Pregnancy and childbirth with Dr Greg

In episode 10 of the Pregnancy and Childbirth podcast, Dr Greg Jenkins, obstetrician and gynaecologist, talks about breech presentation; when your baby is trying to come out bottom first instead of head first.
Listen to this episode to learn about:

• When does breech position matter?
• Three options for giving birth if your baby is breech coming into the last month of pregnancy: external cephalic version (ECV), vaginal breech birth and elective caesarean
  

Happy listening and don’t forget to subscribe to the Pregnancy and Childbirth podcast with Dr Greg on Apple Podcasts to get new episodes as they become available.

00:00:00

Hi, I'm Greg Jenkins and welcome to this edition of my pregnancy podcast. Today we're going to talk about breech presentation. So breech presentation is when your baby is trying to come out bottom first instead of head first.

00:00:14

This issue matters because delivering your baby as a vaginal breech birth is a little bit more risky for the baby and a bit more complicated than delivering your baby vaginally from a head first position.

00:00:29

So when does breech position matter? We know that at 30 weeks gestation, so 30 weeks into your pregnancy, that about one in three babies are in a breech position.

00:00:39

We also know that by the time you get to 37 weeks gestation that only about 3% of babies remain in a breech position. So if your baby is breech at 30 or 32 weeks, we don't need to be too worried about this because we know that 90% of these babies are going to turn around all by themselves by the time you get to 36 or 37 weeks.

00:01:02

Now, if it's your first baby and your baby breech at 36 weeks, the chance of it turning around on its own after that are quite small. Similarly, if it's your second or subsequent baby, we tend to give baby another week to turn on its own. But if your baby is still breech at 37 weeks, then it's probably not going to turn around on its own after that.

00:01:25

So, depending on whether or not this is your first pregnancy, 36 to 37 weeks is the time when we become really interested in the position of your baby in terms of whether your baby is head first or bottom first.

00:01:38

Even if your baby is breech at 36 to 37 weeks, there is still a small chance your baby will turn around on its own, and most babies don't. If your baby is breech coming into the last month of pregnancy, we need to make some decisions about how you're going to give birth. There are three options.

00:02:00

We can do a procedure called an ECV, which is an external cephalic version, and that's where we attempt to turn the baby around from a breech position into a head first position and we'll talk about that in a bit more detail in a minute.

00:02:16

The second option would be to leave your baby in a breech position and attempt a vaginal breech birth and we'll talk about that also. And the final option would be to do an elective caesarean, and if all else is well with your pregnancy and assuming that you don't come into labour prior, this would usually be done close to 39 weeks gestation.

00:02:38

It's worth mentioning that this decision is very much a shared decision made between you, your partner and your pregnancy care provider, and in my podcast on birth after caesarean section I spend a little bit of time talking about the process of shared decision making.

00:02:56

Let's start by talking about ECV or external cephalic version. So this procedure is generally done at around 37 weeks gestation. It's done in a supervised environment, such as in a birth unit environment or similar, somewhere where we have an ultrasound so we can verify the baby's position and somewhere where we can continuously monitor the baby's heartbeat throughout the procedure to make sure that we're not doing anything that's going to compromise the baby's well-being.

00:03:26

So what do we know about ECV? We know that if it started around 37 weeks gestation, that it's a safe procedure, so the risks associated with ECV are really very small provided it's done in those circumstances I mentioned previously. We know that it doesn't always work.

00:03:46

If it's your first baby, the success rate is probably around about 30%, and if it's your second or subsequent baby, then success rates of over 50% would usually be expected. We also know that if the ECV works, your baby is very unlikely to turn back, so less than 5% of babies will spontaneously turn back to breech position if the ECV was successful. And for those women where the baby remains in a head first position, ...

In episode 5 of the Pregnancy and Childbirth podcast, Dr Greg discusses reproductive carrier screening.

Carrier screening involves testing parents prior to pregnancy, or in the early stages of pregnancy, to determine whether or not they are at risk of having a baby with a serious genetic condition.

It is recommended that all couples in Australia who are contemplating pregnancy, or who are in the early stages of pregnancy, are informed about their options in regard to reproductive carrier screening.

In this podcast you’ll discover how carrier screening works, what conditions we can test for and what your options are if your baby is found to be affected by any of these conditions.

• Mackenzie’s Mission will provide reproductive genetic carrier screening to 10,000 Australian couples who are either planning to have children or are in early pregnancy
• Sonic Genetics gives doctors and patients access to an extensive range of genetic tests, provided through Sonic Healthcare’s network of Australian and international laboratories
• NSW Health reproductive genetic carrier screening fact sheet

0:01
Hi, I'm Greg Jenkins, and welcome to this edition of my pregnancy podcast. Today we're going to be talking about a thing called reproductive carrier screening. This is testing that can be carried out, either prior to pregnancy or during the early stages of pregnancy to determine whether you and your partner, may be a risk of giving birth to a child, who could have a potentially serious genetic condition. It is recommended that for all couples in Australia who are contemplating pregnancy, who or who are in the early stages of pregnancy, that they be informed about their options in regard to reproductive carrier screening. You may choose not to pursue testing in this area but it is important part of your decision making to be informed about this and to give it some consideration.
0:53
So before we can talk about reproductive carrier screening, we need to understand a little bit about what it is that we're talking about. So this is not about testing for conditions like Down Syndrome, for example, these are chromosome conditions rather than genetic conditions. So what we're talking about in this case, is conditions that would usually be inherited from the parents. And the way that these are inherited is that in most instances, one or both of the partners are a carrier for this condition, and they pass the condition on to some of their children. There are quite literally 1000s of these conditions. And it's estimated that there may be something like a million people living in Australia, who are affected by a genetically inherited condition.
1:44
Some of these conditions are very serious, and have a major impact on both duration and quality of life. And some relatively minor with minimal impact on quality of life. The commonest of these conditions is something that you might be familiar with, is a condition called Cystic Fibrosis. Now in order to understand how this works, we need to have a bit of a chat about genetics. So genes generally occur in pairs. In order to inherit a genetic condition, you generally need to have both pairs of the gene for that condition. Now, we all carry faulty genes, on average, most of us carry at least two faulty genes. Now, if you happen to be having a baby with somebody who has the same faulty gene as you, then there's a possibility that some of your children will get both of your faulty genes, and therefore will actually have the condition that's related to these genes, and this is called autosomal recessive inheritance. So these genes are recessive. And in order to get the disease, which the gene is particular to, you need to have both of the faulty genes.
3:01
There's another way of inheriting a genetic condition, and that's called an X linked recessive condition. In these conditions, the faulty gene resides on the X chromosome. Now, you're probably aware that females have 2x chromosomes and males have an X chromosome and a Y chromosome. So for an X linked condition provided there is a normal X chromosome to balance out the gene on the faulty X chromosome, the condition won't generally occur. However, in boys, if they inherit the X chromosome with the faulty gene, they don't have an extra another X chromosome with a normal gene to cancel it out. So in X linked conditions, we normally say the visible nature of this disease, are much mor...

In episode 4 of the Pregnancy and Childbirth podcast, Dr Greg discusses pregnancy related nausea and vomiting.

Nausea and vomiting are common symptoms that affect many pregnant women, particularly during the first trimester. This condition is often referred to as morning sickness, although this is misleading as symptoms can occur at any time. Join Dr Greg as he discusses how to manage pregnancy nausea and vomiting so that they have a minimum impact on your day-to-day function and on your general well-being.

Happy listening and don’t forget to subscribe to the Pregnancy and Childbirth podcast with Dr Greg on Apple Podcasts to get new episodes as they become available.

0:01
Hi, I'm Greg Jenkins and welcome to this edition of my pregnancy podcast. Today, we're going to be talking about nausea and vomiting in pregnancy. This is a really common symptom. It affects a large proportion of women and predominantly is confined to the first trimester or the first 12 weeks of pregnancy. It's also commonly referred to as morning sickness, although typically for a lot of women, the symptoms are not confined to the morning and can occur at any time during the day.
0:34
In most women, the symptoms are bothersome, but not a major concern to their health. However, for a small group of women, they develop a more severe version of nausea and vomiting in early pregnancy, and this is called hyperemesis gravidarum, or often referred to as HG. In the symptoms are severe enough to cause significant weight loss and or dehydration. In these women, periods of hospitalisation may be required for administration of intravenous medications and intravenous fluids. And at the more severe end of the spectrum, this can have a significant impact on health and well being.
1:19
For most women however, their symptoms are more mild than this and can be managed without the need for admission to hospital. And there are usually measures involving lifestyle and dietary modification and simple medications, which will keep the symptoms reasonably well controlled.
1:40
So what causes nausea and vomiting in early pregnancy? Well, it's undoubtedly related to pregnancy hormones. And the higher the pregnancy hormone levels, for example, in multiple pregnancies, women tend to have more severe symptoms than in women with single pregnancies. It's not clear, however, why some women develop quite severe symptoms, and other women very mild symptoms, and some women no symptoms at all. The trajectory of symptoms does, however, follow reasonably well, the rise and fall in the pregnancy hormone level through the first trimester of pregnancy. So it's reasonably predictable, that symptoms of nausea and vomiting and pregnancy reached their worst by about 9 to 10 weeks. And after this time, in the vast majority of women, they gradually improve over the next few weeks. There are, however, a small group of women who experienced persistent nausea and vomiting for much longer than the first trimester, and very occasionally, throughout the entire duration of pregnancy.
2:47
So how do we manage nausea and vomiting and pregnancy? Well, unfortunately, the bad news is, there isn't anything we can do that's going to make it go away. So the key is to find a way to manage the symptoms, so they have a minimal impact on your day to day function, and on your general well-being. Now the majority of women find that the longer they go without having anything to eat or drink, the worse they tend to feel. So it's a little bit paradoxical. In order to not feel sick, you need to eat or drink something. Most women this is reasonably predictable. Now it doesn't really matter what you eat or drink. However, most women find that foods that are fairly bland, are carbohydrate rich, and easily digestible, are the things that work best. Similarly, with fluid, it doesn't especially matter what you drink. Some women find water to be not particularly palatable in the early trimester of pregnancy, and things like dilute fruit juice, even soft drinks, sports drinks, Hydralyte, any of those sorts of things can help to manage the symptoms and also provide carbohydrates that provide fuel and energy for your body. In terms of foods, small bland snacks, so crackers, sugary lollies, sometimes, dry toast, all of those things can be helpful, and it's a matter of experimenting with a few things and see what works best for you. You might even find that carrying snacks around. Some women find that having a snack by their bedside. So as soon as they wake up in the morning, they can have something to eat before they get out of bed that can help with the feelings of nausea and vomiting first thing in the morning.
4:33
You need n...

In episode 12 of the Pregnancy and Childbirth podcast, Dr Greg Jenkins, obstetrician and gynaecologist, discusses the recovery process after a caesarean section.

The recovery process is important because it allows you to heal physically and emotionally after your caesarean. It is also an opportunity for you to learn about your own body and how to care for yourself following surgery. The recovery process will vary from woman to woman, but there are a few things that are common to most women, and these will be covered in this episode.

Listen in as Dr Jenkins discusses pain relief options, the healing process, guidelines for discharge from the hospital, dressing your wound, what activities you can and should do as you recover and more. Whether this is your first or second caesarean, you will find this podcast informative and helpful as you navigate the road to recovery. So, tune in now for all the information and advice you need to make your recovery as smooth and easy as possible.

Happy listening and don’t forget to subscribe to the Pregnancy and Childbirth podcast with Dr Greg on Apple Podcasts to get new episodes as they become available.

00:00:00

Hi I'm Greg Jenkins. Welcome to my pregnancy and childbirth podcast. Today we're going to talk about recovery after your caesarean. This topic was suggested by the partner of one of my patients. If you have any suggestions for podcast topics, please let me know.

00:00:18

There are two types of caesarean. There's the caesarean that's performed during labour, where there was a plan to aim for a vaginal birth but something happened during the course of labour to change direction and move towards a caesarean. The second type of caesarean is where there was always the intention to carry out a caesarean.

00:00:36

Now the recovery for both of these and the post caesarean care is very similar for both. Really, the only difference is that if you laboured for some time before you had a cesarean, there may be a little bit more recovery needed in the first couple of days as you will be recovering from the labour as well as recovering from the caesarean itself.

00:00:57

We'll start by talking about what to expect immediately at the end of your cesarean. So you'll usually have either a spinal or epidural type of anesthetic, in some instances they might leave an epidural catheter in your back and give you some anesthetic down the epidural immediately following your caesarean.

00:01:17

Some will give you some medication, some long acting medication through the epidural or the spinal to help with your pain relief for the 1st 12 hours or so after the caesarean and on other occasions you might have a drip with a push button that'll give you small amounts of pain relief as you need it.

00:01:35

Whichever approach it is, the anaesthetist will ensure that you have some good quality pain relief to get you through the 1st 12 hours or so after your caesarean. The same thing would apply if you had a general anesthetic or a go to sleep anesthetic for caesarean. So you have some good quality pain relief.

00:01:55

You'll also have an intravenous drip, and drip will stay there usually until the following day, and that enables you to have some intravenous fluid, you might need some extra antibiotics and that just helps to keep you well hydrated and keep you well during your post operative recovery.

00:02:15

You'll have a catheter in your bladder. It's important that your bladder is able to be emptied following caesarean and you might not be able to do that yourself. So the catheter will usually stay there until the following day.

00:02:28

In terms of the skin closure from your caesarean, we'd usually use the dissolving stitches in the skin so it would be unusual to have a stitch which required removal so they'll usually be a dissolving skin stitch, and then there'll be a waterproof dressing over the top of the skin stitch and I would usually use a clear dressing so that we can see the wound quite clearly through the dressing.

00:02:52

If the caesarean is fairly straightforward and there were no other complicating factors, it'll usually be ok for you to have something light to eat and something to drink, within the first few hours after your caesarean. And this is actually a good thing to do because it helps to speed up your recovery.

00:03:10

Now, there may be occasions where this is not advisable, in which case we'll be sure to let you know that's the case. Generally, on the first day of your caesarean, we wouldn't expect you to be getting up out of bed. This is generally a rest day where you'l...

In episode 11 of the Pregnancy and Childbirth podcast, Dr Greg Jenkins, obstetrician and gynaecologist, talks about what happens if you catch COVID-19 whilst you're pregnant. Dr Greg provides advice specific to where we are in the pandemic at the present time, so it's important to note that this podcast was recorded in mid January 2022 and in Sydney where Dr Greg is based.
Listen to this episode to learn about:

• What to do if you catch COVID-19 during pregnancy
• Effects of COVID-19 illness on vaccinated and unvaccinated pregnant women
• What symptoms you are likely to experience and how to manage them
• What happens if you're in late pregnancy and your waters break? Or you go into labour before you've been able to deisolate?
  

Happy listening and don’t forget to subscribe to the Pregnancy and Childbirth podcast with Dr Greg on Apple Podcasts to get new episodes as they become available.

00:00:00

Hi, I'm Greg Jenkins, obstetrician. Welcome to my podcast. Today we're going to talk about what happens if you catch COVID whilst you're pregnant. The advice I'm going to give is specific to where we are in the pandemic at the present time, so it's important to note that this podcast is being recorded in mid January 2022 and in Sydney where I'm based. We're in the midst of a rather large outbreak of Omicron COVID.

00:00:32

At the outset, I should mention that this advice is of a very general nature only, and it assumes that you are basically a healthy person with a healthy pregnancy. If you have any pre-existing medical problems or any significant issues during your pregnancy, it's very important that you seek immediate advice from your pregnancy care provider if you're diagnosed with COVID. That's because the advice I'm going to provide here may not be particularly applicable to you.

00:01:03

Now for every pregnant woman who catches COVID during pregnancy, they should make early contact with their pregnancy health care provider so that they can obtain a specific advice to their particular needs.

00:01:16

Now if you catch COVID during pregnancy, it matters whether you're a vaccinated or unvaccinated person. We're seeing significantly milder illness in vaccinated pregnant women are with unvaccinated women a bit more likely to experience a more significant illness. And we're seeing a very small number of unvaccinated women admitted to hospital with very severe, and in some cases critical illness, requiring intensive care support.

00:01:45

So I would just reiterate the advice from one of my earlier podcasts around vaccination, if you haven't accessed COVID vaccination up to this point, I would strongly encourage you to do so at the earliest opportunity.

00:02:00

This is also useful opportunity to reflect on the public health advice, so follow whatever public health orders happen to be in place, but we do know that masks significantly reduce the transmission of COVID. So when you're in a crowded public indoor areas, it's very helpful to be wearing a mask, to maintain social distancing wherever possible, and to practice good hand hygiene, and of course if you have symptoms then isolate at home until your symptoms have resolved and get a COVID test, of course.

00:02:40

It's very possible that you've done all those things extremely well, and that you're a double vaccinated person, but now you find yourself having contracted COVID. So what does that mean? Well, the first thing to say is that you're very unlikely to experience a significant illness, and by a significant illness I mean an illness that's significant enough for you to require care in hospital.

00:03:03

The symptoms can be quite bothersome and you may well feel quite unwell for a few days. Most women will experience a sore throat, often described as a scratchy throat, a cough for a couple of days, maybe a sense of chest tightness, fatigue, fevers, and generalised muscle aches and pains, and headaches would be the most common symptoms that we're seeing during COVID illness.

00:03:33

The respiratory symptoms, the sore throat, and a cough and the chest tightness usually pass fairly quickly, and most commonly only last a few days. Some people with COVID will experience significant nausea and vomiting, and if you're a woman in early pregnancy who catches COVID, if you're in early pregnancy and you're already experiencing our troublesome early pregnancy, nausea and vomiting, it's possible that COVID might make this worse.

00:04:02

If you reach a point where you're not able to keep all fluids down, without vomiting, then this would be a trigger fo...