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Speaker 1: You're listening to a Muma Mia podcast.

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Speaker 2: Mom and Maya acknowledges the traditional owners of land and

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Speaker 2: waters that this podcast is recorded on.

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Speaker 3: I am pregnanty.

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Speaker 1: Welcome to Hello Bump.

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Speaker 2: We're making pregnancy less overwhelming and more manageable.

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Speaker 1: I'm Grace Rubrey.

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Speaker 2: I'm pregnant for the first time and the rings on

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Speaker 2: my fingers are starting to feel a little tight.

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Speaker 3: Oh shame. I'm Yana Pittman. I'm a former Olympian mother

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Speaker 3: of six, and I'm training to be an obstetrician.

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Speaker 2: Each week, we'll be holding your hand week by week

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Speaker 2: through the mysterious perplexing where every day is a whole

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Speaker 2: new symptom, but still a miracle. It is pregnancy all

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Speaker 2: the way from a poppy seed to a pumpkin.

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Speaker 1: Week twenty eight, How big is our baby?

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Speaker 3: So we're kind of looking at a baby that's around

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Speaker 3: the size of a coconut.

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Speaker 2: Now it is a large eggplant, loafe of bread, lofe

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Speaker 2: of bread.

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Speaker 1: One of those half ones are like a full one.

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Speaker 1: It's a half one.

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Speaker 2: Yeah, you to compare it to the goga dar a

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Speaker 2: full one feels aggress see it if it was like

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Speaker 2: maybe full term yeah, yeah, that's a full time baby.

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Speaker 1: Yeah, a big sour dough full term baby.

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Speaker 3: And an animal from Australia as a potteroo.

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Speaker 1: What's the potter room? I don't really know. I was

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Speaker 1: hoping you could tell me. I googled that one. It

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Speaker 1: feels like some type of marsupial. That's a right greatly.

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Speaker 3: Something, but it's about a kilo in size by if

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Speaker 3: you're actually thinking about the measurement per se.

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Speaker 2: And what's our placenta measuring? Like, wait wise, because if

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Speaker 2: we're starting to feel uncomfortable and like we aren't carrying

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Speaker 2: more weight, if the baby's only one kilo, what's our

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Speaker 2: placenta's sort of way well?

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Speaker 3: Percenters and will change through out pregnancy depending on how

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Speaker 3: much nutrition is going through and whether you've got preclamps

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Speaker 3: or anything like that. But you've also got the amniotic fluids.

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Speaker 3: You got to think there's a lot more than just

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Speaker 3: your percent to your baby and your own blood volumes.

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Speaker 3: There's a whole lot more changing in your body at

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Speaker 3: this point.

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Speaker 1: The blood volume, keep your exact blood volume.

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Speaker 2: Yeah, and how has that baby developed this week?

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Speaker 3: Baby's growing rapidly at this point, so he or she

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Speaker 3: in your case, she is now starting to develop sleep

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Speaker 3: wake cycles and might even be having rem sleep, which

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Speaker 3: I think is really cute to think that they're actually

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Speaker 3: having those similar cycles that they will when they're a

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Speaker 3: kid in adult and they're now seeing more defined grooves

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Speaker 3: in their brain, so that brain isn't again growing and differentiating.

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Speaker 2: And this is that theory of like the sleep cycle

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Speaker 2: is every ninety minutes or so, you should probably feel something.

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Speaker 3: In field movements exactly. And you might find this point

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Speaker 3: if you've gone in with the CREASFIITL movements to the hospital.

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Speaker 3: For example, they'll put on a little CTG where they

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Speaker 3: actually monitor baby's heart rate and we actually can see

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Speaker 3: it on the scan. You can actually see when the

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Speaker 3: baby has like a lower heart rate, when it's actually

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Speaker 3: dropping and not doing very much activity, and then it

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Speaker 3: becomes really active.

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Speaker 1: And that's what we.

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Speaker 3: Call those sleepwake cycles. And we do want you to

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Speaker 3: watch that because sometimes if there's no movements, it's a

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Speaker 3: little one sleeping. But if that is going on for

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Speaker 3: too long, then we need to really adjust how we're

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Speaker 3: thinking about our baby's movements and potentially go and see

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Speaker 3: the hospital.

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Speaker 2: It is a hard one because sometimes if you're busy,

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Speaker 2: you haven't really checked in with your body. I even

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Speaker 2: had it just this morning. I was like, I haven't

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Speaker 2: felt her normally. I feel her when I'm laying down

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Speaker 2: in bed. And then I was busy and I went

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Speaker 2: and had food, and then I came and lay on

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Speaker 2: the couch and I was like, just check in, and

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Speaker 2: then she moved.

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Speaker 1: I was like, okay, but I.

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Speaker 3: Think you hit the nail on the head there. So

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Speaker 3: taking some time out is your first step if you

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Speaker 3: think your babies, if you haven't really during the day

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Speaker 3: you think, oh, maybe they're not moving as much, is

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Speaker 3: to just take that twenty minutes time out, have something

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Speaker 3: to eat, drinks and water, because often they do have

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Speaker 3: less movement. When you're a little bit dehydrated, lie down

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Speaker 3: and see if you can check in with your little one.

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Speaker 1: What's happening, what's happening to me, and what's happening to

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Speaker 1: our bodies.

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Speaker 3: Well, I think we'll go into this quite a bit,

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Speaker 3: but now your uterus is pushing up very much underneath

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Speaker 3: that rib cage, so there's a lot less movement of

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Speaker 3: that diaphragm and your lung, so you're going to feel

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Speaker 3: a lot more breathless. So and I think women are

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Speaker 3: still trying to do a lot twenty eight weeks and

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Speaker 3: it's starting to get harder. So all bending down, tying

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Speaker 3: your shoelaces, all that sort of stuff is now going

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Speaker 3: to become just that little bit more challenging.

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Speaker 1: Yes, that's definitely happening for me.

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Speaker 2: And I wanted to ask about when they're sort of

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Speaker 2: up around your ribs, that you're starting to feel that discomfort.

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Speaker 2: But then one of the biggest things that you hear

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Speaker 2: about preoclampsia is pain underneath the ribs.

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Speaker 1: It's differentiating.

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Speaker 2: It's like everything in pregnancy is like a normal symptom

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Speaker 2: or like you should go to the hospital, and it's

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Speaker 2: just whether it's paired with the right amount of things.

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Speaker 2: So how do we figure out the difference between the

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Speaker 2: discomfort and when we should be worried.

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Speaker 3: That's a tough question to say. Look, I think things

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Speaker 3: like preclamps is obviously related to blood pressure, and that's

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Speaker 3: to do with the way your capsule around your liver

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Speaker 3: is being irritated or swelling. So it's a late stage

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Speaker 3: of preclamps And now that's and I know my fellow

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Speaker 3: obstetric trainees and bosses will go, oh, that's not correct

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Speaker 3: going or it can be the first stage, because there's

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Speaker 3: definitely different ways that preclamps you can eventuate. But in

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Speaker 3: most cases you leave the fighter baby that's small and ultrasound,

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Speaker 3: and then they look for a reason why, or a

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Speaker 3: woman has increased dema quickly and sometimes unilateral. Sometimes it

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Speaker 3: happens more.

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Speaker 1: You know, all of us swelling.

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Speaker 3: Pregnant emma is swelling, Yes, swelling exactly. Sorry, yes, thank

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Speaker 3: you for the non medical deal. But it happens more quickly,

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Speaker 3: so we do expect to see some swelling again, can

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Speaker 3: be normal, can be a problem. Headaches is a big one.

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Speaker 3: Changes in your vision, so any of those kind of

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Speaker 3: things clue us into what's going on. But again, headaches

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Speaker 3: are normal in pregnancy.

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Speaker 1: Vision changes not so much.

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Speaker 3: If you have diabetes. It's a really big one when

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Speaker 3: you have to check in with your eyesight because it

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Speaker 3: can deteriorate ord written not with the in pregnancy. But

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Speaker 3: all of those things can be very normal. And that's

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Speaker 3: the hardest part is if you're concerned, that's what a

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Speaker 3: midwife and a doctor's for. Give them a call, tell

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Speaker 3: them what you're symptoms are. They'll either reassure you or

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Speaker 3: tell you to come in for an assessment.

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Speaker 2: Yeah.

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Speaker 1: Look, I have made calls to my midwife.

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Speaker 2: I was sitting at a high bench at a pub

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Speaker 2: and my calves were swollen and I was like, oh

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Speaker 2: my gosh, another DBT or yeahah yeah, and I had

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Speaker 2: a slight headache as well, and I was like, this

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Speaker 2: is it.

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Speaker 1: It's like it's the end.

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Speaker 2: And then she I just called and she was like, no,

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Speaker 2: it's sort of be like swelling and it doesn't go down. Yeah,

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Speaker 2: it's like look for your face, your hands, but the hands.

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Speaker 1: Get itchy too.

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Speaker 3: Not yet, hopefully in pregnancy if you can get to

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Speaker 3: think called colystasis, which is when you get itchy hens

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Speaker 3: and feet. We actually had a lady this week come

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Speaker 3: in with rip rowing colystasis, and the only symptoms she

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Speaker 3: had was itchy hens and otherwise a completely healthy pregnancy

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Speaker 3: had been It was her second pregnancy, no concerns in

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Speaker 3: the last one, and this one we had to unfortunately

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Speaker 3: birth her earlier because she had significant problems with her liver. Again,

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Speaker 3: liver pain could be a symptom.

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Speaker 1: Of that as well.

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Speaker 3: So there's all these different things in pregnancy that can

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Speaker 3: point to different directions of what's going on.

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Speaker 2: It is that thing of like, every symptom is normal,

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Speaker 2: every symptom is problematic. Potentially sorry, yeah, potential problematic, And

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Speaker 2: it's okay to call.

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Speaker 3: In fact, we want we want you to. I think

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Speaker 3: the biggest thing that comes out of that is if

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Speaker 3: you're concerned. It's most public hospitals are a twenty four

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Speaker 3: to seven service. So that's why we're there, is for reassurance,

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Speaker 3: but also to occasionally pick up on what mum's intuition

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Speaker 3: is saying, because often it's the thing to go by most.

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Speaker 1: Is this normal is normal?

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Speaker 2: Is this normal is about nipples?

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Speaker 1: Okay?

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Speaker 2: Sometimes they are a little bit crusty when I take

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Speaker 2: off my bra at nighttime, and I just don't know

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Speaker 2: if that's is that too early for colostrum or what

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Speaker 2: are the changes around this time that we can start

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Speaker 2: to see.

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Speaker 3: Well, your breasts start changing in first tremester already you

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Speaker 3: notice that the size change yet Okay, sure, think but

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Speaker 3: it's also that the ductal developments. Everything's changing to get

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Speaker 3: you in preparation for breastfeeding. It's not too early. We

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Speaker 3: do have women that have colostrum at twenty eight thirty weeks.

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Speaker 3: It's normally closer to thirty four and thirty six. We

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Speaker 3: don't want you to stimulate your breasts, ladies, at this gestation,

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Speaker 3: because pre term labor is not something we want to induce,

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Speaker 3: and it's very much an old wives tale, and certainly

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Speaker 3: in countries that don't have sintocin and things like that,

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Speaker 3: where they actually get women to stimulate their nipples in

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Speaker 3: early labor to try and get that labor starting. So

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Speaker 3: we don't want that just yet, but it's usually a

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Speaker 3: good sign. If you can get some closterum coming naturally,

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Speaker 3: it means that you've got a better chance of being

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Speaker 3: out of breastfeed if that's what you choose to do.

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Speaker 2: And still even if you are, haven't cost them now.

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Speaker 2: It's not an indication of how well or how easy.

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Speaker 2: It's just a real mix bag. I think one of

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Speaker 2: the things that I've been told by a lot of

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Speaker 2: pregnant friends is how hard breastfeeding is, and they were

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Speaker 2: just not prepared for how hard it was going to be.

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Speaker 3: And I think that's a lovely message to even be

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Speaker 3: saying now, because there should be no judgment in this space.

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Speaker 3: Yet there is so much judgment, and there's so much

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Speaker 3: on social media, and so many women walk out of

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Speaker 3: that experience feeling like they've let them and their babies down,

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Speaker 3: when ultimately I have breastfed most of my babies. One

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Speaker 3: of them was particularly difficult, and I like the saying

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Speaker 3: fedti's best. But if you can't, the relationship with your

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Speaker 3: baby could being greatly affected if you push that envelope

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Speaker 3: too hard and it's not working, and it's sometimes just

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Speaker 3: nicer for the entire relationship to say this isn't working.

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Speaker 3: I've sought out all the options, I've tried everything. Congrats,

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Speaker 3: I've done a great job. And stop it earlier than before.

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Speaker 3: You're really hitting a brick wall with it.

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Speaker 2: And what can we do this week? What are some

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Speaker 2: important things to book in or.

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Speaker 3: Look that for. I think twenty eight weeks is a

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Speaker 3: really important time because this is when we start actually

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Speaker 3: looking for babies that may be struggling. So we sort

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Speaker 3: of touched on preclamps here, and obviously there's things like diabetes,

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Speaker 3: So around twenty eight weeks is when we first look

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Speaker 3: for signs in your baby via ultrasound. So if you

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Speaker 3: have a higher risk pregnancy, even just being a bit

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Speaker 3: older unfortunately puts.

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Speaker 1: Through in that categories.

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Speaker 3: Sometimes we like to do an ultrasound at twenty eight

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Speaker 3: weeks because we actually start looking at babies growth and

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Speaker 3: then compare it at thirty two and thirty six weeks

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Speaker 3: to make sure they're not either becoming too big in

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Speaker 3: the case of diabetes, which is called macrosomia, or becoming

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Speaker 3: too small in the case of growth restriction. So we

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Speaker 3: also look at dopplers now, so we start looking at

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Speaker 3: the vessels that feed your baby, and the particular vessels

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Speaker 3: for example, in the baby's brain and around their liver,

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Speaker 3: around how they're coping with the pregnancy as a whole.

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Speaker 2: Well, for my talk kit this week, I wanted to

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Speaker 2: actually ask you a question about iron tablets versus an

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Speaker 2: iron infusion. So I was on iron tablets and just

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Speaker 2: taking them every second day was what I was prescribed.

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Speaker 2: They've redone my iron, hemoglobin and vitamin D and it

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Speaker 2: was mostly fun except my iron had gone down even

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Speaker 2: though I was on iron tablets every second day, and

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Speaker 2: they just said to go well, up your tablets to

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Speaker 2: every day now. But why isn't it going straight to

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Speaker 2: an iron infusion. Why would we be waiting at twenty

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Speaker 2: eight weeks?

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Speaker 3: Yeah, great question, now, I think the big thing is

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Speaker 3: I actually learned this only two weeks ago, which shows

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Speaker 3: I'm really.

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Speaker 1: Still training guys.

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Speaker 3: Okay, so there's a lot of smarter doctor other than me.

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Speaker 3: But we actually excrete a lot more of the components

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Speaker 3: that make up iron and hemoglobin through the urine when

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Speaker 3: we're pregnant because we've got leakia glamarola. Like basically your

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Speaker 3: kidneys work harder and so you're losing some of that

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Speaker 3: ability to hold onto your iron. Plus the baby takes

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Speaker 3: your iron, Plus you're obviously using it more to create

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Speaker 3: more hemoglobin, which is how you carry oxygen around your body.

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Speaker 3: So you are definitely going to be depleted. And so

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Speaker 3: ooral ion is fantastic. We don't absorb enough of it,

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Speaker 3: which is why sometimes women all require or they get

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Speaker 3: really constipated, let's be honest, and they can't tolerate taking

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Speaker 3: oral Ion's probably the biggest reason women don't take it.

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Speaker 3: Then we start looking at an infusion. But why do

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Speaker 3: we want this? It's optimizing birth, So it's actually not

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Speaker 3: about now, Yes, it helps fatigue in things, but you

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Speaker 3: know you're going to lose a bit of blood when

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Speaker 3: you actually have your baby, and so if you go

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Speaker 3: into that space with a low hemoglobe, so a low

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Speaker 3: carrying capacity of oxygen, you're going to feel terrible. So

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Speaker 3: if we do it now, though, it's just a little

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Speaker 3: too early, so unless we think your labor is coming soon.

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Speaker 3: So if there's some an indication that you've either had

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Speaker 3: a bleed, for example, if you've got an aph, if

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Speaker 3: you're bleeding regularly and your ions dropped significantly and you've

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Speaker 3: got a low, really low hemoglob and then of course

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Speaker 3: we'll do an iron infusion or sometimes a blood transfusion,

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Speaker 3: but ideally we wait till about thirty four to thirty

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Speaker 3: six weeks to make sure the ooral didn't work and

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Speaker 3: that we're giving it close enough to birth that's going

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Speaker 3: to support you when you need it most, which is

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Speaker 3: in labor and that postpartum period.

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Speaker 2: We hope you enjoyed this episode of Hello Bump. We

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Speaker 2: have so many episodes of this series filled with tips

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Speaker 2: and stories from women and.

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Speaker 1: Experts who've been through it all before.

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Speaker 3: You can go back and listen to everything else Hello

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Speaker 3: Bump related in this podcast feed.

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Speaker 2: And while you're there, we'd love if you could give

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Speaker 2: us a flying star rating and maybe leave us a review,

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Speaker 2: or even share this episode with a friend.

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Speaker 3: This episode was produced by Courtne Ammenhauser with audio production

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Speaker 3: by Tom Lyon We'll catch you next time.

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Speaker 2: This episode of Hello Bump was made in partnership with

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Speaker 2: Huggies Bye Bye