WEBVTT - Week 37: Inductions, Epidurals And Instrumental Deliveries: Understanding Interventions 0:00:11.149 --> 0:00:13.909 You're listening to a Muma Mia podcast. 0:00:14.829 --> 0:00:17.869 Mom and Maya acknowledges the traditional owners of land and 0:00:17.949 --> 0:00:20.069 waters that this podcast is recorded on. 0:00:21.389 --> 0:00:23.909 I am pregnanty. 0:00:27.389 --> 0:00:28.429 Welcome to Hello Bump. 0:00:28.469 --> 0:00:31.949 We're making pregnancy less overwhelming and more manageable, hopefully. I'm 0:00:31.949 --> 0:00:33.909 grace through very I'm pregnant for the first time and 0:00:34.109 --> 0:00:35.909 things are getting exciting. 0:00:35.589 --> 0:00:37.709 Because you're a full term at thirty seven weeks. 0:00:37.709 --> 0:00:39.989 It's amazing. I'm Jana Pittman, I'm a former Olympian, I'm 0:00:39.989 --> 0:00:42.229 a mother of six, and I'm training to be an obstetrician. 0:00:42.269 --> 0:00:44.949 And it is really exciting because thirty seven weeks is 0:00:44.949 --> 0:00:47.229 a massive milestone for any woman full term. 0:00:47.789 --> 0:00:50.269 Each episode, Yonder and I will be holding your hand 0:00:50.309 --> 0:00:53.629 week by week through the mysterious, perplexing and exciting miracle 0:00:53.669 --> 0:00:56.269 that is pregnancy, all the way from a poppy seed 0:00:56.269 --> 0:00:56.789 to a pumpkin. 0:00:59.269 --> 0:01:04.429 Week thirty seven, I've got that our baby is a leak. 0:01:04.669 --> 0:01:08.149 But that feels that's small fair, Yeah, but I mean 0:01:08.189 --> 0:01:10.589 I guess if it's long, it's lots. Okay, We'll go 0:01:10.629 --> 0:01:12.389 with the length of a lace kith. 0:01:12.069 --> 0:01:15.669 And the size of a watermelon, yes, or a throw pillow. 0:01:17.229 --> 0:01:18.909 I do just feel like that. You know, mums when 0:01:18.909 --> 0:01:20.549 you're a kid used to shove the pillow up your tummy. 0:01:20.629 --> 0:01:22.349 Yes to baby's look pregnant, and it comes through. 0:01:22.989 --> 0:01:23.869 Yeah, I like that. 0:01:24.109 --> 0:01:27.189 Baby's about two point nine to three kilos on average, 0:01:27.469 --> 0:01:29.749 and so yes, full term is important, but it doesn't 0:01:29.749 --> 0:01:31.789 mean baby's ready to come. So we get a lot 0:01:31.789 --> 0:01:33.309 of mums at this point that really go, oh, I'm 0:01:33.349 --> 0:01:35.549 so jack of pregnancy. Please induce me. And we're gonna 0:01:35.549 --> 0:01:37.229 talk a bit about induction. I know today because I've 0:01:37.229 --> 0:01:38.469 got some questions for you and you can have something 0:01:38.469 --> 0:01:39.869 from me. I'll try and answer them the best of 0:01:39.909 --> 0:01:42.549 my ability. But it's not time yet. There's still a 0:01:42.549 --> 0:01:45.509 lot of growing and development for baby to do. So 0:01:45.549 --> 0:01:47.589 it's laying down the fat, it's the brain maturity and 0:01:47.629 --> 0:01:50.509 things like that. So we know that all the research 0:01:50.549 --> 0:01:53.029 says that up until thirty nine weeks, there's still as 0:01:53.109 --> 0:01:55.389 long as mum's safe and there's no medical reason it's 0:01:55.389 --> 0:01:58.589 better to stay pregnant. Ironically, though, after thirty nine weeks 0:01:58.589 --> 0:02:01.189 it's more about mum's comfort and baby has done all 0:02:01.189 --> 0:02:03.149 it's growing, it will do equally well on the outside 0:02:03.149 --> 0:02:03.789 as it went on the. 0:02:04.029 --> 0:02:06.029 So it comes about us. Now that's nice. 0:02:06.269 --> 0:02:08.469 Yeah, so exactly I had the whole friend, it's been 0:02:08.509 --> 0:02:10.549 a bear and then now it's about mum. So it 0:02:10.629 --> 0:02:12.629 is a question that people get, is why is wise 0:02:12.749 --> 0:02:15.309 term thirty seven weeks? Well, baby's really beautifully developed at 0:02:15.309 --> 0:02:17.629 this point, but there's still a great benefit to keeping 0:02:17.669 --> 0:02:22.429 them inside for two more weeks if we can. And 0:02:22.469 --> 0:02:24.749 what's happening to our bodies, Well, you can't predict when 0:02:24.789 --> 0:02:26.349 labor's going to start, but at some point you're going 0:02:26.389 --> 0:02:29.269 to start feeling changes in your body towards labor. So 0:02:29.749 --> 0:02:32.189 things obviously the Old wives tales like you start getting 0:02:32.189 --> 0:02:33.869 dire every year and things like that. But your cervix 0:02:33.909 --> 0:02:35.589 will start to come anteriorly. So at the moment it 0:02:35.669 --> 0:02:37.509 SIT's really right up near your back passage. We call 0:02:37.509 --> 0:02:40.549 it a posterior cervix, which means it's holding your cervix closed. 0:02:40.669 --> 0:02:43.789 It'll start moving forward, it'll start softening. You might find 0:02:43.789 --> 0:02:45.869 you have a lot more mucous at this point in pregnancy. 0:02:46.229 --> 0:02:48.349 You're starting to pee even more than last week. Don't 0:02:48.349 --> 0:02:50.069 know how that's possible, but it is, and it's very 0:02:50.149 --> 0:02:52.709 normal to have even more anxiety because birth is approaching 0:02:52.749 --> 0:02:53.989 and you don't know what it's going to be like. 0:02:54.229 --> 0:02:56.829 Is it rare for the placenta to move down? I 0:02:56.829 --> 0:02:59.469 can't remember what it's called when it, Oh, if low lying? 0:02:59.909 --> 0:03:02.669 Will it ever become low lying at this point as 0:03:02.709 --> 0:03:03.869 you get closer. 0:03:03.869 --> 0:03:05.229 Not that I've ever heard of. So we know the 0:03:05.309 --> 0:03:07.589 placenta goes the other way. So hopefully if you had 0:03:07.589 --> 0:03:09.629 a low lying placenta, found it morphology, So that's around 0:03:09.629 --> 0:03:12.989 the twenty week We should have importantly done an ultrasound 0:03:13.029 --> 0:03:14.829 around the thirty four week mark to rule it out. 0:03:14.949 --> 0:03:17.269 Most placentas actually move up, so as you're the lower 0:03:17.309 --> 0:03:20.309 segment of the uterus is created, so basically as your 0:03:20.389 --> 0:03:23.549 whole uterus change of shape and grows up towards your diaphragm, 0:03:23.829 --> 0:03:26.709 this placenta usually gets dragged with it. So it's very 0:03:26.789 --> 0:03:28.589 rare for percenters to stay down. But there are a 0:03:28.629 --> 0:03:31.109 whole what we call a creative spectrum, so all different 0:03:31.149 --> 0:03:33.389 types of placentas. Some of them are butt the offs, 0:03:33.429 --> 0:03:35.389 which basically is where the baby comes out from where 0:03:35.429 --> 0:03:37.789 the cervic starts. Some of them are a centimeter or 0:03:37.789 --> 0:03:40.789 two away, and some of them cross completely. Sometimes vessels 0:03:40.829 --> 0:03:43.829 run across the cervix. So there's all these different and 0:03:43.949 --> 0:03:46.149 all of those things. Guys, by now at thirty seven weeks, 0:03:46.349 --> 0:03:48.229 you don't have it if your old doctor hasn't spoken 0:03:48.269 --> 0:03:49.829 about it, So it's a little irrelevant. 0:03:49.869 --> 0:03:51.149 You go checked, you're fine. 0:03:51.309 --> 0:03:52.949 But if you look at your yellow card now which 0:03:52.989 --> 0:03:54.629 most of us have, or your white card, depending on 0:03:54.669 --> 0:03:57.029 what hospital you're at, and it says low lying placenta 0:03:57.229 --> 0:04:00.349 and someone hasn't checked, you've just saved your baby's life. 0:04:00.389 --> 0:04:02.069 Go and get an ultrasound now in triple check that 0:04:02.189 --> 0:04:03.749 placenta is out of the way. That does not mean 0:04:03.789 --> 0:04:05.069 if it doesn't say anything, you have to go and 0:04:05.109 --> 0:04:06.629 get it. If you have an ultrasound, now it's just 0:04:06.669 --> 0:04:08.629 for fun. Ninety nine percent of the chance will have 0:04:08.629 --> 0:04:10.909 picked that up at a much earlier stations there. Now, 0:04:11.789 --> 0:04:13.189 is this normal? Is normal? 0:04:13.629 --> 0:04:13.789 Now? 0:04:13.949 --> 0:04:13.989 My? 0:04:14.269 --> 0:04:17.189 Is this normal? Is about interventions? 0:04:17.349 --> 0:04:20.869 Okay, Well, it's something that I first learned about in 0:04:20.909 --> 0:04:25.149 the birth courses, and that an intervention statistically leads to 0:04:25.949 --> 0:04:29.669 other interventions like epidurals, forceps. 0:04:29.389 --> 0:04:32.949 Vacuum cesarean sections, pain like yell everything, yeah. 0:04:32.669 --> 0:04:37.749 Yes, So why do we induce such a loaded question? 0:04:37.909 --> 0:04:40.309 It is a loaded question than some pausing me not 0:04:40.349 --> 0:04:43.829 saying something is do you know again? We have already 0:04:43.829 --> 0:04:45.829 said this a few times. And I think the hardest 0:04:45.909 --> 0:04:48.789 situation here is women that feel forced into a decision. 0:04:49.549 --> 0:04:52.749 I don't know any obstetricians that force someone to make 0:04:52.789 --> 0:04:55.109 a decision unless they're really scared. Now our midwife, and 0:04:55.109 --> 0:04:56.989 I know most of my friends are midwives more than doctors. 0:04:56.989 --> 0:04:59.389 To be honest, say, well, doctors get too scared. You know, 0:04:59.549 --> 0:05:02.509 birth is a very physiological process. It will happen, give 0:05:02.549 --> 0:05:05.429 it time. All the statistics that you know are about 0:05:05.629 --> 0:05:08.229 a particular woman. Every woman's different. You can't lob her 0:05:08.269 --> 0:05:11.309 in with the same statistics as others. But ultimately, birth's 0:05:11.309 --> 0:05:12.949 been happening for a long time. There's a lot of 0:05:12.949 --> 0:05:15.189 research in this space, and so we know there's certain 0:05:15.229 --> 0:05:19.509 parameters and certain diseases in pregnancy where a baby could 0:05:19.669 --> 0:05:22.789 have a terrible outcome if we push pregnancy too long, 0:05:23.349 --> 0:05:25.869 and so an induction is often offered to women with 0:05:25.949 --> 0:05:28.949 certain risk factors. So it might be, for example, you 0:05:29.069 --> 0:05:32.509 have a very small baby and you have preeclampsia or 0:05:32.549 --> 0:05:34.469 you have diabetes, and we know the risk of still 0:05:34.469 --> 0:05:36.269 birth around that thirty six week mark is real and 0:05:36.429 --> 0:05:38.669 women with type one diabetes, we know that babies that 0:05:38.709 --> 0:05:40.589 are very, very big, you know, in the ninety fifth 0:05:40.629 --> 0:05:42.669 to ninety eighth centile do have a risk of shoulder 0:05:42.709 --> 0:05:46.149 dustotia or peranial trauma, and so that it be offered. Now, 0:05:46.149 --> 0:05:47.989 that's a circumstance where a woman might say, no, I'm 0:05:48.029 --> 0:05:50.709 okay with having a tear. I'd prefer a vaginal birth, 0:05:50.749 --> 0:05:52.789 even if I have a fourth degree. That's her choice, 0:05:53.109 --> 0:05:55.389 but the recommendation has to be given that this is 0:05:55.429 --> 0:05:57.549 what we would do or this is what the recommended 0:05:57.589 --> 0:05:59.869 research would say is the safest way for mum and 0:05:59.869 --> 0:06:02.309 baby to come out of this with a positive experience. 0:06:03.309 --> 0:06:05.309 Now that's where it gets tricky, is that if a 0:06:05.349 --> 0:06:07.469 doctor offers it to you, ask questions. You know, it 0:06:07.549 --> 0:06:09.589 is your right to know why, what is the research? 0:06:09.669 --> 0:06:11.509 Why you saying this is the right thing for me 0:06:11.949 --> 0:06:13.109 and the one that I struggle with. 0:06:13.149 --> 0:06:13.789 But I know the reason. 0:06:13.789 --> 0:06:15.549 I know I've got to get in trouble for this work. 0:06:15.789 --> 0:06:17.309 But I am an ama mum, as I I am 0:06:17.309 --> 0:06:19.669 an old woman, I had lots of babies, and often 0:06:19.709 --> 0:06:22.789 women get asked or recommended to have an induction at 0:06:22.789 --> 0:06:25.069 thirty nine or forty weeks when they're over forty years 0:06:25.109 --> 0:06:28.669 of age, because we know the placenta is more likely 0:06:28.749 --> 0:06:31.389 to get tired and we don't want a baby to 0:06:31.429 --> 0:06:33.189 pass away. So where what we're afraid of is still 0:06:33.189 --> 0:06:34.509 birth now. 0:06:34.389 --> 0:06:37.589 Id is it's not delivering nutrients an exactly. 0:06:37.389 --> 0:06:39.989 It's running around gas. Yeah, so it's no longer feeding 0:06:39.989 --> 0:06:42.389 your baby the right way. And people will say, well, 0:06:42.389 --> 0:06:44.029 I had an ultrasound at thirty six weeks and it 0:06:44.069 --> 0:06:45.989 was normal. Baby looked great, But we have an ultra 0:06:46.029 --> 0:06:47.829 sound on you in the last week or two, so 0:06:47.869 --> 0:06:50.349 we don't know that hasn't changed. So again, fetal movements 0:06:50.389 --> 0:06:52.029 and all that kind of come into play, and that's 0:06:52.029 --> 0:06:54.189 where it's really tough. And there's lots of research saying that, 0:06:54.269 --> 0:06:56.749 you know, you have to do a thousand inductions to 0:06:56.789 --> 0:06:58.589 save one baby's life and things like that. You know, 0:06:58.669 --> 0:07:00.669 there's all that sort of stuff, But you have to 0:07:00.709 --> 0:07:02.229 decide what's right for you and what kind of risks 0:07:02.269 --> 0:07:04.469 you're prepared to sit with. So they're the difficult inductions. 0:07:04.469 --> 0:07:06.749 Whereas if I'm telling you need an induction for college stasis, 0:07:06.789 --> 0:07:08.909 that has a really high chance of stillbirth. So therefore 0:07:08.909 --> 0:07:12.869 there's preaclance that's the itching, but it's not just itching. 0:07:12.869 --> 0:07:14.509 It's actually related to your liver and you've got liver 0:07:14.549 --> 0:07:16.869 function and all these different reactions within the body that 0:07:16.909 --> 0:07:19.069 we don't want that we know are linked. 0:07:18.869 --> 0:07:19.589 To still birth. 0:07:19.909 --> 0:07:22.189 And so when there's certain risk factors that we say, 0:07:22.229 --> 0:07:23.629 this is the reason we think you should have an 0:07:23.629 --> 0:07:27.229 induction of labor, and they're very strongly backed research. It's 0:07:27.229 --> 0:07:29.549 a bit different. But again, the older age woman, the 0:07:29.589 --> 0:07:33.269 IVF pregnancy, So definitely women have an IVF pregnancy. You know, 0:07:33.349 --> 0:07:36.429 we say it's a very wanted pregnancy, So is every pregnancy. 0:07:36.509 --> 0:07:38.829 You know, there's no pregnancy that's well not every pregnancy, 0:07:38.829 --> 0:07:41.269 but most people getting to that point in wanting to 0:07:41.269 --> 0:07:43.429 protect their baby, and it's equally as valuable as someone 0:07:43.429 --> 0:07:45.989 who went through ten rounds of IVF. But there's that 0:07:46.029 --> 0:07:48.309 tendency to think, well, why did that woman need IVF, 0:07:48.309 --> 0:07:50.389 and therefore would you consider an induction. Now, my hospital 0:07:50.389 --> 0:07:52.909 doesn't do it for IVF, for example, So you'd have 0:07:52.949 --> 0:07:55.149 to have multiple risk factors like being forty two years 0:07:55.149 --> 0:07:57.509 of age, IVF pregnancy in a small baby. There's a 0:07:57.629 --> 0:08:01.229 real spectrum of when we would offer an induction. The 0:08:01.269 --> 0:08:03.389 difficult ones, though, grace, are the ones that are women 0:08:03.429 --> 0:08:05.349 are having a maternal or crest induction. So that is, 0:08:05.469 --> 0:08:07.749 are we doing an induction because the woman has just 0:08:07.829 --> 0:08:11.549 decided she doesn't want to continue with pregnancy. Now, that 0:08:11.629 --> 0:08:14.029 might be for social reasons, it might because she's really uncomfortable. 0:08:14.069 --> 0:08:15.469 It might because she has one or two of the 0:08:15.469 --> 0:08:19.349 softer risk factors, and you know, there's her decision, is 0:08:19.589 --> 0:08:20.229 that let's. 0:08:20.069 --> 0:08:20.749 Have this baby. 0:08:21.029 --> 0:08:24.029 They're the harder ones because yes, absolutely, induction of labor, 0:08:24.309 --> 0:08:26.789 we know, leads to higher rates of evy dural which 0:08:26.789 --> 0:08:28.589 means you're stuck on the bed, which means it's harder 0:08:28.629 --> 0:08:30.589 to push, and it can lead to higher rates of 0:08:30.589 --> 0:08:33.629 instrumental delivery, not caesareans, Funnily enough, although there is some 0:08:33.669 --> 0:08:35.469 new research showing that there may be a slight increase 0:08:35.469 --> 0:08:38.029 of caesarean rates too, But the moment, we don't counsel that. 0:08:38.469 --> 0:08:42.069 Can I ask about the induction to having an appy zurule. 0:08:42.389 --> 0:08:46.269 Why does that increase? Is it because labor stalls? Oh no, no, 0:08:46.269 --> 0:08:47.869 it's so I've done it. So obviously again I can 0:08:48.109 --> 0:08:50.069 step out of my doctors and into my mum's shoes here. 0:08:50.629 --> 0:08:52.909 My second labor was an induction of labor, and it 0:08:52.989 --> 0:08:55.349 just came on so fast. And like you know, we're 0:08:55.349 --> 0:08:56.949 not thinking of tattoos in pregnancy, but I always think 0:08:56.989 --> 0:08:58.109 if you have it. I don't know anyone who's had 0:08:58.109 --> 0:08:59.349 a tattoo. I've got a few from. 0:08:59.229 --> 0:09:01.469 Sport and limp and rings and things. But when it 0:09:01.509 --> 0:09:03.269 first start help, it hurts so badly, but then you 0:09:03.269 --> 0:09:06.189 get accustomed to it. So in labor, if you go 0:09:06.189 --> 0:09:08.509 into spontaneous labor, you have a contraction every two or 0:09:08.509 --> 0:09:10.349 three hours, and then then they're in every hour, and then 0:09:10.349 --> 0:09:11.389 there are two or three and now, and then your 0:09:11.429 --> 0:09:14.389 body builds up those contractions. The studies show that after 0:09:14.429 --> 0:09:16.269 six centimeters the pain is no worse. So it's in 0:09:16.309 --> 0:09:18.309 the discomfort or the surge, or however you want to 0:09:18.469 --> 0:09:20.829 label your pain. It doesn't get worse. It's just becomes 0:09:20.829 --> 0:09:23.389 more frequent. But you can cope with it. But when 0:09:23.429 --> 0:09:24.949 you go from zero to sitting here like you and 0:09:24.989 --> 0:09:26.549 I are, now, I stiff could drip on your arm 0:09:26.549 --> 0:09:29.549 and I thump the sintocinin through. Your contractions come on 0:09:29.789 --> 0:09:32.149 fast and thick, and that labor I had an epidural, 0:09:32.149 --> 0:09:33.229 and it was the best thing I ever did, to 0:09:33.229 --> 0:09:35.229 be honest with you, because it meant it meant that 0:09:35.229 --> 0:09:37.469 I was able to just actually concentrate on my birth, 0:09:37.469 --> 0:09:39.549 whereas before that I was climbing the walls and in 0:09:39.589 --> 0:09:42.189 so much discomfort. And so that's where it comes from. 0:09:42.229 --> 0:09:46.509 So the induction causes the contractions to come on quickly, 0:09:47.109 --> 0:09:50.029 but you've got to remember that we're only mimicking what 0:09:50.069 --> 0:09:51.389 your body does. We're not going to put you into 0:09:51.389 --> 0:09:55.029 fifteen contractions in a minute. We're trying to replicate exactly 0:09:55.029 --> 0:09:58.589 what your natural body is doing. The arguments come about, well, 0:09:58.629 --> 0:10:01.429 sometimes there's more babies that are posterior, for example, because 0:10:01.469 --> 0:10:03.789 we've started a labor before the babies decided it wants 0:10:03.869 --> 0:10:06.109 to come. But it comes back to grace. We're doing 0:10:06.149 --> 0:10:08.389 it for a medical reason. If it's a maternal request 0:10:08.429 --> 0:10:10.029 that's different, then you really need to look at the 0:10:10.149 --> 0:10:12.629 risks of induction and are you happy to have an epidural. 0:10:12.949 --> 0:10:14.109 And a lot of the time these women are like, 0:10:14.109 --> 0:10:15.349 I don't really care if I have a season yan 0:10:15.389 --> 0:10:17.429 I'd be great. If I have a vaginal birth, wonderful, 0:10:17.469 --> 0:10:18.709 But if it ends up with a season, I don't 0:10:18.709 --> 0:10:21.149 really care. So I get it, You're like, it's all 0:10:21.189 --> 0:10:23.709 about maternal choice. But if there is a reason why 0:10:23.749 --> 0:10:25.789 I'm really worried about your baby so that I've said 0:10:25.789 --> 0:10:27.349 to you, I think an induction is the best thing 0:10:27.349 --> 0:10:29.749 for you, then you're sitting with the risks of a 0:10:29.749 --> 0:10:32.989 potential epidural, a potential requirement for a vacuum assisted birth, 0:10:33.829 --> 0:10:36.509 or a baby that's really compromised. That's when you have 0:10:36.549 --> 0:10:38.549 to make these decisions more difficult, and that's when it's 0:10:38.589 --> 0:10:40.069 really hard when there's a lot of language out in 0:10:40.109 --> 0:10:42.269 social media at the moment sort of saying you know, 0:10:42.349 --> 0:10:45.949 doctors are forcing inductions on women. No, we're recommending inductions. 0:10:45.949 --> 0:10:48.909 You could always decline. You can say no to everything. 0:10:49.189 --> 0:10:50.789 That's what I think women need to remember is you 0:10:50.829 --> 0:10:54.469 don't have to say yes to anything, but do understand 0:10:54.509 --> 0:10:56.669 that there's a consequence if you don't, and that has 0:10:56.749 --> 0:10:58.709 to be on the person making that decision. 0:10:59.869 --> 0:11:01.189 In terms of when you've been in labor for a 0:11:01.229 --> 0:11:04.549 certain amount of time, there is a point where you 0:11:04.789 --> 0:11:07.549 probably can't be rushed to an emergency c section because 0:11:07.549 --> 0:11:08.709 the baby's already in the birth. 0:11:08.869 --> 0:11:09.989 Yeah, it's a bit different. 0:11:10.149 --> 0:11:11.789 That's when the vacuums in the forest. 0:11:11.509 --> 0:11:13.069 When the vacuum and the forceps, because you know, you 0:11:13.149 --> 0:11:14.669 see on TV where they're like, quick, let's go to 0:11:14.709 --> 0:11:16.709 an emergency C section, but the baby's crowning. 0:11:16.709 --> 0:11:17.229 I don't know. 0:11:18.829 --> 0:11:21.269 Well, no, look, and this is where I want to 0:11:21.269 --> 0:11:23.429 ask you. The question of you is what are you 0:11:23.469 --> 0:11:26.149 more afraid of? The cesarean section or an instrumental birth. 0:11:26.589 --> 0:11:30.869 That's a very good question, both cesarian. 0:11:30.989 --> 0:11:34.709 I'm I am worried about being in the operating room 0:11:34.749 --> 0:11:37.189 and not being out of feel like my legs and 0:11:37.309 --> 0:11:40.709 panicking and what that would. But I think I worry 0:11:40.749 --> 0:11:44.709 about that panic. My husband is terrified of blood and 0:11:44.829 --> 0:11:46.349 things like. I know that they'll be the little thing, 0:11:46.389 --> 0:11:49.029 but I worry about needing a support person and him 0:11:49.069 --> 0:11:51.469 not being able to do that for me. I'm sure 0:11:51.469 --> 0:11:53.069 they'll be a nurse that'll hold my hand if he 0:11:53.109 --> 0:11:55.109 goes white and passes out. And I'm sure he won't 0:11:55.149 --> 0:11:56.229 be the first person. 0:11:55.989 --> 0:11:58.269 To be I've had plenty of several patients in the room, 0:11:58.349 --> 0:11:58.749 let's say. 0:11:59.309 --> 0:12:02.389 But then when it comes to forceps in vacuum, I 0:12:02.469 --> 0:12:06.389 worry about pro labs, the damage. 0:12:05.949 --> 0:12:08.749 To the baby's head with the vacuum with. 0:12:08.749 --> 0:12:11.789 The vacuum, like, there's something that in that course I 0:12:11.909 --> 0:12:14.589 learn about force ofs. My brain's just gone, don't hod 0:12:14.669 --> 0:12:17.149 onto that. That's where I went, Oh, I'm okay with 0:12:17.189 --> 0:12:20.589 an episiotomy. It was the best scenario, And I think 0:12:20.669 --> 0:12:22.749 I liked the idea of trying not to do it 0:12:22.749 --> 0:12:25.829 with an epidural because then you'd be able to feel it. 0:12:25.909 --> 0:12:27.389 But then there was also a woman in the class 0:12:27.429 --> 0:12:30.429 who said her labor stopped progressing and she was a 0:12:30.429 --> 0:12:33.109 pelvic floor physio, so she actually got an epidural because 0:12:33.109 --> 0:12:36.269 her labor stalled and she got it and then her 0:12:36.269 --> 0:12:38.269 cervix did dilate the rest of the way. So I 0:12:38.309 --> 0:12:40.429 was like, oh, okay, I see the point. But I 0:12:40.429 --> 0:12:43.429 think I do have a lot of anxiety about intervention. 0:12:43.509 --> 0:12:47.069 And it's no judgment on pain relief. I'm not woo 0:12:47.069 --> 0:12:51.349 woo namastae. Shouldn't women squat it in fields? Oh my god, I'm. 0:12:51.189 --> 0:12:53.629 Not like that at all. I'm like, I'll have gas 0:12:53.629 --> 0:12:54.629 can I who has? 0:12:54.909 --> 0:12:58.309 But there's just I guess there's some anxiety around, you know, 0:12:58.389 --> 0:13:00.029 TOUCH would have been very lucky to not be in 0:13:00.029 --> 0:13:03.189 an o R. And I don't know what my anxiety 0:13:03.349 --> 0:13:04.509 will be in like in that room. 0:13:04.749 --> 0:13:06.509 I think it's very I'm sure there's lots of people 0:13:06.509 --> 0:13:08.349 listening that will feel exactly the same. And I think 0:13:08.389 --> 0:13:10.949 the thing is that everybody's experience and thoughts and feelings 0:13:10.949 --> 0:13:13.149 around this are going to be very different. And part 0:13:13.149 --> 0:13:16.189 of it is actually acknowledging what are those fears, because 0:13:16.229 --> 0:13:17.949 if you can have a discussion with your birth team 0:13:17.989 --> 0:13:19.909 around what those fears are, we can hopefully help you 0:13:20.189 --> 0:13:21.829 reduce some of those. And if you end up in 0:13:21.829 --> 0:13:23.469 that space, it might be that we need to keep 0:13:23.509 --> 0:13:24.909 the drapes up a little bit more, that we don't 0:13:24.949 --> 0:13:26.389 drop the when Bobby comes out, because it's a bit 0:13:26.389 --> 0:13:28.629 more blood in that setting. And can we put some 0:13:28.749 --> 0:13:31.189 music on? Can we educate you on different things? Is 0:13:31.229 --> 0:13:33.789 there a real hard no on some of the options 0:13:33.789 --> 0:13:36.269 that we're offering in birth, because I think there's a 0:13:36.269 --> 0:13:40.149 few big points in the birth scenario. Is that epidriols 0:13:40.149 --> 0:13:41.909 are not just for pain. You kind of mentioned just then. 0:13:41.949 --> 0:13:43.709 We often use them for women with type pelvic floor 0:13:43.789 --> 0:13:45.509 as well, and so for example, we might be eight 0:13:45.589 --> 0:13:48.949 centimeters and just not quite getting there. It actually relaxes 0:13:48.949 --> 0:13:50.829 her whole pelvic floor and lets it open up. We 0:13:50.869 --> 0:13:53.789 give it for prolonged labor. Someone who's been laboring beautifully 0:13:53.869 --> 0:13:56.349 like a queen for two days, who's absolutely smashed and 0:13:56.389 --> 0:13:58.189 needs a break for a few hours to be able 0:13:58.229 --> 0:14:00.269 to lie down and actually recover, and in that time 0:14:00.309 --> 0:14:02.549 her whole body relaxes and she pelvic opens up, baby 0:14:02.629 --> 0:14:04.829 rotates into a great position and she has a beautiful birth. 0:14:05.349 --> 0:14:07.589 If you need an instrumental birth, and epidurol is much 0:14:07.589 --> 0:14:11.669 easier because you don't feel the application. Again, I've done 0:14:11.709 --> 0:14:13.509 lots of for steps and back in birth. That's what 0:14:13.549 --> 0:14:15.749 my job is as an obstetrician. I don't love doing them. 0:14:15.789 --> 0:14:17.669 I don't go into work saying today I want to 0:14:17.669 --> 0:14:19.709 do five four steps. That's what I've signed up for. 0:14:19.989 --> 0:14:22.189 I get tickled pink when I come into the room 0:14:22.189 --> 0:14:23.349 and they don't need me, and I just get to 0:14:23.349 --> 0:14:25.629 watch a beautiful birth like that, to me is the 0:14:25.709 --> 0:14:27.749 highlight of my day. Is that the woman as a 0:14:27.829 --> 0:14:30.069 queen and a power. But they're there for a reason. 0:14:30.349 --> 0:14:32.429 We use them when your baby is sick. So if 0:14:32.469 --> 0:14:35.069 we notice on the CTG, on the measuring that their 0:14:35.069 --> 0:14:37.909 little heart rate is dropping really low. If you're pushing 0:14:37.949 --> 0:14:40.549 and you're pushing, and you're pushing, and you're pushing. The 0:14:40.589 --> 0:14:43.549 prolats risk comes from a baby sitting on that perineum 0:14:43.949 --> 0:14:46.669 for too long. And so we do a disservice to 0:14:46.709 --> 0:14:48.749 you if we let you push for three or four hours, 0:14:48.789 --> 0:14:51.069 because that baby and that pressure and all those peranial 0:14:51.109 --> 0:14:53.869 muscles and all the pelvic floor of your pelvic diaphragm, 0:14:53.909 --> 0:14:57.029 not the harbor diaphram, the one in your whole pelvis 0:14:57.469 --> 0:14:59.629 get stretched and stretch and stretch and stretched and stretched. 0:14:59.829 --> 0:15:02.429 There's also a massive increased risk of bleeding afterwards. When 0:15:02.429 --> 0:15:04.109 that uterus is what we call a tonic, it just 0:15:04.149 --> 0:15:06.789 sits open. It's contracting for hours and hours and hours 0:15:06.829 --> 0:15:09.549 and hours, and so there is a It's so hard 0:15:09.589 --> 0:15:11.989 because giving all this information scares women, but there is 0:15:12.109 --> 0:15:15.389 reasons why we expedite birth, either for mum or for baby. 0:15:15.509 --> 0:15:17.189 But I can wholeheartedly tell you that none of us 0:15:17.189 --> 0:15:20.189 do it without a lot of consideration beforehand. You just 0:15:20.229 --> 0:15:22.309 have to again make sure you know the doctor in 0:15:22.309 --> 0:15:23.989 the room, because it's only doctors that do the midwives 0:15:24.029 --> 0:15:26.989 don't do the instrumental births. Be confident that that person's 0:15:27.029 --> 0:15:29.349 got your back. And when you lock eyes with them, 0:15:29.349 --> 0:15:30.749 which is what I do with my women. I hold 0:15:30.749 --> 0:15:32.549 her hand and I say I need to do this 0:15:32.589 --> 0:15:34.909 to help you and your baby, and she's like okay, 0:15:35.229 --> 0:15:36.989 and we do it together. I like, look at her 0:15:37.029 --> 0:15:39.029 and we go and I grunt with her and I 0:15:39.109 --> 0:15:40.669 count with her, and we're in it. We're like a 0:15:40.709 --> 0:15:42.989 full team in that space. Well, that's what I think 0:15:43.029 --> 0:15:45.109 it's about. That's what birth is is. It's the woman 0:15:45.149 --> 0:15:47.149 doing the work, but just there you're there to support her. 0:15:48.869 --> 0:15:50.869 I've just got a quick one for my tool kid, 0:15:50.949 --> 0:15:53.309 which is a new mantra that I learned from a friend, 0:15:53.589 --> 0:15:55.709 which is you can do anything for sixty seconds. 0:15:56.189 --> 0:15:59.509 I love it. I can't beat that. Just it's gonna. 0:15:59.349 --> 0:16:01.309 Be sure to be yeah, but you can do anything 0:16:01.349 --> 0:16:02.149 for sixty seconds. 0:16:02.229 --> 0:16:07.149 I repeat. We hope you enjoyed this episode of Hello Bump. 0:16:07.269 --> 0:16:09.989 We have so many episodes of this series filled with 0:16:10.189 --> 0:16:12.189 tips and stories from women and. 0:16:12.149 --> 0:16:13.989 Experts who've been through it all before. 0:16:14.309 --> 0:16:16.149 You can go back and listen to everything else Hello 0:16:16.189 --> 0:16:17.909 Bump related in this podcast feed. 0:16:17.869 --> 0:16:19.629