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Speaker 1: You're listening to a mum and me a podcast.

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

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Speaker 2: waters that this podcast is recorded on.

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Speaker 3: I am pregnanty.

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Speaker 2: Welcome to Hello Bump. We're making pregnancy less overwhelming and

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Speaker 2: more manageable, hopefully. I'm Grace rue Ray, pregnant for the

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Speaker 2: first time and at thirty six weeks, it's starting to

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Speaker 2: get a little bit old.

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Speaker 3: It's getting very real now you're only a week away

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Speaker 3: from being full termed. So anyway, I am Jana Pittman.

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Speaker 3: I am a training obstitution and gynecologist, a mum of

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Speaker 3: six beautiful babies, and I used to run for Australia.

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Speaker 2: Each episode, we will be holding your hands week by

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Speaker 2: week through the mysterious, perplexing and sometimes tiring miracle that

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Speaker 2: is pregnancy, all the way from a poppy seed to

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Speaker 2: a pumpkin.

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Speaker 3: Week thirty six, we're very much on the pumpkin side

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Speaker 3: now you are welcome to thirty six weeks.

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Speaker 2: But if we're not a pumpkin, what else are we

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Speaker 2: a popcas? We are you're a podcast. You're officially a

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Speaker 2: pupkin thisst but a small pumpkin.

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Speaker 1: Yes, a small smallish honey, ye pupkin.

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Speaker 2: But anyway, I've got a large lettuce but now that

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Speaker 2: feels quite small, or.

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Speaker 1: A small watermelon I've got here as well.

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Speaker 2: Yeah, melon, melon, melons forever, all right.

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Speaker 3: So baby is around two point seven to three kilos now,

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Speaker 3: so we really are very close to term.

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Speaker 1: So if you have a high risk.

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Speaker 3: Pregnancy, this is around the time that we actually do

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Speaker 3: start seeing some women being induced. Now we're talking very

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Speaker 3: high risk like preclamps here and growth restriction and things

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Speaker 3: like that. So again it'll be a very obstetric lead decision,

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Speaker 3: but definitely some women will be starting to have that

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Speaker 3: conversation if you have a few of those risk factors around,

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Speaker 3: when the timing of birth is most.

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Speaker 2: Appropriate for you and what have they developed most.

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Speaker 3: Things now, like there's not much leads just getting cuter,

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Speaker 3: is getting cute, but like no steroids at this point,

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Speaker 3: no lung support like little ones coming out if they're

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Speaker 3: normally grown babies at two point seven to three kilos,

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Speaker 3: we'll stay with mum. So thirty six weeks again, it's

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Speaker 3: a huge milestone because think most babies do very very

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Speaker 3: well at this point.

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Speaker 2: What's happening to me and what's happening to us.

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Speaker 3: You might start feeling that drop in the in your pelvist.

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Speaker 3: So look, it tends to happen sort of between thirty

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Speaker 3: six and thirty eight weeks where you still feel that

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Speaker 3: very much the baby's sitting underneath your ribs. But then

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Speaker 3: all of a sudden you wake up and you're like, oh,

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Speaker 3: I can breathe a bit better again. And that's because

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Speaker 3: we're hoping that the baby's head is heading down into

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Speaker 3: that pelvis, so increase problems passing your oine and things

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Speaker 3: like that. But we're getting closer.

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Speaker 2: So it is a physical feeling rather than just the

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Speaker 2: visual of like, oh, it looks like it's dropped, Like

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Speaker 2: did you notice a change?

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Speaker 3: I felt like I noticed a change. But again it's

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Speaker 3: a little bit of a wive's table. I mean, it

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Speaker 3: is obviously that head is going to head down. You

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Speaker 3: might notice that, for example, when you go for your

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Speaker 3: mid with free appointment. Now they do that really horrible

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Speaker 3: thing where they shove their hand down and try and

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Speaker 3: feel the baby's head and see if it's engaged or not.

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Speaker 3: So that basically means is the baby's head still coming

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Speaker 3: in and out of the pelvis like it would have

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Speaker 3: been two or three weeks ago, or is it nicely

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Speaker 3: lodged down there, And that's the first start of labor.

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Speaker 3: That's the first time where baby's getting in that right

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Speaker 3: direction and that pressure will start happening on that service

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Speaker 3: because that's how the cervix opens, is the baby's pressure

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Speaker 3: of the head.

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Speaker 1: Is against it.

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Speaker 3: And then when the uterus contracts, obviously it then allows

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Speaker 3: that cervix to open. But the first thing is having

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Speaker 3: something ahead or a bum pushing heavily on that cervix.

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Speaker 2: That's fascinating, isn't it.

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Speaker 1: I mean, partly it'll be the shape of the uterus.

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Speaker 3: I mean, babies do go obviously transverse and sideways and

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Speaker 3: bleak in all these different positions. But if you think

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Speaker 3: the longitudinal shape of your uterus, does you know, you'd

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Speaker 3: hope sort of define the way they lie. But I've

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Speaker 3: seen some cheeky babies in some very unusual positions.

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Speaker 2: Oh and that's what's terrifying if they go down there

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Speaker 2: and then you rock up at a hospital and they've

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Speaker 2: moved again, like you said a few episodes ago.

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Speaker 1: And I think actually it's a really good point.

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Speaker 3: There's a couple of really important things we do in

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Speaker 3: this week, and the first one is if you go

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Speaker 3: into labor now, it is actually a really good idea

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Speaker 3: to ask them to do a quick ultrasound to check

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Speaker 3: baby's head down. Now, most of the time the midwives

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Speaker 3: are going to do it anyway, or the doctors, but

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Speaker 3: you don't want to be caught out fully blown labor

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Speaker 3: and find there's a foot there. So it is just

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Speaker 3: nice to know that there's definitely ahead. Now. We can

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Speaker 3: usually feel that through your tummy, but even the most

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Speaker 3: senior midwives can sometimes get it wrong and it's a button,

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Speaker 3: not a head, so just get them to chuck the

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Speaker 3: ultrasound on. This is also the week that we do

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Speaker 3: and it's a bit controversial, but we have done all

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Speaker 3: the controversial topics in this podcast. Your GBS swab, so

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Speaker 3: that is a bacteria that grows in the vagina. Normally

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Speaker 3: it's very transient. It's about one in four women will

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Speaker 3: have it, and you need to decide if you're happy

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Speaker 3: to have it. So a lot of women say, yep,

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Speaker 3: no problems. I'd prefer to know because we know that

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Speaker 3: there's some significant problems for the baby at birth does

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Speaker 3: not affect you at all. So if a woman's got

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Speaker 3: GBS positive, she'll be just slight the twenty five percent

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Speaker 3: of other women that do not concerning for mum at all.

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Speaker 3: But if bubby could catch it, it can cause really significant

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Speaker 3: problems with their lungs and also with their brains, so

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Speaker 3: in terms of being very unwell post birth. So you

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Speaker 3: can get late onset and at term GBS sepsis in

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Speaker 3: a baby, so you know, look it's rare to get it,

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Speaker 3: but if baby does get it, there's a very high

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Speaker 3: mortality rate, which means that the ones can die from it.

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Speaker 3: And so look that sounds very scary. And I know

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Speaker 3: some people be listening to this, you know, saying, oh,

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Speaker 3: you know, that's ridiculous. I don't want antibiotics in birth,

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Speaker 3: because that's what it means. So what does it mean

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Speaker 3: is if you're positive, it means if you wraps your membranes,

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Speaker 3: we will recommend. We won't do it, we will recommend,

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Speaker 3: and then it's your choice, but strongly recommend that you

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Speaker 3: have an induction, so as soon as your waters are broken,

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Speaker 3: versus if you break waters without having that GBS bug,

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Speaker 3: you can have twenty four to forty eight hours to

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Speaker 3: see if your body goes into labor naturally, So that's

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Speaker 3: that intervention of if I do this swab and it's positive,

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Speaker 3: I'm going to have an induction. And then the second

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Speaker 3: thing is that we recommend antibiotics in labor because we

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Speaker 3: know that we can protect the baby via the placenta

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Speaker 3: to not get that infection. And then women worry about, well,

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Speaker 3: is that going to change my bastmel because it's going

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Speaker 3: to change the baby's biota and things like that, and look, yes,

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Speaker 3: absolutely there are those real concerns. But I think if

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Speaker 3: you've seen a baby get very sick from gbos sepsis,

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Speaker 3: which unfortunately I have seen, it was pretty heartbreaking, you

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Speaker 3: want to know that you've done and you put your

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Speaker 3: best foot forward, and so it is a discussion to

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Speaker 3: have with your midwife, and I look as an obstitution,

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Speaker 3: I have to say I recommend it, but there are

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Speaker 3: I've definitely had mums who come up with some really

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Speaker 3: good reasons and they said they're happy to have the

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Speaker 3: extended stay in hospital and watch their baby closely, and

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Speaker 3: that they prefer that. And ultimately, remember it's your body,

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Speaker 3: it's your baby, and you have to make the decision

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Speaker 3: that's right for you.

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Speaker 1: In this space.

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Speaker 2: But you know, why do they do it so far

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Speaker 2: out then.

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Speaker 3: Because unfortunately the taste takes quite a bit of time

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Speaker 3: to come back and there's no way of testing, like

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Speaker 3: no the PC go to labor. Yeah, there is some

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Speaker 3: places that can do a quick test it's a PCR test,

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Speaker 3: but it comes back you know, in four or five hours.

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Speaker 3: It's extremely expensive. And you know, the New South Wales

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Speaker 3: government when it comes to immunizations and swab tests and

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Speaker 3: things like this, I guess do a nationwide thing where

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Speaker 3: there's a budget that allows for the best number of

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Speaker 3: women to be treated and the most number of babies

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Speaker 3: to be safe. And I guess the recommendation at the

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Speaker 3: point is to do it. But you are right because

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Speaker 3: by forty weeks you may not be positive at all.

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Speaker 3: In other words, you might be overtreating and worse. That

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Speaker 3: lady for example, that we had, she did do the

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Speaker 3: swab and it was negative for thirty six weeks and

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Speaker 3: the baby got sick. So she did nothing wrong because

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Speaker 3: she didn't know she had GBS in labor and so

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Speaker 3: you know, there's a lot of arguments there are saying

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Speaker 3: that is it a useless test? Then unfortunately we don't

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Speaker 3: have anything better at the moment, and so I think

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Speaker 3: it really comes down to like, for my case, I

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Speaker 3: made the decision to do it, and I did the swab,

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Speaker 3: I was I've been GBS positive once, so I had

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Speaker 3: the antibiotics in labor for that, and then I just

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Speaker 3: took probiotics after labor.

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Speaker 2: Is it an ivy antibiotic?

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Speaker 3: It is Benzl penicillin unless you have a penicillin allergy.

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Speaker 3: And then I gave a little bit of probotics to

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Speaker 3: the baby as well, which again is a bit controversial,

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Speaker 3: but Kiara is a isolated from breast milk, so we

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Speaker 3: basically put a time a little bit on my nipple

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Speaker 3: or in their formula to try and help with their

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Speaker 3: gut biota afterwards. So again it's a very personal decision

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Speaker 3: and I think the really hard spot in that space

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Speaker 3: is that some hospitals don't do it, but many do.

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Speaker 3: So it's a conversation to have with you midwife and

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Speaker 3: get her to do that. The stats are very real,

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Speaker 3: Like you, A one percent of babies will get the

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Speaker 3: infection if mum's positive, and at the mortality rate can

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Speaker 3: be up to fifty percent in babies that catch it.

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Speaker 1: That get sick.

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Speaker 3: So there's all these like really long winded statistics, but

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Speaker 3: you're probably better off getting a leaflet about it and

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Speaker 3: then making it yourself when you can have an educated decision.

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Speaker 2: I want to ask about fetal movements, so we talk

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Speaker 2: about them so often, but one thing that I've read

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Speaker 2: is that the movements may change because they've gotten bigger

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Speaker 2: and they're running out of space. Is that true? And

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Speaker 2: how are we still looking for patterns to make sure

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Speaker 2: in the safe zone.

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Speaker 3: It's really hard and you know, their babies do have

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Speaker 3: less room because they're bigger now they're all curled up.

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Speaker 3: But again we're looking frequency of movements. So if your

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Speaker 3: baby moves all day and is sleepy at night, that's

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Speaker 3: their normal pattern. And if that changes and all of

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Speaker 3: a sudden they're really quiet during the day, you come

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Speaker 3: on into the hospital. I think we need to look

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Speaker 3: at how often it happens as well. So things that

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Speaker 3: we are looking for is that has there been some abruption,

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Speaker 3: has there been some decrease in placental function, has babies

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Speaker 3: growth reduced? So there's there's reasons as to why a

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Speaker 3: baby stops moving. Because I get I liken it too.

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Speaker 3: You know, if you go for a hard run and

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Speaker 3: you run out of food and no one gives you

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Speaker 3: a protein shake or and energy drink. After you've gone

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Speaker 3: for an exercise, you want to lie on the couch

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Speaker 3: and do nothing. And so, yeah, babies stop moving because

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Speaker 3: they're running out of supply, and that can be that

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Speaker 3: they're having chronic hypoxia, which basically means they've got something wrong.

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Speaker 3: Like you know, we get your recist negative mums that

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Speaker 3: don't have anti D for example, that might have a

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Speaker 3: baby that's developing a chronic anemia, and they obviously stop

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Speaker 3: moving as much.

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Speaker 1: And we do a.

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Speaker 3: Test called a KLIHOW which is special test to actually

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Speaker 3: see whether there's a reaction between the baby and the mother,

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Speaker 3: and if that's positive, we know that there's a reason

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Speaker 3: to birth baby. So there's we want you to come

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Speaker 3: in case there's something terrible like that. Nineteen nine percent

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Speaker 3: of the time, Grace, by the time you baby come

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Speaker 3: you come into the hospital, it's doing cartwheels in your

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Speaker 3: belly and you feel embarrassed. It's totally fine, and I

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Speaker 3: really want to reassure you it's one hundred percent the

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Speaker 3: right thing. Because we have had many, many mummies save

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Speaker 3: their babies lives by coming in because of concerns.

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Speaker 2: And this is something that you've spoken about before, is

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Speaker 2: that you have been called to an er so many

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Speaker 2: times and you don't care.

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Speaker 3: No, it's a twenty four to seven service and in fact,

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Speaker 3: most of the time you're sitting there going I've got

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Speaker 3: nothing to do.

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Speaker 2: Oh yeah, yes, I want to come around and say

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Speaker 2: hello too, sometimes anxious, I'm ready.

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Speaker 1: You needed to come.

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Speaker 3: And we also have a lot of junior doctors in

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Speaker 3: the hospital and they often get to come and learn

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Speaker 3: from those experiences because it is and look, I've mean

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Speaker 3: this in a negative way, but it is a bit

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Speaker 3: of the cry wolf, but if you're not careful, you'll

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Speaker 3: miss the real wolf, like as in you need to

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Speaker 3: be really good in that space of saying taking every

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Speaker 3: single woman who comes in seriously with mother's intuitions enormous

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Speaker 3: and even if you have a normal categ and a

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Speaker 3: normal ultrasound and everything's normal, if it changes again, I

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Speaker 3: want you to come back like it doesn't. It's there

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Speaker 3: were all screening tools, they're not diagnostic, So if you're concerned,

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Speaker 3: you come back. And I still vividly remember this incredible

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Speaker 3: woman who unfortunately did have a still birth, and then

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Speaker 3: she came back pregnant, and she came in and I

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Speaker 3: met her. The's only six months ago and she's only

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Speaker 3: thirty five weeks pregnant. She's like, there's something wrong. And

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Speaker 3: the CTG was normal and the ultrasound was normal and

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Speaker 3: everything was normal. She's like, there's something wrong, but we

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Speaker 3: couldn't find it. We just couldn't find it, and so

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Speaker 3: we admitted her and watched and it was just like

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Speaker 3: a bit of a gut instinctive and obviously a bit

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Speaker 3: of ten to eleven care because she'd had a terrible

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Speaker 3: outcome before. In the middle of the night, she's like,

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Speaker 3: something's really wrong. We popped the CTG on and the

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Speaker 3: heart rate had dropped right down to sixty and we

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Speaker 3: did a beautiful birth and she has a baby to

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Speaker 3: go home with. But had she not stuck to her

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Speaker 3: guns and pushed and pushed back on us to say

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Speaker 3: something is wrong, she may have had an even worse

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Speaker 3: outcome than she'd been through previously. Can't imagine two things

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Speaker 3: happening to the same person, but it sometimes does. So

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Speaker 3: listen to your heart. It's completely fine, and we much

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Speaker 3: prefer to see you then come in with a terrible outcome.

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Speaker 2: My took kit this week I wanted to ask you

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Speaker 2: about is packing your bag?

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Speaker 1: Okay?

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Speaker 2: It is thirty six weeks late. Late, too late, yes,

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Speaker 2: too late.

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Speaker 3: I want you ladies, we probably should have put that

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Speaker 3: a few weeks ago. Thirty two weeks.

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Speaker 1: I think a bag a shuld be at the front

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Speaker 1: door or maybe in the.

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Speaker 2: Car double oops before Look, you're.

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Speaker 1: Probably not going to need it.

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Speaker 3: Let's be really honest, you're probably not going to need it. Well,

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Speaker 3: worst case scenario, have a little day bag which is

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Speaker 3: a pair of undies, and your charge it.

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Speaker 1: For your phone.

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Speaker 3: Okay, because sitting around in birth units is so boring

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Speaker 3: and it's very long when your phone always goes dead.

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Speaker 3: And so I guess every time you go to your

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Speaker 3: antenatal clinic is an opportunity where something might say, sorry

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Speaker 3: to race, you have to come into hospital overnight.

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Speaker 1: So to me, it's just better.

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Speaker 3: It don't mean it's gonna happ you have your baby

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Speaker 3: that night, but it does mean we might need to

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Speaker 3: monitor you if there's something we're concerned about. So, if

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Speaker 3: it's in the back of the car, are you telling

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Speaker 3: me you haven't got your bag right now?

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Speaker 1: It's a little worry.

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Speaker 2: Yeah, okay, tonight, yeap tonight, We'll do it tonight. This

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Speaker 2: is a bit terrifying, but all right, what's on your

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Speaker 2: checklist for this week?

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Speaker 3: I think this is the time when you need to

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Speaker 3: book a night away with your partner or a friend,

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Speaker 3: like have your baby moon or whatever you're going to

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Speaker 3: do with your favorite person of choice, because again, things

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Speaker 3: are getting real and it's getting soon.

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Speaker 1: Don't go into.

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Speaker 3: State, just putting it out there because I had a

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Speaker 3: lovely lady this week who flew from Brisbane down here

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Speaker 3: and then went into early labor, and it's a long

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Speaker 3: way from home. So I think somewhere within thirty to

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Speaker 3: forty minutes from home is about the best option, just

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Speaker 3: so you can have that safety of your medical team

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Speaker 3: that's been looking after you the whole time and the

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Speaker 3: comforts of home.

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Speaker 2: Well, we're doing a staycation, but not only is it

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Speaker 2: within forty minutes or what it's like within ten minutes, Oh,

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Speaker 2: that's booked a hotel in the city, And that does

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Speaker 2: remind me. I spoke to my husband today. I was like,

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Speaker 2: I'm going to ask you on to this question. Can

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Speaker 2: I have a bath now? Because this hotel room has

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Speaker 2: a bath. Yeah, So is it the same rules as

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Speaker 2: the first trimester or are they different rules.

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Speaker 3: Look, we still say that anything overheat, your baby can't

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Speaker 3: regulate it's temperature the same as you. But like, if

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Speaker 3: you're going to have a lovely warm bath, not stinking hot,

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Speaker 3: and you're in there for five or ten minutes, if

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Speaker 3: you sold for forty five minutes to an hour, probably

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Speaker 3: not the best thing for.

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Speaker 2: Yeah, but if I still do a little at bit.

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Speaker 1: That's fine. Ten minutes I think.

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Speaker 3: I mean, you know, in labor, we're gonna you in

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Speaker 3: the bath, hopefully because it's a lovely way to relax

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Speaker 3: a woman in labor. But I think it's all in

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Speaker 3: moderation at this point.

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Speaker 2: I hear, Yes, that's what I Yes. We hope you

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Speaker 2: enjoyed this episode of Hello Bump. We have so many

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Speaker 2: episodes of this series filled with tips and stories from

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Speaker 2: women and experts who've been through it all before.

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

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Speaker 3: Bump related in this podcast feed.

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

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

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

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

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Speaker 3: by Tom Lyon We'll catch You Next Time.

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

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Speaker 2: Huggies Bye Bye