Hello BumpWelcome 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 size of a plum or a jelly donut hole! Week 12 is last week of the first trimester and also when you might be able to hear your baby’s heart beat for the first time. Jana explains why you need a full bladder during ultrasounds, and what to do if you’re having trouble passing urine. Plus, Jana tells Grace exactly what doctors can understand about your baby’s development at this point in the pregnancy.
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CREDITS:
Hosts: Jana Pittman and Grace Rouvray
Executive Producer: Courtney Ammenhauser
Audio Production: Thom Lion
Mamamia acknowledges the Traditional Owners of the Land we have recorded this podcast on, the Gadigal people of the Eora Nation. We pay our respects to their Elders past and present, and extend that respect to all Aboriginal and Torres Strait Islander cultures.
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Mom and Maya acknowledges the traditional owners of land and waters that this podcast is recorded on.
I am pregnanty.
Welcome to Hello Bump. We're making pregnancy less overwhelming and more manageable. I feel like it's more manageable already. I'm Grace Roobrain, I'm pregnant for the first time.
And i'man A Pippin. I am a mother of six now. I am a former olympian and an obstetric trainee. I've had many many first Romessa's greens, so you know we can pretty much go anywhere with that.
Each episode, Jana and I will be holding your hand week by week through the mysterious, perplexing, and sometimes overwhelming miracle that is pregnancy.
Week twelve. What objects are we A plum?
A plum baby's the size of a plumb or a small egg.
A jelly doughnut hole, yes, exact?
Or passion fruit. I mean you go with lots of fruits. There's a lot of fruits.
This it's very fruit based in the first trimestery.
Fruit based, and then animals in the last. Fromesser I've noticed, we'll get there.
What have they developed in the last week.
So their little kidneys are starting to make you ryan, which is actually amniotic fluid. Guys, your babies are swimming around in their own WII and drinking it and then peeing it out again. So it's around this time the baby starts to swallow that amniotic fluid and then it sort of moves through the body and then they pass it out. You can now often see or hear that heartbeat. When we talked about ages ago, you couldn't hear it. You can now hear that heartbeat, and even on an external doppler, So when you go and see your midwife, they can often not away, so don't be worried if they can't hear it. It also does depend a little bit on our body, on our size of our tummy, but they can often hear it externally, so you can hear what the little ones baby sounds like.
I did hear it for the firty time I did.
Just beautiful as it.
Yeah, I can say that even though I felt so sick, like I'm not a monster, I love hearing the heartbeat like it is something that's really beautiful to beautiful.
But on that note, there are a lot of dopplers you can buy outside of the home, and we sort of touched on this earlier. There's definitely a crazy women would love to be able to listen to their baby at home. Now, if you are going to buy one, because like you and I love listening to a baby's heart, that's fine, But there is never a time I want you to use it if you're worried about the baby's heartbeat, because the placenta sounds different to the fetus, and most untrained ears won't be able to differentiate both.
Would so pick up your own heart.
Yes, So unless you're really really sure what you're listening to, and for example, if it's decreased fetal movements, you need to come and see us. Anyway, even a midwife would not be happy just using a handheld doppler. They'd send you in for sixty minutes. You know you need a little bit longer to work out what the patterns of the baby's heart are. So it's absolutely not something for you to be using. I have seen horrible outcomes where someone has thought it was okay, but it was the it was not. So it's just a fun thing at home to listen in a lovely way. It is not something I want you to use to look after your pregnancy, and let us do that.
One question I do have about all these tests is you have to go in with a full bladder?
Yes?
Yes, Is that because it makes the baby more visible? Or I've actually had no idea why we have to drink a bunch of way because it's.
Very bothersame pregnancy, isn't it Because you get there and you're busting, You're like, can a little a little bit out, but I probably don't have enough blooder.
Control a little it is all going to go out.
We actually use the bladder as a window, so it actually it's the way the ultrasound works is it sends, you know, the ultra sound beams through and we use the bladder to actually to highlight the different black and dark colored structures of the baby and the fetus behind it. So if there's an empty bladder, two things you can't use that as a window. And the second thing is that lifts the uterus out slightly. So you can imagine the bladder sits in front of the pregnancy and as with a full bladder, it just lifts the pregnancy up a little bit more so you can actually scan it more easily.
This is probably a dumb question. But none of it goes into their sack.
To the urine.
No, no, no, the water. It doesn't go into their amniotic fluid or anything like that.
I mean, there's the theory is not now Later in pregnancy, you know that if your baby, if you have low amniotic fluid, the midwife might say go and drink more and hopefully the fluid levels will increase on the next pregnancy. Ultimately, whatever you feed through the baby, if your dehydrated, your baby may often move less and therefore have less fluid, less intake in, take output. But no, right before an ultra sound that a cute thing is not going to make any Okay, okay, yeah.
What's happening to me? And what else is happening to our bodies?
At week twelve, again from last week, it's getting worse with that laxicity. You're feeling more and more floppy, I think is the way you can feel it. Some people now do find they have almost a bit of an obstruction when it comes to their bladder, so difficultly difficult passing urine because that baby is literally sitting right where that bladder is soon it'll come up and get out of the pelvis. But you're right on that cusp where it doesn't.
Feel like the stream is as free well yeah, free flowing, or it's just not as even though you feel busting.
It's like trickles out exactly.
You've pretty much nailed it perfectly. But that's the baby, unfortunately, pushing against that bladder and just causing restriction of the urethra.
And that's because of the position that It's not that they're it's so big, it's just the position of where your uterus.
Is because the baby's quite small still, but it's literally if you think about your pubic bone, which is a bone, so there's nowhere for the bladder to go up and a ways the bladder will fill upwards towards your belly button, but that's where your useress is literally sitting and cramping in that space, so it can actually you can actually there is a condition where you can actually get full bladder obstruction. So it's another red flag. We're going to start calling the red flags as we get through this podcast, where things that are really bad you need to see a doctor straight away. So the first red flag in the past was that ectopic pregnancy we were talking about before bleeding, And this is another one. If you find you can't pass you urine in pregnancy, it's time to go straight to either the birth unit or your or your ED. And now before twenty weeks, guys, that is ED, So you go to ED up until twenty weeks or e GP. After twenty weeks you call the berthing unit you're planning to deliver it.
A lot of the time people might think that symptoms of not being able to pass urine is feeling like a uti.
How do we know the difference several hours?
So if you have an obstruction, you'll need you'll you'll find you can't pass more than dribbles for hours and hours. Whereas I mean, urine retract infections in pregnancy can present in so many different ways. And just like the thrush we talked about before, really common and asymptomatic urine retract infections are really common too. Why because we drop arou immune system because we're pregnant. So I know, another fun thing, but basically you know we have we don't want to have any problems from a rejection perspective with the baby. And you're also taking on a lot, your nutrition's going somewhere else, you're not sleeping as much, you're uncomfortable. There's lots of reasons our immune systems reduce, and so therefore symptoms of urine. We probably all know of them, burning, stinging, funny odor. Back pain is a big one, and we can often mask.
Oh i've got a pregnancy coming.
I've got a bit of back pain, but definitely worth getting it checked, color change in the urine, any concern is really easy to pee in a little cup that you can get from your GP and they can send it off. Is this normal? Is normal?
I have a few questions for is this normal?
Because I've just gone through these the first trimester screening and the NIPT. I want to know if the nipt I got the sex revealed.
To me because she's a girl, So I want to.
That's what I wanted, and my partner said that that's what he wanted as well. I don't know that if that was real, but anyway, we're both both happy. The names are easier, I think, so I want to know how accurate that test is at this stage. And then I also want to know about I sort of said to the sonographer when I was in there, or is everything looking fine or is everything healthy? And they sort of said their wording around it was as much as we can tell, yes, and they wouldn't sort of give any kind of clarity answers because they said.
It's still too small exactly.
I guess what are they specifically looking for in these tests to go it's viable or whatever, and what could potentially still develop that could make it a non viable pregnancy or have problems later on.
It's a hard discussion around abnimalodies and pregnancy chromosome or genetic abnimalodies or structural abnormalody. So as we sort of discussed before the NIPT is the blood test, we still strongly recommend to have an ultrasound as well because the NIPT does miss things like triplody, pregnancies and things that aren't tested. So it's ninety nine percent sensitive for Down syndrome, pertousyn drome, and Edward, which are three more common disorders that it can pick up, whereas the combined first tromester screen, which is the government fund and run, is around sort of the eighty five to ninety percent, so it's still very good. It has about a four to five percent false positive rate. But again both of them do, so I think it's really hard, and I get a lot of women actually asking should I have both, Like you know, I can afford it, Should I have the government one and the NIPT? And some I know, I have a lot of an amazing bosses that I work for who obviously training me to be an obstecution and some of them are on the fence with it. So some of them say yes, get both. Why not? Others say no, that's just overuse of you know, government funds and medicare. But having had, as I said close friend in the past, you went through that and ended up having a terribly unwell baby that didn't survive at fourteen weeks with a normal nipped you can see why women do it. So perhaps the agreement really is that you do NIPT if you can afford it, but also have your structural study. And there's lots of other things that come out of that screening as well, with the blood tests around the hypertension and the potential for gross restrictions. So the bottom line is, though you may find something you don't want to know, and then you have to decide what to do about it. It's a really tough conversation to have with yourself because some people will continue apprenticeing no matter what. I want to reassure you that if you are in that position, because a lot of women are, you'll have thorough genetic counseling. You'll meet with the Maternal Fiddle Medicine Department which work with this space really really well, council women around this all the time you have time. So in Australia we are really lucky that there are hospitals that will support your decision till very late in gestation. Now we may not all like that ethically, but some women take couples, I should say, take ten weeks to make a decision around a baby that may not have a good life trajectory. So there are people who will support your decision no matter what you make, and many decide I don't want to have the invasive testing. I'll wait for morphology because morphology the baby is bigger and it's the most accurate time we can look at brain, heart, liver. What side is the heart is the body on? Are there any funny abnormalities with the kidneys? Are there cysts on the kidneys? Are there two kidneys so there's all these really amazing things that can sometimes indicate chromosomal ABNAML that aren't the standard three that we look at with the NIPT, and that's what those structural ultra sounds do. But it is hard you only look at major things at the twelve to thirteen week mark, like are there four chambers in the heart? Does it have a brain?
Yeah?
You know, is it obviously you know, got kidneys and a normal that they measure that sounds are silly, but the length of the legs to the size of the hedge, like those kind of things you say are there because they're telltale signs. Some of the major chromosomeal abnormalodies often have really abnormal sized legs and arms compared to its its brain and it's utical.
Yeah.
So all they've sort of told me was, well, it's got two arms, two legs, a heartbeat, and a head and that's all we're looking for. And I was like, okay, you're sort of I don't know if there's if there are people who listening who are quite anxious pregnant people, I guess I was surprised there wasn't more reassurance, But then I don't know what I was looking for.
Yeah, with that reassurance.
I think it's hard and it's a hard topic to touch on, but it's because you can't give a result and then a mother or a father later comes back and said, well, I was told at my first tremester ultrasound that it was all normal. They can only give to the best of their ability of what they can see, and that's why we always say, well, if you concerned, have that morphology done, even potentially a little early, because we recommend the morphology be sort of between eighteen and twenty two weeks. Have it earlier if there's a concern, or go and see the genetic counselor and discuss whether you want a more invasive tests which can give you a far stronger probability of whether this baby is affected.
And one of the things we can do.
Because you're tested for pre eclampsia multiple times throughout your pregnancy, this is the first time that you are tested. What if your tests come back and your high risk at this point at twelve weeks.
Lots of obsertcutions will recommend you're starting aspirin at this point. They know that it can help. You might have already been on aspirin. To be honest, if you've had preclamps here in your last pregnancy, it would be something that your obstetution will start pretty early. But if you come back with a high risk screening at this point, a whole combination of that algorithm with the papa A and all different mechanisms of related to this test, but they might suggest some ways to try and reduce it, which is starting on aspirin, and it's important we start that as early as possible too, as in after this, so now ten weeks, eleven weeks, twelve weeks, not twenty two tis twenty three to twenty four weeks to try and change because it actually helps. Well, the theory is that it helps with the way the placenter is developing, so the way the arteries and the spiral arteries that actually feed the placenter and the maternal interface develop, which is where there's lots of theories around what preclamps here is.
But what one of the theories is that And as we go along, we'll talk about preclams here a lot more because there are so many other different ways that it can be picked up.
So I have a lot of questions for you, which I'm sure we'll get into.
My talkit this week is something that we talked about weeks ago or episodes ago. Is because I cleared all my tests. For me, that was a moment of this is real. Yes, so I went and bought my first item.
It's perfect. Yeah, I love it.
I'm not going to add anything that I think it's the perfect time.
To do it. Hope, we hope you enjoyed this episode of Hello Bumb. We have so many episodes of this series filled with tips and stories from women and experts who've been through it all before.
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This episode was produced by Courtney Ammenhauser with audio production by Tom Lyon.
We'll catch you next time.
Bye.
This episode of Hello Bump was made in partnership with Huggies.
