaker 5: feeding if my baby isn't latching or my milk supplier 177 00:10:20,720 --> 00:10:23,680 Speaker 5: is not coming through. Additionally, I've also heard from many 178 00:10:23,720 --> 00:10:26,560 Speaker 5: women that husbands don't feel like they lose all sense 179 00:10:26,600 --> 00:10:29,360 Speaker 5: of power in the birthing experience, and I don't want 180 00:10:29,360 --> 00:10:31,600 Speaker 5: to be the one answering all the yes or no questions. 181 00:10:31,880 --> 00:10:33,760 Speaker 5: I want my husband to advocate for me, but I'm 182 00:10:33,800 --> 00:10:36,200 Speaker 5: worried the medical team will insist that I answer, even 183 00:10:36,240 --> 00:10:39,520 Speaker 5: though he knows that bad plan. Also, I've been told 184 00:10:40,440 --> 00:10:42,640 Speaker 5: by my midwife that you know, this is my birth 185 00:10:42,640 --> 00:10:45,960 Speaker 5: and I should feel empowered and it's me and my baby. 186 00:10:46,200 --> 00:10:47,760 Speaker 5: But I feel like when it comes down to it, 187 00:10:47,800 --> 00:10:50,480 Speaker 5: I will lose control of these decisions as they need 188 00:10:50,520 --> 00:10:53,160 Speaker 5: to be made quickly. So what are some practical steps 189 00:10:53,160 --> 00:10:55,800 Speaker 5: I can take to stay empowered? How I can communicate 190 00:10:55,880 --> 00:10:59,320 Speaker 5: these fears effectively effectively? And how do I create a 191 00:10:59,360 --> 00:11:02,920 Speaker 5: birth plan balances my ideal wishes with being prepared for 192 00:11:03,040 --> 00:11:04,079 Speaker 5: unexpected changes. 193 00:11:04,760 --> 00:11:05,160 Speaker 6: Thank you. 194 00:11:05,760 --> 00:11:07,880 Speaker 5: That would be really great if you could answer this, 195 00:11:08,000 --> 00:11:11,240 Speaker 5: because I don't know why this fear hangs on me heavily. 196 00:11:12,120 --> 00:11:15,160 Speaker 7: You can just hear the distress right at the end, right, Yeah, 197 00:11:15,160 --> 00:11:18,559 Speaker 7: so that's somebody who it seems like the way the 198 00:11:18,600 --> 00:11:20,120 Speaker 7: way I listened to that, there's still a fair way 199 00:11:20,120 --> 00:11:25,040 Speaker 7: off and a lot of worries have crept in there. 200 00:11:25,320 --> 00:11:28,959 Speaker 1: It's like, you know, we we can pick the worries, 201 00:11:29,000 --> 00:11:30,560 Speaker 1: but she seems to have picked all of them. 202 00:11:30,880 --> 00:11:37,880 Speaker 2: Yes, yes, that's my concern too. And yeah, it sounds 203 00:11:37,880 --> 00:11:40,080 Speaker 2: a bit like she's read the Big Book of worries 204 00:11:40,920 --> 00:11:42,760 Speaker 2: and not enough of the Big Book of happiness and 205 00:11:42,760 --> 00:11:43,480 Speaker 2: good outcomes. 206 00:11:43,960 --> 00:11:47,880 Speaker 1: So and it is hard because you know, people feel 207 00:11:47,880 --> 00:11:49,360 Speaker 1: like they need to share their bad outcome. 208 00:11:49,440 --> 00:11:50,880 Speaker 2: Yeah, they do tell that. 209 00:11:50,960 --> 00:11:54,760 Speaker 1: And if you look on any social media, it's all 210 00:11:54,800 --> 00:11:57,400 Speaker 1: about how out of control you can be in the 211 00:11:57,440 --> 00:12:00,680 Speaker 1: medical system. Yes, which is you know, problematic and I 212 00:12:00,720 --> 00:12:03,160 Speaker 1: know you and I have talked about that tongues too. Yes, 213 00:12:03,200 --> 00:12:05,040 Speaker 1: And it really was one of the reasons why we 214 00:12:05,120 --> 00:12:09,560 Speaker 1: got the psychologist Rebecca Wheeler on and she did the 215 00:12:09,640 --> 00:12:13,960 Speaker 1: episodes on tocophobia and not saying that this woman has tacophobia. 216 00:12:14,000 --> 00:12:17,760 Speaker 1: That's not my area to diagnose, but Rebecca did talk 217 00:12:17,760 --> 00:12:22,440 Speaker 1: about how to cope with common fears, how to not 218 00:12:23,000 --> 00:12:26,040 Speaker 1: make that part of your only sort of thought pattern 219 00:12:26,040 --> 00:12:27,240 Speaker 1: when you're thinking about a baby. 220 00:12:27,400 --> 00:12:30,600 Speaker 2: Yeah, so definitely there would be something for this caller 221 00:12:30,679 --> 00:12:33,520 Speaker 2: in that episode. But also it's why we made the 222 00:12:33,520 --> 00:12:35,439 Speaker 2: podcast in the first place, isn't it. And they grow 223 00:12:35,520 --> 00:12:39,920 Speaker 2: My Baby program is because of this exact problem of 224 00:12:40,040 --> 00:12:47,080 Speaker 2: people seeing of being so worried about potential problematic outcomes, 225 00:12:47,200 --> 00:12:53,280 Speaker 2: the loss of control, unnecessary intervention that they have become 226 00:12:54,160 --> 00:12:59,000 Speaker 2: distressed by all that worry, and also people feeling blindsided 227 00:12:59,480 --> 00:13:02,760 Speaker 2: if stuff happens and they need some intervention, which may 228 00:13:02,800 --> 00:13:08,600 Speaker 2: be perfectly well advised and perfectly sensible and perfectly legitimate. 229 00:13:09,559 --> 00:13:12,959 Speaker 2: But the woman did't even know there was such thing. Yeah, 230 00:13:13,120 --> 00:13:17,960 Speaker 2: So I think that one of the problems and we've 231 00:13:17,960 --> 00:13:21,120 Speaker 2: discussed this before, but one of the problems is that 232 00:13:21,160 --> 00:13:25,080 Speaker 2: it's easy to think that some of the things that 233 00:13:25,280 --> 00:13:30,360 Speaker 2: happen because a birth, typically a first birth, is not 234 00:13:30,520 --> 00:13:34,880 Speaker 2: going according to plan, that some of those things are 235 00:13:34,920 --> 00:13:38,240 Speaker 2: actually routine. It's easy to think that, but of course 236 00:13:38,240 --> 00:13:40,120 Speaker 2: they're not. So if we look at if we look 237 00:13:40,200 --> 00:13:45,280 Speaker 2: at call and mention the baby being taken away, well, 238 00:13:46,360 --> 00:13:50,559 Speaker 2: why would we ever do that if everything had gone well? 239 00:13:51,760 --> 00:13:57,720 Speaker 2: We don't even involve pediatric if everything's gone well, so 240 00:13:58,640 --> 00:14:02,920 Speaker 2: reasonably unusual to need a pediatrician who would want to 241 00:14:03,160 --> 00:14:04,800 Speaker 2: and they would never want to take a healthy baby 242 00:14:04,800 --> 00:14:09,280 Speaker 2: out of the room and into the nursery, So that 243 00:14:09,400 --> 00:14:13,760 Speaker 2: would only have happened in the scenario of there being 244 00:14:13,800 --> 00:14:18,480 Speaker 2: a problem and their pediatrician, after discussion with the family, 245 00:14:18,480 --> 00:14:20,680 Speaker 2: thought that that problem was best managed in the nursery, 246 00:14:20,720 --> 00:14:28,760 Speaker 2: and the family greed. So Vaginal examinations in labor is 247 00:14:28,800 --> 00:14:33,640 Speaker 2: another one. Recurrent vaginal examinations in labor are rarely necessary 248 00:14:33,680 --> 00:14:36,760 Speaker 2: if the progress is often really is often going really normally, 249 00:14:37,760 --> 00:14:41,120 Speaker 2: but an important part of getting things back on track 250 00:14:41,440 --> 00:14:44,360 Speaker 2: if the progress is very poor. So we need to 251 00:14:44,400 --> 00:14:49,200 Speaker 2: remember that some of the things we've heard going on 252 00:14:49,800 --> 00:14:55,040 Speaker 2: in people's labors are things that went on because there 253 00:14:55,160 --> 00:15:00,040 Speaker 2: was a problem, not things that went on because their routine. 254 00:15:00,120 --> 00:15:02,400 Speaker 1: And I think people hear that the hospital has a 255 00:15:02,400 --> 00:15:04,800 Speaker 1: guideline that every four hours someone needs to have a 256 00:15:04,880 --> 00:15:09,560 Speaker 1: vaginal examination, and I suppose there are those protocols out. 257 00:15:09,480 --> 00:15:12,040 Speaker 2: There pad So it could depend, of course on what 258 00:15:12,280 --> 00:15:15,760 Speaker 2: sort of hospital, where in which care model we're in. 259 00:15:16,280 --> 00:15:19,000 Speaker 2: But for example, if someone was coming in and having 260 00:15:19,040 --> 00:15:22,840 Speaker 2: their third baby and was clearly progressing well, then that 261 00:15:23,040 --> 00:15:26,120 Speaker 2: woman really doesn't need much at all, and we might 262 00:15:26,160 --> 00:15:28,560 Speaker 2: have a listen to the fetal heart every now and again, 263 00:15:28,600 --> 00:15:33,520 Speaker 2: but that's about it. If somebody was having their first baby, 264 00:15:33,560 --> 00:15:37,320 Speaker 2: it was going very slowly, they were on a sintoson 265 00:15:37,360 --> 00:15:39,880 Speaker 2: on infusion to try and get the labor back on track, 266 00:15:40,200 --> 00:15:45,440 Speaker 2: then yes, we would recommend some internal examinations to make 267 00:15:45,480 --> 00:15:49,400 Speaker 2: sure that the intervention was working. So it's just yet 268 00:15:49,440 --> 00:15:52,440 Speaker 2: another example of some of the things that we hear 269 00:15:52,520 --> 00:15:56,280 Speaker 2: about and might get scared of are not part of 270 00:15:56,280 --> 00:16:01,080 Speaker 2: a routine care. They're part of interventions designed to get outcomes. 271 00:16:01,600 --> 00:16:04,720 Speaker 1: One of the biggest things that might be helpful for 272 00:16:04,760 --> 00:16:08,520 Speaker 1: this caller is for her to have some psychological assistance, 273 00:16:08,880 --> 00:16:12,440 Speaker 1: seeing a psychologist that works within the perinatal space that 274 00:16:12,480 --> 00:16:14,560 Speaker 1: can talk her through these issues. 275 00:16:14,520 --> 00:16:18,400 Speaker 2: For sure. I think that is a good example. It 276 00:16:18,440 --> 00:16:20,760 Speaker 2: depends where the fear sits. So if the fear sits 277 00:16:20,800 --> 00:16:22,200 Speaker 2: is something that we go God, I hope that doesn't 278 00:16:22,200 --> 00:16:23,960 Speaker 2: happen to me anyway, I'm getting one with my day, 279 00:16:24,920 --> 00:16:29,760 Speaker 2: then no. But if it's if the fear is creating 280 00:16:30,600 --> 00:16:36,600 Speaker 2: recurrent problematic negative thoughts, it's resulting in anxiety and depression, 281 00:16:37,480 --> 00:16:40,160 Speaker 2: it makes us wish we weren't doing this those sort 282 00:16:40,160 --> 00:16:44,920 Speaker 2: of things, then yes, some help from trained professional can 283 00:16:44,960 --> 00:16:47,960 Speaker 2: definitely be useful. And the last thing, of course, is education. 284 00:16:48,520 --> 00:16:53,640 Speaker 2: So caller brought up about She opened with I don't 285 00:16:53,680 --> 00:16:55,880 Speaker 2: know enough. Yeah, yeah, I don't know enough. So that's 286 00:16:55,920 --> 00:16:59,000 Speaker 2: what we're here for. That's why we're doing this. Education 287 00:17:00,440 --> 00:17:06,280 Speaker 2: is what unlocks some of that fear, because we know 288 00:17:07,160 --> 00:17:10,959 Speaker 2: why an obstetrician might recommend augmentation of labor to make 289 00:17:11,000 --> 00:17:13,840 Speaker 2: it go fast, or why someone might recommend this or 290 00:17:13,880 --> 00:17:17,520 Speaker 2: that intervention in a birth, and that allows us to 291 00:17:17,680 --> 00:17:21,600 Speaker 2: understand it. That unlocks a lot of the fear. If 292 00:17:21,640 --> 00:17:24,320 Speaker 2: we don't understand what it's for, we might be sitting 293 00:17:24,440 --> 00:17:26,520 Speaker 2: The patient might be sitting there thinking this would happen 294 00:17:26,520 --> 00:17:30,120 Speaker 2: to be at any time for no reason. Whereas if 295 00:17:30,160 --> 00:17:32,600 Speaker 2: the patient understands that that would only be done in 296 00:17:32,680 --> 00:17:36,199 Speaker 2: circumstances X y Z, and she's in and she's not 297 00:17:36,280 --> 00:17:39,960 Speaker 2: in circumstances xy, then she really has nothing to fear. 298 00:17:42,760 --> 00:17:47,320 Speaker 2: I think early in the pregnancy, addressing the degree of 299 00:17:47,320 --> 00:17:51,520 Speaker 2: the anxiety is a great idea learning more. There was 300 00:17:51,560 --> 00:17:54,720 Speaker 2: also what other really interesting things she said about partner. 301 00:17:54,840 --> 00:17:55,719 Speaker 1: Yeah, that consent. 302 00:17:56,000 --> 00:17:59,359 Speaker 2: Yeah, so that is an interesting one. I've come across 303 00:17:59,400 --> 00:18:02,320 Speaker 2: that a cup full of times in the in my 304 00:18:02,760 --> 00:18:05,960 Speaker 2: obstetric career, not in my private practice when I when 305 00:18:06,000 --> 00:18:09,160 Speaker 2: I know the patients, but in the public ward where 306 00:18:09,200 --> 00:18:11,400 Speaker 2: I tend to come in if there's a problem, and 307 00:18:11,440 --> 00:18:15,560 Speaker 2: I don't know the patients until there's some sort of issue, 308 00:18:15,720 --> 00:18:21,600 Speaker 2: that can be difficult. We want partners to be well 309 00:18:21,720 --> 00:18:26,440 Speaker 2: educated and good advocates for their for their for their 310 00:18:26,480 --> 00:18:31,359 Speaker 2: for the laboring woman's well being. And I think to 311 00:18:31,560 --> 00:18:34,000 Speaker 2: advocate well, you need to know what's talking about. So 312 00:18:34,040 --> 00:18:36,280 Speaker 2: we want to we want to have high levels of 313 00:18:36,320 --> 00:18:39,040 Speaker 2: knowledge for the partners as well, and we hope that 314 00:18:39,040 --> 00:18:41,160 Speaker 2: people listen to the podcast together and do the grab 315 00:18:41,200 --> 00:18:45,000 Speaker 2: my baby stuff together. Unfortunately, at the end of the day, 316 00:18:45,040 --> 00:18:49,159 Speaker 2: if something is being proposed like a cesarean section or 317 00:18:49,160 --> 00:18:54,200 Speaker 2: an instrumental birth, we need consent from the patients, from 318 00:18:54,240 --> 00:18:57,160 Speaker 2: the woman. That's the laws of Australia. That's not that's 319 00:18:57,240 --> 00:19:01,720 Speaker 2: not something that we can we can negotiate or refer 320 00:19:01,840 --> 00:19:08,639 Speaker 2: to it. Absolutely not no, so we I think the 321 00:19:08,720 --> 00:19:10,720 Speaker 2: key to that is to give people plenty of times, 322 00:19:11,160 --> 00:19:14,640 Speaker 2: so as much as possible, and it's not always possible, 323 00:19:14,640 --> 00:19:16,320 Speaker 2: but as much as possible if we can see that 324 00:19:16,359 --> 00:19:20,359 Speaker 2: a problem is coming up. A lot of good obstetrics 325 00:19:20,720 --> 00:19:24,639 Speaker 2: is picking problems almost before they happen and not waiting 326 00:19:24,720 --> 00:19:26,800 Speaker 2: until there's a major drama before we and. 327 00:19:26,800 --> 00:19:28,919 Speaker 1: Everyone's rushing in the room, which exactly you know, I 328 00:19:28,920 --> 00:19:31,119 Speaker 1: don't think happens that often, does it well? 329 00:19:31,520 --> 00:19:33,960 Speaker 2: When we do it well, it shouldn't because we should 330 00:19:34,000 --> 00:19:37,760 Speaker 2: be able to see it coming. So, for example, if 331 00:19:37,760 --> 00:19:40,560 Speaker 2: we think that the progress has been extremely poor and 332 00:19:40,600 --> 00:19:43,480 Speaker 2: the fetal condition is deteriorating, we need to sort of 333 00:19:44,080 --> 00:19:45,960 Speaker 2: you know, I think good obstetrics is to talk to 334 00:19:46,000 --> 00:19:48,680 Speaker 2: the couple and say, look, here's here's the problem as 335 00:19:48,720 --> 00:19:51,719 Speaker 2: I see it. Here are the issues, and here's what 336 00:19:51,760 --> 00:19:55,440 Speaker 2: happens if we do intervention ABC. Here's what would happen 337 00:19:55,440 --> 00:19:57,400 Speaker 2: if we what I think would happen if we don't 338 00:19:57,520 --> 00:20:01,720 Speaker 2: do intervention ABC. But if you give yourself enough time, 339 00:20:02,119 --> 00:20:06,160 Speaker 2: the consent process I don't think is terribly difficult. If 340 00:20:06,200 --> 00:20:10,160 Speaker 2: you rush people, you have made it difficult. 341 00:20:10,240 --> 00:20:13,800 Speaker 1: Yeah, and sort of raise the emergency stakes, you know, 342 00:20:13,920 --> 00:20:18,160 Speaker 1: like that would be very hard for someone that's already 343 00:20:18,200 --> 00:20:19,280 Speaker 1: anxious to deal with. 344 00:20:19,520 --> 00:20:21,720 Speaker 2: Yes, yes, I think it would be difficult for any 345 00:20:21,800 --> 00:20:22,760 Speaker 2: anybody exactly. 346 00:20:23,160 --> 00:20:26,359 Speaker 1: So all right, I'm just gonna collate it. So first 347 00:20:26,400 --> 00:20:30,400 Speaker 1: off is education, and he's a plug for the Grow 348 00:20:30,440 --> 00:20:33,880 Speaker 1: My Baby program. It is a every week you get 349 00:20:33,880 --> 00:20:36,800 Speaker 1: a new piece of information that is current to your 350 00:20:36,960 --> 00:20:39,960 Speaker 1: week of pregnancy, so you're not getting overwhelmed and you 351 00:20:40,000 --> 00:20:43,359 Speaker 1: can digest that and pat mentions that we love it. 352 00:20:43,400 --> 00:20:45,200 Speaker 1: If your partner's doing it with you, If you've got 353 00:20:45,200 --> 00:20:47,679 Speaker 1: a partner, it's really important for you both to be 354 00:20:47,760 --> 00:20:51,760 Speaker 1: on the same page. The second is potentially having some 355 00:20:53,080 --> 00:20:56,199 Speaker 1: seeking out a perinatal psychologist just to go through this 356 00:20:56,640 --> 00:20:59,679 Speaker 1: pre birth stage so you can talk through some of 357 00:20:59,680 --> 00:21:01,680 Speaker 1: those years and anxieties. 358 00:21:01,720 --> 00:21:07,280 Speaker 2: For anyone where the anxiety is becoming a persistent, pervasive problem. 359 00:21:07,440 --> 00:21:10,920 Speaker 2: And where's the line. It's individual? You just want to 360 00:21:10,920 --> 00:21:13,520 Speaker 2: be able to say, am I a little bit worried 361 00:21:13,560 --> 00:21:15,640 Speaker 2: about how the birth's going to go? Yes, but I'm 362 00:21:15,680 --> 00:21:17,840 Speaker 2: otherwise totally fine getting on with my life. I guess 363 00:21:17,880 --> 00:21:21,800 Speaker 2: that's normal. Is this becoming something that is really really 364 00:21:21,800 --> 00:21:25,919 Speaker 2: troubling me every day? Am I feeling anxiety? Am I? 365 00:21:25,960 --> 00:21:29,520 Speaker 2: Am I consistently worried about things that probably won't happen 366 00:21:29,600 --> 00:21:31,320 Speaker 2: to me. That needs some intervention. 367 00:21:33,000 --> 00:21:34,840 Speaker 1: The third thing I think is to listen to the 368 00:21:35,280 --> 00:21:37,720 Speaker 1: top of Phibia episode. 369 00:21:37,280 --> 00:21:39,600 Speaker 2: That we did. Yeah, fascinating and we didn't mention it. 370 00:21:39,640 --> 00:21:44,000 Speaker 1: But maybe the fourth thing is to actively avoid negative stories. 371 00:21:44,080 --> 00:21:49,080 Speaker 2: Ah, yes, that is a problem. I think that's part 372 00:21:49,119 --> 00:22:00,160 Speaker 2: of the problem. Perfectly happy, perfectly good birth stories pleasant 373 00:22:00,200 --> 00:22:03,600 Speaker 2: to listen to, but not nearly as riveting as the 374 00:22:03,760 --> 00:22:11,080 Speaker 2: highly dramatic, problematic ones. And the internet just can't help that, 375 00:22:11,320 --> 00:22:14,400 Speaker 2: just can't help over promote the problems. 376 00:22:14,440 --> 00:22:17,200 Speaker 1: Yeah, yeah, we're sort of attracted to the negative. 377 00:22:17,880 --> 00:22:22,399 Speaker 2: Yeah, and the most dramatic problems are the ones that 378 00:22:22,520 --> 00:22:27,960 Speaker 2: sort of come out of nowhere. And and and as 379 00:22:27,960 --> 00:22:31,600 Speaker 2: the listener, we have no way of knowing how common 380 00:22:31,640 --> 00:22:32,439 Speaker 2: that really is. 381 00:22:34,080 --> 00:22:35,840 Speaker 1: I want to actually say one more thing before we 382 00:22:35,880 --> 00:22:41,439 Speaker 1: move on, and that is the idea of a perfect birth. 383 00:22:43,400 --> 00:22:46,640 Speaker 1: And that differs from a practitioner to a patient to. 384 00:22:46,560 --> 00:22:48,960 Speaker 2: Begin with, absolutely, yeah. 385 00:22:48,320 --> 00:22:51,720 Speaker 1: But within a patient cohort, I think that differs as well. 386 00:22:51,840 --> 00:22:55,720 Speaker 1: So you know, it's about working out, well, what is 387 00:22:55,760 --> 00:22:58,720 Speaker 1: a perfect birth? That there really isn't a perfect birth. 388 00:22:59,040 --> 00:23:01,280 Speaker 2: No, we might stay start by saying there probably isn't 389 00:23:01,440 --> 00:23:07,800 Speaker 2: any such thing. But if the perfect birth for an 390 00:23:07,840 --> 00:23:17,120 Speaker 2: individual is one that is entirely without medical intervention, then 391 00:23:17,160 --> 00:23:21,399 Speaker 2: that's okay. But if someone else has an idea that 392 00:23:22,880 --> 00:23:27,640 Speaker 2: if they require or request some medical intervention, that intervention 393 00:23:27,720 --> 00:23:30,040 Speaker 2: works like a charm and things go on very well 394 00:23:30,040 --> 00:23:33,680 Speaker 2: from there. I don't see an important difference between those 395 00:23:33,680 --> 00:23:36,280 Speaker 2: two scenarios in terms of the happiness of the outcome. 396 00:23:37,520 --> 00:23:41,800 Speaker 1: Yeah, and some people feel very empowered during or when 397 00:23:41,960 --> 00:23:44,680 Speaker 1: or if they do have medical intervention. They still feel empowered. 398 00:23:44,680 --> 00:23:48,320 Speaker 1: Like people often talk about birth needing to feel empowered. Yes, 399 00:23:48,680 --> 00:23:51,280 Speaker 1: I think being empowered is I grew a baby and 400 00:23:51,320 --> 00:23:54,440 Speaker 1: I have a baby that is in my arms. That's very, 401 00:23:54,560 --> 00:23:56,639 Speaker 1: very empowering. When you get on the other side. 402 00:23:57,359 --> 00:24:00,119 Speaker 2: Yeah, I know a lot of people of contact to 403 00:24:00,240 --> 00:24:06,840 Speaker 2: us with stories about their birth not having gone according 404 00:24:06,840 --> 00:24:10,680 Speaker 2: to plan, but they were able to utilize the high 405 00:24:10,760 --> 00:24:16,439 Speaker 2: level of education they had about how obstetrics works to 406 00:24:16,800 --> 00:24:21,080 Speaker 2: feel call, come and collected through that birth. And then 407 00:24:21,080 --> 00:24:23,720 Speaker 2: they describe a birth that was not according to plan 408 00:24:24,119 --> 00:24:31,440 Speaker 2: by any stretch, but they still felt empowered, healthy, Well, 409 00:24:31,480 --> 00:24:32,360 Speaker 2: the outcome was good. 410 00:24:33,200 --> 00:24:35,719 Speaker 1: Those are the stories that just make me, you know, 411 00:24:36,040 --> 00:24:37,840 Speaker 1: feel really proud of the work that we do. 412 00:24:38,119 --> 00:24:39,760 Speaker 2: To be honest, me too. 413 00:24:41,119 --> 00:24:43,240 Speaker 1: All right, a little bit of a change of pace. 414 00:24:43,280 --> 00:24:46,840 Speaker 1: We're going to have someone describing her birth now, Pad hy. 415 00:24:46,840 --> 00:24:49,520 Speaker 6: Bridget and doctor Pat thanks so much for the wonderful 416 00:24:49,560 --> 00:24:53,679 Speaker 6: resource that is your podcast. Knowledge is Power. I have 417 00:24:54,040 --> 00:24:58,840 Speaker 6: several questions about baby's head shape, posterior positioning, and plesiotomy. 418 00:24:59,240 --> 00:25:03,000 Speaker 6: For context, I've had a positive vaginal birth at my 419 00:25:03,040 --> 00:25:07,080 Speaker 6: local tertiary hospital through the MGP program here in Melbourne. 420 00:25:07,560 --> 00:25:10,000 Speaker 6: I had a long posterior labor. At the thirty two 421 00:25:10,000 --> 00:25:13,639 Speaker 6: hour mark of experiencing regular painful contractions, I was seven 422 00:25:13,720 --> 00:25:17,320 Speaker 6: centimeters and opted for an epidural. I was able to 423 00:25:17,400 --> 00:25:19,960 Speaker 6: labor on my hands and knees and move around somewhat 424 00:25:20,040 --> 00:25:23,159 Speaker 6: while remaining on the bed. After another four hours, I 425 00:25:23,160 --> 00:25:25,399 Speaker 6: had a vaginal exam and was informed that I was 426 00:25:25,440 --> 00:25:30,040 Speaker 6: ten centimeters, which made me very relieved. The pushing phase 427 00:25:30,200 --> 00:25:33,000 Speaker 6: was approximately forty minutes and my baby girl was born 428 00:25:33,720 --> 00:25:37,240 Speaker 6: at a healthy weight of four point two kilos. Towards 429 00:25:37,280 --> 00:25:40,360 Speaker 6: the end of pushing, her heart rate showed signs of 430 00:25:40,480 --> 00:25:45,080 Speaker 6: dropping and several medical professionals came into the room, but 431 00:25:45,160 --> 00:25:49,800 Speaker 6: I could tell that they weren't stressed and yelling at 432 00:25:49,840 --> 00:25:52,760 Speaker 6: each other and running around or anything like that. They 433 00:25:52,760 --> 00:25:56,720 Speaker 6: were just kind of sitting on the sidelines. I opted 434 00:25:56,920 --> 00:26:02,840 Speaker 6: for my trusted midwife to perform in a pisiotomy after 435 00:26:02,880 --> 00:26:05,040 Speaker 6: they sort of gave me a few more contractions to 436 00:26:05,080 --> 00:26:08,840 Speaker 6: try and get her out. Thankfully, after the episiotomy, my 437 00:26:08,880 --> 00:26:11,000 Speaker 6: baby popped out like a pea out of a pod. 438 00:26:11,400 --> 00:26:15,200 Speaker 6: I healed really well from the episiotomy. I barely noticed 439 00:26:15,240 --> 00:26:18,600 Speaker 6: the stitches. I didn't even take my pery water bottle 440 00:26:18,680 --> 00:26:23,480 Speaker 6: spray out of its packet. So the pisiotomy and epidural 441 00:26:23,840 --> 00:26:27,959 Speaker 6: were really positive experiences all around, despite wanting a relatively 442 00:26:28,000 --> 00:26:32,919 Speaker 6: low intervention birth. My questions are my baby had a 443 00:26:32,960 --> 00:26:36,640 Speaker 6: ninety nine percentile head circumference and did not have any coning. 444 00:26:37,160 --> 00:26:39,960 Speaker 6: This was noted by some people in the room. I 445 00:26:40,000 --> 00:26:42,479 Speaker 6: wanted to know how common is coning and would this 446 00:26:42,560 --> 00:26:46,159 Speaker 6: have impacted on the duration of the labor. Would posterior 447 00:26:46,200 --> 00:26:50,200 Speaker 6: positioning have played a part in potential lack of coning. 448 00:26:50,840 --> 00:26:53,280 Speaker 6: I walked forty one kilometers in the week prior to 449 00:26:53,320 --> 00:26:56,160 Speaker 6: giving birth. I gave birth at forty one and four. 450 00:26:56,520 --> 00:26:58,640 Speaker 6: I felt like I did lots to turn the baby, 451 00:26:58,720 --> 00:27:01,280 Speaker 6: but to no avail. She seemed like she was really 452 00:27:01,320 --> 00:27:04,199 Speaker 6: happy in that position. Is there anything I can do 453 00:27:04,359 --> 00:27:09,639 Speaker 6: to get an anterior positioning or to help for, you know, 454 00:27:09,760 --> 00:27:13,840 Speaker 6: optimal positioning in a potential subsequent pregnancy. I'm so excited 455 00:27:13,880 --> 00:27:16,480 Speaker 6: to give birth again, as it was the most epic, 456 00:27:16,600 --> 00:27:21,400 Speaker 6: mind blowing experience. However, my preference would for it would 457 00:27:21,440 --> 00:27:23,640 Speaker 6: be for it to go a bit quicker. If I'm 458 00:27:23,720 --> 00:27:25,040 Speaker 6: being quite honest with you. 459 00:27:25,400 --> 00:27:26,480 Speaker 2: Thanks there you go. 460 00:27:26,560 --> 00:27:29,119 Speaker 1: Well, I hope our previous call listens to her absolutely, 461 00:27:29,160 --> 00:27:31,960 Speaker 1: because you know, she wanted no intervention and quite it 462 00:27:32,000 --> 00:27:32,960 Speaker 1: got some intervention. 463 00:27:33,160 --> 00:27:35,000 Speaker 2: Yeah, but that's exactly what we're talking about. 464 00:27:35,000 --> 00:27:35,040 Speaker 6: It. 465 00:27:35,359 --> 00:27:38,720 Speaker 2: You know, here's somebody who has utilized a bit of 466 00:27:38,760 --> 00:27:44,840 Speaker 2: intervention very wisely, I think and has had a cracking outcome. 467 00:27:44,920 --> 00:27:49,080 Speaker 2: It's fantastic when I say cracking outcome a woman has baby. 468 00:27:49,119 --> 00:27:52,719 Speaker 2: That that shouldn't be headline news. But someone laboring for 469 00:27:52,800 --> 00:27:58,280 Speaker 2: that long posterior to four point tilo four port tekulo 470 00:27:58,400 --> 00:28:04,560 Speaker 2: baby get to to get that. Maybe up vagiintly with 471 00:28:04,720 --> 00:28:07,400 Speaker 2: minimal assistance is a terrific. 472 00:28:07,119 --> 00:28:09,560 Speaker 1: Act first birth as well. 473 00:28:09,760 --> 00:28:14,040 Speaker 2: Yeah, yeah, so let's take the let's take the story 474 00:28:14,040 --> 00:28:15,960 Speaker 2: out of a part a little bit. My favorite bits 475 00:28:16,000 --> 00:28:17,359 Speaker 2: at the end when you said it might have been 476 00:28:17,359 --> 00:28:22,880 Speaker 2: a bit quicker, fair enough, right on. Yeah, So, look, 477 00:28:23,560 --> 00:28:27,639 Speaker 2: you know we've we've discussed this before, but the the 478 00:28:27,720 --> 00:28:32,280 Speaker 2: use of an EPI at that stage get a bit 479 00:28:32,320 --> 00:28:35,040 Speaker 2: of bad press from time to time. You know, it'll 480 00:28:35,040 --> 00:28:37,040 Speaker 2: slow your labor down. This labor couldn't have been much 481 00:28:37,119 --> 00:28:41,000 Speaker 2: couldn't have been much slower if we dried, And that 482 00:28:41,560 --> 00:28:46,400 Speaker 2: air PI has actually increased this woman's chances of having 483 00:28:46,400 --> 00:28:49,880 Speaker 2: a vaginal birth quite apart from you know, depending on 484 00:28:49,880 --> 00:28:52,360 Speaker 2: what you read, that would be that that statement might 485 00:28:52,360 --> 00:28:56,560 Speaker 2: be radical. But an EPI in this circumstance has undoubtedly 486 00:28:56,760 --> 00:29:01,320 Speaker 2: increased this patient's chance of having a vaginal birth because 487 00:29:01,960 --> 00:29:04,600 Speaker 2: after all of that time with an OP baby looking 488 00:29:05,000 --> 00:29:10,560 Speaker 2: up instead of down, labor still only seven centimeters, which 489 00:29:10,600 --> 00:29:14,360 Speaker 2: is okay, but we need more then the has the 490 00:29:14,720 --> 00:29:20,040 Speaker 2: has really helped that to happen. It's also doubtless help 491 00:29:20,120 --> 00:29:24,920 Speaker 2: this woman regroup after such a long labor and put 492 00:29:24,960 --> 00:29:28,040 Speaker 2: some manji back in the back in the tank for 493 00:29:28,160 --> 00:29:32,040 Speaker 2: what sounds like an epic pushing face. Yeah, so, so 494 00:29:33,440 --> 00:29:35,560 Speaker 2: kudos for for for looking at an EPI at that 495 00:29:35,600 --> 00:29:38,200 Speaker 2: stage that that that was a wise decision, I think. 496 00:29:39,360 --> 00:29:42,920 Speaker 2: So It's not an easy decision for someone to make 497 00:29:43,000 --> 00:29:45,400 Speaker 2: if their whole plan was never to do that. But 498 00:29:45,480 --> 00:29:47,640 Speaker 2: here we are. This is not the label we asked for. 499 00:29:47,960 --> 00:29:51,120 Speaker 2: It's the labor that we're having, and so we try 500 00:29:51,160 --> 00:29:53,560 Speaker 2: and make some some good decisions. That that was one 501 00:29:53,560 --> 00:29:58,160 Speaker 2: of them. Sure enough, that worked. The the the the 502 00:29:58,200 --> 00:30:02,040 Speaker 2: woman progressed nicely to full diletation over the next few hours. 503 00:30:02,200 --> 00:30:06,800 Speaker 2: Still op though, and so mostly occasionally you can push 504 00:30:06,800 --> 00:30:08,640 Speaker 2: your baby out looking up at the ceiling. If you're 505 00:30:08,680 --> 00:30:11,960 Speaker 2: lying on your back, then a baby would come out 506 00:30:11,960 --> 00:30:14,800 Speaker 2: looking at the ceiling, and that is it's hard to do. 507 00:30:15,160 --> 00:30:19,440 Speaker 2: They don't really fit out that way, but occasionally they 508 00:30:19,560 --> 00:30:23,360 Speaker 2: will it takes a long time. So in the pushing phase, 509 00:30:23,360 --> 00:30:25,160 Speaker 2: what we hope is that the face rotates and looks 510 00:30:25,160 --> 00:30:28,040 Speaker 2: down the floor, and in that position the chin will 511 00:30:28,080 --> 00:30:31,560 Speaker 2: tuck in and a smaller diameter of the fetal head 512 00:30:31,560 --> 00:30:35,800 Speaker 2: will be presented to the vaginal outlet the baby will 513 00:30:35,800 --> 00:30:39,360 Speaker 2: come out. What happened next sounds like she got to 514 00:30:39,520 --> 00:30:43,480 Speaker 2: full dilatation, probably head on view, And there were some 515 00:30:43,520 --> 00:30:49,480 Speaker 2: concerns about decreasing fetal heart rate during pushing. Doubtless there's 516 00:30:49,520 --> 00:30:51,680 Speaker 2: a lot of compression on the feedtal head at this stage. 517 00:30:51,760 --> 00:30:56,080 Speaker 2: Sometimes there's compression on the cord and the fetal heart 518 00:30:56,160 --> 00:31:00,240 Speaker 2: rate can decelerate at that point in a way that 519 00:31:00,360 --> 00:31:03,760 Speaker 2: is not always dangerous, but can be problematic if it 520 00:31:03,800 --> 00:31:06,240 Speaker 2: goes on and on and on for a long time. Babies, 521 00:31:06,280 --> 00:31:10,000 Speaker 2: just like us, they get tired, so there are a 522 00:31:10,080 --> 00:31:13,640 Speaker 2: number of different interventions that can be done at that time. 523 00:31:14,280 --> 00:31:18,520 Speaker 2: And this woman, in conjunction with her care has decided 524 00:31:18,560 --> 00:31:22,800 Speaker 2: to have an episiotomy just to make the vaginal lopeing 525 00:31:22,800 --> 00:31:26,600 Speaker 2: a little larger, and bingo, out came the baby. So 526 00:31:26,640 --> 00:31:28,760 Speaker 2: there's nothing wrong with her pushing efforts. She said that 527 00:31:28,800 --> 00:31:30,720 Speaker 2: the baby came out like a pre out of a 528 00:31:30,760 --> 00:31:33,680 Speaker 2: pod just popped down. And that's because we just the 529 00:31:33,720 --> 00:31:37,480 Speaker 2: APUSI had just made the very last hurdle, which was 530 00:31:37,520 --> 00:31:41,640 Speaker 2: the parent end being type, just created a little bit 531 00:31:41,640 --> 00:31:45,000 Speaker 2: of extra room and with a doubtless and almighty push 532 00:31:45,120 --> 00:31:48,000 Speaker 2: out came that baby. And then she recovered from that 533 00:31:48,080 --> 00:31:55,280 Speaker 2: expertly done episiotomy very well. This is the scenario where 534 00:31:55,720 --> 00:32:00,720 Speaker 2: episiotomies can be extremely useful. They don't anything if the 535 00:32:00,760 --> 00:32:03,800 Speaker 2: head's still so far up and we've got a problem 536 00:32:03,880 --> 00:32:06,160 Speaker 2: with the abnormal feeder heart rate because you can cut 537 00:32:06,200 --> 00:32:06,800 Speaker 2: no pissy with. 538 00:32:06,720 --> 00:32:08,520 Speaker 1: It, no pressure, there's no baby. 539 00:32:08,720 --> 00:32:10,440 Speaker 2: If that's not what's holding the baby bag, then that 540 00:32:10,480 --> 00:32:13,600 Speaker 2: won't work. You kind of have a pussy if you're 541 00:32:13,600 --> 00:32:15,600 Speaker 2: not fully dilated. But also the head has to be 542 00:32:15,640 --> 00:32:17,920 Speaker 2: right down and pushing against the paranem and you have 543 00:32:17,960 --> 00:32:20,840 Speaker 2: to be pretty convinced that that's actually what's holding things back. 544 00:32:22,240 --> 00:32:28,760 Speaker 2: So again, a wise decision, an intervention that she didn't 545 00:32:28,920 --> 00:32:30,520 Speaker 2: plan for or think she was going to need, but 546 00:32:30,560 --> 00:32:34,400 Speaker 2: one that she, in her wisdom, took advice on and 547 00:32:34,760 --> 00:32:37,800 Speaker 2: and it went extremely well. 548 00:32:37,680 --> 00:32:40,600 Speaker 1: All right, So things that she wanted to have some 549 00:32:40,640 --> 00:32:44,240 Speaker 1: clarity on was the head coning. So no, the baby 550 00:32:44,240 --> 00:32:44,960 Speaker 1: didn't have anything. 551 00:32:45,160 --> 00:32:48,080 Speaker 2: The molding. Yeah, that's that's interesting, such a long op label. 552 00:32:48,120 --> 00:32:49,880 Speaker 2: Normally that there'd be molding. 553 00:32:49,600 --> 00:32:50,920 Speaker 1: With it'd be quite squished. 554 00:32:50,920 --> 00:32:53,640 Speaker 2: They're like like a cone head. Yeah, we call that 555 00:32:53,720 --> 00:33:01,440 Speaker 2: molding and and cat put where there's like a sponginess 556 00:33:01,560 --> 00:33:03,480 Speaker 2: or like a bruise on top of the baby's head 557 00:33:03,840 --> 00:33:09,840 Speaker 2: from the prolonged labor, And those things are not always seen. 558 00:33:12,240 --> 00:33:14,640 Speaker 2: I don't think there's any great significance to the fact 559 00:33:14,640 --> 00:33:19,280 Speaker 2: that they weren't there on this occasion. The baby's head 560 00:33:19,320 --> 00:33:22,440 Speaker 2: is somewhat designed to fit out, and this baby did 561 00:33:22,440 --> 00:33:24,520 Speaker 2: fit out eventually. 562 00:33:24,880 --> 00:33:26,600 Speaker 1: And it's interesting, isn't it If she says that other 563 00:33:26,600 --> 00:33:28,960 Speaker 1: people in the room commented that the baby had no coating, 564 00:33:29,000 --> 00:33:31,520 Speaker 1: it's so interesting how you remember those things. 565 00:33:31,800 --> 00:33:33,880 Speaker 2: Yes, yes, I'm sure the people in the room were 566 00:33:33,920 --> 00:33:36,280 Speaker 2: mentioning that is a little bit of a medical oddity, 567 00:33:36,760 --> 00:33:39,720 Speaker 2: but not something that they put any great store. I'm sure. 568 00:33:40,520 --> 00:33:42,560 Speaker 2: I don't think it means anything at all for next time. 569 00:33:43,640 --> 00:33:45,720 Speaker 1: And next time, is she more likely to have a 570 00:33:45,760 --> 00:33:47,280 Speaker 1: posterior presentation? 571 00:33:47,640 --> 00:33:50,000 Speaker 2: Yeah, I think that some people. It's a bit like 572 00:33:50,040 --> 00:33:52,640 Speaker 2: the breach we discussed before. Some people have probably got 573 00:33:52,640 --> 00:33:55,320 Speaker 2: a shape to their pelvic inlet to their pelvic floor 574 00:33:55,680 --> 00:34:02,520 Speaker 2: that might promote OP position and other time, but that's 575 00:34:02,560 --> 00:34:05,920 Speaker 2: that's probably the exception and not the rule. Each time 576 00:34:06,000 --> 00:34:09,320 Speaker 2: is probably a new roll of the dice. It's mostly 577 00:34:09,360 --> 00:34:11,600 Speaker 2: fetal behavior. It's where the baby wants to be. It's 578 00:34:11,600 --> 00:34:16,279 Speaker 2: presumably where the baby feels right, most comfortable, and it's 579 00:34:16,360 --> 00:34:18,719 Speaker 2: new roll of dice each time. One thing's for sure, though, 580 00:34:18,719 --> 00:34:21,279 Speaker 2: if you've had a previous vaginal birth, it's a whole 581 00:34:21,320 --> 00:34:24,400 Speaker 2: new ball game that the problem of being op is 582 00:34:24,440 --> 00:34:29,319 Speaker 2: significantly less significant, significantly less significant. 583 00:34:30,360 --> 00:34:30,759 Speaker 4: There we go. 584 00:34:30,800 --> 00:34:34,359 Speaker 2: That's a statistical temp way less of a worry. Yeah, 585 00:34:34,440 --> 00:34:37,080 Speaker 2: because there's just more room, there's way less resistance on 586 00:34:37,120 --> 00:34:39,480 Speaker 2: the tissue. And you often see someone who's had a 587 00:34:39,560 --> 00:34:42,120 Speaker 2: previous vaginal birth, the head will descend all the way 588 00:34:42,160 --> 00:34:43,800 Speaker 2: to the paranem such that you can actually see the 589 00:34:43,880 --> 00:34:46,799 Speaker 2: hair and then the baby's hair, and then and the 590 00:34:47,040 --> 00:34:49,240 Speaker 2: and the the baby will be looking at the ceiling 591 00:34:49,480 --> 00:34:51,239 Speaker 2: and then with one push you just see the head 592 00:34:51,320 --> 00:34:56,440 Speaker 2: go and turn around to be looking at the floor. Yeah, 593 00:34:56,520 --> 00:34:59,600 Speaker 2: And that's just because there's a bit more room because 594 00:34:59,600 --> 00:35:02,839 Speaker 2: a baby's heads come out of that vagina before. So 595 00:35:04,000 --> 00:35:09,200 Speaker 2: in that scenario, a baby coming down OP way less 596 00:35:09,200 --> 00:35:09,800 Speaker 2: of a drama. 597 00:35:11,080 --> 00:35:13,200 Speaker 1: And then the final thing that she wanted to know 598 00:35:13,440 --> 00:35:15,600 Speaker 1: is would her labor be as long? 599 00:35:16,480 --> 00:35:19,160 Speaker 2: Well, the second and subsequent should be shorter anyway, if 600 00:35:19,200 --> 00:35:23,040 Speaker 2: the first baby's born vaginally, so that's on her side. 601 00:35:24,120 --> 00:35:26,680 Speaker 2: Even if it was OP again, there's every chance that 602 00:35:26,719 --> 00:35:31,120 Speaker 2: would correct itself and correct itself faster. And let's say 603 00:35:31,120 --> 00:35:34,040 Speaker 2: there was OP with obstruction if someone's had a previous 604 00:35:34,120 --> 00:35:37,800 Speaker 2: vaginal birth, that's typically something we're pretty good at at correcting, 605 00:35:38,320 --> 00:35:40,759 Speaker 2: where it could be very hard to correct in a 606 00:35:41,560 --> 00:35:42,680 Speaker 2: someone having their first baby. 607 00:35:43,040 --> 00:35:45,799 Speaker 1: Yeah, and a four point two kilo baby is likely 608 00:35:45,840 --> 00:35:48,120 Speaker 1: she'll have another large baby too, Is that right? 609 00:35:48,280 --> 00:35:51,120 Speaker 2: Yes, well that might just be a genetics. 610 00:35:52,040 --> 00:35:54,040 Speaker 1: But anyway, thank you so much for calling in and 611 00:35:54,040 --> 00:35:56,640 Speaker 1: telling us your story. We'd love to get pregnant again 612 00:35:56,680 --> 00:35:57,400 Speaker 1: and have your baby. 613 00:35:57,680 --> 00:35:58,040 Speaker 2: Let us go. 614 00:35:58,960 --> 00:36:00,640 Speaker 1: I'm sure we'll still be doing that, so let us 615 00:36:00,680 --> 00:36:03,319 Speaker 1: know how it all went. We would love to hear. 616 00:36:03,920 --> 00:36:06,040 Speaker 1: All right, Pat, I'm looking at the clock and you 617 00:36:06,120 --> 00:36:09,280 Speaker 1: have to go, So that's us for today. 618 00:36:09,719 --> 00:36:11,200 Speaker 2: Nice. It's pretty good that. 619 00:36:11,480 --> 00:36:13,120 Speaker 1: We manage to get quite a few ins So we'll 620 00:36:13,160 --> 00:36:15,120 Speaker 1: be back with another Q and A in about three 621 00:36:15,160 --> 00:36:19,520 Speaker 1: or four weeks, but until then, we're back next week. 622 00:36:20,000 --> 00:36:22,799 Speaker 1: Have a good week, keep growing those babies, and look 623 00:36:22,840 --> 00:36:23,440 Speaker 1: after yourselves. 624 00:36:23,440 --> 00:36:24,960 Speaker 2: Thanks for listening, everybody. 625 00:36:24,560 --> 00:36:31,239 Speaker 1: Bye for now. Hey, even though doctor Pat is well 626 00:36:31,239 --> 00:36:33,480 Speaker 1: a doctor and we get lots of other doctors and 627 00:36:33,560 --> 00:36:36,640 Speaker 1: other experts on our podcast, I just need to remind 628 00:36:36,680 --> 00:36:41,120 Speaker 1: you that this podcast is for informational purposes only. We 629 00:36:41,160 --> 00:36:44,640 Speaker 1: share lots of medical insights and experience, but everything we 630 00:36:44,680 --> 00:36:47,880 Speaker 1: talk about is general in nature and may not apply 631 00:36:47,960 --> 00:36:52,080 Speaker 1: to your specific situation. Please always consult with your own 632 00:36:52,120 --> 00:36:56,040 Speaker 1: healthcare provider for your individual medical advice when you grow 633 00:36:56,080 --> 00:36:56,600 Speaker 1: your baby