May 25, 2025 • 16 mins
Welcome to Hello Bump, a podcast about what you’re not expecting when you’re expecting.
In this episode, hosts Jana Pittman and Grace Rouvray discover your baby is around the length of a leek or the size of a watermelon! At week 37, you’re officially full term and your baby will be around 2.9–3kg in size. Jana explains the things your body will start to do as you approach birth. Plus, Grace asks about managing anxiety around birth interventions including epidurals, inductions, forceps and C-sections.
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CREDITS:
Hosts: Jana Pittman and Grace Rouvray
Executive Producer: Courtney Ammenhauser
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:11):
You're listening to a Muma Mia podcast.
Speaker 2 (00:14):
Mom and Maya acknowledges the traditional owners of land and
waters that this podcast is recorded on.
Speaker 3 (00:21):
I am pregnanty.
Speaker 1 (00:27):
Welcome to Hello Bump.
Speaker 2 (00:28):
We're making pregnancy less overwhelming and more manageable, hopefully. I'm
grace through very I'm pregnant for the first time and
things are getting exciting.
Speaker 1 (00:35):
Because you're a full term at thirty seven weeks.
Speaker 3 (00:37):
It's amazing. I'm Jana Pittman, I'm a former Olympian, I'm
a mother of six, and I'm training to be an obstetrician.
And it is really exciting because thirty seven weeks is
a massive milestone for any woman full term.
Speaker 2 (00:47):
Each episode, Yonder and I will be holding your hand
week by week through the mysterious, perplexing and exciting miracle
that is pregnancy, all the way from a poppy seed
to a pumpkin.
Speaker 1 (00:59):
Week thirty seven, I've got that our baby is a leak.
But that feels that's small fair, Yeah, but I mean
I guess if it's long, it's lots. Okay, We'll go
with the length of a lace kith.
Speaker 3 (01:12):
And the size of a watermelon, yes, or a throw pillow.
I do just feel like that. You know, mums when
you're a kid used to shove the pillow up your tummy.
Yes to baby's look pregnant, and it comes through.
Speaker 1 (01:22):
Yeah, I like that.
Speaker 3 (01:24):
Baby's about two point nine to three kilos on average,
and so yes, full term is important, but it doesn't
mean baby's ready to come. So we get a lot
of mums at this point that really go, oh, I'm
so jack of pregnancy. Please induce me. And we're gonna
talk a bit about induction. I know today because I've
got some questions for you and you can have something
from me. I'll try and answer them the best of
my ability. But it's not time yet. There's still a
lot of growing and development for baby to do. So
(01:45):
it's laying down the fat, it's the brain maturity and
things like that. So we know that all the research
says that up until thirty nine weeks, there's still as
long as mum's safe and there's no medical reason it's
better to stay pregnant. Ironically, though, after thirty nine weeks
it's more about mum's comfort and baby has done all
it's growing, it will do equally well on the outside
as it went on the.
Speaker 1 (02:04):
So it comes about us. Now that's nice.
Speaker 3 (02:06):
Yeah, so exactly I had the whole friend, it's been
a bear and then now it's about mum. So it
is a question that people get, is why is wise
term thirty seven weeks? Well, baby's really beautifully developed at
this point, but there's still a great benefit to keeping
them inside for two more weeks if we can. And
what's happening to our bodies, Well, you can't predict when
labor's going to start, but at some point you're going
(02:26):
to start feeling changes in your body towards labor. So
things obviously the Old wives tales like you start getting
dire every year and things like that. But your cervix
will start to come anteriorly. So at the moment it
SIT's really right up near your back passage. We call
it a posterior cervix, which means it's holding your cervix closed.
It'll start moving forward, it'll start softening. You might find
you have a lot more mucous at this point in pregnancy.
You're starting to pee even more than last week. Don't
(02:48):
know how that's possible, but it is, and it's very
normal to have even more anxiety because birth is approaching
and you don't know what it's going to be like.
Speaker 2 (02:54):
Is it rare for the placenta to move down? I
can't remember what it's called when it, Oh, if low lying?
Will it ever become low lying at this point as
you get closer.
Speaker 3 (03:03):
Not that I've ever heard of. So we know the
placenta goes the other way. So hopefully if you had
a low lying placenta, found it morphology, So that's around
the twenty week We should have importantly done an ultrasound
around the thirty four week mark to rule it out.
Most placentas actually move up, so as you're the lower
segment of the uterus is created, so basically as your
whole uterus change of shape and grows up towards your diaphragm,
this placenta usually gets dragged with it. So it's very
(03:26):
rare for percenters to stay down. But there are a
whole what we call a creative spectrum, so all different
types of placentas. Some of them are butt the offs,
which basically is where the baby comes out from where
the cervic starts. Some of them are a centimeter or
two away, and some of them cross completely. Sometimes vessels
run across the cervix. So there's all these different and
all of those things. Guys, by now at thirty seven weeks,
you don't have it if your old doctor hasn't spoken
(03:48):
about it, So it's a little irrelevant.
Speaker 1 (03:49):
You go checked, you're fine.
Speaker 3 (03:51):
But if you look at your yellow card now which
most of us have, or your white card, depending on
what hospital you're at, and it says low lying placenta
and someone hasn't checked, you've just saved your baby's life.
Go and get an ultrasound now in triple check that
placenta is out of the way. That does not mean
if it doesn't say anything, you have to go and
get it. If you have an ultrasound, now it's just
for fun. Ninety nine percent of the chance will have
picked that up at a much earlier stations there. Now,
(04:11):
is this normal? Is normal?
Speaker 2 (04:13):
Now?
Speaker 3 (04:13):
My?
Speaker 1 (04:14):
Is this normal? Is about interventions?
Speaker 2 (04:17):
Okay, Well, it's something that I first learned about in
the birth courses, and that an intervention statistically leads to
other interventions like epidurals, forceps.
Speaker 3 (04:29):
Vacuum cesarean sections, pain like yell everything, yeah.
Speaker 1 (04:32):
Yes, So why do we induce such a loaded question?
Speaker 3 (04:37):
It is a loaded question than some pausing me not
saying something is do you know again? We have already
said this a few times. And I think the hardest
situation here is women that feel forced into a decision.
I don't know any obstetricians that force someone to make
a decision unless they're really scared. Now our midwife, and
I know most of my friends are midwives more than doctors.
To be honest, say, well, doctors get too scared. You know,
(04:59):
birth is a very physiological process. It will happen, give
it time. All the statistics that you know are about
a particular woman. Every woman's different. You can't lob her
in with the same statistics as others. But ultimately, birth's
been happening for a long time. There's a lot of
research in this space, and so we know there's certain
parameters and certain diseases in pregnancy where a baby could
(05:19):
have a terrible outcome if we push pregnancy too long,
and so an induction is often offered to women with
certain risk factors. So it might be, for example, you
have a very small baby and you have preeclampsia or
you have diabetes, and we know the risk of still
birth around that thirty six week mark is real and
women with type one diabetes, we know that babies that
are very, very big, you know, in the ninety fifth
(05:40):
to ninety eighth centile do have a risk of shoulder
dustotia or peranial trauma, and so that it be offered. Now,
that's a circumstance where a woman might say, no, I'm
okay with having a tear. I'd prefer a vaginal birth,
even if I have a fourth degree. That's her choice,
but the recommendation has to be given that this is
what we would do or this is what the recommended
research would say is the safest way for mum and
baby to come out of this with a positive experience.
(06:03):
Now that's where it gets tricky, is that if a
doctor offers it to you, ask questions. You know, it
is your right to know why, what is the research?
Why you saying this is the right thing for me
and the one that I struggle with.
Speaker 1 (06:13):
But I know the reason.
Speaker 3 (06:13):
I know I've got to get in trouble for this work.
But I am an ama mum, as I I am
an old woman, I had lots of babies, and often
women get asked or recommended to have an induction at
thirty nine or forty weeks when they're over forty years
of age, because we know the placenta is more likely
to get tired and we don't want a baby to
pass away. So where what we're afraid of is still
birth now.
Speaker 1 (06:34):
Id is it's not delivering nutrients an exactly.
Speaker 3 (06:37):
It's running around gas. Yeah, so it's no longer feeding
your baby the right way. And people will say, well,
I had an ultrasound at thirty six weeks and it
was normal. Baby looked great, But we have an ultra
sound on you in the last week or two, so
we don't know that hasn't changed. So again, fetal movements
and all that kind of come into play, and that's
where it's really tough. And there's lots of research saying that,
you know, you have to do a thousand inductions to
save one baby's life and things like that. You know,
(06:58):
there's all that sort of stuff, But you have to
decide what's right for you and what kind of risks
you're prepared to sit with. So they're the difficult inductions.
Whereas if I'm telling you need an induction for college stasis,
that has a really high chance of stillbirth. So therefore
there's preaclance that's the itching, but it's not just itching.
It's actually related to your liver and you've got liver
function and all these different reactions within the body that
we don't want that we know are linked.
Speaker 1 (07:18):
To still birth.
Speaker 3 (07:19):
And so when there's certain risk factors that we say,
this is the reason we think you should have an
induction of labor, and they're very strongly backed research. It's
a bit different. But again, the older age woman, the
IVF pregnancy, So definitely women have an IVF pregnancy. You know,
we say it's a very wanted pregnancy, So is every pregnancy.
You know, there's no pregnancy that's well not every pregnancy,
but most people getting to that point in wanting to
(07:41):
protect their baby, and it's equally as valuable as someone
who went through ten rounds of IVF. But there's that
tendency to think, well, why did that woman need IVF,
and therefore would you consider an induction. Now, my hospital
doesn't do it for IVF, for example, So you'd have
to have multiple risk factors like being forty two years
of age, IVF pregnancy in a small baby. There's a
real spectrum of when we would offer an induction. The
difficult ones, though, grace, are the ones that are women
(08:03):
are having a maternal or crest induction. So that is,
are we doing an induction because the woman has just
decided she doesn't want to continue with pregnancy. Now, that
might be for social reasons, it might because she's really uncomfortable.
It might because she has one or two of the
softer risk factors, and you know, there's her decision, is
that let's.
Speaker 1 (08:20):
Have this baby.
Speaker 3 (08:21):
They're the harder ones because yes, absolutely, induction of labor,
we know, leads to higher rates of evy dural which
means you're stuck on the bed, which means it's harder
to push, and it can lead to higher rates of
instrumental delivery, not caesareans, Funnily enough, although there is some
new research showing that there may be a slight increase
of caesarean rates too, But the moment, we don't counsel that.
Speaker 2 (08:38):
Can I ask about the induction to having an appy zurule.
Why does that increase? Is it because labor stalls? Oh no, no,
it's so I've done it. So obviously again I can
step out of my doctors and into my mum's shoes here.
My second labor was an induction of labor, and it
just came on so fast. And like you know, we're
not thinking of tattoos in pregnancy, but I always think
if you have it. I don't know anyone who's had
a tattoo. I've got a few from.
Speaker 3 (08:59):
Sport and limp and rings and things. But when it
first start help, it hurts so badly, but then you
get accustomed to it. So in labor, if you go
into spontaneous labor, you have a contraction every two or
three hours, and then then they're in every hour, and then
there are two or three and now, and then your
body builds up those contractions. The studies show that after
six centimeters the pain is no worse. So it's in
the discomfort or the surge, or however you want to
label your pain. It doesn't get worse. It's just becomes
(09:20):
more frequent. But you can cope with it. But when
you go from zero to sitting here like you and
I are, now, I stiff could drip on your arm
and I thump the sintocinin through. Your contractions come on
fast and thick, and that labor I had an epidural,
and it was the best thing I ever did, to
be honest with you, because it meant it meant that
I was able to just actually concentrate on my birth,
whereas before that I was climbing the walls and in
so much discomfort. And so that's where it comes from.
(09:42):
So the induction causes the contractions to come on quickly,
but you've got to remember that we're only mimicking what
your body does. We're not going to put you into
fifteen contractions in a minute. We're trying to replicate exactly
what your natural body is doing. The arguments come about, well,
sometimes there's more babies that are posterior, for example, because
we've started a labor before the babies decided it wants
(10:03):
to come. But it comes back to grace. We're doing
it for a medical reason. If it's a maternal request
that's different, then you really need to look at the
risks of induction and are you happy to have an epidural.
And a lot of the time these women are like,
I don't really care if I have a season yan
I'd be great. If I have a vaginal birth, wonderful,
But if it ends up with a season, I don't
really care. So I get it, You're like, it's all
about maternal choice. But if there is a reason why
I'm really worried about your baby so that I've said
(10:25):
to you, I think an induction is the best thing
for you, then you're sitting with the risks of a
potential epidural, a potential requirement for a vacuum assisted birth,
or a baby that's really compromised. That's when you have
to make these decisions more difficult, and that's when it's
really hard when there's a lot of language out in
social media at the moment sort of saying you know,
doctors are forcing inductions on women. No, we're recommending inductions.
(10:45):
You could always decline. You can say no to everything.
That's what I think women need to remember is you
don't have to say yes to anything, but do understand
that there's a consequence if you don't, and that has
to be on the person making that decision.
Speaker 2 (10:59):
In terms of when you've been in labor for a
certain amount of time, there is a point where you
probably can't be rushed to an emergency c section because
the baby's already in the birth.
Speaker 1 (11:08):
Yeah, it's a bit different.
Speaker 3 (11:10):
That's when the vacuums in the forest.
Speaker 2 (11:11):
When the vacuum and the forceps, because you know, you
see on TV where they're like, quick, let's go to
an emergency C section, but the baby's crowning.
Speaker 1 (11:16):
I don't know.
Speaker 3 (11:18):
Well, no, look, and this is where I want to
ask you. The question of you is what are you
more afraid of? The cesarean section or an instrumental birth.
Speaker 1 (11:26):
That's a very good question, both cesarian.
Speaker 2 (11:30):
I'm I am worried about being in the operating room
and not being out of feel like my legs and
panicking and what that would. But I think I worry
about that panic. My husband is terrified of blood and
things like. I know that they'll be the little thing,
but I worry about needing a support person and him
not being able to do that for me. I'm sure
(11:51):
they'll be a nurse that'll hold my hand if he
goes white and passes out. And I'm sure he won't
be the first person.
Speaker 3 (11:55):
To be I've had plenty of several patients in the room,
let's say.
Speaker 2 (11:59):
But then when it comes to forceps in vacuum, I
worry about pro labs, the damage.
Speaker 1 (12:05):
To the baby's head with the vacuum with.
Speaker 2 (12:08):
The vacuum, like, there's something that in that course I
learn about force ofs. My brain's just gone, don't hod
onto that. That's where I went, Oh, I'm okay with
an episiotomy. It was the best scenario, And I think
I liked the idea of trying not to do it
with an epidural because then you'd be able to feel it.
But then there was also a woman in the class
who said her labor stopped progressing and she was a
(12:30):
pelvic floor physio, so she actually got an epidural because
her labor stalled and she got it and then her
cervix did dilate the rest of the way. So I
was like, oh, okay, I see the point. But I
think I do have a lot of anxiety about intervention.
And it's no judgment on pain relief. I'm not woo
woo namastae. Shouldn't women squat it in fields? Oh my god, I'm.
Speaker 1 (12:51):
Not like that at all. I'm like, I'll have gas
can I who has?
Speaker 2 (12:54):
But there's just I guess there's some anxiety around, you know,
TOUCH would have been very lucky to not be in
an o R. And I don't know what my anxiety
will be in like in that room.
Speaker 3 (13:04):
I think it's very I'm sure there's lots of people
listening that will feel exactly the same. And I think
the thing is that everybody's experience and thoughts and feelings
around this are going to be very different. And part
of it is actually acknowledging what are those fears, because
if you can have a discussion with your birth team
around what those fears are, we can hopefully help you
reduce some of those. And if you end up in
that space, it might be that we need to keep
the drapes up a little bit more, that we don't
(13:24):
drop the when Bobby comes out, because it's a bit
more blood in that setting. And can we put some
music on? Can we educate you on different things? Is
there a real hard no on some of the options
that we're offering in birth, because I think there's a
few big points in the birth scenario. Is that epidriols
are not just for pain. You kind of mentioned just then.
We often use them for women with type pelvic floor
as well, and so for example, we might be eight
(13:45):
centimeters and just not quite getting there. It actually relaxes
her whole pelvic floor and lets it open up. We
give it for prolonged labor. Someone who's been laboring beautifully
like a queen for two days, who's absolutely smashed and
needs a break for a few hours to be able
to lie down and actually recover, and in that time
her whole body relaxes and she pelvic opens up, baby
rotates into a great position and she has a beautiful birth.
If you need an instrumental birth, and epidurol is much
(14:07):
easier because you don't feel the application. Again, I've done
lots of for steps and back in birth. That's what
my job is as an obstetrician. I don't love doing them.
I don't go into work saying today I want to
do five four steps. That's what I've signed up for.
I get tickled pink when I come into the room
and they don't need me, and I just get to
watch a beautiful birth like that, to me is the
highlight of my day. Is that the woman as a
(14:27):
queen and a power. But they're there for a reason.
We use them when your baby is sick. So if
we notice on the CTG, on the measuring that their
little heart rate is dropping really low. If you're pushing
and you're pushing, and you're pushing, and you're pushing. The
prolats risk comes from a baby sitting on that perineum
for too long. And so we do a disservice to
you if we let you push for three or four hours,
(14:48):
because that baby and that pressure and all those peranial
muscles and all the pelvic floor of your pelvic diaphragm,
not the harbor diaphram, the one in your whole pelvis
get stretched and stretch and stretch and stretched and stretched.
There's also a massive increased risk of bleeding afterwards. When
that uterus is what we call a tonic, it just
sits open. It's contracting for hours and hours and hours
and hours, and so there is a It's so hard
(15:09):
because giving all this information scares women, but there is
reasons why we expedite birth, either for mum or for baby.
But I can wholeheartedly tell you that none of us
do it without a lot of consideration beforehand. You just
have to again make sure you know the doctor in
the room, because it's only doctors that do the midwives
don't do the instrumental births. Be confident that that person's
got your back. And when you lock eyes with them,
which is what I do with my women. I hold
(15:30):
her hand and I say I need to do this
to help you and your baby, and she's like okay,
and we do it together. I like, look at her
and we go and I grunt with her and I
count with her, and we're in it. We're like a
full team in that space. Well, that's what I think
it's about. That's what birth is is. It's the woman
doing the work, but just there you're there to support her.
Speaker 2 (15:48):
I've just got a quick one for my tool kid,
which is a new mantra that I learned from a friend,
which is you can do anything for sixty seconds.
Speaker 1 (15:56):
I love it. I can't beat that. Just it's gonna.
Speaker 2 (15:59):
Be sure to be yeah, but you can do anything
for sixty seconds.
Speaker 1 (16:02):
I repeat. We hope you enjoyed this episode of Hello Bump.
Speaker 2 (16:07):
We have so many episodes of this series filled with
tips and stories from women and.
Speaker 1 (16:12):
Experts who've been through it all before.
Speaker 3 (16:14):
You can go back and listen to everything else Hello
Bump related in this podcast feed.
Speaker 2 (16:17):
And while you're there, we'd love if you could give
us a five star rating and maybe leave us a
review or even share this episode with a friend.
Speaker 3 (16:23):
This episode was produced by Courtney Ammenhauser with audio production
by Tom Lyon.
Speaker 1 (16:27):
We'll catch You next Time.
Speaker 2 (16:28):
This episode of Hello Bump was made in partnership with
Huggies Bye Bye
You're listening to a Muma Mia podcast.
Speaker 2 (00:14):
Mom and Maya acknowledges the traditional owners of land and
waters that this podcast is recorded on.
Speaker 3 (00:21):
I am pregnanty.
Speaker 1 (00:27):
Welcome to Hello Bump.
Speaker 2 (00:28):
We're making pregnancy less overwhelming and more manageable, hopefully. I'm
grace through very I'm pregnant for the first time and
things are getting exciting.
Speaker 1 (00:35):
Because you're a full term at thirty seven weeks.
Speaker 3 (00:37):
It's amazing. I'm Jana Pittman, I'm a former Olympian, I'm
a mother of six, and I'm training to be an obstetrician.
And it is really exciting because thirty seven weeks is
a massive milestone for any woman full term.
Speaker 2 (00:47):
Each episode, Yonder and I will be holding your hand
week by week through the mysterious, perplexing and exciting miracle
that is pregnancy, all the way from a poppy seed
to a pumpkin.
Speaker 1 (00:59):
Week thirty seven, I've got that our baby is a leak.
But that feels that's small fair, Yeah, but I mean
I guess if it's long, it's lots. Okay, We'll go
with the length of a lace kith.
Speaker 3 (01:12):
And the size of a watermelon, yes, or a throw pillow.
I do just feel like that. You know, mums when
you're a kid used to shove the pillow up your tummy.
Yes to baby's look pregnant, and it comes through.
Speaker 1 (01:22):
Yeah, I like that.
Speaker 3 (01:24):
Baby's about two point nine to three kilos on average,
and so yes, full term is important, but it doesn't
mean baby's ready to come. So we get a lot
of mums at this point that really go, oh, I'm
so jack of pregnancy. Please induce me. And we're gonna
talk a bit about induction. I know today because I've
got some questions for you and you can have something
from me. I'll try and answer them the best of
my ability. But it's not time yet. There's still a
lot of growing and development for baby to do. So
(01:45):
it's laying down the fat, it's the brain maturity and
things like that. So we know that all the research
says that up until thirty nine weeks, there's still as
long as mum's safe and there's no medical reason it's
better to stay pregnant. Ironically, though, after thirty nine weeks
it's more about mum's comfort and baby has done all
it's growing, it will do equally well on the outside
as it went on the.
Speaker 1 (02:04):
So it comes about us. Now that's nice.
Speaker 3 (02:06):
Yeah, so exactly I had the whole friend, it's been
a bear and then now it's about mum. So it
is a question that people get, is why is wise
term thirty seven weeks? Well, baby's really beautifully developed at
this point, but there's still a great benefit to keeping
them inside for two more weeks if we can. And
what's happening to our bodies, Well, you can't predict when
labor's going to start, but at some point you're going
(02:26):
to start feeling changes in your body towards labor. So
things obviously the Old wives tales like you start getting
dire every year and things like that. But your cervix
will start to come anteriorly. So at the moment it
SIT's really right up near your back passage. We call
it a posterior cervix, which means it's holding your cervix closed.
It'll start moving forward, it'll start softening. You might find
you have a lot more mucous at this point in pregnancy.
You're starting to pee even more than last week. Don't
(02:48):
know how that's possible, but it is, and it's very
normal to have even more anxiety because birth is approaching
and you don't know what it's going to be like.
Speaker 2 (02:54):
Is it rare for the placenta to move down? I
can't remember what it's called when it, Oh, if low lying?
Will it ever become low lying at this point as
you get closer.
Speaker 3 (03:03):
Not that I've ever heard of. So we know the
placenta goes the other way. So hopefully if you had
a low lying placenta, found it morphology, So that's around
the twenty week We should have importantly done an ultrasound
around the thirty four week mark to rule it out.
Most placentas actually move up, so as you're the lower
segment of the uterus is created, so basically as your
whole uterus change of shape and grows up towards your diaphragm,
this placenta usually gets dragged with it. So it's very
(03:26):
rare for percenters to stay down. But there are a
whole what we call a creative spectrum, so all different
types of placentas. Some of them are butt the offs,
which basically is where the baby comes out from where
the cervic starts. Some of them are a centimeter or
two away, and some of them cross completely. Sometimes vessels
run across the cervix. So there's all these different and
all of those things. Guys, by now at thirty seven weeks,
you don't have it if your old doctor hasn't spoken
(03:48):
about it, So it's a little irrelevant.
Speaker 1 (03:49):
You go checked, you're fine.
Speaker 3 (03:51):
But if you look at your yellow card now which
most of us have, or your white card, depending on
what hospital you're at, and it says low lying placenta
and someone hasn't checked, you've just saved your baby's life.
Go and get an ultrasound now in triple check that
placenta is out of the way. That does not mean
if it doesn't say anything, you have to go and
get it. If you have an ultrasound, now it's just
for fun. Ninety nine percent of the chance will have
picked that up at a much earlier stations there. Now,
(04:11):
is this normal? Is normal?
Speaker 2 (04:13):
Now?
Speaker 3 (04:13):
My?
Speaker 1 (04:14):
Is this normal? Is about interventions?
Speaker 2 (04:17):
Okay, Well, it's something that I first learned about in
the birth courses, and that an intervention statistically leads to
other interventions like epidurals, forceps.
Speaker 3 (04:29):
Vacuum cesarean sections, pain like yell everything, yeah.
Speaker 1 (04:32):
Yes, So why do we induce such a loaded question?
Speaker 3 (04:37):
It is a loaded question than some pausing me not
saying something is do you know again? We have already
said this a few times. And I think the hardest
situation here is women that feel forced into a decision.
I don't know any obstetricians that force someone to make
a decision unless they're really scared. Now our midwife, and
I know most of my friends are midwives more than doctors.
To be honest, say, well, doctors get too scared. You know,
(04:59):
birth is a very physiological process. It will happen, give
it time. All the statistics that you know are about
a particular woman. Every woman's different. You can't lob her
in with the same statistics as others. But ultimately, birth's
been happening for a long time. There's a lot of
research in this space, and so we know there's certain
parameters and certain diseases in pregnancy where a baby could
(05:19):
have a terrible outcome if we push pregnancy too long,
and so an induction is often offered to women with
certain risk factors. So it might be, for example, you
have a very small baby and you have preeclampsia or
you have diabetes, and we know the risk of still
birth around that thirty six week mark is real and
women with type one diabetes, we know that babies that
are very, very big, you know, in the ninety fifth
(05:40):
to ninety eighth centile do have a risk of shoulder
dustotia or peranial trauma, and so that it be offered. Now,
that's a circumstance where a woman might say, no, I'm
okay with having a tear. I'd prefer a vaginal birth,
even if I have a fourth degree. That's her choice,
but the recommendation has to be given that this is
what we would do or this is what the recommended
research would say is the safest way for mum and
baby to come out of this with a positive experience.
(06:03):
Now that's where it gets tricky, is that if a
doctor offers it to you, ask questions. You know, it
is your right to know why, what is the research?
Why you saying this is the right thing for me
and the one that I struggle with.
Speaker 1 (06:13):
But I know the reason.
Speaker 3 (06:13):
I know I've got to get in trouble for this work.
But I am an ama mum, as I I am
an old woman, I had lots of babies, and often
women get asked or recommended to have an induction at
thirty nine or forty weeks when they're over forty years
of age, because we know the placenta is more likely
to get tired and we don't want a baby to
pass away. So where what we're afraid of is still
birth now.
Speaker 1 (06:34):
Id is it's not delivering nutrients an exactly.
Speaker 3 (06:37):
It's running around gas. Yeah, so it's no longer feeding
your baby the right way. And people will say, well,
I had an ultrasound at thirty six weeks and it
was normal. Baby looked great, But we have an ultra
sound on you in the last week or two, so
we don't know that hasn't changed. So again, fetal movements
and all that kind of come into play, and that's
where it's really tough. And there's lots of research saying that,
you know, you have to do a thousand inductions to
save one baby's life and things like that. You know,
(06:58):
there's all that sort of stuff, But you have to
decide what's right for you and what kind of risks
you're prepared to sit with. So they're the difficult inductions.
Whereas if I'm telling you need an induction for college stasis,
that has a really high chance of stillbirth. So therefore
there's preaclance that's the itching, but it's not just itching.
It's actually related to your liver and you've got liver
function and all these different reactions within the body that
we don't want that we know are linked.
Speaker 1 (07:18):
To still birth.
Speaker 3 (07:19):
And so when there's certain risk factors that we say,
this is the reason we think you should have an
induction of labor, and they're very strongly backed research. It's
a bit different. But again, the older age woman, the
IVF pregnancy, So definitely women have an IVF pregnancy. You know,
we say it's a very wanted pregnancy, So is every pregnancy.
You know, there's no pregnancy that's well not every pregnancy,
but most people getting to that point in wanting to
(07:41):
protect their baby, and it's equally as valuable as someone
who went through ten rounds of IVF. But there's that
tendency to think, well, why did that woman need IVF,
and therefore would you consider an induction. Now, my hospital
doesn't do it for IVF, for example, So you'd have
to have multiple risk factors like being forty two years
of age, IVF pregnancy in a small baby. There's a
real spectrum of when we would offer an induction. The
difficult ones, though, grace, are the ones that are women
(08:03):
are having a maternal or crest induction. So that is,
are we doing an induction because the woman has just
decided she doesn't want to continue with pregnancy. Now, that
might be for social reasons, it might because she's really uncomfortable.
It might because she has one or two of the
softer risk factors, and you know, there's her decision, is
that let's.
Speaker 1 (08:20):
Have this baby.
Speaker 3 (08:21):
They're the harder ones because yes, absolutely, induction of labor,
we know, leads to higher rates of evy dural which
means you're stuck on the bed, which means it's harder
to push, and it can lead to higher rates of
instrumental delivery, not caesareans, Funnily enough, although there is some
new research showing that there may be a slight increase
of caesarean rates too, But the moment, we don't counsel that.
Speaker 2 (08:38):
Can I ask about the induction to having an appy zurule.
Why does that increase? Is it because labor stalls? Oh no, no,
it's so I've done it. So obviously again I can
step out of my doctors and into my mum's shoes here.
My second labor was an induction of labor, and it
just came on so fast. And like you know, we're
not thinking of tattoos in pregnancy, but I always think
if you have it. I don't know anyone who's had
a tattoo. I've got a few from.
Speaker 3 (08:59):
Sport and limp and rings and things. But when it
first start help, it hurts so badly, but then you
get accustomed to it. So in labor, if you go
into spontaneous labor, you have a contraction every two or
three hours, and then then they're in every hour, and then
there are two or three and now, and then your
body builds up those contractions. The studies show that after
six centimeters the pain is no worse. So it's in
the discomfort or the surge, or however you want to
label your pain. It doesn't get worse. It's just becomes
(09:20):
more frequent. But you can cope with it. But when
you go from zero to sitting here like you and
I are, now, I stiff could drip on your arm
and I thump the sintocinin through. Your contractions come on
fast and thick, and that labor I had an epidural,
and it was the best thing I ever did, to
be honest with you, because it meant it meant that
I was able to just actually concentrate on my birth,
whereas before that I was climbing the walls and in
so much discomfort. And so that's where it comes from.
(09:42):
So the induction causes the contractions to come on quickly,
but you've got to remember that we're only mimicking what
your body does. We're not going to put you into
fifteen contractions in a minute. We're trying to replicate exactly
what your natural body is doing. The arguments come about, well,
sometimes there's more babies that are posterior, for example, because
we've started a labor before the babies decided it wants
(10:03):
to come. But it comes back to grace. We're doing
it for a medical reason. If it's a maternal request
that's different, then you really need to look at the
risks of induction and are you happy to have an epidural.
And a lot of the time these women are like,
I don't really care if I have a season yan
I'd be great. If I have a vaginal birth, wonderful,
But if it ends up with a season, I don't
really care. So I get it, You're like, it's all
about maternal choice. But if there is a reason why
I'm really worried about your baby so that I've said
(10:25):
to you, I think an induction is the best thing
for you, then you're sitting with the risks of a
potential epidural, a potential requirement for a vacuum assisted birth,
or a baby that's really compromised. That's when you have
to make these decisions more difficult, and that's when it's
really hard when there's a lot of language out in
social media at the moment sort of saying you know,
doctors are forcing inductions on women. No, we're recommending inductions.
(10:45):
You could always decline. You can say no to everything.
That's what I think women need to remember is you
don't have to say yes to anything, but do understand
that there's a consequence if you don't, and that has
to be on the person making that decision.
Speaker 2 (10:59):
In terms of when you've been in labor for a
certain amount of time, there is a point where you
probably can't be rushed to an emergency c section because
the baby's already in the birth.
Speaker 1 (11:08):
Yeah, it's a bit different.
Speaker 3 (11:10):
That's when the vacuums in the forest.
Speaker 2 (11:11):
When the vacuum and the forceps, because you know, you
see on TV where they're like, quick, let's go to
an emergency C section, but the baby's crowning.
Speaker 1 (11:16):
I don't know.
Speaker 3 (11:18):
Well, no, look, and this is where I want to
ask you. The question of you is what are you
more afraid of? The cesarean section or an instrumental birth.
Speaker 1 (11:26):
That's a very good question, both cesarian.
Speaker 2 (11:30):
I'm I am worried about being in the operating room
and not being out of feel like my legs and
panicking and what that would. But I think I worry
about that panic. My husband is terrified of blood and
things like. I know that they'll be the little thing,
but I worry about needing a support person and him
not being able to do that for me. I'm sure
(11:51):
they'll be a nurse that'll hold my hand if he
goes white and passes out. And I'm sure he won't
be the first person.
Speaker 3 (11:55):
To be I've had plenty of several patients in the room,
let's say.
Speaker 2 (11:59):
But then when it comes to forceps in vacuum, I
worry about pro labs, the damage.
Speaker 1 (12:05):
To the baby's head with the vacuum with.
Speaker 2 (12:08):
The vacuum, like, there's something that in that course I
learn about force ofs. My brain's just gone, don't hod
onto that. That's where I went, Oh, I'm okay with
an episiotomy. It was the best scenario, And I think
I liked the idea of trying not to do it
with an epidural because then you'd be able to feel it.
But then there was also a woman in the class
who said her labor stopped progressing and she was a
(12:30):
pelvic floor physio, so she actually got an epidural because
her labor stalled and she got it and then her
cervix did dilate the rest of the way. So I
was like, oh, okay, I see the point. But I
think I do have a lot of anxiety about intervention.
And it's no judgment on pain relief. I'm not woo
woo namastae. Shouldn't women squat it in fields? Oh my god, I'm.
Speaker 1 (12:51):
Not like that at all. I'm like, I'll have gas
can I who has?
Speaker 2 (12:54):
But there's just I guess there's some anxiety around, you know,
TOUCH would have been very lucky to not be in
an o R. And I don't know what my anxiety
will be in like in that room.
Speaker 3 (13:04):
I think it's very I'm sure there's lots of people
listening that will feel exactly the same. And I think
the thing is that everybody's experience and thoughts and feelings
around this are going to be very different. And part
of it is actually acknowledging what are those fears, because
if you can have a discussion with your birth team
around what those fears are, we can hopefully help you
reduce some of those. And if you end up in
that space, it might be that we need to keep
the drapes up a little bit more, that we don't
(13:24):
drop the when Bobby comes out, because it's a bit
more blood in that setting. And can we put some
music on? Can we educate you on different things? Is
there a real hard no on some of the options
that we're offering in birth, because I think there's a
few big points in the birth scenario. Is that epidriols
are not just for pain. You kind of mentioned just then.
We often use them for women with type pelvic floor
as well, and so for example, we might be eight
(13:45):
centimeters and just not quite getting there. It actually relaxes
her whole pelvic floor and lets it open up. We
give it for prolonged labor. Someone who's been laboring beautifully
like a queen for two days, who's absolutely smashed and
needs a break for a few hours to be able
to lie down and actually recover, and in that time
her whole body relaxes and she pelvic opens up, baby
rotates into a great position and she has a beautiful birth.
If you need an instrumental birth, and epidurol is much
(14:07):
easier because you don't feel the application. Again, I've done
lots of for steps and back in birth. That's what
my job is as an obstetrician. I don't love doing them.
I don't go into work saying today I want to
do five four steps. That's what I've signed up for.
I get tickled pink when I come into the room
and they don't need me, and I just get to
watch a beautiful birth like that, to me is the
highlight of my day. Is that the woman as a
(14:27):
queen and a power. But they're there for a reason.
We use them when your baby is sick. So if
we notice on the CTG, on the measuring that their
little heart rate is dropping really low. If you're pushing
and you're pushing, and you're pushing, and you're pushing. The
prolats risk comes from a baby sitting on that perineum
for too long. And so we do a disservice to
you if we let you push for three or four hours,
(14:48):
because that baby and that pressure and all those peranial
muscles and all the pelvic floor of your pelvic diaphragm,
not the harbor diaphram, the one in your whole pelvis
get stretched and stretch and stretch and stretched and stretched.
There's also a massive increased risk of bleeding afterwards. When
that uterus is what we call a tonic, it just
sits open. It's contracting for hours and hours and hours
and hours, and so there is a It's so hard
(15:09):
because giving all this information scares women, but there is
reasons why we expedite birth, either for mum or for baby.
But I can wholeheartedly tell you that none of us
do it without a lot of consideration beforehand. You just
have to again make sure you know the doctor in
the room, because it's only doctors that do the midwives
don't do the instrumental births. Be confident that that person's
got your back. And when you lock eyes with them,
which is what I do with my women. I hold
(15:30):
her hand and I say I need to do this
to help you and your baby, and she's like okay,
and we do it together. I like, look at her
and we go and I grunt with her and I
count with her, and we're in it. We're like a
full team in that space. Well, that's what I think
it's about. That's what birth is is. It's the woman
doing the work, but just there you're there to support her.
Speaker 2 (15:48):
I've just got a quick one for my tool kid,
which is a new mantra that I learned from a friend,
which is you can do anything for sixty seconds.
Speaker 1 (15:56):
I love it. I can't beat that. Just it's gonna.
Speaker 2 (15:59):
Be sure to be yeah, but you can do anything
for sixty seconds.
Speaker 1 (16:02):
I repeat. We hope you enjoyed this episode of Hello Bump.
Speaker 2 (16:07):
We have so many episodes of this series filled with
tips and stories from women and.
Speaker 1 (16:12):
Experts who've been through it all before.
Speaker 3 (16:14):
You can go back and listen to everything else Hello
Bump related in this podcast feed.
Speaker 2 (16:17):
And while you're there, we'd love if you could give
us a five star rating and maybe leave us a
review or even share this episode with a friend.
Speaker 3 (16:23):
This episode was produced by Courtney Ammenhauser with audio production
by Tom Lyon.
Speaker 1 (16:27):
We'll catch You next Time.
Speaker 2 (16:28):
This episode of Hello Bump was made in partnership with
Huggies Bye Bye
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