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

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

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Speaker 1: becoming a parent.

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

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

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Speaker 2: babies to be born.

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Speaker 1: And our experience of running a women's health clinic and

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Speaker 1: parenting for boys.

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

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

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Speaker 1: Welcome everyone. I'm Bridgid Maloney.

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Speaker 3: And I'm obstitrician doctor Patrick.

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Speaker 1: Maine, and we're going to do another Q and A today, Pat,

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Speaker 1: I can't believe how quickly Q and A has come around,

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Speaker 1: Like we try to do one a month and I

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Speaker 1: can't believe it's been like a month since we've done one.

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Speaker 3: I love that everyone gets in touch. It's fantastic.

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Speaker 1: It is really good, isn't it.

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Speaker 3: So?

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Speaker 1: You know we like to get straight to the point

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Speaker 1: and start it all off, don't we?

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Speaker 4: No?

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Speaker 1: I mucking around? Big your pardon?

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Speaker 3: We get let's go.

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Speaker 1: Let's go.

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Speaker 4: My doctor pattern Bridget, I have just had my first

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Speaker 4: cesarean after two vaginal births. My baby was breach so

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Speaker 4: it was a planned caesar, and I just have a

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Speaker 4: question about post cesarean pain. So I experienced some episodes

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Speaker 4: of pain after the Caesar that were i would say

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Speaker 4: worse than my previous sort of mostly unmedicated vaginal birth,

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Speaker 4: so really severe pain kind of up and to the

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Speaker 4: side of where the incision was, but not around the

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Speaker 4: incision itself. And then I also experienced sometimes of just

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Speaker 4: really expreciating pain where I would start off walking and

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Speaker 4: be perfectly fine, and after about sort of ten twenty

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Speaker 4: meters just being kind of this agonizing, sort of burning

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Speaker 4: pain around my belly. And my question is is that

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Speaker 4: a normal experience of post cesarean pain and recovery, because

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Speaker 4: I just found that the sort of presentation of the

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Speaker 4: pain was really unusual and unexpected for what I thought

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Speaker 4: I would be in, which would be sort of like

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Speaker 4: a low level constant pain. So yeah, I'll just be

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Speaker 4: interesting to hear about kind of what is normal post

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Speaker 4: caesar pain and what can others expect in a recovery.

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Speaker 1: All right, So is this post cesarean section pain normal?

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Speaker 1: What can people expect from post aesarian pain?

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Speaker 3: Yeah? I think this is a really good question because

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Speaker 3: it highlights the difference between the pain we might experience

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Speaker 3: after a vaginal birth versus after a caesar, and our

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Speaker 3: caller is an expert because she's had both. So let's

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Speaker 3: break this down a little bit. When we've had a

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Speaker 3: vaginal birth, there's sort of two different types of pain

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Speaker 3: to be expected. There's there's something called involution pain, which

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Speaker 3: is where the urus is coming back to its old

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Speaker 3: size and shape. And then there's also and that pain

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Speaker 3: can be severe, intermittent, sometimes brought on by breast feeding.

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Speaker 3: So every time we feed the baby, the uterus cramps

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Speaker 3: a little bit, and that's zeros trying to go back

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Speaker 3: to its old size and shape, which is a big

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Speaker 3: difference between term uterus with the baby and placenta still

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Speaker 3: inside versus trying to go back to its old little

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Speaker 3: apricot sized, non pregnant shade. And then there's pain that

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Speaker 3: she might experience around the vaginal opening from the stretching

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Speaker 3: of vaginal childbirth plus or minus a tear and stitches.

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Speaker 3: And that's a lot to deal with, and it tends

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Speaker 3: to be a lot in the first couple of weeks.

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Speaker 3: With the cesarean section situation, you get all you get,

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Speaker 3: the involution pain, you don't get the vaginal opening pain

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Speaker 3: because that's not where the baby came out, But you

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Speaker 3: do get surgical pain because we've cutched tummy open, and

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Speaker 3: so it's it's different. And what what our listener is

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Speaker 3: describing is pretty typical surgical pain, and it's not outside

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Speaker 3: the realms of normality for that to still be going

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Speaker 3: intermittently at two weeks.

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Speaker 1: And she talks about pain to the edge of where

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Speaker 1: the incisions sort of started or stopped.

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Speaker 3: Yeah, so this is thought to be because when we

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Speaker 3: make the cut, we're certainly cutting through some cutaneous nerves

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Speaker 3: in the skin, and then you know, sometimes it's it's

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Speaker 3: not awesome to know how the sausage is made sort

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Speaker 3: of thing with surgery. But when we open the sheath,

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Speaker 3: which is the strong layer under the skin that keeps

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Speaker 3: our insides in, we give it a pretty big to

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Speaker 3: make that whole big enough for the baby's had to

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Speaker 3: come out. And that's that's you know, you can have

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Speaker 3: You can have more bruising and swelling on one side

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Speaker 3: than the other, which presumably explains why the pain can

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Speaker 3: be a fair bit worse on one side than the other.

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Speaker 1: And I don't know like it for me I remember

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Speaker 1: the very first cesarian I had. I did have a

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Speaker 1: lot of right side pain at the edge of the incision,

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Speaker 1: and I think it is that cutaneous nerve pain. And

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Speaker 1: if I would say one thing, it does get better.

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Speaker 1: Like nerves do heal, absolutely, so these are the nerves

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Speaker 1: that do heal.

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Speaker 3: So we if we make a surgical cut in the skin,

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Speaker 3: those nerves will will settle down and heal. These aren't

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Speaker 3: like it's not like a spinal cord where the dam

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Speaker 3: which those nerves can be permanent. These are cutaneous nerves

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Speaker 3: that would heal and grow back. So one day, which

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Speaker 3: is just gonna our list is just going to look

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Speaker 3: down down, it's really settled.

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Speaker 1: Yeah, I don't have that pain anymore.

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Speaker 3: Yeah, it'll come along in sort of leaps and bounds.

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Speaker 3: But to still be needing some pain relief for two

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Speaker 3: weeks is common. To still have intermitted in it two

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Speaker 3: weeks and I still have some pain that comes on

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Speaker 3: after walking twenty meters. This is normal and what your

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Speaker 3: body needs is tons of rest, rest and time.

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Speaker 1: Good luck. I hope everything goes well with your healing.

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Speaker 3: Good luck.

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Speaker 1: All right, let's move to our next to Cola.

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Speaker 5: Hello, my name is Stephanie. I'm from Canada. I previously

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Speaker 5: asked a question about traveling while pregnant. So I've had

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Speaker 5: a baby boy December fourth, twenty twenty three, and I

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Speaker 5: breastfed him for two years, and I stopped breastfeeding November fifteenth,

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Speaker 5: twenty twenty five, and I have yet to get my

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Speaker 5: cycle back, and I really want another baby. I've had

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Speaker 5: blood tests done and my most recent blood panel was

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Speaker 5: a bit concerning. I haven't gone over the results with

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Speaker 5: my doctor yet, but it looks it's like that. My

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Speaker 5: estrogen is low. It's less than forty, is what it says,

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Speaker 5: and it's been it's been low, but it hasn't been

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Speaker 5: this low. This is my third blood panel that I've

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Speaker 5: done since January, and my FSH is six point nine,

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Speaker 5: my LH is two point six, which I'm reading is normal.

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Speaker 5: My prolactin is low which is three, and all my

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Speaker 5: other blood results are good. My iron levels are good,

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Speaker 5: my ferretin is a bit low, it's empty anyways, and

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Speaker 5: my testosterone is less than point four. So I just

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Speaker 5: don't know. Am I perimionopostal premenopausal. I just would like

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Speaker 5: some answers, So I just would love your thoughts and

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Speaker 5: what's kind of going on right now? Thank you.

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Speaker 1: I love that big side that she gives this as

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Speaker 1: by having to think about all.

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Speaker 3: Exhaustion and frustration. And whilst I applaud this listener's attempts

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Speaker 3: to sort of nut this out for itself, what she

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Speaker 3: needs is some expert guidance.

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Speaker 1: So think about reading blood tests right, Like, you know,

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Speaker 1: even when I get my blood tests with the doctor

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Speaker 1: that I live with, and I look at them and go,

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Speaker 1: that's like a on the low side of normal, Like

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Speaker 1: what can I do about that?

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Speaker 3: Yeah, So basically the blood sound fine. What I don't

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Speaker 3: know if she told us how old, you know, it's

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Speaker 3: a shame, because that would be very useful. So the

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Speaker 3: things that I would be looking at in this situation

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Speaker 3: what's happening here is that is that it's taking a

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Speaker 3: long time for the natural ovulatory cycle to kick back

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Speaker 3: in after a prolonged period of breastfeeding. And it really

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Speaker 3: depends what we might do about this really depends on

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Speaker 3: exactly what this couple have got planned. So what I

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Speaker 3: would be asking if I'd seen this listener in my

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Speaker 3: consulting room is how much of a hurry are we

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Speaker 3: in here? Because in a young person this will kick

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Speaker 3: back in, and if we've got time to wait, you

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Speaker 3: could just wait. The cycle will come back. There'll be

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Speaker 3: a period that's the new day one, and that should

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Speaker 3: be followed by ovulation halfway through the subsequent month. And

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Speaker 3: that is something we could wait for if the person

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Speaker 3: was young and had enough time to wait. When we've

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Speaker 3: got women in there so mid to late thirties trying

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Speaker 3: to have another baby, we may not have all the

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Speaker 3: time in the world to wait for that. And also

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Speaker 3: it's relevant how many more babies the couple, because we've

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Speaker 3: got to sort of count backwards from our late thirties

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Speaker 3: and say, right, if we want two more babies, then

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Speaker 3: changes the time frame just a little bit. So the

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Speaker 3: there are treatment options here in somebody where this cycle

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Speaker 3: is taking too long to kick back in, and that's

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Speaker 3: something she could certainly discuss with her local doctor. The bloods,

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Speaker 3: as she read out, don't indicate a premature menopause picture.

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Speaker 3: They represent a post part of a menorrhea picture, which

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Speaker 3: is just that the natural cycle hasn't kicked back in yet.

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Speaker 1: Well, I'm sure she'd be pleased to hear that.

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Speaker 3: Well, absolutely, but so the most likely thing to be

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Speaker 3: wrong is nothing, and then if we can afford to wait,

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Speaker 3: we will and it'll come back. And if we can't

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Speaker 3: afford to wait, there are some treatment.

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Speaker 1: Options like ovulation induction or Yeah, good luck with that.

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Speaker 1: Thanks for calling from Canada. We love it. Yeah, and

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Speaker 1: congratulations for feeding your baby for two years. Don't feel

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Speaker 1: bad about that.

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Speaker 3: And if that's a great work.

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Speaker 1: If you're now saying, oh, well, is that the cause

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Speaker 1: of me not getting my period backs open, have another baby,

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Speaker 1: it's a.

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Speaker 3: Yeah, experiencing right now. As nature is contraceptive, so that

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Speaker 3: very reason why you don't get pregnant frequently while you're breastfeeding.

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Speaker 3: It kicks on a little bit afterwards, and the cycle

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Speaker 3: just hasn't come back yet.

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Speaker 1: Yeah, good, all.

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Speaker 6: Right, Hi doctor Pat and Bridget. I love your podcast.

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Speaker 6: It's been such a helpful resource during my early years

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Speaker 6: of motherhood. I have a two and a half year

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Speaker 6: old son and was fortunate to conceive him in the

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Speaker 6: first month of trying. Since giving birth, my periods have

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Speaker 6: become extremely heavy, needing to change a super tampon like

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Speaker 6: every hour, and it hasn't improved over two and a

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Speaker 6: half years. I recently saw my GP and was found

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Speaker 6: to have very low iron, which I had an infusion for.

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Speaker 6: Scans showed pcos twenty four follicles on one and twenty

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Speaker 6: on the other, and possible endo as my over his

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Speaker 6: aunt mobile.

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Speaker 1: My AMH is fifty.

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Speaker 6: My homemones are all normal, and I'm booked to see

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Speaker 6: a specialist in June. My husband and I have been

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Speaker 6: trying to see for six months. I have a healthy,

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Speaker 6: active last style, eat an anti inflammatory diet, and have

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Speaker 6: regular cycles between thirty thirty four days. Usually ovulate around

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Speaker 6: day eighteen, but the lu tell phase of fourteen to

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Speaker 6: sixteen days. I don't have typical PCOS or ENDO symptoms,

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Speaker 6: just very mild back pain. My question is, if everything

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Speaker 6: seems fairly normal, why am I struggling to conceive? And

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Speaker 6: how might PCOS and possible ENDO have developed since my

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Speaker 6: first pregnancy Despite a healthy lifestyle, I feel like I'm

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Speaker 6: doing everything I can. So what should I consider next?

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Speaker 1: What a great question? Well, I mean, I'm sorry, I'm

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Speaker 1: excited by the question. I'm not excited for you.

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Speaker 3: That's I'm sorry to get in trouble. But how well informed?

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Speaker 3: What say today? It's fantastic? So this is somebody taking

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Speaker 3: a very active and well informed and educated approach to

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Speaker 3: our own healthcare, which is music to our eyears, isn't it.

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Speaker 3: I think that that I'm also hearing a little bit

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Speaker 3: of frustration here because here's someone who's taking their health seriously,

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Speaker 3: being very active and healthy, and yet he is running

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Speaker 3: into an issue. And of course that it's common and

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Speaker 3: it doesn't always work that way. That the more attention

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Speaker 3: we paid with our own health that we can necessarily

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Speaker 3: it is not to get out of jail free, can't She.

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Speaker 1: Also doesn't tell us what her period was like before

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Speaker 1: she got pregnant in the first place, or if perhaps

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Speaker 1: she was on the pill or some other suppression, and yeah,

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Speaker 1: this might have been her pattern even before pregnancy.

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Speaker 3: So that's the problem, isn't it is that often, for

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Speaker 3: perfectly legitimate and sensible reasons, people have managed their period

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Speaker 3: in one way or another to try and avoid pregnancy

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Speaker 3: in their early years, or manage a painful cycle or whatever,

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Speaker 3: and then they might come off that contraception that they've

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Speaker 3: been on since the teenagers in their mid to late

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Speaker 3: twenties to try it for pregnancy. Their body's in pretty

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Speaker 3: good nick at that stage, then go they get pregnant, fantastic,

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Speaker 3: breastfed that baby for a while. Wait, try again. You know,

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Speaker 3: we're a little bit older, and suddenly we start to

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Speaker 3: have a few problems. And it's tempting to think that

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Speaker 3: those problems brand new, and why has this happened now,

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Speaker 3: And a lot of the time they're problems that have

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Speaker 3: been there all along, but have been pretty well managed

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Speaker 3: by the appeal. In the early stages. We were fortunate

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Speaker 3: enough to get pregnant without intervention the first time around,

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Speaker 3: and then of course masked by pregnancy and breastfeeding because

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Speaker 3: in those years not menstruating anyway, no reason to think

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Speaker 3: there's a problem. So when our caller came and had

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Speaker 3: her ultrasound, that the ovary has had a polycystic appearance,

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Speaker 3: and of course they may always have had a polycystic appearance.

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Speaker 3: She doesn't sound like she's got full blown textbook polycystic

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Speaker 3: ovarian syndrome with the weight tissues and the acne and

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Speaker 3: the excess body hair. But they may always have had

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Speaker 3: this polycystic appearance, and it's just that when she first

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Speaker 3: tried for a pregnancy, the ovary was easily capable of

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Speaker 3: monthly povulation, and now maybe less so.

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Speaker 1: It sounds like she's still having a regular period that

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Speaker 1: she can bank on.

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Speaker 3: Yeah, which is good. But the cycle is a bit long,

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Speaker 3: isn't it. And when she tells us that she's regularly ovulating,

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Speaker 3: I wonder what evidence we've really got for that. So

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Speaker 3: an ovulation predicted gate which a lot of people use,

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Speaker 3: that's the be Hones stick, one from a pharmacy that

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Speaker 3: says you're going to ovulate tomorrow. It doesn't measure ovulation.

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Speaker 3: It measures a hormone that comes out of your brain

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Speaker 3: that tells the ovary to ovulate, and the presence of

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Speaker 3: that hormone doesn't actually mean that ovulation was achieved. It's

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Speaker 3: a good start, So what we'd be looking for is

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Speaker 3: some post ovulation testing of progesterone levels, just to confirm

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Speaker 3: that it really, really did happen. The evidence that we've

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Speaker 3: got that it did happen is that the Lutell phase

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Speaker 3: is about two weeks long. That's a good start, but

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Speaker 3: I'd be looking for a blood test as well, and

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Speaker 3: the end of metriosis situation is a bit less clear. Sounds,

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Speaker 3: I always say, but not all ultrasounds are created equal.

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Speaker 3: There are very very high quality ultrasounds that people can

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Speaker 3: go and get min Australia. They're called covia scans done

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Speaker 3: done by experts, super experts in pelvic sonography, and they're

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Speaker 3: pretty good at picking up in endometriosis. Don't pick up

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Speaker 3: every case, but they're certainly very good at ruling in

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Speaker 3: or out the severe cases. Whereas an ultrasound done at

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Speaker 3: a corner ultrasound provider, where they're one minute they're scanning

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Speaker 3: a woman's ovar is in the next minute they're doing

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Speaker 3: a brain CT in the next minute of broken arm,

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Speaker 3: and those ultrasounds done at general imaging clinics are perhaps

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Speaker 3: less reliable. One of the things that they're looking at

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Speaker 3: on those ultrasounds is mobility of the ovaries, and that,

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Speaker 3: in my experience, is highly operated defended. So I don't

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Speaker 3: put much store by that finding unless it's by a

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Speaker 3: highly experienced ultrasound providing. So when we do a trans

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Speaker 3: vaginal ultrasound and push against the ovaries, it's a subtle

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Speaker 3: sign that they've fixed in position. And sometimes when I

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Speaker 3: read that on a report, I take that with a

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Speaker 3: grain of salt and I'd be looking, is there any

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Speaker 3: other ultrasound evidence of endometriosis in this woman's case, and

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Speaker 3: then I'd take a very careful history and try and

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Speaker 3: unlicit any other signs or symptoms of endometriosis so that

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Speaker 3: we could build a case whether INDO was likely or not.

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Speaker 3: Because if it seems likely that there's endometriosis, of course

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Speaker 3: that could have developed since the last pregnancy, or more

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Speaker 3: likely it was present all along. But when the woman

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Speaker 3: tried to get pregnant the first time around, she was

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Speaker 3: several years younger, the ENDO was less severe and it

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Speaker 3: wasn't enough to prevent conception. Few years later it could be.

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Speaker 3: So we have to look at all of these things

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Speaker 3: on a sliding scale of severity, and also factoring in

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Speaker 3: that by definition, everyone is a few years older than

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Speaker 3: they were a few years ago.

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Speaker 1: And can I ask about the super heavy periods because

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Speaker 1: they sound awful having to change a super temper on

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Speaker 1: every hour during her period.

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Speaker 3: So they are too heavy. The issue there, though, is

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Speaker 3: what we're trying to achieve. So, for example, in someone

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Speaker 3: who had finished their family or was not trying to

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Speaker 3: achieve a pregnancy, we've got treatment abn C, but a

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Speaker 3: lot of the good pretty much all of the good

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Speaker 3: treatments for a heavy period are also contraceptive that we use,

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Speaker 3: the pill, we use marinas, we use operations. But these

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Speaker 3: are all contraceptive things and obviously not a suitable intervention

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Speaker 3: for someone trying for a pregnancy. So the best treatment

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Speaker 3: for this woman's heavy period would to become given that

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Speaker 3: she wants to be pregnant, would be to get pregnant

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Speaker 3: as soon as possible.

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Speaker 1: So her next steps.

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Speaker 3: Needs some expert advice, needs a thorough assessment. This is

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Speaker 3: not a benign situation. If we do nothing, we might

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Speaker 3: miss out. So I can't say firmly enough that this

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Speaker 3: needs to be investigated. And I would be looking at

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Speaker 3: whether we can get a serious expert ultrasounder, some more

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Speaker 3: hormonal testing, and a reproductive opinion about what's wrong. And

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Speaker 3: if we can get that fixed by intervening early, we

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Speaker 3: can help a lot, and we can make sure that

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Speaker 3: people not only get a pregnancy, but get a dos

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Speaker 3: HAD family size.

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Speaker 1: Can I ask a logistics question, so is she better

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Speaker 1: to get her GP to send her.

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Speaker 3: To that.

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Speaker 1: Superuper ultrasounder cogus ultrasound or is she better to go

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Speaker 1: to her gynocologist first, and then that gynocologist refer to

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Speaker 1: the cocus.

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Speaker 3: I've got no problem with people being sent for a

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Speaker 3: tertiary level or sophisticated ultrasound scan just from their GP.

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Speaker 3: I think that's a good idea, and I think that

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Speaker 3: a lot of women's health gps who understand the difference

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Speaker 3: between an ordinary ultrasound and a high quality one are

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Speaker 3: comfortable making that referral first.

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Speaker 1: And what can she if the GP doesn't know what

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Speaker 1: is she exactly asking her GP to do.

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Speaker 3: Is to get a high quality ultrasound done by a

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Speaker 3: dedicated women's imaging service.

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Speaker 1: Great, all right, I hope that's helpful, and good luck.

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Speaker 1: I hope you've got some solutions soon to get you

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Speaker 1: towards your pregnancy.

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Speaker 3: Good luck.

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Speaker 1: All right, let's go on to this one, Petty, Hey, Bridget,

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Speaker 1: and doctor Pat.

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Speaker 7: My name is Sarah. I'm thirty nine years old, twenty

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Speaker 7: nine weeks pregnant with my first who's an IVF BB

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Speaker 7: and calling from across the ditch in New Zealand. I

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Speaker 7: have plusindprevia and I've found the information you've provided to

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Speaker 7: be absolutely invaluable for understanding what's going on and what

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Speaker 7: it means, and so helpful and stopping me from freaking

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Speaker 7: out about it.

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Speaker 5: So thank you.

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Speaker 1: For your podcast. I have two questions for you.

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Speaker 7: The first one is a bit more serious. At the

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Speaker 7: twenty eight week scan, they spotted a fourteen centimeter umbilical

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Speaker 7: vein barracks. Because although twenty week anatime was normal and

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Speaker 7: he's a seventy fifth sentile, it seems likely it's an

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Speaker 7: isolated finding. I've been given a non urgent good sign

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Speaker 7: referral to feed all medicine specialists, and I'm expecting an increased,

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Speaker 7: probably weekly scan schedule later in my pregnancy. It's not

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Speaker 7: something my midwife has seen before, so she's not been

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Speaker 7: able to tell me much about it. So I was

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Speaker 7: hoping that you could explain a little bit about a

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Speaker 7: bit more about it please. My second question is a

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Speaker 7: bit lighter. We've talked a lot about trying for a

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Speaker 7: second while breastfeeding and how breastfeeding can affect ovulation, but

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Speaker 7: what would it mean for a second IVF baby using

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Speaker 7: frozen eggs?

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Speaker 5: Thank you so much?

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Speaker 1: All right, Beatty, I missed what she said that was

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Speaker 1: the diagnosis for the umbilical cord.

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Speaker 3: So they think they can see an number like all

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Speaker 3: vein varicks, which is like a var of Varico's vein. Yeah,

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Speaker 3: there are a number of ultrasounds getting really good, so

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Speaker 3: they get incredibly good at and you know, it's funny

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Speaker 3: to think that that proper ultrasounds that were actually of

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Speaker 3: any use really only came in round about when I

396
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Speaker 3: was a baby, so you know, we really only had

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Speaker 3: decent ultrasound for about fifty years. And it's gone from

398
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Speaker 3: something where the pictures were ridiculously bad and all you know,

399
00:22:34,240 --> 00:22:36,119
Speaker 3: you could find a placenta preview with it and that

400
00:22:36,200 --> 00:22:40,439
Speaker 3: was about it, to these unbelievably clear images with a

401
00:22:40,440 --> 00:22:44,479
Speaker 3: sophisticated ultrasound machine where they can find so much stuff.

402
00:22:45,200 --> 00:22:49,879
Speaker 3: And what they find these days is a lot of

403
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Speaker 3: really important stuff, but also some very minor changes in

404
00:22:53,960 --> 00:22:58,240
Speaker 3: placental and chord anatomy that probably don't mean tons for

405
00:22:58,800 --> 00:23:02,159
Speaker 3: the progress of that pregnancy. And they'll often say on

406
00:23:02,240 --> 00:23:04,840
Speaker 3: the report, you know, we found this funny, slightly funny

407
00:23:04,840 --> 00:23:08,720
Speaker 3: looking cord and in some studies this is weekly associated

408
00:23:08,760 --> 00:23:12,439
Speaker 3: with the trimester growth restriction or other issues, and so

409
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Speaker 3: we you know, sometimes that person will get referred to

410
00:23:15,480 --> 00:23:18,320
Speaker 3: a maternal feeddal medicine specialist or whatever and they say, yeah, yeah,

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Speaker 3: there's some evidence that weekly associated and the main with

412
00:23:22,680 --> 00:23:27,080
Speaker 3: a lot of these relatively subtle variations. In court anatomy,

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Speaker 3: they would recommend more frequent scans in the third trimester

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Speaker 3: to look for fetal growth, and.

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Speaker 1: Well be Yea and Jesus saying that the babies are

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Speaker 1: the seventy fifth centile.

417
00:23:40,160 --> 00:23:45,399
Speaker 3: So both grant find and occasionally they might detect a

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Speaker 3: third trimester growth issue. And whether that's from the subtlely

419
00:23:48,960 --> 00:23:52,320
Speaker 3: abnormal cord or whether it's from other giving us, of

420
00:23:52,359 --> 00:23:56,320
Speaker 3: course we never know. But this is the sophistication which

421
00:23:56,400 --> 00:24:00,879
Speaker 3: we've come to over these things. And you have information

422
00:24:01,040 --> 00:24:02,440
Speaker 3: like that, it's hard to unknow it.

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Speaker 1: Yeah.

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Speaker 3: Yeah, so often we'll stay fine, let's go and do

425
00:24:05,680 --> 00:24:08,240
Speaker 3: those scans, but so often it doesn't come to anything.

426
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Speaker 3: If if there is an issue, it's dealt with, you know,

427
00:24:12,240 --> 00:24:16,879
Speaker 3: with appropriate expertise. Yeah, there's the other question is an

428
00:24:16,880 --> 00:24:20,480
Speaker 3: interesting one. She doesn't need her natural cycle to return,

429
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Speaker 3: and so what people often do is breastfeed for as

430
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Speaker 3: long as they want and then contact their IVF provider

431
00:24:31,240 --> 00:24:34,800
Speaker 3: and say, radio, I'm ready to have another frozen embryo transfer,

432
00:24:35,440 --> 00:24:39,360
Speaker 3: but I'm still breastfeeding what you recommend, and they would say, fine, breastfeeding, breastfeed,

433
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Speaker 3: up until this date and then do X, Y and

434
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Speaker 3: Z to be to have the uterine lining ready for

435
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Speaker 3: another transfer.

436
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Speaker 1: So it is still impacting on the uterine lining whether

437
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Speaker 1: she's breastfeeding or not. Potentially, Yeah, that's why you don't.

438
00:24:55,200 --> 00:24:57,320
Speaker 3: You know. One of the reasons why you don't men

439
00:24:57,359 --> 00:24:59,840
Speaker 3: straight what you're full time breastfeeding line that it's pretty

440
00:24:59,840 --> 00:25:03,840
Speaker 3: thick and that would ensue transfer. So they'll say, fine,

441
00:25:04,000 --> 00:25:06,679
Speaker 3: breastfeed up until this date and then do this, this

442
00:25:06,760 --> 00:25:08,520
Speaker 3: and this, and then we'll see you for a transfer

443
00:25:08,560 --> 00:25:11,879
Speaker 3: when the lining is nice and receptive on ultrasound.

444
00:25:12,440 --> 00:25:15,400
Speaker 1: Let's say she used breastfeeding but her periods have returned,

445
00:25:16,280 --> 00:25:19,320
Speaker 1: then she could just keep breastfeeding and have the embryo transfer.

446
00:25:20,240 --> 00:25:23,040
Speaker 3: They would use ultrasound to make sure it was the thickness.

447
00:25:23,440 --> 00:25:26,160
Speaker 3: We don't want to waste the more transfer than when

448
00:25:26,200 --> 00:25:29,240
Speaker 3: the chance of success is low, because a high quality

449
00:25:29,280 --> 00:25:32,680
Speaker 3: frozen embryo has an excellent chance of turning into a baby. Yeah,

450
00:25:33,119 --> 00:25:36,680
Speaker 3: and they want to keep those. So the question that

451
00:25:36,720 --> 00:25:39,680
Speaker 3: the question is not how is it done? That's all easy.

452
00:25:40,200 --> 00:25:43,280
Speaker 3: The question is how much time have we really got.

453
00:25:43,720 --> 00:25:46,000
Speaker 3: It's nice to have frozen embryos because they're locked in

454
00:25:46,080 --> 00:25:49,040
Speaker 3: time and frozen in time, and you could have those

455
00:25:49,080 --> 00:25:51,760
Speaker 3: transferred at any point, but lots of people still want

456
00:25:51,800 --> 00:25:55,280
Speaker 3: to have finished their family by their early forties, even

457
00:25:55,320 --> 00:25:57,480
Speaker 3: someone who's started at the end of the late thirties

458
00:25:57,480 --> 00:26:01,640
Speaker 3: and cad I so for social reasons whether we want

459
00:26:01,680 --> 00:26:03,840
Speaker 3: to get on with it. So sometimes there's a bit

460
00:26:03,840 --> 00:26:07,680
Speaker 3: of a give and take between the desired breastfeeding time

461
00:26:08,680 --> 00:26:12,959
Speaker 3: versus the realities of transferring the next MB we are

462
00:26:12,960 --> 00:26:14,200
Speaker 3: and getting off with the next pregnancy.

463
00:26:14,359 --> 00:26:17,640
Speaker 1: Yeah, good, all right, well, good luck and speaking of time,

464
00:26:17,680 --> 00:26:19,880
Speaker 1: I think we've only got one time for one more.

465
00:26:19,960 --> 00:26:24,000
Speaker 8: Pat okay, hi doctor Pat and Bridget I'm at ten

466
00:26:24,040 --> 00:26:27,400
Speaker 8: weeks pregnant with my first baby. I have been doing

467
00:26:27,480 --> 00:26:29,639
Speaker 8: IVF for two and a half years now, so in

468
00:26:29,680 --> 00:26:35,199
Speaker 8: preparation for that, have been preparing for potentially having low iron.

469
00:26:35,880 --> 00:26:38,920
Speaker 1: I do already have low iron.

470
00:26:38,760 --> 00:26:42,280
Speaker 8: So I have been taking a supplement every single day

471
00:26:42,400 --> 00:26:47,840
Speaker 8: to get my levels up. Unfortunately, prior to falling pregnant

472
00:26:47,880 --> 00:26:50,960
Speaker 8: this time round, my levels were quite low. I think

473
00:26:51,000 --> 00:26:55,440
Speaker 8: they're about twenty, which is borderline not great. And then

474
00:26:55,760 --> 00:26:58,359
Speaker 8: since falling pregnant, my levels have dropped even further that

475
00:26:58,480 --> 00:27:04,360
Speaker 8: I now have levels that are way too low. Unfortunately

476
00:27:04,400 --> 00:27:07,760
Speaker 8: for me, I am that very small percentage that is

477
00:27:07,840 --> 00:27:11,840
Speaker 8: unaphylactic to iron infusions. So in saying that, I just

478
00:27:11,880 --> 00:27:14,919
Speaker 8: sort of wanted to know what my options were moving forward.

479
00:27:15,119 --> 00:27:17,880
Speaker 8: I'm still trying to take my tablet every single day,

480
00:27:18,200 --> 00:27:21,639
Speaker 8: but it doesn't look like my iron levels are moving Thanks.

481
00:27:22,119 --> 00:27:22,719
Speaker 3: Yeah, Jimmy.

482
00:27:23,000 --> 00:27:26,200
Speaker 1: Well, firstly, like I hope that she didn't find out

483
00:27:26,200 --> 00:27:28,960
Speaker 1: that she was anaphylectic during an iron infusion.

484
00:27:29,720 --> 00:27:32,400
Speaker 3: She did, I don't know that there would be any

485
00:27:32,400 --> 00:27:34,760
Speaker 3: other real way of knowing that, So sorry that happened

486
00:27:34,800 --> 00:27:36,600
Speaker 3: to you. Congratulations on the pregnancy.

487
00:27:36,720 --> 00:27:38,200
Speaker 1: Yeah, two and a half years. Yay.

488
00:27:38,520 --> 00:27:40,399
Speaker 3: I think this is great news that you're pregnant and

489
00:27:40,400 --> 00:27:43,639
Speaker 3: you're doing You're doing a good job. Iron's important in

490
00:27:43,680 --> 00:27:46,399
Speaker 3: our body to run all sorts of metabolic processes, and

491
00:27:46,800 --> 00:27:50,119
Speaker 3: it's important in pregnancy. You need iron to run your body.

492
00:27:50,160 --> 00:27:52,760
Speaker 3: And then you've got a baby growing insolidier that is

493
00:27:52,800 --> 00:27:56,080
Speaker 3: stealing some of your iron for their own metabolic needs.

494
00:27:56,119 --> 00:28:02,160
Speaker 3: So that's why this problem of people who low iron

495
00:28:02,440 --> 00:28:07,000
Speaker 3: but cope okay suddenly can wind up in trouble in pregnancy.

496
00:28:07,359 --> 00:28:11,520
Speaker 3: On the upside, in pregnancy, you're not menstruating, so you're

497
00:28:11,520 --> 00:28:15,080
Speaker 3: not losing iron that way, but the pregnancy itself takes

498
00:28:15,080 --> 00:28:17,840
Speaker 3: a fair bit, so you're doing a good job. It's

499
00:28:17,960 --> 00:28:20,399
Speaker 3: unfortunate that we can't give e infusions because that's our

500
00:28:20,440 --> 00:28:22,680
Speaker 3: get our jail free card. We can just we can

501
00:28:22,840 --> 00:28:26,360
Speaker 3: use infusions to bypass the gut, and in people who

502
00:28:26,359 --> 00:28:29,800
Speaker 3: don't absorb bying pretty well, that's usually the problem that

503
00:28:29,800 --> 00:28:32,399
Speaker 3: the bit of the small bowel, just beyond the stomach

504
00:28:32,400 --> 00:28:38,400
Speaker 3: whereline is observed is absorbed, is just not very efficient

505
00:28:38,440 --> 00:28:43,280
Speaker 3: at doing that. So what else can we do to help? Firstly,

506
00:28:43,400 --> 00:28:45,400
Speaker 3: you're doing a bit better than you think because if

507
00:28:45,440 --> 00:28:49,280
Speaker 3: you are taking an iron tablet every day and that's

508
00:28:49,320 --> 00:28:53,040
Speaker 3: not constipating you too badly, but the levels are staying

509
00:28:53,080 --> 00:28:57,880
Speaker 3: about the same, just the lowest end of the normal range,

510
00:28:58,320 --> 00:29:00,880
Speaker 3: given that the baby is continuing to take it. If

511
00:29:00,880 --> 00:29:04,080
Speaker 3: you were getting absolutely nowhere, those levels would be going backwards.

512
00:29:04,760 --> 00:29:08,960
Speaker 3: So if you feel like you're maintaining a poor level

513
00:29:08,960 --> 00:29:11,840
Speaker 3: but it's not getting distinctly worse, then you are winning

514
00:29:12,280 --> 00:29:14,200
Speaker 3: a bit more than you think you are. How can

515
00:29:14,240 --> 00:29:17,280
Speaker 3: we make them go up even further? You could look

516
00:29:17,320 --> 00:29:19,640
Speaker 3: at the type of iron supplement that you're on. There

517
00:29:19,680 --> 00:29:23,360
Speaker 3: are a number of different ones. A good dietitian can

518
00:29:23,440 --> 00:29:26,800
Speaker 3: really help you with that. Some forms of iron are

519
00:29:27,040 --> 00:29:31,880
Speaker 3: much more easily absorbed than others. The addition of vitamin

520
00:29:31,920 --> 00:29:35,479
Speaker 3: C can help absorption of iron in most people. But

521
00:29:35,520 --> 00:29:38,120
Speaker 3: the other reason why you might get a consultation with

522
00:29:38,160 --> 00:29:40,880
Speaker 3: a good dietian with the experience in the pregnancy space

523
00:29:41,040 --> 00:29:43,880
Speaker 3: is that you could be looking at everything else in

524
00:29:43,920 --> 00:29:47,240
Speaker 3: your diet and maximizing iron that way, give or take.

525
00:29:47,280 --> 00:29:48,880
Speaker 3: Our body is a bit better at getting iron out

526
00:29:48,920 --> 00:29:54,480
Speaker 3: of the traditional sources of meat and some plant products

527
00:29:54,880 --> 00:29:57,920
Speaker 3: better than a pill, and so you could be doing

528
00:29:57,960 --> 00:30:03,800
Speaker 3: both tian, maximize natural sources, make sure you're on the

529
00:30:03,880 --> 00:30:07,160
Speaker 3: right line, don't have an infusion if you're an aphylactive,

530
00:30:07,800 --> 00:30:12,280
Speaker 3: and be confident that if you are maintaining an iron

531
00:30:12,360 --> 00:30:16,040
Speaker 3: level that's low but steady, that you are actually absorbing yourself.

532
00:30:17,000 --> 00:30:20,840
Speaker 1: All right, good luck with that. There's lots of dietitians around.

533
00:30:21,160 --> 00:30:23,680
Speaker 1: We've had a Steph for Lacas on our podcast a

534
00:30:23,720 --> 00:30:27,920
Speaker 1: couple of times, and she's really dedicated to the perinatal space,

535
00:30:28,000 --> 00:30:29,640
Speaker 1: so you might want to look her up if you

536
00:30:29,640 --> 00:30:33,400
Speaker 1: can't find someone likely. All Right, Everyone that's asked for

537
00:30:33,560 --> 00:30:36,800
Speaker 1: this week. If you're wondering how do I get my question?

538
00:30:36,960 --> 00:30:39,200
Speaker 1: Answer it on the speed pipe, go to our website

539
00:30:39,240 --> 00:30:41,840
Speaker 1: and there'll be a link to the speak Pipe, or

540
00:30:41,880 --> 00:30:44,520
Speaker 1: even click into the show notes. There's also a link there.

541
00:30:45,240 --> 00:30:47,360
Speaker 1: We do give priority to people that are in our

542
00:30:47,400 --> 00:30:51,160
Speaker 1: grow My Baby program, so if you are thinking that

543
00:30:51,200 --> 00:30:54,720
Speaker 1: you are urgently wanting something answered, that's not a bad

544
00:30:54,720 --> 00:30:58,120
Speaker 1: way to dump the queue. So until next Q and A,

545
00:30:59,240 --> 00:31:02,280
Speaker 1: keep listening. We'll be back in your ears next week,

546
00:31:02,320 --> 00:31:04,400
Speaker 1: and I hope you're having fun growing of babies.

547
00:31:04,560 --> 00:31:06,240
Speaker 3: Thanks for listening every work bye for now.

548
00:31:12,440 --> 00:31:15,640
Speaker 1: Hey, even though doctor Pat is well a doctor and

549
00:31:15,680 --> 00:31:18,040
Speaker 1: we get lots of other doctors and other experts on

550
00:31:18,080 --> 00:31:20,880
Speaker 1: our podcast, I just need to remind you that this

551
00:31:21,000 --> 00:31:25,440
Speaker 1: podcast is for informational purposes only. We share lots of

552
00:31:25,480 --> 00:31:29,120
Speaker 1: medical insights and experience, but everything we talk about is

553
00:31:29,320 --> 00:31:33,000
Speaker 1: general in nature and may not apply to your specific situation.

554
00:31:33,560 --> 00:31:37,240
Speaker 1: Please always consult with your own healthcare provider for your

555
00:31:37,320 --> 00:31:40,200
Speaker 1: individual medical advice when you grow your baby