Speaker 1: You're listening to a Muma Mia podcast.
Speaker 2: Mom and Maya acknowledges the traditional owners of land and
Speaker 2: waters that this podcast is recorded on.
Speaker 3: I am pregnanty.
Speaker 1: Welcome to Hello Bump.
Speaker 2: We're making pregnancy less overwhelming and more manageable, hopefully. I'm
Speaker 2: grace through very I'm pregnant for the first time and
Speaker 2: things are getting exciting.
Speaker 1: Because you're a full term at thirty seven weeks.
Speaker 3: It's amazing. I'm Jana Pittman, I'm a former Olympian, I'm
Speaker 3: a mother of six, and I'm training to be an obstetrician.
Speaker 3: And it is really exciting because thirty seven weeks is
Speaker 3: a massive milestone for any woman full term.
Speaker 2: Each episode, Yonder and I will be holding your hand
Speaker 2: week by week through the mysterious, perplexing and exciting miracle
Speaker 2: that is pregnancy, all the way from a poppy seed
Speaker 2: to a pumpkin.
Speaker 1: Week thirty seven, I've got that our baby is a leak.
Speaker 1: But that feels that's small fair, Yeah, but I mean
Speaker 1: I guess if it's long, it's lots. Okay, We'll go
Speaker 1: with the length of a lace kith.
Speaker 3: And the size of a watermelon, yes, or a throw pillow.
Speaker 3: I do just feel like that. You know, mums when
Speaker 3: you're a kid used to shove the pillow up your tummy.
Speaker 3: Yes to baby's look pregnant, and it comes through.
Speaker 1: Yeah, I like that.
Speaker 3: Baby's about two point nine to three kilos on average,
Speaker 3: and so yes, full term is important, but it doesn't
Speaker 3: mean baby's ready to come. So we get a lot
Speaker 3: of mums at this point that really go, oh, I'm
Speaker 3: so jack of pregnancy. Please induce me. And we're gonna
Speaker 3: talk a bit about induction. I know today because I've
Speaker 3: got some questions for you and you can have something
Speaker 3: from me. I'll try and answer them the best of
Speaker 3: my ability. But it's not time yet. There's still a
Speaker 3: lot of growing and development for baby to do. So
Speaker 3: it's laying down the fat, it's the brain maturity and
Speaker 3: things like that. So we know that all the research
Speaker 3: says that up until thirty nine weeks, there's still as
Speaker 3: long as mum's safe and there's no medical reason it's
Speaker 3: better to stay pregnant. Ironically, though, after thirty nine weeks
Speaker 3: it's more about mum's comfort and baby has done all
Speaker 3: it's growing, it will do equally well on the outside
Speaker 3: as it went on the.
Speaker 1: So it comes about us. Now that's nice.
Speaker 3: Yeah, so exactly I had the whole friend, it's been
Speaker 3: a bear and then now it's about mum. So it
Speaker 3: is a question that people get, is why is wise
Speaker 3: term thirty seven weeks? Well, baby's really beautifully developed at
Speaker 3: this point, but there's still a great benefit to keeping
Speaker 3: them inside for two more weeks if we can. And
Speaker 3: what's happening to our bodies, Well, you can't predict when
Speaker 3: labor's going to start, but at some point you're going
Speaker 3: to start feeling changes in your body towards labor. So
Speaker 3: things obviously the Old wives tales like you start getting
Speaker 3: dire every year and things like that. But your cervix
Speaker 3: will start to come anteriorly. So at the moment it
Speaker 3: SIT's really right up near your back passage. We call
Speaker 3: it a posterior cervix, which means it's holding your cervix closed.
Speaker 3: It'll start moving forward, it'll start softening. You might find
Speaker 3: you have a lot more mucous at this point in pregnancy.
Speaker 3: You're starting to pee even more than last week. Don't
Speaker 3: know how that's possible, but it is, and it's very
Speaker 3: normal to have even more anxiety because birth is approaching
Speaker 3: and you don't know what it's going to be like.
Speaker 2: Is it rare for the placenta to move down? I
Speaker 2: can't remember what it's called when it, Oh, if low lying?
Speaker 2: Will it ever become low lying at this point as
Speaker 2: you get closer.
Speaker 3: Not that I've ever heard of. So we know the
Speaker 3: placenta goes the other way. So hopefully if you had
Speaker 3: a low lying placenta, found it morphology, So that's around
Speaker 3: the twenty week We should have importantly done an ultrasound
Speaker 3: around the thirty four week mark to rule it out.
Speaker 3: Most placentas actually move up, so as you're the lower
Speaker 3: segment of the uterus is created, so basically as your
Speaker 3: whole uterus change of shape and grows up towards your diaphragm,
Speaker 3: this placenta usually gets dragged with it. So it's very
Speaker 3: rare for percenters to stay down. But there are a
Speaker 3: whole what we call a creative spectrum, so all different
Speaker 3: types of placentas. Some of them are butt the offs,
Speaker 3: which basically is where the baby comes out from where
Speaker 3: the cervic starts. Some of them are a centimeter or
Speaker 3: two away, and some of them cross completely. Sometimes vessels
Speaker 3: run across the cervix. So there's all these different and
Speaker 3: all of those things. Guys, by now at thirty seven weeks,
Speaker 3: you don't have it if your old doctor hasn't spoken
Speaker 3: about it, So it's a little irrelevant.
Speaker 1: You go checked, you're fine.
Speaker 3: But if you look at your yellow card now which
Speaker 3: most of us have, or your white card, depending on
Speaker 3: what hospital you're at, and it says low lying placenta
Speaker 3: and someone hasn't checked, you've just saved your baby's life.
Speaker 3: Go and get an ultrasound now in triple check that
Speaker 3: placenta is out of the way. That does not mean
Speaker 3: if it doesn't say anything, you have to go and
Speaker 3: get it. If you have an ultrasound, now it's just
Speaker 3: for fun. Ninety nine percent of the chance will have
Speaker 3: picked that up at a much earlier stations there. Now,
Speaker 3: is this normal? Is normal?
Speaker 2: Now?
Speaker 3: My?
Speaker 1: Is this normal? Is about interventions?
Speaker 2: Okay, Well, it's something that I first learned about in
Speaker 2: the birth courses, and that an intervention statistically leads to
Speaker 2: other interventions like epidurals, forceps.
Speaker 3: Vacuum cesarean sections, pain like yell everything, yeah.
Speaker 1: Yes, So why do we induce such a loaded question?
Speaker 3: It is a loaded question than some pausing me not
Speaker 3: saying something is do you know again? We have already
Speaker 3: said this a few times. And I think the hardest
Speaker 3: situation here is women that feel forced into a decision.
Speaker 3: I don't know any obstetricians that force someone to make
Speaker 3: a decision unless they're really scared. Now our midwife, and
Speaker 3: I know most of my friends are midwives more than doctors.
Speaker 3: To be honest, say, well, doctors get too scared. You know,
Speaker 3: birth is a very physiological process. It will happen, give
Speaker 3: it time. All the statistics that you know are about
Speaker 3: a particular woman. Every woman's different. You can't lob her
Speaker 3: in with the same statistics as others. But ultimately, birth's
Speaker 3: been happening for a long time. There's a lot of
Speaker 3: research in this space, and so we know there's certain
Speaker 3: parameters and certain diseases in pregnancy where a baby could
Speaker 3: have a terrible outcome if we push pregnancy too long,
Speaker 3: and so an induction is often offered to women with
Speaker 3: certain risk factors. So it might be, for example, you
Speaker 3: have a very small baby and you have preeclampsia or
Speaker 3: you have diabetes, and we know the risk of still
Speaker 3: birth around that thirty six week mark is real and
Speaker 3: women with type one diabetes, we know that babies that
Speaker 3: are very, very big, you know, in the ninety fifth
Speaker 3: to ninety eighth centile do have a risk of shoulder
Speaker 3: dustotia or peranial trauma, and so that it be offered. Now,
Speaker 3: that's a circumstance where a woman might say, no, I'm
Speaker 3: okay with having a tear. I'd prefer a vaginal birth,
Speaker 3: even if I have a fourth degree. That's her choice,
Speaker 3: but the recommendation has to be given that this is
Speaker 3: what we would do or this is what the recommended
Speaker 3: research would say is the safest way for mum and
Speaker 3: baby to come out of this with a positive experience.
Speaker 3: Now that's where it gets tricky, is that if a
Speaker 3: doctor offers it to you, ask questions. You know, it
Speaker 3: is your right to know why, what is the research?
Speaker 3: Why you saying this is the right thing for me
Speaker 3: and the one that I struggle with.
Speaker 1: But I know the reason.
Speaker 3: I know I've got to get in trouble for this work.
Speaker 3: But I am an ama mum, as I I am
Speaker 3: an old woman, I had lots of babies, and often
Speaker 3: women get asked or recommended to have an induction at
Speaker 3: thirty nine or forty weeks when they're over forty years
Speaker 3: of age, because we know the placenta is more likely
Speaker 3: to get tired and we don't want a baby to
Speaker 3: pass away. So where what we're afraid of is still
Speaker 3: birth now.
Speaker 1: Id is it's not delivering nutrients an exactly.
Speaker 3: It's running around gas. Yeah, so it's no longer feeding
Speaker 3: your baby the right way. And people will say, well,
Speaker 3: I had an ultrasound at thirty six weeks and it
Speaker 3: was normal. Baby looked great, But we have an ultra
Speaker 3: sound on you in the last week or two, so
Speaker 3: we don't know that hasn't changed. So again, fetal movements
Speaker 3: and all that kind of come into play, and that's
Speaker 3: where it's really tough. And there's lots of research saying that,
Speaker 3: you know, you have to do a thousand inductions to
Speaker 3: save one baby's life and things like that. You know,
Speaker 3: there's all that sort of stuff, But you have to
Speaker 3: decide what's right for you and what kind of risks
Speaker 3: you're prepared to sit with. So they're the difficult inductions.
Speaker 3: Whereas if I'm telling you need an induction for college stasis,
Speaker 3: that has a really high chance of stillbirth. So therefore
Speaker 3: there's preaclance that's the itching, but it's not just itching.
Speaker 3: It's actually related to your liver and you've got liver
Speaker 3: function and all these different reactions within the body that
Speaker 3: we don't want that we know are linked.
Speaker 1: To still birth.
Speaker 3: And so when there's certain risk factors that we say,
Speaker 3: this is the reason we think you should have an
Speaker 3: induction of labor, and they're very strongly backed research. It's
Speaker 3: a bit different. But again, the older age woman, the
Speaker 3: IVF pregnancy, So definitely women have an IVF pregnancy. You know,
Speaker 3: we say it's a very wanted pregnancy, So is every pregnancy.
Speaker 3: You know, there's no pregnancy that's well not every pregnancy,
Speaker 3: but most people getting to that point in wanting to
Speaker 3: protect their baby, and it's equally as valuable as someone
Speaker 3: who went through ten rounds of IVF. But there's that
Speaker 3: tendency to think, well, why did that woman need IVF,
Speaker 3: and therefore would you consider an induction. Now, my hospital
Speaker 3: doesn't do it for IVF, for example, So you'd have
Speaker 3: to have multiple risk factors like being forty two years
Speaker 3: of age, IVF pregnancy in a small baby. There's a
Speaker 3: real spectrum of when we would offer an induction. The
Speaker 3: difficult ones, though, grace, are the ones that are women
Speaker 3: are having a maternal or crest induction. So that is,
Speaker 3: are we doing an induction because the woman has just
Speaker 3: decided she doesn't want to continue with pregnancy. Now, that
Speaker 3: might be for social reasons, it might because she's really uncomfortable.
Speaker 3: It might because she has one or two of the
Speaker 3: softer risk factors, and you know, there's her decision, is
Speaker 3: that let's.
Speaker 1: Have this baby.
Speaker 3: They're the harder ones because yes, absolutely, induction of labor,
Speaker 3: we know, leads to higher rates of evy dural which
Speaker 3: means you're stuck on the bed, which means it's harder
Speaker 3: to push, and it can lead to higher rates of
Speaker 3: instrumental delivery, not caesareans, Funnily enough, although there is some
Speaker 3: new research showing that there may be a slight increase
Speaker 3: of caesarean rates too, But the moment, we don't counsel that.
Speaker 2: Can I ask about the induction to having an appy zurule.
Speaker 2: Why does that increase? Is it because labor stalls? Oh no, no,
Speaker 2: it's so I've done it. So obviously again I can
Speaker 2: step out of my doctors and into my mum's shoes here.
Speaker 2: My second labor was an induction of labor, and it
Speaker 2: just came on so fast. And like you know, we're
Speaker 2: not thinking of tattoos in pregnancy, but I always think
Speaker 2: if you have it. I don't know anyone who's had
Speaker 2: a tattoo. I've got a few from.
Speaker 3: Sport and limp and rings and things. But when it
Speaker 3: first start help, it hurts so badly, but then you
Speaker 3: get accustomed to it. So in labor, if you go
Speaker 3: into spontaneous labor, you have a contraction every two or
Speaker 3: three hours, and then then they're in every hour, and then
Speaker 3: there are two or three and now, and then your
Speaker 3: body builds up those contractions. The studies show that after
Speaker 3: six centimeters the pain is no worse. So it's in
Speaker 3: the discomfort or the surge, or however you want to
Speaker 3: label your pain. It doesn't get worse. It's just becomes
Speaker 3: more frequent. But you can cope with it. But when
Speaker 3: you go from zero to sitting here like you and
Speaker 3: I are, now, I stiff could drip on your arm
Speaker 3: and I thump the sintocinin through. Your contractions come on
Speaker 3: fast and thick, and that labor I had an epidural,
Speaker 3: and it was the best thing I ever did, to
Speaker 3: be honest with you, because it meant it meant that
Speaker 3: I was able to just actually concentrate on my birth,
Speaker 3: whereas before that I was climbing the walls and in
Speaker 3: so much discomfort. And so that's where it comes from.
Speaker 3: So the induction causes the contractions to come on quickly,
Speaker 3: but you've got to remember that we're only mimicking what
Speaker 3: your body does. We're not going to put you into
Speaker 3: fifteen contractions in a minute. We're trying to replicate exactly
Speaker 3: what your natural body is doing. The arguments come about, well,
Speaker 3: sometimes there's more babies that are posterior, for example, because
Speaker 3: we've started a labor before the babies decided it wants
Speaker 3: to come. But it comes back to grace. We're doing
Speaker 3: it for a medical reason. If it's a maternal request
Speaker 3: that's different, then you really need to look at the
Speaker 3: risks of induction and are you happy to have an epidural.
Speaker 3: And a lot of the time these women are like,
Speaker 3: I don't really care if I have a season yan
Speaker 3: I'd be great. If I have a vaginal birth, wonderful,
Speaker 3: But if it ends up with a season, I don't
Speaker 3: really care. So I get it, You're like, it's all
Speaker 3: about maternal choice. But if there is a reason why
Speaker 3: I'm really worried about your baby so that I've said
Speaker 3: to you, I think an induction is the best thing
Speaker 3: for you, then you're sitting with the risks of a
Speaker 3: potential epidural, a potential requirement for a vacuum assisted birth,
Speaker 3: or a baby that's really compromised. That's when you have
Speaker 3: to make these decisions more difficult, and that's when it's
Speaker 3: really hard when there's a lot of language out in
Speaker 3: social media at the moment sort of saying you know,
Speaker 3: doctors are forcing inductions on women. No, we're recommending inductions.
Speaker 3: You could always decline. You can say no to everything.
Speaker 3: That's what I think women need to remember is you
Speaker 3: don't have to say yes to anything, but do understand
Speaker 3: that there's a consequence if you don't, and that has
Speaker 3: to be on the person making that decision.
Speaker 2: In terms of when you've been in labor for a
Speaker 2: certain amount of time, there is a point where you
Speaker 2: probably can't be rushed to an emergency c section because
Speaker 2: the baby's already in the birth.
Speaker 1: Yeah, it's a bit different.
Speaker 3: That's when the vacuums in the forest.
Speaker 2: When the vacuum and the forceps, because you know, you
Speaker 2: see on TV where they're like, quick, let's go to
Speaker 2: an emergency C section, but the baby's crowning.
Speaker 1: I don't know.
Speaker 3: Well, no, look, and this is where I want to
Speaker 3: ask you. The question of you is what are you
Speaker 3: more afraid of? The cesarean section or an instrumental birth.
Speaker 1: That's a very good question, both cesarian.
Speaker 2: I'm I am worried about being in the operating room
Speaker 2: and not being out of feel like my legs and
Speaker 2: panicking and what that would. But I think I worry
Speaker 2: about that panic. My husband is terrified of blood and
Speaker 2: things like. I know that they'll be the little thing,
Speaker 2: but I worry about needing a support person and him
Speaker 2: not being able to do that for me. I'm sure
Speaker 2: they'll be a nurse that'll hold my hand if he
Speaker 2: goes white and passes out. And I'm sure he won't
Speaker 2: be the first person.
Speaker 3: To be I've had plenty of several patients in the room,
Speaker 3: let's say.
Speaker 2: But then when it comes to forceps in vacuum, I
Speaker 2: worry about pro labs, the damage.
Speaker 1: To the baby's head with the vacuum with.
Speaker 2: The vacuum, like, there's something that in that course I
Speaker 2: learn about force ofs. My brain's just gone, don't hod
Speaker 2: onto that. That's where I went, Oh, I'm okay with
Speaker 2: an episiotomy. It was the best scenario, And I think
Speaker 2: I liked the idea of trying not to do it
Speaker 2: with an epidural because then you'd be able to feel it.
Speaker 2: But then there was also a woman in the class
Speaker 2: who said her labor stopped progressing and she was a
Speaker 2: pelvic floor physio, so she actually got an epidural because
Speaker 2: her labor stalled and she got it and then her
Speaker 2: cervix did dilate the rest of the way. So I
Speaker 2: was like, oh, okay, I see the point. But I
Speaker 2: think I do have a lot of anxiety about intervention.
Speaker 2: And it's no judgment on pain relief. I'm not woo
Speaker 2: woo namastae. Shouldn't women squat it in fields? Oh my god, I'm.
Speaker 1: Not like that at all. I'm like, I'll have gas
Speaker 1: can I who has?
Speaker 2: But there's just I guess there's some anxiety around, you know,
Speaker 2: TOUCH would have been very lucky to not be in
Speaker 2: an o R. And I don't know what my anxiety
Speaker 2: will be in like in that room.
Speaker 3: I think it's very I'm sure there's lots of people
Speaker 3: listening that will feel exactly the same. And I think
Speaker 3: the thing is that everybody's experience and thoughts and feelings
Speaker 3: around this are going to be very different. And part
Speaker 3: of it is actually acknowledging what are those fears, because
Speaker 3: if you can have a discussion with your birth team
Speaker 3: around what those fears are, we can hopefully help you
Speaker 3: reduce some of those. And if you end up in
Speaker 3: that space, it might be that we need to keep
Speaker 3: the drapes up a little bit more, that we don't
Speaker 3: drop the when Bobby comes out, because it's a bit
Speaker 3: more blood in that setting. And can we put some
Speaker 3: music on? Can we educate you on different things? Is
Speaker 3: there a real hard no on some of the options
Speaker 3: that we're offering in birth, because I think there's a
Speaker 3: few big points in the birth scenario. Is that epidriols
Speaker 3: are not just for pain. You kind of mentioned just then.
Speaker 3: We often use them for women with type pelvic floor
Speaker 3: as well, and so for example, we might be eight
Speaker 3: centimeters and just not quite getting there. It actually relaxes
Speaker 3: her whole pelvic floor and lets it open up. We
Speaker 3: give it for prolonged labor. Someone who's been laboring beautifully
Speaker 3: like a queen for two days, who's absolutely smashed and
Speaker 3: needs a break for a few hours to be able
Speaker 3: to lie down and actually recover, and in that time
Speaker 3: her whole body relaxes and she pelvic opens up, baby
Speaker 3: rotates into a great position and she has a beautiful birth.
Speaker 3: If you need an instrumental birth, and epidurol is much
Speaker 3: easier because you don't feel the application. Again, I've done
Speaker 3: lots of for steps and back in birth. That's what
Speaker 3: my job is as an obstetrician. I don't love doing them.
Speaker 3: I don't go into work saying today I want to
Speaker 3: do five four steps. That's what I've signed up for.
Speaker 3: I get tickled pink when I come into the room
Speaker 3: and they don't need me, and I just get to
Speaker 3: watch a beautiful birth like that, to me is the
Speaker 3: highlight of my day. Is that the woman as a
Speaker 3: queen and a power. But they're there for a reason.
Speaker 3: We use them when your baby is sick. So if
Speaker 3: we notice on the CTG, on the measuring that their
Speaker 3: little heart rate is dropping really low. If you're pushing
Speaker 3: and you're pushing, and you're pushing, and you're pushing. The
Speaker 3: prolats risk comes from a baby sitting on that perineum
Speaker 3: for too long. And so we do a disservice to
Speaker 3: you if we let you push for three or four hours,
Speaker 3: because that baby and that pressure and all those peranial
Speaker 3: muscles and all the pelvic floor of your pelvic diaphragm,
Speaker 3: not the harbor diaphram, the one in your whole pelvis
Speaker 3: get stretched and stretch and stretch and stretched and stretched.
Speaker 3: There's also a massive increased risk of bleeding afterwards. When
Speaker 3: that uterus is what we call a tonic, it just
Speaker 3: sits open. It's contracting for hours and hours and hours
Speaker 3: and hours, and so there is a It's so hard
Speaker 3: because giving all this information scares women, but there is
Speaker 3: reasons why we expedite birth, either for mum or for baby.
Speaker 3: But I can wholeheartedly tell you that none of us
Speaker 3: do it without a lot of consideration beforehand. You just
Speaker 3: have to again make sure you know the doctor in
Speaker 3: the room, because it's only doctors that do the midwives
Speaker 3: don't do the instrumental births. Be confident that that person's
Speaker 3: got your back. And when you lock eyes with them,
Speaker 3: which is what I do with my women. I hold
Speaker 3: her hand and I say I need to do this
Speaker 3: to help you and your baby, and she's like okay,
Speaker 3: and we do it together. I like, look at her
Speaker 3: and we go and I grunt with her and I
Speaker 3: count with her, and we're in it. We're like a
Speaker 3: full team in that space. Well, that's what I think
Speaker 3: it's about. That's what birth is is. It's the woman
Speaker 3: doing the work, but just there you're there to support her.
Speaker 2: I've just got a quick one for my tool kid,
Speaker 2: which is a new mantra that I learned from a friend,
Speaker 2: which is you can do anything for sixty seconds.
Speaker 1: I love it. I can't beat that. Just it's gonna.
Speaker 2: Be sure to be yeah, but you can do anything
Speaker 2: for sixty seconds.
Speaker 1: I repeat. We hope you enjoyed this episode of Hello Bump.
Speaker 2: We have so many episodes of this series filled with
Speaker 2: tips and stories from women and.
Speaker 1: Experts who've been through it all before.
Speaker 3: You can go back and listen to everything else Hello
Speaker 3: Bump related in this podcast feed.
Speaker 2: And while you're there, we'd love if you could give
Speaker 2: us a five star rating and maybe leave us a
Speaker 2: review or even share this episode with a friend.
Speaker 3: This episode was produced by Courtney Ammenhauser with audio production
Speaker 3: by Tom Lyon.
Speaker 1: We'll catch You next Time.
Speaker 2: This episode of Hello Bump was made in partnership with
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