Speaker 1: Welcome to the Kick Your Expert led podcast, helping you
Speaker 1: explore and learn everything about getting pregnancy, birth, and becoming
Speaker 1: a parent.
Speaker 2: On the podcast and our online pregnancy program grow My Baby,
Speaker 2: we share my experience of helping more than four thousand
Speaker 2: babies to be born.
Speaker 1: And our experience of running a women's health clinic and
Speaker 1: parenting for boys.
Speaker 2: We're here to help everyone to feel empowered in pregnancy
Speaker 2: and birth with real life, practical information.
Speaker 1: Welcome everyone. I'm Bridget Maloney.
Speaker 2: And I'm obstetrician doctor Patrick, and today we.
Speaker 1: Thought we would cover a topic where you hear about
Speaker 1: pregnancy symptoms all the time, so you think that they're
Speaker 1: common and you make the assumption that they're normal. Sure,
Speaker 1: And part of that reason could be that we all
Speaker 1: want to be reassured. Yeah, so you say to your mate, oh,
Speaker 1: you know, I've got this really painful, sharp pain in
Speaker 1: my hips as I'm walking up the stairs or whatever,
Speaker 1: and your mate goes, oh, yeah, I'm sorry, love, you're
Speaker 1: just pregnant.
Speaker 2: You're pregnant. I had that, Yeah, yeah, I had that.
Speaker 1: That's the other thing people do is they reassured by
Speaker 1: saying it's okay, I had that.
Speaker 2: Ye, But there are some things that actually are potentially
Speaker 2: a sign of a serious issue in pregnancy that so
Speaker 2: they should be checked out. And what we as obstrics
Speaker 2: do is check that out for its potential serious cause
Speaker 2: and if it's not that, then maybe it is just
Speaker 2: because you're pregnant.
Speaker 1: All right, Patty, I want to start with something that
Speaker 1: I think is the most overlooked symptom of pregnancy, and
Speaker 1: that is the impact of pregnancy on your mental health.
Speaker 2: So this is a big one, isn't it. Because there
Speaker 2: are times when you you know you're pregnant, you're tired,
Speaker 2: there might be musculo schaletal pain, there might be anxiety
Speaker 2: about how the pregnancy is going. And there there would
Speaker 2: be some days, individual days when you might actually meet
Speaker 2: the diagnostic definition of someone with mental health issue, but
Speaker 2: it's just that day and you really are just pregnant.
Speaker 2: Other times the person complaining of those things actually does
Speaker 2: have a serious mental health issue. And we're going to
Speaker 2: work out, you know, who's tired and will be fine
Speaker 2: tomorrow and who's in trouble.
Speaker 1: Yeah, and those people that preps are in trouble, they
Speaker 1: don't come out with things like you know, I think
Speaker 1: I have anxiety or depression, or they don't say I
Speaker 1: feel like harming myself or I'm constantly thinking that there's
Speaker 1: something really wrong with my baby. They don't say that,
Speaker 1: do they.
Speaker 2: No, that's quite rare, really for someone to come out
Speaker 2: with an obvious, lay down MAS diagnosis, But they will
Speaker 2: often report a string of symptoms that, taken individually, could
Speaker 2: easily be dismissed as the ups and downs of pregnancy
Speaker 2: or a new parent, but looked at as a collection,
Speaker 2: you're going to stop, think twice and think, hang on
Speaker 2: a minute, are we missing a more significant issue here?
Speaker 1: So we can leave our audience with something if they
Speaker 1: feel that this is perhaps something that they've been just
Speaker 1: sneakily saying something to their partner or to their mother
Speaker 1: or sister or friend, or something about their mental health
Speaker 1: because they're a little bit worried about how they're feeling.
Speaker 1: What are some of the things that would make you
Speaker 1: want to investigate whether someone's mental health needs help.
Speaker 2: Yeah, it's a great question. There are a couple of
Speaker 2: different models. There's a thing called red flag model for
Speaker 2: mental illness, where there are some questions you can ask
Speaker 2: that are pretty much if those things are present, it's
Speaker 2: really never normal. So the big one is suicidal ideation.
Speaker 2: So if you're thinking about killing yourself all day, that's
Speaker 2: never normal and always highly significant. So you just have
Speaker 2: to get really comfortable with as a doctor with asking
Speaker 2: people whether they're planning to harm themselves or kill themselves.
Speaker 2: And the more the more you practice asking it, the
Speaker 2: easier it is to ask it. And no one's ever offended.
Speaker 2: They just say or even weirded out people often think, wow,
Speaker 2: good doctor's asked me that. And that's a good point.
Speaker 2: So it's the it's the care that has the awkwardness,
Speaker 2: not the patient. I've never had anyone stand up more
Speaker 2: going don't be ridiculous. People go, yeah, look now, thanks
Speaker 2: for asking that, because there are days when I've thought
Speaker 2: it might have been easier not to be here. And
Speaker 2: then we go, let's talk about this some more. You know,
Speaker 2: are you hoarding your medication to a term suicide? You know,
Speaker 2: so we press that, you know, for detail, and you know,
Speaker 2: and and and somebody who's doing that probably needs, you know,
Speaker 2: might need inpatient psychiatric care, whereas someone who just says
Speaker 2: some days it feels too hard and that person needs
Speaker 2: more support. But but but they're not they don't have
Speaker 2: mental illness, so so yeah, there are there are some
Speaker 2: red flag type questions. If people's mood is particularly bad,
Speaker 2: they'll often start to develop other symptoms, like a loss
Speaker 2: of appetite or something called early morning waking, when you
Speaker 2: wake up three o'clock in the morning prevously no reason,
Speaker 2: You're wide awaken, com back, can't get back to sleep,
Speaker 2: and these are features of depression, which which helped to
Speaker 2: tear help delineate the disease of depression from someone who's
Speaker 2: just having a bad run. And one of the problems
Speaker 2: with pregnancy and newborn care is they kind of overlap
Speaker 2: with normality a little bit because the breastfeeding mummy is
Speaker 2: up at night. It can be hard to prioritize your
Speaker 2: own epidity in the twenty four hour day phenomenon of
Speaker 2: you know, you've just come out of a complex hormonal
Speaker 2: environment of being pregnant and now you've got a twenty
Speaker 2: four hour day job looking after a baby.
Speaker 1: That is hard for the woman herself but also partners
Speaker 1: in how do they support their partner by saying, you know, well,
Speaker 1: I think this is just pregnancy hormones, or no, I
Speaker 1: think you need to discuss this further with your doctor. Yeah,
Speaker 1: like that that is very tricky.
Speaker 2: Yeah, we do rely on expertise, so nobody. I don't
Speaker 2: think anybody in the history of poor mental health has
Speaker 2: ever been pleased that they've got poor mental health. You know,
Speaker 2: we try and take the stigma out of it, but
Speaker 2: nobody wants it as a condition. So we need to
Speaker 2: be sort of reaching out to our support is more readily,
Speaker 2: and then the cares need to be asking that the
Speaker 2: right questions of everybody.
Speaker 1: Yeah, so that we started with that one that is
Speaker 1: common but not necessarily normal if you feel like you've
Speaker 1: got any of these things that we've just discussed. So
Speaker 1: that's our first good good. I want to move on
Speaker 1: to another one that I knew was not normal in
Speaker 1: my fourth pregnancy, Like I couldn't roll out over in
Speaker 1: bed without excruciating pain in my powers, or go upstairs
Speaker 1: or what was the other I want to kick the football,
Speaker 1: but probably shouldn't have been doing that anyway. I knew
Speaker 1: that was a problem.
Speaker 2: But if it's your first pregnancy, you might think this
Speaker 2: is just what being pregnant is.
Speaker 1: Yeah, because people say, oh, that's you know, that happened
Speaker 1: to me. It's just your ligament stretching, you know you'll
Speaker 1: get over it.
Speaker 2: Yep. So musculo scaletal pain. The where's the line between
Speaker 2: what to expect in pregnancy and what's an actual separate
Speaker 2: condition needing treatment. And I think it's one of functionality.
Speaker 2: So so when you're pregnant, you'll get some musculo sclidal pain,
Speaker 2: but give or take, you should be able to do
Speaker 2: the things that you need to do in that day.
Speaker 2: I know that's a broad statement, but you know, for
Speaker 2: the first for the first three cause of the pregnancy,
Speaker 2: someone who goes to work in an office and does
Speaker 2: a desk job, all things being equal, should be able
Speaker 2: to keep doing that. And if you if you literally
Speaker 2: can't you, if you can't walk, if you can't take
Speaker 2: yourself to a bathroom, then that's that's that's not normal,
Speaker 2: that that's a that's a condition that needs treatment and
Speaker 2: further examination. So we use we use a physiotherapists, and
Speaker 2: once or twice a year, I'll have someone with very
Speaker 2: very severe musculo scletal pain admitted to the hospital for care.
Speaker 1: Yeah, and it can happen like I remember not getting
Speaker 1: that pain until I was sort of in later pregnancy.
Speaker 1: Probably thirty weeks, thirty plus weeks and talking to somebody
Speaker 1: that got really bad pelvic pain in her early early
Speaker 1: on in the pregnancy, like eighteen weeks, and me thinking
Speaker 1: in my brain, I didn't say anything, but me thinking
Speaker 1: here my brain, well, you know, I'm not sure that
Speaker 1: that's that's normal, but her thinking it was you know,
Speaker 1: it can happen at different times.
Speaker 2: Yeah, absolutely, So again we ideally we're in a care situation,
Speaker 2: you know, obstetric care with the doctor, midwifree care with midwife.
Speaker 2: It's where we can say, is.
Speaker 1: This is this normal?
Speaker 2: Normal? This is what's happened to me, what you see
Speaker 2: happen to other people? Because your care will be good
Speaker 2: at that and go no like that, No, I don't
Speaker 2: see that at all. Yeah, most eighteen weeks are fine.
Speaker 1: What about early very early on? We do get lots
Speaker 1: of questions through the speak pipe about sort of pain, cramping,
Speaker 1: stretching early on. Yeah, that's something that is normal.
Speaker 2: Yes, yes it is, and it is normal. And the
Speaker 2: and again where does where's the line? The line is
Speaker 2: definitely if it's associated with bleeding. So someone who's someone
Speaker 2: who's you know, seven or eight weeks pregnant getting lot
Speaker 2: of pain ultrasound. And one of the great reasons, one
Speaker 2: of the great things of having ultrasound machines in our
Speaker 2: consulting rooms is he just reach for it and just
Speaker 2: then I needn't send the patient away for an ultrasound.
Speaker 2: So someone's getting a lot of pain. We want to
Speaker 2: make sure that the uterus, that the pregnancy is in
Speaker 2: the right place in the uterus, and we're not. We're
Speaker 2: not seeing someone who's got a neck topic or god forbid,
Speaker 2: a ruptured eck topic. And then and bleeding is a
Speaker 2: is a good line in the sand as well. It
Speaker 2: definitely shouldn't be bloody, all right.
Speaker 1: I want to run the next scenario by you, and
Speaker 1: that is we're hear it all the time, and I
Speaker 1: remember suffering from it too. Is headaches.
Speaker 2: Headaches.
Speaker 1: I pretty much had headaches all throughout my pregnancies, just
Speaker 1: to sort of my constant for and you know, your
Speaker 1: head feels sore, but it doesn't sort of go from there,
Speaker 1: pretty sure that that was just pregnancy. But when where's
Speaker 1: that line in the sand? When should you go, Okay, well,
Speaker 1: that isn't normal.
Speaker 2: So it's a great example because headache is really common
Speaker 2: and I don't know if it's accurate to call it normal.
Speaker 2: It's just really common, and it's common for it to
Speaker 2: not represent serious underlying disease. There are times in the
Speaker 2: pregnancy when progesterone output from the placenta is very high.
Speaker 2: It peaks from here, it peaks at certain predictable times,
Speaker 2: and headaches are more common. The problem is that headache
Speaker 2: can be a symptom of severe preclamps here, and so
Speaker 2: the line in the sand with headache is what's going
Speaker 2: with the rest of your body. Yeah, So the headache itself,
Speaker 2: it should not be unbearably severe, but a low level
Speaker 2: headache can be harmless. But it's what's going on with
Speaker 2: everything else. So is there associated visual disturbance? And what's
Speaker 2: the blood pressure and the urinalysis doing?
Speaker 1: Yeah?
Speaker 2: Yeah, So someone comes in a thirty weeks with headache,
Speaker 2: first thing I'm doing is taking their blood pressure, checking
Speaker 2: their ankles for swelling, and checking the urine for protein.
Speaker 2: If the headache is part of an onset of severe preclams,
Speaker 2: tour in their bloo pressure one hundred and sixty, one
Speaker 2: hundred and ten, that's preclaims here, and they need to
Speaker 2: be in the hospital and being worked up and managed.
Speaker 2: If everything else is normal and the headache is there,
Speaker 2: then we talk about managing the headache as best we can.
Speaker 1: Which we are in pregnancy allowed or able to take paracetamol.
Speaker 2: Yeah, yeah, paracetamol, increase fluids, you know, things like allied
Speaker 2: health treatments, massage to the neck, trigger point treatments, all
Speaker 2: sorts of things can be really good for headache. And
Speaker 2: things that we can do that are nice for ourselves,
Speaker 2: like get a pregnancy massage and things like that can
Speaker 2: all make low level, long standing headache and pregnancy more tolerable.
Speaker 2: But the number one thing we're gonna do is make
Speaker 2: sure that just because it's common doesn't mean it's normal,
Speaker 2: and we're not sitting on a headache as a manifestation
Speaker 2: of a more severe diagnosis.
Speaker 1: And if anyone is worried about taking paracetamol because of
Speaker 1: the claims made on social media that perhaps there's a
Speaker 1: link to autism, that is not true.
Speaker 2: That is not true, and it's been conclusively disproved. And
Speaker 2: we take our health advice from experts.
Speaker 1: I think anyone listening to this podcast are taking their
Speaker 1: advice from experts. That's what I would like to think,
Speaker 1: all Right, I'm going to run this scenario by you,
Speaker 1: and that is that you know, it's later in pregnancy
Speaker 1: and I'm sitting on the couch and I'm feeling a
Speaker 1: little bit short of breath, and people around me go,
Speaker 1: oh god, the baby's in the wrong positions. Just they're
Speaker 1: pushing up on your lung That happened to me. Yeah, no,
Speaker 1: wonder you're short of breath because you're running out of
Speaker 1: room there, look at your belly.
Speaker 2: Yeah. I think this is another good one, because sometimes
Speaker 2: it's normal and sometimes it's not. And the sort of
Speaker 2: shortness of breath that we should that we can experience
Speaker 2: in pregnancy and can be normal is a sort of
Speaker 2: a vague feeling that we can't quite catch our breath
Speaker 2: and a subtle feeling of being very mildly short of breath.
Speaker 2: And that's thought to be another progesterone effect, but it's
Speaker 2: it's not the same as somebody who literally literally can't
Speaker 2: get said breath. And the other thing we worry about
Speaker 2: with shortness of breath is a pulmonary embolus of blood
Speaker 2: clot in the lungs, and the typical textbook presentation of
Speaker 2: that is sudden nonset shortness of breath. So I was
Speaker 2: fine and then bang, I wasn't.
Speaker 1: Like when you say bang like straight away, like all
Speaker 1: of a sudden.
Speaker 2: Wow. Okay, so that's a blood clot potentially shifting from
Speaker 2: your legs to your lungs and suddenly, you know, in
Speaker 2: a matter of minutes, I was fine, and then I
Speaker 2: was then I was not.
Speaker 1: Yeah, I think that is a very definitive way of
Speaker 1: thinking about that I have. I didn't know that, so
Speaker 1: I I had always thought that a palmary embolism would
Speaker 1: cause like a gradual shortness of breath, and I would
Speaker 1: know that perhaps perhaps I've got an embolism.
Speaker 2: No, well, the textbook definition is sudden onset, and and
Speaker 2: you know, I guess a small one could cause something
Speaker 2: that was less dramatic or more more gradual. But it's
Speaker 2: typically seen in somebody who is who is sick, a
Speaker 2: hospital level type sick, and somebody who's had a vague
Speaker 2: pregnancy related shortness of breath that's been there for weeks
Speaker 2: but otherwise looks fine, needs needs. Some baseline investigations will
Speaker 2: put a little peek on your finger and measure the
Speaker 2: oxygen saturation. But if that's all normal, then then then
Speaker 2: we conclude that it's irritated but normal.
Speaker 1: I think with shortness of breath that I remember, like
Speaker 1: if you have exerted yourself physically, like you've just gone
Speaker 1: off three steps or you've quickly run after a toddler
Speaker 1: or something like that. Yes, that feeling is uncomfortable. That
Speaker 1: shortness of breath. It feels weird. It's something that you
Speaker 1: didn't have when you were not pregnant. But it's gone,
Speaker 1: like you just stopped for a.
Speaker 2: Tick results and results. Yeah, someone with pulmonary endless it
Speaker 2: doesn't settle with rest.
Speaker 1: Next, I want to talk about itching. Now, pregnancy for
Speaker 1: some people can be an itchy time. They feel irritated
Speaker 1: and they want to each sort of different parts of
Speaker 1: their body and stuff. But you know what people would say,
Speaker 1: because we instantly want to reassure someone, Oh, that's normal,
Speaker 1: it's just your skin stretching that happened to me. Put
Speaker 1: some whatever lotion on. What's going through your mind when
Speaker 1: you hear me say that.
Speaker 2: Well, there's one there's one or two severe causes of
Speaker 2: itch in pregnancy that we like to try and exclude.
Speaker 2: And sometimes it's possible to exclude it on the pattern,
Speaker 2: and other times we need to do some blood tests.
Speaker 2: So there's the things called a There's a thing called
Speaker 2: a pups rash, which is a raise ration. When you
Speaker 2: told me that needs some blood tests to make sure
Speaker 2: that the liver's working properly and has it and has
Speaker 2: an actual treatment and should be treated. There's another thing
Speaker 2: called coolystasis of pregnancy, which is a severe, potentially severe
Speaker 2: form of liver dysfunction in pregnancy that can be dangerous
Speaker 2: for the baby. And that needs a blood tests and
Speaker 2: it's got a treatment and investigations. And they both cause
Speaker 2: they both can cause a pattern of itchiness that might
Speaker 2: ring a bell to your care team. But some people
Speaker 2: just get itchy and some people, some women's stretch marks
Speaker 2: are itchy. Yeah, so we do take it seriously. Well,
Speaker 2: we would be asking about the pattern when did it
Speaker 2: come on? Is it on the soles of the feet
Speaker 2: and the palms of the hands, or is it on
Speaker 2: the tummy? Is it all over the tummy or just
Speaker 2: confined to the stretch marks. And then sometimes testing some
Speaker 2: liver function and some stuff some things called bilasses, which
Speaker 2: is just part of the function of the liver to
Speaker 2: make to make sure that those that it's not a
Speaker 2: more dangerous form of itch. So someone with a persistent,
Speaker 2: significant irritating itch in pregnancy, that's when we should be
Speaker 2: getting checked out.
Speaker 1: Yeah right, nice, Okay, well I want to move to
Speaker 1: I think it was Kim Kardashian's candles candles or just
Speaker 1: the feeling. You know, you sit around in your in
Speaker 1: your pregnancy, your prenatal group, and you sort of go, okay,
Speaker 1: well I can't fit my rings on anymore, or my
Speaker 1: feet aren't fitting into my shoes, or yes, I do
Speaker 1: have cankles, and everyone goes ha ha ha, So do
Speaker 1: I look at their.
Speaker 2: Yeah, that's a relatively easy one. The fluid that builds
Speaker 2: up on our body when we're pregnant, you can see
Speaker 2: it in the ankles, it's in your wrists as well,
Speaker 2: in your hands as well, which you can't quite see
Speaker 2: it quite as easily. It's pretty obvious when it builds
Speaker 2: up in the ankles, and if you spend a lot
Speaker 2: of time sitting, it'll build up around the around the
Speaker 2: sacram around the bottom of your back as well. And
Speaker 2: that is fluid that's building up. And the clencher is
Speaker 2: whether the blood pressure is also a problem. So if
Speaker 2: the blood pressure is perfectly normal, and there's no evidence
Speaker 2: of pretty clamsy. Then the swelling is what it is,
Speaker 2: and we try our best. We wear compression garments and
Speaker 2: do some fluid massage and keep active. Yeah, and wait
Speaker 2: until the baby you're more accurately the plus centa is
Speaker 2: out of the out of your body and then it'll
Speaker 2: go back to normal. H if if the if there's
Speaker 2: a lot of swelling in conjunction with high blood pressure,
Speaker 2: that's preclams here, that's serious dangerousneze treatment. So so check
Speaker 2: at blood pressure yep.
Speaker 1: And is it sudden that swelling does does you know,
Speaker 1: you might have a little bit of swelling, but if
Speaker 1: you've got preclamps here, does it sort of swell fast?
Speaker 2: No? No, So that's why we check the swelling at
Speaker 2: every anginatal visit.
Speaker 1: It can be subtle, and everybody should be having their
Speaker 1: blood pressure checked at every antenatal vision.
Speaker 2: Yeah, I mean, what's what's what's antenatal care for? What?
Speaker 2: It's not just to come in and you know, smile
Speaker 2: at your team, have them smile at you and say
Speaker 2: you good only for being pregnant. There's a point to everything,
Speaker 2: and and the antenat the big point of their trimester
Speaker 2: angenatal care. It's actually surveillance for preclams here and ensuring
Speaker 2: adequate federal growth. Yeah, there's other things, try and pick
Speaker 2: the babies that are trying to come out backwards and
Speaker 2: all sorts of things, but the big ticket once the
Speaker 2: things that have made a real different over the years
Speaker 2: to maternal health is picking pre clams here before you
Speaker 2: start fitting, yeah, and treating it with delivery, anti hypertensive drugs,
Speaker 2: hospital care before mum gets hick, and then picking fetal
Speaker 2: growth restriction before stillbirth. They that those interventions come out
Speaker 2: of good anti natal care. And you know, antiinatal care
Speaker 2: is a concept really only it's one hundred years old.
Speaker 1: It's funny, isn't it. So you know, I would wonder
Speaker 1: what everybody thinks anti natal care should be providing, because
Speaker 1: there might be just a gap there because if the
Speaker 1: practitioner is there going okay, gold standard is I'm checking
Speaker 1: blood pressure, I'm checking making sure there's adequate fetal growth,
Speaker 1: and the woman is coming in, And I would and
Speaker 1: this is what I expected, that that practitioner would be
Speaker 1: talking to me about other things like, you know, I
Speaker 1: don't know what supplements I should be on or my
Speaker 1: general health or so. I just wonder if that's where
Speaker 1: there's been a bit of a divide.
Speaker 2: Yes, I I don't know where to go, do you?
Speaker 2: I see what? No, I know, I see what you mean.
Speaker 2: And I'm not saying those other things shouldn't be done.
Speaker 2: I'm just saying that that that's that's what it was for.
Speaker 2: What it was invented for was to prevent poor obstetric outcomes,
Speaker 2: and it's still doing that. Sometimes it's not obvious to
Speaker 2: the woman having a normal progress that that's what her
Speaker 2: cares are doing in the background.
Speaker 1: I loved my obstration and a five minute checks like
Speaker 1: I was like you, beauty, I'm out of there. Ye
Speaker 1: want to hang out?
Speaker 2: Not everyone's there for the big check? No, no, yeah,
Speaker 2: And especially I noticed that the later I'm running, the
Speaker 2: less people are in for the big check.
Speaker 1: They just like, am I okay, You're never running? Like
Speaker 1: what are you talking about? All right? Big key one?
Speaker 1: Nausea and vomiting. I think people are knowing when it's
Speaker 1: normal as opposed to something like hyperemesis. I don't know.
Speaker 1: I could be I could be living in my own
Speaker 1: little bubble there, But when does it When do people
Speaker 1: you know, sort of say, oh, that's just pregnancy, and
Speaker 1: when should people say, oh, actually, that's a bit more
Speaker 1: than just pregnancy.
Speaker 2: Yes, So that that there are some rules about this
Speaker 2: one as well. So I'm pleased that there is a
Speaker 2: good kind of red flag rule for most of these.
Speaker 2: I've never really thought about it this way. But whilst
Speaker 2: it can be quite normal to have nausea in volmiting
Speaker 2: in early parts of pregnancy, it's not normal for that
Speaker 2: nausea and vomiting to be so severe that the woman
Speaker 2: gets dehydrated or malnourished. So dehydration and malnourishment are serious
Speaker 2: and dangerous not only for the woman's general health, but
Speaker 2: also for the well being of the pregnancy. Ah. And
Speaker 2: you know, a good indicator of dehydration is the presence
Speaker 2: of of key tones in the urine. So our body
Speaker 2: only makes key tones when it's undergoing a form of
Speaker 2: abnormal metabolism that creates key tones as a byproduct. So
Speaker 2: if someone is reporting a lot of noise, you're involmiting
Speaker 2: some relief from their tablets but finding it a bit difficult.
Speaker 2: And you take their urine sample and the jar is full,
Speaker 2: you know, they go the toil and they come back
Speaker 2: with the full jar and you dipstick it's normal. That's
Speaker 2: somebody who's got an irritating problem with nausea involmiting, but
Speaker 2: is managing it pretty well and would be best advised
Speaker 2: advised to keep going and hope that it settles it.
Speaker 2: Twelve works and the if someone comes back with it
Speaker 2: with the best they can do is a tiny bit
Speaker 2: of very very dark urine that's positive for key tones,
Speaker 2: then then then that's somebody who needs intravenous rehydration so
Speaker 2: that they're the sort of clinches, because just because it's
Speaker 2: common doesn't mean the degree that you're experiencing it is normal.
Speaker 1: And apart from going to the doctor to have that
Speaker 1: key tone test, what would make that person think, actually,
Speaker 1: I need to test whether this is normal.
Speaker 2: If you've noticed that you're not making nearly enough urine
Speaker 2: in the day, so substantially less than you're normally making,
Speaker 2: so that you go way less often and when you
Speaker 2: do go there's way less volume. That's not normal.
Speaker 1: Okay, good, all right? This one gets my goat and
Speaker 1: I hear it time and time again, and on some
Speaker 1: big podcasts where the baby is movements have slowed down
Speaker 1: and people say Oh, that's okay. It's just that your
Speaker 1: baby's getting ready to be born. It's just resting, or
Speaker 1: you know, the baby's just asleep, or it could be
Speaker 1: some I think that we like to reassure people because
Speaker 1: we really don't like the answer or what might have
Speaker 1: caused that baby's fetal movements to slow down. So we
Speaker 1: got no, no, you're right, you know the baby's just sleeping.
Speaker 2: Well, no one wants to be a negative, now, you know.
Speaker 2: I certain say to the pregnant woman, oh my god,
Speaker 2: you should get that checked out. But one hundred percent
Speaker 2: you should get that checked out. There are no it's
Speaker 2: not true that we can accept absent fetal movements towards term.
Speaker 2: That's that's just not right at all. What we might
Speaker 2: experience is a change in the pattern. But it's then
Speaker 2: important for us to learn the new pattern and say, okay,
Speaker 2: baby's moving to because you know, well people move, and
Speaker 2: now the baby's the pattern's changed a bit because there's
Speaker 2: a bit less room. But the baby's still got a pattern,
Speaker 2: and we need to learn that new pattern so that
Speaker 2: we can have daily reassurance. We never go to sleep
Speaker 2: in the at night on absent field movements.
Speaker 1: I love the analogy that you've used. I think maybe
Speaker 1: now Grow my Baby program, perhaps on this podcast as well,
Speaker 1: where you talk about, like you imagine, when you've been
Speaker 1: really sick at home in bed, you've still got up
Speaker 1: to go to the tour.
Speaker 2: I still get up to have a pee and go
Speaker 2: out of the kitchen, make yourself panut butter toast, and
Speaker 2: you know, watch some bad TV, and then have another
Speaker 2: pen and go back to bed. So if you didn't
Speaker 2: move at all all day, most chances are you there
Speaker 2: would be something very, very very wrong with you. So
Speaker 2: that's not to say that every time a baby doesn't
Speaker 2: seem to be moving there's something wrong, but it means
Speaker 2: that there might be, and that that should be checked out.
Speaker 2: So we don't hope for the best and think I'll
Speaker 2: call it doc tomorrow. We provoke movements in the way
Speaker 2: that we've discussed before. Have a glass of ice cold water,
Speaker 2: poke ourselves in the tummy, get into bed between cool sheets,
Speaker 2: anything that we've noticed in the past makes the baby move.
Speaker 2: Have a shower, warm shower, cold shower, whichever one's made
Speaker 2: the baby move before. And if we're still not happy,
Speaker 2: we called our care team that night.
Speaker 1: That night, Yeah, and you know, you get phone calls
Speaker 1: all at any time, which is great, so our patients
Speaker 1: know that they're not going to go to bed on
Speaker 1: a no fetal movements, but provoke some doesn't work call
Speaker 1: me and it's a bit hard, I think perhaps in
Speaker 1: the public system. So you you really haven't haven't got
Speaker 1: to that point yet where you've got the ready number whatever.
Speaker 2: You have a number because you need to know where
Speaker 2: you get where to go when you go into labor. Yeah,
Speaker 2: so you should have wherever you're having your baby on it.
Speaker 2: You'll have a number. If you have you're having your
Speaker 2: baby at home, you'll have someone someone to someone to call. Yeah,
Speaker 2: and then you run that that scenario by them.
Speaker 1: All right on my list. We had bleeding in pregnancy.
Speaker 1: We've sort of covered that, yep, so you need to
Speaker 1: have that checked. And we've covered the abdominal pain gets
Speaker 1: blamed on stretching. We've I think we've we've done that.
Speaker 1: We haven't talked about urine enough. We have a little bit.
Speaker 1: But ut eyes, some people say, oh, through my pregnancy,
Speaker 1: I had a UTI you know constantly or you know
Speaker 1: at least five times.
Speaker 2: That was normal.
Speaker 1: It was just the pregnancy. When should we think that
Speaker 1: that's not It might be common, but it's not normal.
Speaker 2: There aren't any normal u ties, so that's an easy one.
Speaker 2: They all need investigation and treatment. Yep, that's an easy one.
Speaker 2: That there's them. You might have urinary frequency from the
Speaker 2: bladder being compressed by the baby's head, but that's not
Speaker 2: a UTI. So there are only normal ut eyes and
Speaker 2: we can't just say I'm pregnant. They're bad luck. Each
Speaker 2: one you in specimen to the dock, get a culture
Speaker 2: takes mandy bidics move on. So a bad UTI that
Speaker 2: spreads upwards towards the kidneys, so called pylon auphritis, is
Speaker 2: a common cause of mature labor and delivery, and it
Speaker 2: needs to be headed off when it's just in the bladder.
Speaker 1: Right, all right, So we've talked about lots of things
Speaker 1: that are common. These are the most common symptoms of pregnancy.
Speaker 1: We talked a little bit what people should do if
Speaker 1: they suspect that that it's it's not normal anymore. Can
Speaker 1: we just go through the framework where how somebody should
Speaker 1: go and get a review?
Speaker 2: Yeah, well, I think that the that the red flag
Speaker 2: system that we've discussed today, you know, just does that
Speaker 2: does the does the problem have features that are concerning
Speaker 2: and a good A good template might be is it
Speaker 2: is it new? Is it getting worse? Is it impacting
Speaker 2: my function? And does it feel really different to what
Speaker 2: I was expecting? Great?
Speaker 1: And if I'm a partner or a friend and somebody's
Speaker 1: told me something about their pregnancy that's concerning, that's concerning
Speaker 1: instead of reassuring.
Speaker 2: I think we should speak up. We should speak up. Definitely,
Speaker 2: definitely want to discuss with your caregivers. Yeah.
Speaker 1: Yeah, you don't have to offer the solution, but you
Speaker 1: Sometimes people just need to have permission to say, actually, no,
Speaker 1: I don't think that there's normal. I think you should
Speaker 1: get that checked out.
Speaker 2: Yes, And I think if the person's brought up the
Speaker 2: thing with you in the first place, they're unlikely to
Speaker 2: be offended if you say no, actually that doesn't seem
Speaker 2: right to me. And please to be wrong if you
Speaker 2: get if you get checked out and everything's fine, that's
Speaker 2: what antenatal care is.
Speaker 1: Yeah, please to be wrong.
Speaker 2: Yeah, well, no, that's what angenatal care is. I mean,
Speaker 2: of the thousand things that I check in a month,
Speaker 2: there might be dead that are abnormal.
Speaker 1: Yep, yeah, yep.
Speaker 2: Seriously abnormal.
Speaker 1: Yep, that's great, all right everyone. I hope that has
Speaker 1: helped people are going to jump on this episode just
Speaker 1: because they think, oh my god, you know I've got
Speaker 1: this symptom? Is that normal? I hope this has been
Speaker 1: a really useful episode for you.
Speaker 2: If it has, please.
Speaker 1: Share it with a friend, or if you feel inclined
Speaker 1: to give us a five star review on your wherever
Speaker 1: you get your podcast from. Once Spotify or Apple see
Speaker 1: that review, they push it out as a recommended listen
Speaker 1: to others. So it really does help us in promoting
Speaker 1: our podcast, and we thank you for doing that. Good
Speaker 1: all right, until next week. We hope you are keeping
Speaker 1: well and growing those babies.
Speaker 2: Thanks for listening, everybody.
Speaker 1: Okay, bye for now. Hey, even though doctor Pat is
Speaker 1: well a doctor and we get lots of other doctors
Speaker 1: and other experts on our podcast, I just need to
Speaker 1: remind you that this podcast is for informational purposes only.
Speaker 1: We share lots of medical insights and experience, but everything
Speaker 1: we talk about is general in nature and may not
Speaker 1: apply to your specific situation. Please always consult with your
Speaker 1: own healthcare provider for your individual medical advice. When you
Speaker 1: go her your baby