1 00:00:03,720 --> 00:00:06,800 Speaker 1: Welcome to the kick your Expert led podcast, helping you 2 00:00:06,880 --> 00:00:11,280 Speaker 1: explore and learn everything about getting pregnancy, birth, and becoming 3 00:00:11,280 --> 00:00:11,680 Speaker 1: a parent. 4 00:00:12,039 --> 00:00:15,760 Speaker 2: On the podcast and our online pregnancy program, grow My Baby, 5 00:00:15,960 --> 00:00:18,960 Speaker 2: we share my experience of helping more than four thousand 6 00:00:19,000 --> 00:00:20,360 Speaker 2: babies to be born and. 7 00:00:20,320 --> 00:00:23,279 Speaker 1: Our experience of running a women's health clinic and parenting 8 00:00:23,360 --> 00:00:23,960 Speaker 1: for boys. 9 00:00:24,160 --> 00:00:27,160 Speaker 2: We're here to help everyone to feel empowered in pregnancy 10 00:00:27,320 --> 00:00:30,160 Speaker 2: and birth with real life, practical information. 11 00:00:35,120 --> 00:00:38,800 Speaker 1: Welcome everyone, I'm Bridget Maloney, and today we're going right 12 00:00:38,840 --> 00:00:41,960 Speaker 1: back to one of our very first episodes, what to 13 00:00:42,040 --> 00:00:44,000 Speaker 1: do after you get those two lines on a p 14 00:00:44,159 --> 00:00:48,480 Speaker 1: and the stick. Often it's quite a daunting time you think, gosh, 15 00:00:48,479 --> 00:00:51,080 Speaker 1: what I do next? And what we've done is we've 16 00:00:51,120 --> 00:00:53,720 Speaker 1: broken it up into a can you actually trust the 17 00:00:53,760 --> 00:00:57,760 Speaker 1: pe on the stick tests? Are they accurate? Or do 18 00:00:57,800 --> 00:01:00,319 Speaker 1: you need to go and see a GP? And then 19 00:01:00,440 --> 00:01:03,720 Speaker 1: when you go and see your GP, what information should 20 00:01:03,720 --> 00:01:06,480 Speaker 1: you take to that visit? And so what we've done 21 00:01:06,520 --> 00:01:10,760 Speaker 1: since the very start is we've developed a downloadable checklist 22 00:01:10,959 --> 00:01:13,000 Speaker 1: that is free and you can get that from our 23 00:01:13,040 --> 00:01:16,679 Speaker 1: website and it's a just pregnant check list and our 24 00:01:16,720 --> 00:01:21,120 Speaker 1: website is grow mybaby dot com dot au. So hopefully 25 00:01:21,200 --> 00:01:24,760 Speaker 1: you've picked up this episode because you're either wanting two 26 00:01:24,760 --> 00:01:26,840 Speaker 1: lines on the p on a stick or you've just 27 00:01:26,920 --> 00:01:30,240 Speaker 1: found one. So if you've just found one, congratulations, listen 28 00:01:30,280 --> 00:01:32,679 Speaker 1: on and hopefully you'll get lots of good tips from 29 00:01:32,760 --> 00:01:39,800 Speaker 1: this episode. All right, well, let's go back, you know what, 30 00:01:40,800 --> 00:01:44,800 Speaker 1: eight months to when you first find out you're pregnant. Now, 31 00:01:44,880 --> 00:01:47,560 Speaker 1: we all have a love hate relationship with these pe 32 00:01:47,680 --> 00:01:50,840 Speaker 1: on the stick things. You know, every woman at some 33 00:01:51,000 --> 00:01:53,960 Speaker 1: stage in her life when she's trying to start a 34 00:01:54,000 --> 00:01:58,440 Speaker 1: family has got the box of p on the sticks. Yeah. Anyway, 35 00:01:58,560 --> 00:02:03,560 Speaker 1: so we've done our We've got two lines. And by 36 00:02:03,600 --> 00:02:05,760 Speaker 1: the way, it gets asked of us a lot, doesn't it. 37 00:02:05,840 --> 00:02:08,640 Speaker 1: You know, even if there's a faint second line on 38 00:02:08,680 --> 00:02:10,799 Speaker 1: a pe on a stick, you're pregnant. Yeah. 39 00:02:10,840 --> 00:02:14,519 Speaker 2: Read the box to make sure what a positive test 40 00:02:14,560 --> 00:02:17,320 Speaker 2: is supposed to look like. But on the two line ones, 41 00:02:17,720 --> 00:02:20,240 Speaker 2: even a faint second line is pregnant. 42 00:02:20,360 --> 00:02:20,600 Speaker 1: Yeah. 43 00:02:20,680 --> 00:02:24,320 Speaker 2: The tests are extremely accurate and very very very sensitive. 44 00:02:24,760 --> 00:02:27,280 Speaker 2: So they'll pick up levels of beta hCG, which is 45 00:02:27,280 --> 00:02:31,640 Speaker 2: the pregnancy hormone, when the level reaches about five and 46 00:02:31,680 --> 00:02:35,200 Speaker 2: in early pregnancy the level might be fifty thousand. Yeah. Wow, 47 00:02:35,280 --> 00:02:39,480 Speaker 2: So they'll turn positive as soon as that pregnancy hormone 48 00:02:39,600 --> 00:02:42,960 Speaker 2: is present in the urine, which is as early as 49 00:02:43,000 --> 00:02:45,000 Speaker 2: a couple of days before the miss period. 50 00:02:45,800 --> 00:02:49,640 Speaker 1: Wow. So I can actually start testing just days after conception. 51 00:02:49,880 --> 00:02:53,160 Speaker 2: No, yeah, well a few days before the So povulation 52 00:02:53,280 --> 00:02:55,880 Speaker 2: happens in the middle of the cycle and then the 53 00:02:55,960 --> 00:02:58,000 Speaker 2: little time takes for sperm to meet egg and then 54 00:02:58,000 --> 00:02:59,600 Speaker 2: a little time for them to get together and come 55 00:02:59,680 --> 00:03:02,000 Speaker 2: down into the uterus and implant into the wall of 56 00:03:02,080 --> 00:03:06,560 Speaker 2: the uterus. But there's some bitter hCG pregnancy hormone present 57 00:03:07,120 --> 00:03:10,040 Speaker 2: even before the missed periods, So even before you know 58 00:03:10,120 --> 00:03:12,320 Speaker 2: you're pregnant because you're over due. Yeah. 59 00:03:12,320 --> 00:03:14,840 Speaker 1: Well yeah, all right. So we talked a little bit 60 00:03:14,919 --> 00:03:19,560 Speaker 1: last podcast about you know, just any generic pregnancy test, 61 00:03:19,840 --> 00:03:23,240 Speaker 1: So any cheap pregnancy test will pick that up. 62 00:03:23,400 --> 00:03:25,520 Speaker 2: Yeah. They're pretty simple, and I mean there's some fancy 63 00:03:25,520 --> 00:03:28,160 Speaker 2: ones that try and tell you how many weeks you 64 00:03:28,240 --> 00:03:30,120 Speaker 2: might be pregnant and so forth. But let's say that's 65 00:03:30,120 --> 00:03:32,399 Speaker 2: a couple who are trying for a pregnancy, and they're 66 00:03:32,440 --> 00:03:35,600 Speaker 2: monitoring their dates and they know precisely when to look Okay, 67 00:03:36,040 --> 00:03:38,080 Speaker 2: as soon as the periods chew on one day and 68 00:03:38,120 --> 00:03:40,720 Speaker 2: it's not there, then that couple will look and all 69 00:03:40,720 --> 00:03:42,760 Speaker 2: you need is a yes no test. Yeah, and it 70 00:03:42,800 --> 00:03:44,320 Speaker 2: doesn't have to be fancy or expensive. 71 00:03:44,400 --> 00:03:47,320 Speaker 1: Yeah, well, how exciting it is. Mostly it's exciting. I 72 00:03:47,360 --> 00:03:50,880 Speaker 1: know that sometimes a positive pregnancy test isn't looked or 73 00:03:50,880 --> 00:03:54,120 Speaker 1: hoped for, but mostly it's exciting. So you've got your 74 00:03:54,160 --> 00:03:58,160 Speaker 1: positive pregnancy test. How long do you wait before you 75 00:03:58,200 --> 00:03:58,760 Speaker 1: see your GP? 76 00:03:59,400 --> 00:04:01,800 Speaker 2: Well, I think think that one of the will return 77 00:04:01,800 --> 00:04:03,360 Speaker 2: to this again and again, but one of the great 78 00:04:03,480 --> 00:04:06,720 Speaker 2: ideas is to have already been to see local doctor 79 00:04:07,080 --> 00:04:09,400 Speaker 2: before you get that positive p hon a stick test, 80 00:04:09,920 --> 00:04:12,200 Speaker 2: so that a lot of the things are already sorted out. 81 00:04:12,520 --> 00:04:14,320 Speaker 2: And by that I mean that you've had a chat 82 00:04:14,360 --> 00:04:18,160 Speaker 2: to the GP about being on some folate supplementation, that 83 00:04:18,320 --> 00:04:23,520 Speaker 2: your protection against rubella has been has been checked or 84 00:04:23,560 --> 00:04:27,480 Speaker 2: boosted if it was thought to be inadequate, and perhaps 85 00:04:27,560 --> 00:04:31,039 Speaker 2: even had a conversation with the doc about care models, 86 00:04:31,720 --> 00:04:32,960 Speaker 2: so that you know a lot about what to do 87 00:04:33,000 --> 00:04:36,480 Speaker 2: when you when you when you already get that that 88 00:04:36,520 --> 00:04:39,240 Speaker 2: positive test. But let's say it was a bit of 89 00:04:39,279 --> 00:04:43,360 Speaker 2: a surprise and that that pre pregnancy visit hasn't happened. 90 00:04:43,400 --> 00:04:46,080 Speaker 2: So the things that are important at that stage once 91 00:04:46,120 --> 00:04:48,599 Speaker 2: you get that positive p test is that is that 92 00:04:48,640 --> 00:04:52,000 Speaker 2: you're on some pregnancy multivitamin or at least some folate supplementation. 93 00:04:52,920 --> 00:04:54,760 Speaker 2: And that's when we make a visit to go and 94 00:04:54,760 --> 00:04:58,600 Speaker 2: see our GP and hopefully getting to see them at 95 00:04:58,839 --> 00:05:00,480 Speaker 2: about the six weeks mark. 96 00:05:00,880 --> 00:05:03,320 Speaker 1: Okay, And what is the six week mark? Is that 97 00:05:03,360 --> 00:05:05,919 Speaker 1: from the first day of your last period. 98 00:05:06,160 --> 00:05:09,000 Speaker 2: Yes, excellent. So that's a really important question. So let's 99 00:05:09,040 --> 00:05:10,680 Speaker 2: make sure we're all on the same page about that. 100 00:05:10,920 --> 00:05:15,040 Speaker 2: When we talk about six weeks pregnant, we mean six 101 00:05:15,080 --> 00:05:20,000 Speaker 2: weeks from the last period, not six weeks since the 102 00:05:20,240 --> 00:05:23,480 Speaker 2: ovulation or six weeks since intercourse or six weeks since 103 00:05:23,480 --> 00:05:26,640 Speaker 2: we got the positive pregnancy test. We mean six weeks 104 00:05:26,680 --> 00:05:27,679 Speaker 2: from the last period. 105 00:05:27,839 --> 00:05:28,279 Speaker 1: Yeah. 106 00:05:28,320 --> 00:05:30,599 Speaker 2: And this is an old fashioned idea of it. It dates 107 00:05:30,640 --> 00:05:32,680 Speaker 2: back to the days where there were no ultrasounds and 108 00:05:32,720 --> 00:05:35,720 Speaker 2: there was no great understanding of the hormonal basis of 109 00:05:35,760 --> 00:05:40,240 Speaker 2: ovulation and so forth, so that all we knew were 110 00:05:40,240 --> 00:05:43,200 Speaker 2: the dates. Yeah, And a woman was said to be 111 00:05:43,320 --> 00:05:45,719 Speaker 2: ten weeks pregnant if there had been ten weeks since 112 00:05:45,760 --> 00:05:48,920 Speaker 2: her period, because that's that's all we can know for sure. 113 00:05:49,000 --> 00:05:52,200 Speaker 1: Yeah, that's right. So you go to your local doc. 114 00:05:53,080 --> 00:05:55,880 Speaker 1: And we know from our experience in our practice that 115 00:05:55,920 --> 00:05:59,000 Speaker 1: there are many many women who actually don't have a 116 00:05:59,000 --> 00:06:02,760 Speaker 1: local doctor. You know, they've been for years. They've either 117 00:06:02,839 --> 00:06:05,600 Speaker 1: moved around and they haven't sort of picked up on 118 00:06:05,640 --> 00:06:09,400 Speaker 1: a GP that they go to regularly. And let's face it, 119 00:06:09,440 --> 00:06:11,120 Speaker 1: so many women are just healthy and all you need 120 00:06:11,160 --> 00:06:15,080 Speaker 1: to pop to the doctor for in those days is 121 00:06:15,160 --> 00:06:17,640 Speaker 1: you know, maybe the treatment of the odd uti or something, 122 00:06:17,640 --> 00:06:20,680 Speaker 1: and your head down to your bulk billing twenty four 123 00:06:20,680 --> 00:06:23,039 Speaker 1: hour clinic and you haven't really built that rippor or 124 00:06:23,040 --> 00:06:24,279 Speaker 1: that relationship with the doctor. 125 00:06:24,440 --> 00:06:27,679 Speaker 2: Absolutely, and I think that's a pretty common scenario these days. 126 00:06:27,760 --> 00:06:31,400 Speaker 2: So you really only need to see the local doctor 127 00:06:31,520 --> 00:06:35,040 Speaker 2: that six week mark to have a talk about those 128 00:06:35,080 --> 00:06:38,280 Speaker 2: big ticket things FOL eight and so forth, get some 129 00:06:38,320 --> 00:06:41,560 Speaker 2: pregnancy blood tests, organized the first round of blood tests, 130 00:06:42,240 --> 00:06:47,280 Speaker 2: and ideally arrange for an early scan, and that can 131 00:06:47,360 --> 00:06:50,640 Speaker 2: be done through any local doctor. It's really nice if 132 00:06:50,680 --> 00:06:52,840 Speaker 2: you've got an established local doctor who can go and 133 00:06:52,880 --> 00:06:57,080 Speaker 2: see because building up a relationship with that person is 134 00:06:57,120 --> 00:06:59,560 Speaker 2: a terrific thing to do, not only during the pregnancy, 135 00:07:00,160 --> 00:07:03,120 Speaker 2: whether you're having your care as shared care with that 136 00:07:03,240 --> 00:07:06,159 Speaker 2: doctor or shared care with a midwife, or shared care 137 00:07:06,200 --> 00:07:09,880 Speaker 2: with a consultant obstetrician, the GP wants to see you 138 00:07:09,880 --> 00:07:13,040 Speaker 2: in pregnancy and help to look after you. And then 139 00:07:13,080 --> 00:07:15,720 Speaker 2: when you're got a newborn, you're never at the dock 140 00:07:15,800 --> 00:07:16,320 Speaker 2: more than. 141 00:07:16,360 --> 00:07:19,320 Speaker 1: Yeah, yeah, that's right. It seems like every sniffle you're 142 00:07:19,320 --> 00:07:23,600 Speaker 1: down there because you really, you know, it's such unknown territory. 143 00:07:23,280 --> 00:07:27,400 Speaker 2: You're nervous, and a rash and a running nose. You're 144 00:07:27,400 --> 00:07:29,480 Speaker 2: at the dock a bit. And a lot of people 145 00:07:29,520 --> 00:07:31,760 Speaker 2: get their vaccinations for the baby through the local dock 146 00:07:31,800 --> 00:07:35,160 Speaker 2: as well. So if you're a client of an established clinic, 147 00:07:35,400 --> 00:07:37,320 Speaker 2: even if it's not the same dock every time, it's 148 00:07:37,320 --> 00:07:40,440 Speaker 2: at least the same practice. That's a really nice thing 149 00:07:40,440 --> 00:07:42,160 Speaker 2: to be thinking about it this early stage. 150 00:07:42,480 --> 00:07:44,880 Speaker 1: All right, So you've got an appointment with your local doctor. 151 00:07:44,920 --> 00:07:48,160 Speaker 1: It's six weeks. What do you have to tell them? 152 00:07:48,480 --> 00:07:50,280 Speaker 2: Well, what they want to know at that stage is 153 00:07:50,880 --> 00:07:53,320 Speaker 2: just back to basics. Is your history? Is this your 154 00:07:53,360 --> 00:07:57,760 Speaker 2: first pregnancy? Are you pleased to be pregnant? Before I 155 00:07:57,800 --> 00:08:00,080 Speaker 2: was a specialist obstetrician, I was a GP for a 156 00:08:00,080 --> 00:08:03,560 Speaker 2: little while many years ago, and that was the phrase 157 00:08:03,600 --> 00:08:07,320 Speaker 2: that I'd worked out was a tactful way of opening 158 00:08:07,360 --> 00:08:10,840 Speaker 2: the discussion. And if someone's not pleased to be pregnant, 159 00:08:11,320 --> 00:08:12,520 Speaker 2: then it's a whole different discussion. 160 00:08:12,560 --> 00:08:13,640 Speaker 1: Yeah, that's exactly right. 161 00:08:14,120 --> 00:08:16,679 Speaker 2: So if we open with are you pleased to be pregnant? 162 00:08:16,800 --> 00:08:20,360 Speaker 2: Then yes, of course, we've been trying to get pregnant 163 00:08:20,360 --> 00:08:22,600 Speaker 2: for three or four months and tracking our povulation and 164 00:08:23,560 --> 00:08:28,320 Speaker 2: we're thrilled. Then there'll be some early questions about the 165 00:08:28,440 --> 00:08:35,320 Speaker 2: women's medical history and also histories for the partner family history, 166 00:08:36,080 --> 00:08:39,320 Speaker 2: whether there's any body in the extended family here any 167 00:08:39,360 --> 00:08:44,520 Speaker 2: unhealthy or unusual babies, whether the woman or her partner 168 00:08:44,559 --> 00:08:48,040 Speaker 2: have any issues with drugs and alcohol. I think these 169 00:08:48,120 --> 00:08:50,960 Speaker 2: days it's very important that we get in early and 170 00:08:51,000 --> 00:08:54,640 Speaker 2: ask people about things like family violence. Family violence is 171 00:08:54,679 --> 00:08:58,600 Speaker 2: a problem that gets worse in pregnancy, and. 172 00:08:58,520 --> 00:09:02,560 Speaker 1: Then that might be kind of quite confronting for someone 173 00:09:02,559 --> 00:09:05,000 Speaker 1: that's just come in with really happy news that they're pregnant. 174 00:09:06,320 --> 00:09:07,760 Speaker 1: Why do you actually ask them? 175 00:09:08,000 --> 00:09:09,360 Speaker 2: Well, we don't have to go You don't have to 176 00:09:09,360 --> 00:09:11,719 Speaker 2: ask that up front, right, Okay, So what I say 177 00:09:11,720 --> 00:09:14,160 Speaker 2: to my students is, don't forget to say congratulations, yeah, 178 00:09:14,200 --> 00:09:16,880 Speaker 2: oh my god, and be happy, be happy for the patient. 179 00:09:17,240 --> 00:09:19,400 Speaker 2: But at some point we do need to ask about 180 00:09:19,400 --> 00:09:25,000 Speaker 2: those those serious things, those negative things. That's part of pregnancy. 181 00:09:24,480 --> 00:09:27,400 Speaker 1: Care, right, I would imagine too. Another thing that you'd 182 00:09:27,400 --> 00:09:29,440 Speaker 1: be asking about is their mental health. 183 00:09:29,640 --> 00:09:33,560 Speaker 2: Absolutely, so people with a hit. Let's let's use that 184 00:09:33,600 --> 00:09:35,680 Speaker 2: as a great example. A one with a history of 185 00:09:35,679 --> 00:09:38,520 Speaker 2: depression anxiety, for example, which is common. She might be 186 00:09:38,559 --> 00:09:42,319 Speaker 2: on a medication at that time, which is okay for 187 00:09:42,360 --> 00:09:44,640 Speaker 2: her to be on in the first few weeks of pregnancy, 188 00:09:44,679 --> 00:09:47,000 Speaker 2: but may not be an ideal thing to be on 189 00:09:47,120 --> 00:09:49,920 Speaker 2: for the whole pregnancy. So we like to see her 190 00:09:49,920 --> 00:09:51,880 Speaker 2: at the start, so we can say, fine, let's change 191 00:09:51,880 --> 00:09:54,240 Speaker 2: it from drug X to drug why that's got a 192 00:09:54,280 --> 00:09:58,600 Speaker 2: better pregnancy safety profile. We also know that pregnancy can 193 00:09:58,679 --> 00:10:02,800 Speaker 2: be a challenging time for people, for anybody, but also 194 00:10:03,040 --> 00:10:05,480 Speaker 2: for a woman with a history of depression and anxiety, 195 00:10:05,559 --> 00:10:09,160 Speaker 2: So we would say, how are you coping? Are you pleased? 196 00:10:09,240 --> 00:10:10,120 Speaker 2: Is your family pleased? 197 00:10:11,320 --> 00:10:13,760 Speaker 1: Have you got any sort of support mechanisms? Absolutely? 198 00:10:14,600 --> 00:10:18,480 Speaker 2: And then if the let's say that woman, she's been fine, 199 00:10:18,520 --> 00:10:20,960 Speaker 2: she's been totally fine. Mental health for a couple of years, 200 00:10:20,960 --> 00:10:23,439 Speaker 2: but before that she'd had some issues. Well, this might 201 00:10:23,440 --> 00:10:27,600 Speaker 2: be the perfect time to reconnect with her psychologist, go 202 00:10:27,679 --> 00:10:32,680 Speaker 2: back over the principles of the cognitive behavior therapy. Happy 203 00:10:32,679 --> 00:10:35,880 Speaker 2: thoughts lead to happiness, not to go down negative thought spirals. 204 00:10:36,400 --> 00:10:39,920 Speaker 2: And because the pregnancy itself, it's a funny time hormonally, 205 00:10:39,960 --> 00:10:43,160 Speaker 2: it's a time of great change in flux, and you know, 206 00:10:43,440 --> 00:10:48,760 Speaker 2: it's a time when mental health problems be really triggered. 207 00:10:48,800 --> 00:10:51,400 Speaker 1: I could imagine you know it is you question everything 208 00:10:51,440 --> 00:10:54,760 Speaker 1: and you're so anxious about you know, right now, but 209 00:10:54,800 --> 00:10:57,080 Speaker 1: also the future. Like there's a lot coming onto your plate, 210 00:10:57,120 --> 00:10:59,120 Speaker 1: isn't it. It's not just that you're growing a baby. 211 00:10:59,160 --> 00:11:01,120 Speaker 1: It's like, you know, you're lifestyle is going to change, 212 00:11:01,120 --> 00:11:03,320 Speaker 1: your relationship with your partner may or may not change, 213 00:11:03,320 --> 00:11:06,280 Speaker 1: And all of those things seem to sort of just 214 00:11:06,360 --> 00:11:07,920 Speaker 1: come in not a person. 215 00:11:08,120 --> 00:11:10,640 Speaker 2: Yeah, and that's not those aren't things that are going 216 00:11:10,679 --> 00:11:12,840 Speaker 2: to change for someone with a history of mental health problem. 217 00:11:12,880 --> 00:11:14,000 Speaker 2: That's going to change everyone. 218 00:11:13,800 --> 00:11:16,800 Speaker 1: Everybody, that's right, Yeah, all right. What other sort of 219 00:11:17,040 --> 00:11:20,280 Speaker 1: medical history is your GP interested. 220 00:11:19,920 --> 00:11:22,559 Speaker 2: In any health problems you've had in the past, be 221 00:11:22,679 --> 00:11:31,359 Speaker 2: they medical, law, surgical, asthma, epilepsy, diabetes, thyroid, history of operations, tonsils, 222 00:11:31,520 --> 00:11:32,199 Speaker 2: gall bladder. 223 00:11:32,360 --> 00:11:34,959 Speaker 1: Really what would tonsils and gallbladder have. 224 00:11:34,920 --> 00:11:39,640 Speaker 2: To do with Well, let's say, for example, I had 225 00:11:39,679 --> 00:11:44,040 Speaker 2: my person has a history, I had my gall bladder 226 00:11:44,040 --> 00:11:47,440 Speaker 2: out and I had a severe anesthetic compemation. We need 227 00:11:47,720 --> 00:11:50,680 Speaker 2: we want to know that. We want to know what 228 00:11:50,880 --> 00:11:55,600 Speaker 2: that was and how did you go? And let's say 229 00:11:55,720 --> 00:11:58,839 Speaker 2: cut forward eight and a half months you have a 230 00:11:58,920 --> 00:12:02,240 Speaker 2: cesarian section. I want to know what the anesthetic problem was. 231 00:12:02,320 --> 00:12:05,000 Speaker 2: So everything's relevant. It might not seem so, but everything 232 00:12:05,040 --> 00:12:07,800 Speaker 2: we're going to ask at that early stage is relevant 233 00:12:08,520 --> 00:12:11,880 Speaker 2: and there will be a reason method in that madness. 234 00:12:12,400 --> 00:12:21,559 Speaker 2: So absolutely, medical and surgical history, mental health history, lifestyle issues, drugs, alcohol, 235 00:12:22,920 --> 00:12:26,240 Speaker 2: and it's all part about building a picture which even 236 00:12:26,280 --> 00:12:28,760 Speaker 2: as early as that first visit and what's going on 237 00:12:28,840 --> 00:12:33,800 Speaker 2: in your caregiver's mind is stratifying the risk. Is this 238 00:12:33,880 --> 00:12:38,880 Speaker 2: a person with a complex medical history where the pregnancy 239 00:12:39,720 --> 00:12:44,199 Speaker 2: is going to make a difference to the medical problems 240 00:12:44,200 --> 00:12:48,160 Speaker 2: they've already got, Plus the medical problem is going to 241 00:12:48,160 --> 00:12:52,200 Speaker 2: make a difference to the pregnancy. And that's a complex person. 242 00:12:52,240 --> 00:12:54,040 Speaker 2: And we might say to that person, well, this is 243 00:12:54,040 --> 00:12:55,679 Speaker 2: all looking a bit tricky. Perhaps we'll get you off 244 00:12:55,679 --> 00:12:58,959 Speaker 2: to consultation with an obstrition straight away, because you've got 245 00:12:58,960 --> 00:13:02,880 Speaker 2: a lot going on versus somebody who's totally fine, regular cycles, 246 00:13:03,000 --> 00:13:08,839 Speaker 2: history of perfectly good health, normal childhood vaccinations, who's got 247 00:13:09,240 --> 00:13:13,320 Speaker 2: noash's door. And you might say to that person, congratulations, fantastic. 248 00:13:13,400 --> 00:13:16,040 Speaker 2: Let's organize a dating scan and you can go and 249 00:13:16,040 --> 00:13:20,760 Speaker 2: book in at the public anti natal clinic in whenever 250 00:13:20,800 --> 00:13:23,120 Speaker 2: they'll see you, yep. And if that's not till fifteen weeks, 251 00:13:23,120 --> 00:13:26,480 Speaker 2: don't matter, okay, yep. So we're trying to work out 252 00:13:26,520 --> 00:13:30,240 Speaker 2: the appropriate place to send people and the appropriate timeframe 253 00:13:30,280 --> 00:13:31,000 Speaker 2: to send them there. 254 00:13:31,320 --> 00:13:34,240 Speaker 1: So when you know, you often think that you have 255 00:13:34,280 --> 00:13:37,280 Speaker 1: to go to the doctor because you need a blood 256 00:13:37,280 --> 00:13:38,800 Speaker 1: test to confirm the pregnancy. 257 00:13:39,320 --> 00:13:41,720 Speaker 2: Is that the case, Yeah, you don't. You don't need 258 00:13:41,760 --> 00:13:46,120 Speaker 2: a blood test to confirm a pregnancy. So the urine 259 00:13:46,120 --> 00:13:48,559 Speaker 2: test is extremely accurate. And if it says you're pregnant, 260 00:13:48,600 --> 00:13:52,239 Speaker 2: you're pregnant. It doesn't say that you're not going to miscarry, 261 00:13:52,800 --> 00:13:54,640 Speaker 2: or even that it's not a neck topic pregnancy that's 262 00:13:54,640 --> 00:13:56,719 Speaker 2: stuck in the tube rather than the uterus, but does 263 00:13:56,760 --> 00:14:00,360 Speaker 2: say you're pregnant. So the blood tests are not just 264 00:14:00,960 --> 00:14:04,720 Speaker 2: to confirm that a healthy person with a normal pregnancy 265 00:14:04,760 --> 00:14:08,760 Speaker 2: is pregnant. We already know that from the positive urine test, 266 00:14:09,200 --> 00:14:11,400 Speaker 2: and an ultrasound at six weeks will show us that 267 00:14:11,440 --> 00:14:14,320 Speaker 2: the pregnancy is in the uterus. My heart's beating, So 268 00:14:14,360 --> 00:14:18,800 Speaker 2: that person certainly doesn't need a blood test that counts 269 00:14:18,880 --> 00:14:22,360 Speaker 2: up the amount of pregnancy hormone. That's called a quantitative 270 00:14:22,800 --> 00:14:25,480 Speaker 2: beta hCG, and that gives you a number like the 271 00:14:25,560 --> 00:14:29,160 Speaker 2: number might be one thousand or twenty thousand. Those blood 272 00:14:29,160 --> 00:14:32,440 Speaker 2: tests are for where the situation is not clear. So 273 00:14:32,600 --> 00:14:36,160 Speaker 2: for example, we do an ultrasound at six weeks and 274 00:14:36,240 --> 00:14:38,840 Speaker 2: the woman's pregnant, the uters is empty, and we think, okay, 275 00:14:38,880 --> 00:14:41,640 Speaker 2: what are possibilities. It might be an ectopic pregnancy, might 276 00:14:41,640 --> 00:14:45,320 Speaker 2: be somewhere else. It might be an early miscarriage, or 277 00:14:45,360 --> 00:14:48,880 Speaker 2: it might be that we're earlier than we think and 278 00:14:48,920 --> 00:14:50,440 Speaker 2: that just hasn't had a chance to show up in 279 00:14:50,480 --> 00:14:54,120 Speaker 2: the uterus yet. Well, if we get a pregnancy hormone level, 280 00:14:54,560 --> 00:14:56,200 Speaker 2: that will help us answer that question. 281 00:14:56,320 --> 00:14:59,080 Speaker 1: Yeah, right, so that's that beta hCG. 282 00:14:59,680 --> 00:15:01,360 Speaker 2: Yeah, and that might do two of those in a row. 283 00:15:01,440 --> 00:15:03,800 Speaker 2: And if we do it on a Wednesday and it's 284 00:15:03,800 --> 00:15:06,320 Speaker 2: a thousand, and we do it on a Friday and 285 00:15:06,960 --> 00:15:10,800 Speaker 2: it's two thousand, then that's doubling normally every forty eight hours, 286 00:15:10,800 --> 00:15:13,360 Speaker 2: and that's a sign of healthy. If it was falling 287 00:15:13,400 --> 00:15:16,120 Speaker 2: over that forty eight hours, probably a miscarriage. Yeah, staying 288 00:15:16,160 --> 00:15:18,240 Speaker 2: about the same over that forty eight hours might be 289 00:15:18,240 --> 00:15:21,440 Speaker 2: a topic. So that's what those numbers are for. But 290 00:15:21,480 --> 00:15:24,320 Speaker 2: they're not really to confirm a normal pregnancy, and they're 291 00:15:24,320 --> 00:15:26,840 Speaker 2: not very useful to conform a normal pregnancy, because if 292 00:15:26,880 --> 00:15:30,560 Speaker 2: you're ten weeks pregnant, the normal range of quantitative beta 293 00:15:30,680 --> 00:15:33,720 Speaker 2: hCG might be five thousand, it might be might be 294 00:15:33,720 --> 00:15:34,320 Speaker 2: twenty thousand. 295 00:15:34,360 --> 00:15:36,760 Speaker 1: And it's different for every woman, isn't it. So there's 296 00:15:36,760 --> 00:15:39,240 Speaker 1: no point in comparing yourself to anybody else. 297 00:15:39,680 --> 00:15:42,160 Speaker 2: No, And it doesn't predict outcomes like that. 298 00:15:42,360 --> 00:15:46,160 Speaker 1: Right, hCG, what does it stand for? What's that acronym? 299 00:15:46,280 --> 00:15:50,400 Speaker 2: Oh B is for beta. That's just like the Greek alphabet. 300 00:15:50,400 --> 00:15:54,880 Speaker 2: There's an alphab hCG and a beta HG and H 301 00:15:55,040 --> 00:16:01,760 Speaker 2: is human, c is choreonic and choonic means is part 302 00:16:01,800 --> 00:16:05,760 Speaker 2: of the early pregnancy. The cooreon is the outer sack 303 00:16:08,080 --> 00:16:10,480 Speaker 2: and the G is something called going out a trophy, 304 00:16:10,480 --> 00:16:13,080 Speaker 2: and that's just what the hormone's called. 305 00:16:13,400 --> 00:16:16,320 Speaker 1: Right, Okay, good, because people do talk a lot about 306 00:16:16,480 --> 00:16:21,120 Speaker 1: hCG and they sort of tend to, well, they're at 307 00:16:21,120 --> 00:16:23,240 Speaker 1: that point where they're anxious about a miscarriage and they 308 00:16:23,240 --> 00:16:26,560 Speaker 1: start talking about hCG and you know the levels of hCG. 309 00:16:26,640 --> 00:16:28,520 Speaker 1: But the big thing that I'm getting from you right 310 00:16:28,520 --> 00:16:31,840 Speaker 1: now is that it's just if it's doubling, and don't 311 00:16:31,840 --> 00:16:34,440 Speaker 1: compare yourself to somebody else's hCG level. 312 00:16:34,600 --> 00:16:38,920 Speaker 2: Absolutely so. In twenty nineteen, the management of what's called 313 00:16:38,920 --> 00:16:41,680 Speaker 2: the uncited pregnancy, so we know the woman's pregnant, but 314 00:16:41,680 --> 00:16:43,960 Speaker 2: we're not sure whether it's in the uterus where it belongs, 315 00:16:44,280 --> 00:16:48,760 Speaker 2: miscarrying or a topic. The management of that is based 316 00:16:48,760 --> 00:16:54,600 Speaker 2: on ultrasounds and interpretation of serial beta hCG, so having 317 00:16:54,640 --> 00:16:57,280 Speaker 2: a few in a row and that's how the diagnosis 318 00:16:57,360 --> 00:17:00,480 Speaker 2: is made. But if we're in this territory under an 319 00:17:00,480 --> 00:17:01,240 Speaker 2: expert help. 320 00:17:01,160 --> 00:17:03,240 Speaker 1: Yeah, a medical expert, and we should just sort of 321 00:17:03,440 --> 00:17:06,240 Speaker 1: know that they've got that. Yeah, all right, So does 322 00:17:06,359 --> 00:17:10,320 Speaker 1: every woman need or have a dating scan? 323 00:17:11,000 --> 00:17:13,400 Speaker 2: It's a good question. You don't absolutely need a dating scan. 324 00:17:13,680 --> 00:17:17,960 Speaker 2: If you're pregnant and there's no sign that anything's wrong, 325 00:17:18,080 --> 00:17:22,360 Speaker 2: like you've got consistent pregnancy symptoms, there's no early pregnancy bleeding, 326 00:17:23,000 --> 00:17:26,040 Speaker 2: then it is safe to assume that things are fine, 327 00:17:26,520 --> 00:17:30,240 Speaker 2: and we probably tend to get a dating scan done. 328 00:17:30,920 --> 00:17:33,240 Speaker 2: The dating scan probably doesn't tend to get done until 329 00:17:33,240 --> 00:17:35,720 Speaker 2: it's done, for example, as part of down syndrome screen, 330 00:17:36,080 --> 00:17:38,520 Speaker 2: which depending on what we're doing, might be ten or 331 00:17:38,520 --> 00:17:40,920 Speaker 2: twelve weeks, and that might be the woman's first scan, 332 00:17:41,040 --> 00:17:44,920 Speaker 2: and that's fine. But if if she wants a dating scan, 333 00:17:45,160 --> 00:17:47,320 Speaker 2: or if one's thought to be necessary because there's some 334 00:17:47,600 --> 00:17:51,199 Speaker 2: confusion about exactly what's going on, then from about six 335 00:17:51,280 --> 00:17:53,760 Speaker 2: and a half weeks, you can see you can see 336 00:17:53,760 --> 00:17:56,080 Speaker 2: the what's called the fiddle pole, which is a start 337 00:17:56,119 --> 00:17:57,879 Speaker 2: of the baby and the heart beating. 338 00:17:58,160 --> 00:17:59,600 Speaker 1: Oh, you can actually see the heart beating. 339 00:18:00,160 --> 00:18:01,720 Speaker 2: Baby looks like a tony little jelly bean, and in 340 00:18:01,760 --> 00:18:02,960 Speaker 2: the middle that's a beating heart. 341 00:18:03,119 --> 00:18:04,480 Speaker 1: Yeap, oh cool, and not. 342 00:18:04,359 --> 00:18:06,680 Speaker 2: Thing's only a few millimeters long, but you can quite 343 00:18:06,720 --> 00:18:07,840 Speaker 2: clearly see that going on. 344 00:18:07,960 --> 00:18:10,840 Speaker 1: And you have to go to an ultrasound clinic for that. 345 00:18:11,800 --> 00:18:14,240 Speaker 2: Yep. So the GP will send you off to an 346 00:18:14,320 --> 00:18:18,200 Speaker 2: ultrasound clinic, and a lot of obstetrician gynecologists like myself. 347 00:18:18,200 --> 00:18:21,520 Speaker 2: I've got an ultrasound machine ourselves, and I might see 348 00:18:21,600 --> 00:18:24,280 Speaker 2: people in very early pregnancy if they're worried, and scan 349 00:18:24,359 --> 00:18:24,879 Speaker 2: them myself. 350 00:18:25,359 --> 00:18:27,080 Speaker 1: And do you know whether that is bulk build or 351 00:18:27,080 --> 00:18:29,359 Speaker 1: whether you can have a bulk build early dating scan. 352 00:18:29,560 --> 00:18:32,760 Speaker 2: Yeah, so there are some ultrasound clinics that offer bulk 353 00:18:32,800 --> 00:18:35,840 Speaker 2: billing and an early scan is not rocket science for 354 00:18:35,840 --> 00:18:39,040 Speaker 2: them to do. So when your GP sends you for 355 00:18:39,040 --> 00:18:40,520 Speaker 2: a scan, like anything else, you ring up to make 356 00:18:40,520 --> 00:18:42,639 Speaker 2: the appointment and you ask very clearly how much it costs, 357 00:18:43,119 --> 00:18:45,240 Speaker 2: and don't hesitate to shop around a little bit. 358 00:18:45,400 --> 00:18:47,720 Speaker 1: Yeah. Yeah, that's right because there are lots of providers 359 00:18:47,720 --> 00:18:49,120 Speaker 1: out there, isn't there certainly. Yeah. 360 00:18:49,200 --> 00:18:53,080 Speaker 2: In the ultrasound world, there's big variation between For example, 361 00:18:53,119 --> 00:18:57,920 Speaker 2: the ultrasound department of a public hospital, which is free 362 00:18:57,960 --> 00:19:01,360 Speaker 2: to go to it has it might not have as 363 00:19:01,359 --> 00:19:04,480 Speaker 2: many appointments for people because it's a busy public hospital 364 00:19:04,800 --> 00:19:08,639 Speaker 2: clinic that's looking after the patients of that hospital, the 365 00:19:08,680 --> 00:19:11,520 Speaker 2: inpatients of that hospital, but it's available to people for 366 00:19:11,560 --> 00:19:14,520 Speaker 2: people to use as an ultrasound clinic. It's usually free. 367 00:19:14,880 --> 00:19:17,360 Speaker 2: It might not have as many bells and whistles as 368 00:19:17,400 --> 00:19:21,479 Speaker 2: a private clinic, but that's fine. Right up to the 369 00:19:21,680 --> 00:19:24,200 Speaker 2: full service private clinical at the end of your street 370 00:19:24,240 --> 00:19:26,080 Speaker 2: that we'll charge you in out of pocket costs, but 371 00:19:26,200 --> 00:19:28,399 Speaker 2: they'll give you they'll give you photos and a video 372 00:19:28,440 --> 00:19:32,760 Speaker 2: and a DVD and a USB with the pictures and everything. 373 00:19:33,119 --> 00:19:35,640 Speaker 1: So pad, how do we even know like when our 374 00:19:35,680 --> 00:19:38,000 Speaker 1: babies a jew Like, how do we have a date 375 00:19:38,040 --> 00:19:38,679 Speaker 1: in mind for that? 376 00:19:39,240 --> 00:19:42,800 Speaker 2: Yeah? So good question. This is about something called an 377 00:19:43,080 --> 00:19:46,199 Speaker 2: ed D or an e d C, and an e 378 00:19:46,920 --> 00:19:51,400 Speaker 2: d D is estimated date of delivery, So basically when 379 00:19:51,400 --> 00:19:54,399 Speaker 2: the baby's due, and an e d C is a 380 00:19:54,760 --> 00:19:57,960 Speaker 2: beautiful old fashioned term. That's an estimated date of confinement. 381 00:19:57,960 --> 00:19:59,919 Speaker 1: Well confine, my gosh, I haven't heard that for you. 382 00:20:00,920 --> 00:20:04,520 Speaker 2: Some of my senior colleagues in of cetric still say confinement. 383 00:20:05,119 --> 00:20:07,480 Speaker 2: So that's back in the day when the pregnancy was 384 00:20:07,520 --> 00:20:09,040 Speaker 2: shrouded in mystery. 385 00:20:08,920 --> 00:20:11,159 Speaker 1: And you had to hide at home and never let 386 00:20:11,200 --> 00:20:12,040 Speaker 1: your belly be shown. 387 00:20:12,119 --> 00:20:14,760 Speaker 2: Yeah, so the woman would be confined to her house 388 00:20:14,840 --> 00:20:19,000 Speaker 2: for presumably weeks before delivery and to hangover from those days. 389 00:20:19,160 --> 00:20:22,199 Speaker 2: So basically the JEW date. There's two important ways to 390 00:20:22,240 --> 00:20:25,320 Speaker 2: calculate that. One is based on the period dates, and 391 00:20:25,359 --> 00:20:30,120 Speaker 2: that's extremely accurate if the woman had a nice, regular 392 00:20:30,240 --> 00:20:35,760 Speaker 2: cycle leading up to conceiving, and it's very reliable that 393 00:20:35,880 --> 00:20:41,200 Speaker 2: the baby's due forty weeks after the woman's last period. Again, 394 00:20:41,520 --> 00:20:44,159 Speaker 2: when she not the date of sex and not the 395 00:20:44,200 --> 00:20:46,480 Speaker 2: date of population, but the date of the period in 396 00:20:46,520 --> 00:20:49,440 Speaker 2: the pre ultrasound the era, that's all on you. So 397 00:20:50,640 --> 00:20:53,359 Speaker 2: you can just calculate, and you've seen your local doctor's 398 00:20:53,359 --> 00:20:55,840 Speaker 2: got one of those wheels where you turn the wheel 399 00:20:55,880 --> 00:20:58,800 Speaker 2: around to the known date of the first day of 400 00:20:58,800 --> 00:21:00,880 Speaker 2: the last period, and then the error on the other 401 00:21:00,920 --> 00:21:04,160 Speaker 2: side will indicate the date that the baby's jew. Yeah, 402 00:21:04,240 --> 00:21:07,240 Speaker 2: it's important to have an answer because a lot of 403 00:21:07,280 --> 00:21:09,399 Speaker 2: the tests during pregnancy at times, so we need to 404 00:21:09,400 --> 00:21:11,040 Speaker 2: know when someone is twenty eight weeks and when they 405 00:21:11,040 --> 00:21:13,800 Speaker 2: are thirty six weeks. But it's particularly important at the 406 00:21:13,800 --> 00:21:18,199 Speaker 2: other end when if we're going to interfere in the 407 00:21:18,240 --> 00:21:21,480 Speaker 2: pregnancy because we think the woman's overdue, then we need 408 00:21:21,520 --> 00:21:24,680 Speaker 2: to know she really is. The other way to calculate 409 00:21:24,760 --> 00:21:28,320 Speaker 2: the estimated your d is off a dating scan and 410 00:21:29,200 --> 00:21:33,520 Speaker 2: first trimester dating scanning done trans vaginally is very accurate. 411 00:21:33,840 --> 00:21:36,480 Speaker 1: Okay, hang on a minute. What is trans vaginally? 412 00:21:36,720 --> 00:21:41,480 Speaker 2: Well, that's that glamorous procedure where the ultrasound is done internally, so. 413 00:21:41,280 --> 00:21:43,600 Speaker 1: That you got Yes, I've had quite a few of those. 414 00:21:43,640 --> 00:21:44,800 Speaker 1: That's the probe. 415 00:21:44,920 --> 00:21:47,160 Speaker 2: Yeah, So the probe with the cover over that goes 416 00:21:47,240 --> 00:21:48,920 Speaker 2: up the vagina and it puts the source of the 417 00:21:49,000 --> 00:21:52,040 Speaker 2: ultrasound but in which is the wand right up close 418 00:21:52,040 --> 00:21:54,760 Speaker 2: to the pregnancy, and the pitches are much better. And 419 00:21:54,800 --> 00:21:58,000 Speaker 2: if you've got a good view in early pregnancy, then 420 00:21:58,040 --> 00:22:03,640 Speaker 2: everybody's everybody's sick week fetus is the same length. Genetic 421 00:22:03,720 --> 00:22:07,399 Speaker 2: differences haven't come into it yet, so if you're an 422 00:22:07,440 --> 00:22:09,679 Speaker 2: African or an Eskima, it doesn't matter that it's going 423 00:22:09,720 --> 00:22:12,760 Speaker 2: to be about the same length. And so we can 424 00:22:12,840 --> 00:22:16,720 Speaker 2: say very confidently that if the early pregnancy is so 425 00:22:16,800 --> 00:22:20,000 Speaker 2: many millimeters long, then it must be so many days 426 00:22:20,000 --> 00:22:20,639 Speaker 2: and weeks old. 427 00:22:21,080 --> 00:22:24,160 Speaker 1: And how often is that different from somebody's estimated sort 428 00:22:24,160 --> 00:22:26,800 Speaker 1: of last day of their period and what they think they're, 429 00:22:27,160 --> 00:22:28,360 Speaker 1: how pregnant they think they are. 430 00:22:28,520 --> 00:22:31,840 Speaker 2: Yeah, it can be. So if you've got any irregular cycle, 431 00:22:32,320 --> 00:22:34,040 Speaker 2: you can be more or less pregnant than you think 432 00:22:34,040 --> 00:22:37,240 Speaker 2: you are. If you had an episode of bleeding in 433 00:22:37,280 --> 00:22:43,320 Speaker 2: early pregnancy that happened about four weeks in and you 434 00:22:43,440 --> 00:22:46,040 Speaker 2: thought that was a period, but it was in fact 435 00:22:46,040 --> 00:22:49,000 Speaker 2: a bleed at four weeks, then you're four weeks more 436 00:22:49,000 --> 00:22:51,960 Speaker 2: pregnant than you thought you were. Yeah, and if there's 437 00:22:52,000 --> 00:22:57,399 Speaker 2: a significant discrepancy, the period dates are more likely to 438 00:22:57,480 --> 00:22:58,960 Speaker 2: be wrong than the ultrasound. 439 00:23:00,240 --> 00:23:02,399 Speaker 1: A little off topic, a little down the way, but 440 00:23:02,440 --> 00:23:06,080 Speaker 1: it's of interest. So it's always puzzled me why women 441 00:23:06,200 --> 00:23:09,560 Speaker 1: might get to that point and they find out suddenly 442 00:23:09,600 --> 00:23:13,439 Speaker 1: that they're twenty weeks pregnant, Like, how does that suddenly happen? 443 00:23:14,160 --> 00:23:16,400 Speaker 1: You know, I knew the minute I've been pregnant every 444 00:23:16,400 --> 00:23:18,680 Speaker 1: four all four times. Well it happened. 445 00:23:18,680 --> 00:23:21,239 Speaker 2: It happens. I mean, some people just don't know. So 446 00:23:21,280 --> 00:23:24,680 Speaker 2: you could have no pregnancy symptoms at all. You might 447 00:23:24,720 --> 00:23:27,919 Speaker 2: be somebody who only menstrates twice a year anyway, so 448 00:23:28,000 --> 00:23:31,359 Speaker 2: you don't notice the absent period. Some women continue to 449 00:23:31,359 --> 00:23:33,879 Speaker 2: bleed a little bit, even in a regular basis in 450 00:23:33,920 --> 00:23:37,840 Speaker 2: the pregnancy and think that they're just having periods, So 451 00:23:38,040 --> 00:23:38,640 Speaker 2: it happens. 452 00:23:38,960 --> 00:23:41,240 Speaker 1: Okay, sorry that was off topic anyway, back to it. 453 00:23:41,840 --> 00:23:45,040 Speaker 1: All right, So we've covered taking of the medical history, 454 00:23:46,000 --> 00:23:50,000 Speaker 1: a dating scan. What what are the other bloods for? 455 00:23:50,040 --> 00:23:51,800 Speaker 1: What do you need a blood test for? 456 00:23:52,640 --> 00:23:55,520 Speaker 2: Well, the blood tests in early pregnancy are mostly an 457 00:23:55,520 --> 00:24:00,439 Speaker 2: infectious diseases screen. Oh yeah, So historically some of the 458 00:24:00,520 --> 00:24:06,400 Speaker 2: major problems in pregnancy were related to infectious diseases, and 459 00:24:06,480 --> 00:24:09,679 Speaker 2: we don't see tons of those these days because of 460 00:24:09,800 --> 00:24:14,159 Speaker 2: vaccination and because of improved living standards and nutrition. But 461 00:24:14,960 --> 00:24:17,160 Speaker 2: we still check for those things because some of them 462 00:24:17,560 --> 00:24:20,399 Speaker 2: can have a devastating impact on pregnancy. So what are 463 00:24:20,400 --> 00:24:22,679 Speaker 2: we talking there, Well, we still checked for syphilis. I've 464 00:24:22,720 --> 00:24:25,680 Speaker 2: never seen Yeah, I've never seen a positive syphlis test 465 00:24:25,680 --> 00:24:28,760 Speaker 2: in pregnancy in all of the time I've been doing obstetrics. 466 00:24:29,240 --> 00:24:32,480 Speaker 2: But it's still checked four because there is a little 467 00:24:32,520 --> 00:24:37,840 Speaker 2: bit of syphilis around in our country and certainly globally 468 00:24:37,880 --> 00:24:42,000 Speaker 2: it's still around, and a syphless infection in pregnancy is catastrophic. 469 00:24:42,040 --> 00:24:50,040 Speaker 2: There's causes dreadfully severe fetal abnormalities. So that's still checked four. 470 00:24:50,080 --> 00:24:54,600 Speaker 2: In twenty nineteen, probably of more relevance, there's a check 471 00:24:54,680 --> 00:24:59,639 Speaker 2: for hepatitis. That's because we now know the way to 472 00:25:00,080 --> 00:25:02,880 Speaker 2: use what's called vertical transmission. So if the mother's got 473 00:25:02,920 --> 00:25:06,760 Speaker 2: hepatitis BC or HIV, we can stop that being passed 474 00:25:06,760 --> 00:25:10,720 Speaker 2: down to the vetus in pregnancy. And so we can't 475 00:25:10,760 --> 00:25:12,720 Speaker 2: do that unless we know who's got it, So that's 476 00:25:12,760 --> 00:25:15,720 Speaker 2: what those tests are for. There's a urine a urine 477 00:25:15,720 --> 00:25:18,120 Speaker 2: test as part of the first lot, which is about 478 00:25:18,720 --> 00:25:23,880 Speaker 2: finding women who've got what's called subclinical utili so's they've 479 00:25:23,920 --> 00:25:27,240 Speaker 2: got bacteria in the urine, but they feel fine, and 480 00:25:27,480 --> 00:25:31,840 Speaker 2: we know that those women, if the if that's not 481 00:25:31,920 --> 00:25:36,440 Speaker 2: picked up, may carry that bacterial infection through pregnancy and 482 00:25:36,480 --> 00:25:39,280 Speaker 2: that can be involved in things like premature labor and delivery. 483 00:25:40,080 --> 00:25:43,160 Speaker 2: So that's what the urine culture is for. And then 484 00:25:43,200 --> 00:25:45,920 Speaker 2: we look for the blood group. It's very very important. 485 00:25:46,440 --> 00:25:50,119 Speaker 2: Women who are a negative blood group have some special 486 00:25:50,960 --> 00:25:54,160 Speaker 2: potential complications of pregnancy, which will cover in a future 487 00:25:54,920 --> 00:25:57,720 Speaker 2: episode of The Kick. And so we want to know 488 00:25:57,800 --> 00:26:00,040 Speaker 2: whether the woman, what the woman's blood group is, and 489 00:26:00,119 --> 00:26:04,080 Speaker 2: whether she's got any abnormal blood antibodies. And then lastly, 490 00:26:05,000 --> 00:26:07,480 Speaker 2: you know the hemoglobin, just hemoglobin and nine levels to 491 00:26:07,480 --> 00:26:10,560 Speaker 2: make sure that they're adequate for nice, healthy early pregnancy. 492 00:26:11,200 --> 00:26:14,919 Speaker 1: Yeah great, all right, So is there any other things 493 00:26:14,960 --> 00:26:18,000 Speaker 1: that would happen at your first GP visit. 494 00:26:18,760 --> 00:26:20,760 Speaker 2: Well, I think the other thing that would commonly happen 495 00:26:20,840 --> 00:26:22,639 Speaker 2: is the GP would ask you, right, yo, where do 496 00:26:22,680 --> 00:26:27,520 Speaker 2: you want to have your care? And we're lucky in Australia. 497 00:26:27,560 --> 00:26:31,359 Speaker 1: We've got options, so many options, so many options that 498 00:26:31,440 --> 00:26:32,800 Speaker 1: sometimes it's a little confusing. 499 00:26:33,280 --> 00:26:37,720 Speaker 2: Yep, it certainly, it certainly can be confusing, but I 500 00:26:37,720 --> 00:26:41,520 Speaker 2: think we can help people, you know, sort of clear 501 00:26:41,600 --> 00:26:44,720 Speaker 2: some of that confusion a little bit. And that first 502 00:26:44,800 --> 00:26:47,080 Speaker 2: visit with the local doc is a great idea to 503 00:26:47,080 --> 00:26:50,280 Speaker 2: get the local doc's view on that and the options 504 00:26:50,280 --> 00:26:53,919 Speaker 2: that are available to you in your local area. The 505 00:26:54,040 --> 00:26:58,200 Speaker 2: pregnancy care in Australia is typically provided by a number 506 00:26:58,240 --> 00:27:04,879 Speaker 2: of different practitioners, from midwives from gps, from independent midwives 507 00:27:04,880 --> 00:27:10,480 Speaker 2: out of a hospital up to consultant obstetrician and there's 508 00:27:10,800 --> 00:27:13,760 Speaker 2: a choice available to people which is terrify. So the 509 00:27:13,760 --> 00:27:16,520 Speaker 2: GP can help you find your way through that mace. 510 00:27:17,800 --> 00:27:20,439 Speaker 2: It's good idea in the first trimester to make a 511 00:27:20,600 --> 00:27:23,720 Speaker 2: decision about where that care will happen. The Ancinata clinic 512 00:27:23,760 --> 00:27:27,080 Speaker 2: of your local public hospital. You might go there at 513 00:27:27,400 --> 00:27:30,920 Speaker 2: ten or twelve weeks and be assessed again as to 514 00:27:30,960 --> 00:27:33,080 Speaker 2: whether you need you've got high risk issues that need 515 00:27:33,160 --> 00:27:36,880 Speaker 2: to see the doctors and obstetricians every time, or whether 516 00:27:36,920 --> 00:27:40,080 Speaker 2: you've got lower risk issues and can go through the 517 00:27:40,080 --> 00:27:44,440 Speaker 2: Midwiffree clinic, see midwife each time and be booted out 518 00:27:44,440 --> 00:27:48,000 Speaker 2: back to the high risk clinic if you develop some abnormality, 519 00:27:48,119 --> 00:27:50,720 Speaker 2: or you might be able to see a midwife practicing 520 00:27:50,760 --> 00:27:53,600 Speaker 2: outside the hospital who does lower risk et ceterac here 521 00:27:53,640 --> 00:27:56,639 Speaker 2: in the same way. And then a lot of people 522 00:27:56,680 --> 00:28:01,240 Speaker 2: can have care through private obstetrician, which is what I 523 00:28:01,320 --> 00:28:05,120 Speaker 2: do for a living. It's a very very rewarding relationship 524 00:28:05,200 --> 00:28:08,520 Speaker 2: I think where people get to see the same person 525 00:28:08,840 --> 00:28:13,240 Speaker 2: i e. The obstetric right through the pregnancy for each 526 00:28:13,280 --> 00:28:17,160 Speaker 2: of the visits and also have that person attend the 527 00:28:17,200 --> 00:28:20,159 Speaker 2: birth to support the woman in birth and deal with 528 00:28:20,200 --> 00:28:21,639 Speaker 2: any complications that could arise. 529 00:28:21,880 --> 00:28:22,080 Speaker 1: Yeah. 530 00:28:22,760 --> 00:28:25,120 Speaker 2: And then and then lastly, there's a thing called shared 531 00:28:25,160 --> 00:28:28,440 Speaker 2: care where you can have your pregnancy visits with your 532 00:28:28,440 --> 00:28:32,320 Speaker 2: GP if they're a GP with an interest in pregnancy care, 533 00:28:32,960 --> 00:28:36,640 Speaker 2: and then from time to time a visit at the hospital. 534 00:28:36,720 --> 00:28:39,200 Speaker 1: And it really you know, your decision might be based 535 00:28:39,240 --> 00:28:43,000 Speaker 1: around whether you have private health insurance or not, and 536 00:28:43,040 --> 00:28:46,760 Speaker 1: we do see it in the practice where people want 537 00:28:46,800 --> 00:28:49,520 Speaker 1: to come and see you, but perhaps they haven't had 538 00:28:49,560 --> 00:28:53,120 Speaker 1: their private health insurance for long enough. So you know, 539 00:28:53,240 --> 00:28:55,240 Speaker 1: in the it's another thing to put into your pre 540 00:28:55,280 --> 00:28:57,160 Speaker 1: planning stage and phase. 541 00:28:57,200 --> 00:28:58,680 Speaker 2: I think it's on our list, isn't it. 542 00:28:58,760 --> 00:28:58,920 Speaker 1: Yeah. 543 00:28:59,000 --> 00:29:01,520 Speaker 2: Yeah, yeah. If you're thinking of having a baby and 544 00:29:01,560 --> 00:29:03,800 Speaker 2: you're thinking that when you are pregnant you might go 545 00:29:03,880 --> 00:29:07,240 Speaker 2: through a private obstetution and in particular to give birth 546 00:29:07,280 --> 00:29:09,880 Speaker 2: to private hospital, then you need to have you ducks 547 00:29:09,920 --> 00:29:11,920 Speaker 2: in a row with insurance in advance. 548 00:29:11,760 --> 00:29:13,600 Speaker 1: At least nine months in advance. 549 00:29:13,960 --> 00:29:16,480 Speaker 2: Yeah, well, most of with most of the health funds, 550 00:29:16,480 --> 00:29:19,880 Speaker 2: if you increase your cover to cover pregnancy, then they 551 00:29:19,920 --> 00:29:22,400 Speaker 2: won't cover you for a year. Now, the year includes 552 00:29:22,440 --> 00:29:24,480 Speaker 2: the nine months of the pregnancy. So then if you 553 00:29:24,640 --> 00:29:28,520 Speaker 2: once you've increased your cover, probably not if avoidable not 554 00:29:28,520 --> 00:29:30,800 Speaker 2: to get pregnant that first three months, and then by 555 00:29:30,840 --> 00:29:33,120 Speaker 2: the time the pregnancy is run its course, your year 556 00:29:33,120 --> 00:29:35,520 Speaker 2: will be up. You should be fine, Yeah, because the 557 00:29:35,560 --> 00:29:37,200 Speaker 2: bit the funder paying for is the delivery and the 558 00:29:37,240 --> 00:29:39,640 Speaker 2: private hospital state at the end. Yes, so the nine 559 00:29:39,640 --> 00:29:42,000 Speaker 2: months of the pregnancy are going to count in that year. 560 00:29:42,480 --> 00:29:45,239 Speaker 1: So Let's say you don't have private health insurance and 561 00:29:45,320 --> 00:29:47,800 Speaker 1: you go to your public hospital and you're in the 562 00:29:47,840 --> 00:29:50,640 Speaker 1: antenatal clinic. You mentioned that they may not see you 563 00:29:50,640 --> 00:29:53,760 Speaker 1: if you're considered low risk until about fifteen weeks. So 564 00:29:53,920 --> 00:29:57,200 Speaker 1: is this something that your doctor will discuss with you 565 00:29:57,240 --> 00:30:00,680 Speaker 1: what happens between their visit at six weeks and when 566 00:30:00,720 --> 00:30:02,280 Speaker 1: you see someone at the anteen eighty climate. 567 00:30:02,480 --> 00:30:05,440 Speaker 2: Yeah, that's a terrific question and something that I'm quite 568 00:30:05,480 --> 00:30:08,240 Speaker 2: passionate about because in that gap there's a couple of 569 00:30:08,240 --> 00:30:10,120 Speaker 2: things that need to be done, and the big ticket 570 00:30:10,120 --> 00:30:13,080 Speaker 2: one is down syndrome screening. So if the couple want 571 00:30:13,120 --> 00:30:17,120 Speaker 2: down syndrome screening, that needs to be organized through the 572 00:30:17,160 --> 00:30:20,440 Speaker 2: local dock because the window to get that done is 573 00:30:20,480 --> 00:30:24,240 Speaker 2: going to have expired by the time the couple get 574 00:30:24,240 --> 00:30:27,000 Speaker 2: to the public antenatal clinic, if that's where they're going, 575 00:30:27,760 --> 00:30:30,600 Speaker 2: if they're going to a private obstetrition I see patients 576 00:30:30,600 --> 00:30:32,760 Speaker 2: who are referred to me at ten weeks, so that 577 00:30:32,800 --> 00:30:35,160 Speaker 2: I can organize the down syndrome screening because I've got 578 00:30:35,200 --> 00:30:38,160 Speaker 2: my people who do it well and so forth. But 579 00:30:38,920 --> 00:30:40,840 Speaker 2: a patient on their way to the public clinic that's 580 00:30:40,880 --> 00:30:42,440 Speaker 2: going to have to be sorted out first. 581 00:30:42,760 --> 00:30:47,160 Speaker 1: Yeah, and we'll do a whole other kick episode about 582 00:30:47,800 --> 00:30:51,800 Speaker 1: down syndrome screening and the NIPS test. But I think 583 00:30:52,000 --> 00:30:53,800 Speaker 1: you know, it's just important for women to talk to 584 00:30:53,840 --> 00:30:56,320 Speaker 1: their GP at their six week visit, yes, about what 585 00:30:56,360 --> 00:30:59,360 Speaker 1: their plan might be for their down syndrome screening, whether 586 00:30:59,400 --> 00:31:00,680 Speaker 1: they have it or not, that's choice. 587 00:31:00,720 --> 00:31:02,320 Speaker 2: Oh yeah, that one's optional. You don't have to have it, 588 00:31:02,360 --> 00:31:05,160 Speaker 2: but if you do want it, it's very important and 589 00:31:05,200 --> 00:31:06,680 Speaker 2: dear in my heart that it's offered to you at 590 00:31:06,680 --> 00:31:10,320 Speaker 2: the right time so that we don't have people turning 591 00:31:10,400 --> 00:31:12,640 Speaker 2: up in more advanced pregnancy who haven't been screened. 592 00:31:13,000 --> 00:31:15,840 Speaker 1: And this is all about having the knowledge to be 593 00:31:15,880 --> 00:31:19,840 Speaker 1: premed with the facts. You know, we have seen it before, 594 00:31:19,920 --> 00:31:22,360 Speaker 1: haven't we, Where somebody's come to our practice and they've 595 00:31:22,400 --> 00:31:26,280 Speaker 1: come later they might have swapped out of the antenatal 596 00:31:26,360 --> 00:31:29,200 Speaker 1: care into private care or whatever it might be, and 597 00:31:29,240 --> 00:31:32,320 Speaker 1: that window is passed. So you know, that's a point 598 00:31:32,360 --> 00:31:34,520 Speaker 1: of great sort of confusion and frustration. 599 00:31:35,040 --> 00:31:38,640 Speaker 2: Yes, this is our part of our knowledge is power mantra. 600 00:31:39,480 --> 00:31:44,280 Speaker 2: We really want to see an educated group of young 601 00:31:44,320 --> 00:31:48,160 Speaker 2: women who know the basic facts about these things so 602 00:31:48,240 --> 00:31:51,840 Speaker 2: that they can take personal power and responsibility for making 603 00:31:51,840 --> 00:31:55,400 Speaker 2: sure that some of the stuff gets done properly and 604 00:31:55,400 --> 00:31:57,920 Speaker 2: that they can take full advantage of all of the 605 00:31:58,040 --> 00:32:03,440 Speaker 2: technology that's available. And I guess our ideal patient out there, 606 00:32:03,520 --> 00:32:08,200 Speaker 2: our ideal young pregnant woman is someone who is literate 607 00:32:08,280 --> 00:32:11,760 Speaker 2: pregnancy literate, knows about these things and says, Okay, I 608 00:32:12,040 --> 00:32:14,640 Speaker 2: already know what I need, and I'm interested in the 609 00:32:15,440 --> 00:32:18,479 Speaker 2: doctor's expertise, but I've also learned a lot myself. 610 00:32:18,480 --> 00:32:21,680 Speaker 1: All right, So what are we doing? Is everything at 611 00:32:21,720 --> 00:32:23,680 Speaker 1: the GPS. You know there's a lot to cover in 612 00:32:23,720 --> 00:32:24,680 Speaker 1: twenty minute appointment. 613 00:32:24,840 --> 00:32:27,160 Speaker 2: Well, that's a good point. You should book a long appointment. 614 00:32:28,200 --> 00:32:30,160 Speaker 2: It's an awfully long time ago. But I was a 615 00:32:30,240 --> 00:32:33,440 Speaker 2: GP once upon a time, and you book a long appointment, 616 00:32:33,520 --> 00:32:34,920 Speaker 2: especially if there's something to discuss. 617 00:32:35,160 --> 00:32:37,200 Speaker 1: So you're ringing up the receptionist and you're saying, I 618 00:32:37,240 --> 00:32:38,120 Speaker 1: need a long appointment. 619 00:32:38,200 --> 00:32:40,360 Speaker 2: Yeah, yeah, yeah, And I'm sure the GP i'd love 620 00:32:40,400 --> 00:32:42,600 Speaker 2: you booked that in advance, especially if there's a lot 621 00:32:42,640 --> 00:32:44,800 Speaker 2: to discuss. Yeah, if you think it's going to be 622 00:32:45,000 --> 00:32:47,280 Speaker 2: the GP goes congratulations. Here's some blood tests. He's an 623 00:32:47,360 --> 00:32:50,360 Speaker 2: ultrasound and he's a referral to doctor Maloney. Then great, 624 00:32:50,680 --> 00:32:54,080 Speaker 2: ten minutes, it's done. But you know, if this is 625 00:32:54,120 --> 00:32:57,880 Speaker 2: your first pregnancy after a period of infertility, and you've 626 00:32:57,920 --> 00:33:02,280 Speaker 2: got a history of type one diabetes and hyper thyroidism 627 00:33:02,320 --> 00:33:05,080 Speaker 2: and a strong family history of cystic fibrosis, then okay 628 00:33:05,680 --> 00:33:05,960 Speaker 2: to do. 629 00:33:06,120 --> 00:33:10,880 Speaker 1: Yeah, yeah, that's right. Thank you everyone for listening to 630 00:33:10,960 --> 00:33:14,080 Speaker 1: our episode. I hope you are now the full bottle 631 00:33:14,160 --> 00:33:16,480 Speaker 1: on what to do next now that you've got your 632 00:33:16,520 --> 00:33:19,800 Speaker 1: p on the stick. As we always say, if you 633 00:33:19,880 --> 00:33:22,920 Speaker 1: find our information useful, then share it with a friend, 634 00:33:23,600 --> 00:33:26,400 Speaker 1: and if you are so inclined, please give us a 635 00:33:26,640 --> 00:33:30,640 Speaker 1: five star review on either Spotify or Apple Podcasts, because 636 00:33:30,640 --> 00:33:33,360 Speaker 1: that then helps those platforms to push them out to 637 00:33:33,520 --> 00:33:36,520 Speaker 1: other people, and that really helps our message get out 638 00:33:36,600 --> 00:33:39,080 Speaker 1: to all those people that are probably floundering with some 639 00:33:39,160 --> 00:33:43,120 Speaker 1: information on pregnancy that they need. All right, until next week, 640 00:33:43,200 --> 00:33:45,960 Speaker 1: we'll be back in your ears. Then keep growing those 641 00:33:45,960 --> 00:33:54,960 Speaker 1: babies by fore an our Hey, even though doctor Pat 642 00:33:55,080 --> 00:33:57,200 Speaker 1: is well a doctor and we get lots of other 643 00:33:57,240 --> 00:34:00,520 Speaker 1: doctors and other experts on our podcast, just need to 644 00:34:00,560 --> 00:34:04,640 Speaker 1: remind you that this podcast is for informational purposes only. 645 00:34:05,280 --> 00:34:08,760 Speaker 1: We share lots of medical insights and experience, but everything 646 00:34:08,800 --> 00:34:11,799 Speaker 1: we talk about is general in nature and may not 647 00:34:11,840 --> 00:34:16,120 Speaker 1: apply to your specific situation. Please always consult with your 648 00:34:16,120 --> 00:34:20,040 Speaker 1: own healthcare provider for your individual medical advice. When you 649 00:34:20,080 --> 00:34:20,840 Speaker 1: grow your baby,