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…fully cooked! At week 40, your baby is mostly just gaining fat and growing bigger and you’re likely feeling pretty heavy and uncomfortable as you wait to give birth. Jana explains how to manage your mental health if your birth plan doesn't go to plan. Plus, Grace asks how long it takes for your uterus to shrink down after birth as well as what to look for in your postpartum recovery.
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CREDITS:
Hosts: Jana Pittman and Grace Rouvray
Executive Producer: Courtney Ammenhauser
Audio Production: Jacob Round
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.
You're listening to a Muma Mia podcast.
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 we hopefully have made it more manageable for you. I'm Grace Reebray, I'm pregnant for the first time, and we're all about to become a parent.
I'm young A Pittman. I'm a former Olympian mother of six. I'm definitely not about to become a parent. I am now training to be an obstetric and Guiney registrar.
Hopefully. Each week we have been holding your hand through the mysterious, perplexing and wonderful miracle that is pregnancy, all the way from a poppy seed to a pumpkin.
Oh week forty.
What size are we? Can you get bigger than a melon?
Well, babies could be up to five and a half kilos. I don't know. If you've looked up the Guinness Book of Records. They could be bog You remember that when you're a kid's gna?
Yes?
Yes.
The biggest baby I've ever birth, though, is only four point nine so I've still got a bit of a way to go. A couple of my friends have had bigger baby.
What's that one pounds?
Twelvesh lots?
Yeah, okay, okay, okay, But most babies Grace will be between three point four and three point six kilos at full term. Now, remember there is still two weeks before we consider a baby beyond post dates, so it still postdates. Now, even anytime after forty weeks is postdates. But the normal as in term baby pregnancy is thirty seven to forty two. So even though we're finished with this podcast, there is still women who'll be pregnant for at least another two weeks.
What's the maximum cutoff you would ever let a woman get to.
I think that's an interesting number because or interesting word, because, of course, our recommendation is to have a baby by forty two weeks, again because of that personal insufficiency we've talked about, but there are lots of women that decline. Now you know, I personally wouldn't, but there's definitely women who feel very strongly about natural labor and they wait beyond forty three weeks. But I think, if this is you, I just really want you to have a conversation with your midwife, be really open minded. And again I come back to it again, we don't do things to you because we want to hurt you. We do things because we want to see a good outcome. So for both of you, it just needs to be very well monitored, lots of lots of CTG monitoring and things like that. And if it's your choice, it's always always the woman's choice.
Now I'm guessing there's no updates to what the baby is doing this week.
It's getting fatter, like quite a bit fatter and quite a bit bigger. So I think that is where we start thinking about babies. That if you know, at thirty six weeks you had a big, little chunky monkey on board who was already on the ninety fifth centile, for example, I'd be thinking now about having a baby and doing all those things to bring this little one on naturally, and you know, and just being really open to the idea of what it would look like to have a four and a half kilo baby, because it is a it's a little unit.
It's in like know, double low sized.
Clothes, yeah, oh when they come out double over big about and quadruploths, I'm excited to learn those sizes because I've got a bunch of stuff, but I just don't know what she's going to come out at to know what I need more of or what I don't even need at all.
Well, even even big babies are still little babies, Like even like a big four and a half is still tiny, Like they're still inter blows. They're little guys, but they're just certainly a lot bigger than your premier babies that come out at you know, two kilos and one kilo and five hundred grams. So a mixture of everything would be my answer to that.
This is a Roague question. Do any patients who are having an elective cesarean do you ever work with them to wait for labor to come on naturally so they can feel the body is ready and then have a cesarean.
And we like it when that happens, but it means it's not an elective labor. It's actually considered an emergency caesar because they'll come in laboring. So now regularly when this happens, is a woman who'd love, love love a VBAC. And because we many doctors won't do an induction because that sintosin and increases the risk of that rupture of the scar from the first pregnancy, so they won't start that sintosin and drip. So we book the caesar date as late as possible, like as in as late as possible, with the hope you'll go into spontaneous labor. But I reckon I wouldn't know the exact percent, but a lot of women who with book cesarians come in with rupture membranes or early labor, and all that means is we do the season earlier. And in most cases, like you know, I guess we have to be a bit honest. Here in rural settings, maybe we can't open a theater as quickly, but in Sydney and some of the major states around Australia, there's a hospital pretty close and they can usually get a labour team there to do the birth fairly, fairly swiftly. So it's not a bad thing because it means your baby's picked its judate and and you still had that elective season that you've wanted.
What what's happening to me? What's happening to our bodies? Apart from probably being really uncomfortable and angry at the world.
Because it's just not happy.
Maybe people have a lot of bliss. Maybe I'm looking at this through a negative lens, but what is happening to our bodies.
I don't know many women that haven't got to forty weeks and think they've had enough. You know, even women who are very very pro spontaneous vaginal birth and really wanting minimal intervention and you know, a water birth at home, are happy to have a baby at forty weeks.
They just want it to happen naturally.
Yeah, you're heavy, you're uncomfortable, everything hurts, you know, it's not fun. No one, no one is happy at forty weeks pregnant. So but you know, it happens a lot, and so we just have to roll with those punches. But babies just getting bigger at this point, they're fully developed. And now again it is extremely important to watch those movements. The highest risk of plus senal insufficiency is beyond forty weeks. So if you go postates that's what we call it. After forty weeks, we'll start seeing you a little more. So you'll usually get what's called a postate's ultrasound providing your low risk just to check the baby's growing still well and that placenta is still fine. They'll check the dopplers and things. They'll check the fluid around baby because one of the signs of a bubby getting tired and the placenta getting insufficient is that the fluid volume drops down. That's the amniotic fluid around the baby. So there's all those signs. They'll check in with you if everything goes well. We just hope you go into spontaneous labor by forty one and five days. Otherwise ninety percent of places will say we think you should have an induction of labor.
And if the amniotic fluid is dropping down, is that the only way for that to drop is to come like out your vagina like you will notice or.
No, So it's the baby's absorption, so it actually is less. So it's very good question because you're right that you would assume it means you're leaking from the vagina. If you're leaking from the vagina, that means your labor is hopefully starting because your waters are broken, or we would again offer an induction. We don't like someone sitting on broken waters, particularly at term, for much longer than ideally twenty four hours. Is the recommendation. We will wait three days with raptured water, provided there's no signs of infection and no gbs. You know, that's fine, that's a woman's decision. But if you're leaking, it's it's baby time. No, it's actually because your baby is not getting as much volume and nutrition from the placenta. Your bubby's not weaning as much, so it's actually not swallowing and creating that much urine. So it basically shows us that the fetus is distressed. So not always it's a soft sign, but it's okay, one of the only ones we have. So if your post dates and your baby's not moving as much and there's not as much fluid around, that's a really strong indication to bring you to start your labor.
Is this normal?
Is normal?
Way? Is this normal? Questions are about when will all the bad pregnancy stuff go away?
Well, do you mean like the big belly in the scene, a big belly?
I feel like I'm quite I feel like I'm informed that the bounce back is weeks. In terms of months, yeah, months, in terms of your uterus shrinking, I'm talking about nausea reflux. It's probably just the blood pressure yeah.
Blood yeah, blood pressure, yeah, exactly, and diabetes and things like that. So look, in most cases, things happen fairly quickly in the first few days after birth. Now, for certain conditions like the nausea, it often goes away almost as soon as you've had your baby. It's phenomenal. I know, you breathe a sigh of relief. Things like blood pressure. Unfortunately, when your baby comes out, it basically is like a big boost of blood back to your system. So your kind of output goes even up higher straight after birth than it did in pregnancy. So the swelling gets worse sometimes for a few days before it gets better. Your body swelling, your blood pressure can actually be the worst on day four and five postpartum. So there are a few things to sort of watch out for in that space, which is why if you do have pre plants yea, we often ask you to stay longer in hospital for four up to four or five days after and we can really tyitrate your medications. For ladies with GDM, you don't have to worry about it. The minute your baby comes out, you can go back to it. Well, we still want you to be careful because remember there is a real risk with GDM that you will actually develop type two diabetes within the next ten to fifteen years. So we don't want you to go back to chocolates and macers forever. But you are very welcome to have any real.
And we don't have to watch your blood.
You'll the levels, they can have whatever they want.
Yea, that in those couple of days and things. But yeah, so yeah, your body will bounce back. It's remarkable. We're made to do this as women.
So what are the stats on how long it takes for your uterus to shrink back to its original size.
Well, it happens quite quickly, so we monitor that afterwards. We like your uterus to be under your umbilical so under your belly button or ready by the next day. And so you'll get someone who'll come and give this nasty rub on your tummy and be like oh, you'd be like, oh my god.
Al leave me alone.
I just did this thing exactly because we're going to check that uterus has shrunk down and it's central. We don't want it to be deviated because that can sometimes mean there's a bit of percenter left or something like that. So you will also check your pad. Now, remember there is that chance of bleeding and pregnancy and certainly in birth, and we check that pad afterwards to make sure that the bleeding is not too excessive.
What are the stages of how much bleeding is normal? And at what point do you call your midwife or call the hospital and come back in.
Yeah, great question, And in birth vaginal birth normals up to five hundred mils. It sounds like a lot, but remember you've got that extra two to three liters on board anyway up in a cesara and it's up to a litera still considered a big bleed, but we tolerate it and we often repeat your bloods the next day if you've bled a bit too much in labor. So things to look out for in that postpart and period is if you're passing clots, unless you've been lying down for a long time. Therefore it's just like coagulated and you stand up and it comes straight out. There's never really a good time that clots should be happening. Abnormal discharge. So if it smells funny, if you've got pain, we can get endometritis, which is an infection inside the uterus. That's a concern if you're bleeding stops and then it comes back heavy. That's a concern. So you will bleed like a heavy period for two or three weeks can be quite normal. Beyond that, we need to investigate, and any kind of weird pain and discharge is something we need to just review and check because, look, it's not common, but there sometimes can be a little bit of placenta, a little bit of the membrane still inside, and in most cases your body will pass it out naturally, but we need to do an ultracent and check that there's nothing large, because placentas is something we didn't talk about before. Actually percentas can usually be round, but sometimes there are actually this two percenters there's an extra lobe of the placenta, and we just need to make sure the whole things come out.
Why wouldn't they do an ultrasound of your uterus to make sure there's nothing of the placenta when you're still in the hospital.
There's a lot of blood in there, and it's quite hard to differentiate between tissue and blood associated and the uterine lining coming away, So it's initially quite hard. I mean you can I certainly there's a big bees oft plercenta, you'll see it. And so certainly if someone has a retained placenter, which we haven't talked about, but that's when after birth, between thirty and forty five minutes afterwards, despite having the injection in your leg to help it birth, it's still inside and.
That injection is to help eat up percenter delivery.
Yeah, it makes the uterus contract to hopefully then let it release off the wall. But unfortunately, some placentas do get stuck, particularly if you've had a previous arian section. It could be around that front of that womb. But again that's when we worry about placenta cretors and things that's gone. If you've had your baby vaginally, you don't have to worry that, but we just need to make sure that whole ples center comes out. And they do get stuck. It's not an uncommon thing to see. I'd see, you know, once or twice a week we get a stuck a placenter at my hospital. And so that is a time unfortunately, even if you've had a beautiful vaginal birth, that you may end up going to the operating theater because it's the safest place to remove it.
And what can we expect hospital stay wise. Best case scenario for both a cesarean and a vaginal birth.
Sure, So I mean we have an I did with my fourth women who leave five hours after vaginal birth from the birth un it, I mean we have people at birth at home. Remember like women are very, very amazing. It'll depend so if you've had risk factors, you'll have to say a few days. But I'd say most women go home. They say, one night in hospital in a public hospital and go home the next day. In private hospitals you get five nights of free accommodation, lactation consultants, peroneal care, and most places even let you leave your baby for an evening to go out for a dinner meal. So it very much depends on what model of care you've had, and so therefore it ranges from sort of one to five. And I think it's probably at this point when we should talk about a little bit of the postpartum stuff. So you need to see your GP in about two weeks after earth just to check on things. Paraneal care is really important. If you've had some stitches, Let's be honest, most people have, it's important to clear them really clean and dry, Please don't put any soap on them, keep them just you know, change your pad regularly. Every time you open your boughs. Wash with warm water, no soap, just salty your warm water. If you're concerned, call up monitor your cesarean wound. The dressings come off usually day five to seven. There's no stitches, are all internal. There's nothing to do there. But things to sort of keep an eye on are infections, paining your tummy, pain in your wounds, feeling sick, feeling hot and bothered, all of those sort of things. You need to go back to the birth unit, even if you went home on the same day.
What about those who feel quite a lot of anxiety around the first pooh.
Yes, your boughs get very particularly with cesarean sections, because it's sort of being moved around in that cason space. It feels weird having done it multiple times, it just feels uncomfortable. You can sometimes have and it's very normal to have a bit of flatus in continents. In other words, you fight and you can't hold it in.
Very normal.
It comes back to usually comes back providing your hat haven't had a big fourth degree tere in a couple of in a couple of days, if not a week. I think the big thing to highlight there is if your urinary contents is the same, you're not going to make it to the toilet half the time. You're going to be sort of waddling to the toilet.
You're going to leak. Again.
That's very it's just been stunned during the birth. It comes back over a week or two. I am a big believer no matter what birth, you have to book in with a pelvic physiotherapist. It's really strongly believe in it, no matter what birth you've had. Women as a approach perimenopause and menopause are going to have problems within continents and bladder issues. So preparing yourself to retrain after birth, to me is a no brainer. So if you're having excessive concerns, see it earlier. Otherwise start looking at that process in about six weeks. I'm also a big believer if you choose to breastfeed, to get a breastfeeding consultant because they can just sort of nullify some of the issues that are flying around in your head.
For my toolkit, again, it's just questions. I'm just I've got you here at the end I cut you here, so I'm just gonna mind you for knowledge. I want to talk about two things. If you have a birth plan that you don't get and the mental health around that. That's the first one. So what are the risk factors when someone does have a plan and it doesn't plan go to plan? And I mean risk factors for their mental health? Certainly, obviously some people are going to be like who cares? But there are some people who are going to be very traumatized, very traumatized, and well really held onto an idea of how they wanted it to go.
I think that's a huge thing to unpack. But I think most people don't get the birth they thought they were going to have. And I think if we go in with that attitude of with a really open mind of this is what I would love to happen, but I accept that it may or may not be that way. Again, a bit like the breastfeeding consultant and the pelvic physiotherapist, I think booking in a psychology appointment after birth, no matter how your birth is, is a great idea. We know that women are going to get postan or blues on day three to four. Anyway, it's as your milk comes in and your hormones change and everybody cries. The strongest woman will have a good cry and it's appropriate and normal, and we see is reassuring, but that can sometimes last longer than that having an identifiable or someone in your world that can actually identify that you're out of character and knowing where those resources are to go and get help, so you know there are lots of good online and good resources to try and look at from a postcanner depression perspective, but birth trauma definitely can make it a lot worse because if you're going there wanting and desperately hoping this is what your birth's going to be, and then it doesn't go to how you plan, it's a really hard language to say to yourself, well, I did everything humanly possible for it to plan, it didn't go that way, and I'm proud of myself. Most women just feel defeated by it. And I think it's actually our responsibility, particularly people like you and I who get on social media and talk about this, to be able to really highlight that it doesn't regularly go to plan and therefore you have done brilliantly. Even if you end up with a really bad case scenario, because there's no person that goes into that situation with that idea in mind. You go in with the best intentions and no matter if as long as you come out knowing that you tried the best you can and even if you didn't, even if you went in there with a whole plan and then bailed the first time you had a contraction, that's okay too, because there are no heroes in the birth environment. There's just a happy, well mum and a beautiful baby at the end of it.
I really like this clip that you actually played just before we started recording, which is I don't know if they're obstectric. Yeah, I'm saying that this sentence is so problematic of you were given a baby you were meant to birth.
Yeah, and you can't grow a baby that you weren't meant to birth, or your body is made to have this baby.
Can you talk about why that makes you so angry that statement?
Well, I think it's just more it doesn't make me angry, it makes me sad, because yes, most of our bodies are you know, we create a baby that fits the size of our body, but some of us are five foot tall and marry six foot five husbands, and those babies are naturally going to be bigger. There are also babies that get themselves in the craziest positions and what we call a synclintic, which means their little head's getting completely stuck in the wrong part of the pels and it doesn't matter how well she pushes, it's not coming out. And she can try, and she can try, and she can try it, bubby won't come. There are also babies that will get stressed as soon as they get hugged by a contraction.
And that's what I think. Can you imagine if I came over to your.
Grace and hugged you and hugged you and hugged you and hugged you and hugged you for four or five hours, over and over and over again. It's tiring, and sometimes these little babies can't make it, and it's hard to say that. There are also some disorders like diabetes that me and your babies are much bigger than your body would normally create your baby, And so there are circumstances when, no matter how hard we try, our bodies aren't made to have the baby that's inside us. And that's where women three four hundred years ago would die in labor. All those babies would pass away, And so we need to be aware that in most cases, we hope your body can do this, but if it can't, it's okay. And that's where the medical world comes in to make sure that your baby meets this world and you have hopefully the best experience out of what your birth can offer. And we just want women to know that they have not failed, they have done everything right, and that we're there to support them in that process.
My other question is around recovery. I feel like we've talked about the vaginal side of recovery in terms of stitches and things like that, but for a sea section scar one, how long is it and when can you start applying oil to try and reduce that?
So sea section scars they look a lot bigger when when it first happens, because I've see you can imagine if you had a tattoo, it all stretched it up when it goes back down and saying about ten centimeters and it usually hides below your undies. Caesarean section wounds are they get their heal on their own. We just want you to leave it alone. There are you can go and put a little silicon gel patches. People could put botox in them, bi oil. Not for the first six weeks. Just let your body heal and knit really nicely back together. You'll probably be too busy with your baby anyway, but realistically it'll hide under your rundies and hopefully you know it just becomes part of your beautiful wound that is a representative of the fact that you birth the baby.
I want to end by the moment, Oh my god, I'm gonna cry it so silly. I want to end on the moment you actually become a parent. Joanna, can you talk me through the moment the baby is plumped on your chest. I've been told this is just so magical, But is it as whimsical and wonderful as everyone says it is?
For me, it was I felt that such a beautiful connection when that little one was placed on my chest, and it was all the efforts, all the heartache, all the things that have gone through that pregnancy, the hyperomises, the sick anything that you've been through. Every reason as to why that happened is lying in front of you now. And remember, we've always got to be positive. But some women don't have that automatic connection.
It will come and that's okay.
It takes time sometimes, but you know, capture those moments because and even those that do take a few days, I know, I expected lots of women that later they say I still remember. I still remember vividly the smell of the baby and the fact they often like try and find the nipple and have that really beautiful bonding moment. So you know, ultimately, pregnancy can be.
Tough, but it is. It is the best thing I've ever done.
Hence I've done it six times or five times and six babies, and you know, we can only encourage women that they're incredibly strong. You know, they're very powerful, and we're so lucky that we have the opportunity to be able to carry babies, and you know, supporting women who are going through that fertility challenge and who are in early pregnancy at the moment and being fair for them for their journey going forward.
What is your favorite part about your job of watching women.
I have to say that the favorite part of my job is birth.
I absolutely love being in the birth unit, being with that woman and seeing the expression on her face when the little one comes out that very first look and that shock and that joy and those tears and that excitement. You can just see in their face that everything they've been through is worth it. And I particularly love the dads too, when they start crying and they just realize that this enormous thing has just come into their life, and this change and this opportunity, and how incredible their partner is. It's a pretty special job and I feel so incredibly privileged to be in that sacred space.
I think that's the perfect place to end it. Good luck to all of our listeners who are awaiting their baby and are about to become parents for the first time. I hope you have found this useful and enjoyed the newborn bubble. We hope you enjoyed this episode of Hello Bump. 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.
This episode of Hello Bump was made in partnership with Huggies.
Bye Bye, m
