The Kick Pregnancy Podcast
Everything you need to know about getting pregnant, being pregnant, giving birth and bringing your baby home. Your host Obstetrician Dr Patrick Moloney and co-host Brigid Moloney focus on the essentials of growing a baby without heavy medical jargon and with lots of relatable stories of their work helping thousands of women have babies, as well as being parents to four boys. Each episode has expert led content that will help you cut through the swathe of pregnancy information, restoring your calm and giving you the confidence to know that mama, you got this!
The Kick Pregnancy Podcast
121. Ask Dr Pat, or Brigid! Our fourteenth Q and A session.
Dr Pat and Brigid are back with their fourteenth Q and A session as they answer questions from listeners of The Kick.
This Q and A session answers the following listener questions:
- Taking aspirin in pregnancy to support the placenta and foetal growth.
- Painful postpartum intercourse.
- Should I be worried about ovulation spotting or bleeding?
- What is a MET call?
- Preeclampsia in pregnancy
- Can lubricant affect your chances of becoming pregnant?
- Does stress affect your fertility?
If you have a question you want answered, please leave your message on speakpipe to be chosen for Dr Pat to answer during a Q & A:
https://www.speakpipe.com/growmybaby
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The information in this podcast is provided for education and research information only. It is not a substitute for professional health advice.
Speaker 2:If you're trying to get pregnant, or you are pregnant and you feel a little bit overwhelmed by all you need to know, then this is the right podcast for you. Welcome to the show. I'm Bridget Maloney.
Speaker 1:And I'm obstetrician Dr Patrick Maloney, and this is the Kick, your expert-led podcast that delivers the essentials of growing a baby. Make sure you head to our website growmybabycomau to get some awesome free tools, like our Pregnancy Knowledge Checker, to help you feel like you got this.
Speaker 2:Welcome everyone. I'm Bridget Maloney.
Speaker 1:And I'm obstetrician, Dr Patrick Maloney.
Speaker 2:And here we are with another Q&A episode.
Speaker 1:Excellent.
Speaker 2:Which is sweet. I know that we love doing them, you love hearing from them and we're getting some really cracking questions in, so that's really good. We're here doing a couple of episodes today and I had to drag Pat out from talking to our producer about US politics. You're so fascinated by US politics, aren't?
Speaker 1:you. That's weird, isn't it? It's my guilty obsession.
Speaker 2:Yeah, I wonder whether Americans realise how obsessed I am about it.
Speaker 1:Yeah, yeah, just you, pat.
Speaker 2:They probably don't know that they don't know that bit, but whether they know how obsessed the rest of the world is about US politics.
Speaker 1:It's fascinating, it's only because it's full of really good villains. It's like a play.
Speaker 2:It's like one of those pantomime. And it's the fascination because we don't get passionate really about politics here in Australia. Much do we.
Speaker 1:Well, ours is a fair bit more, I guess, mainstream.
Speaker 3:Yeah.
Speaker 2:And less of a pitched battle.
Speaker 1:Yeah, less of a pitched battle between one point of view and another.
Speaker 2:Yeah, yeah, all right Now. People don't want to hear about that. They want to hear their questions.
Speaker 1:Good, let's go.
Speaker 2:Here we go. We're going to start with this one.
Speaker 5:Hi Dr, Pat and Bridget. My name is Amanda. Firstly, Thank you for your wonderfully informative podcast and easy to listen to voice. Your podcast is very relaxing. I listened to all of your episodes during my first pregnancy and felt well informed. My first baby was induced at 38 plus 3 due to growth decline, so my question is related to potential growth issues with a second baby. I've been told to take aspirin early in the pregnancy to support the placenta and thereby support fetal growth. However, I'm struggling to find many studies that have examined this and found much of a positive effect for growth from using aspirin. So I am wondering what your thoughts are. If this is necessary, if it's the best option if fetal growth issues for subsequent births is likely, if it's the best option if fetal growth issues for subsequent births is likely, and what might the associated risks be? Should I take aspirin early on? Thank you.
Speaker 2:Excellent Okay a few questions there for you, Pat.
Speaker 1:There's a bit in that. Yes, there really is. Yeah, one of the things that it comes down to the role of aspirin. One of the things that it comes down to is whether the growth restriction in the third trimester had anything to do with preeclampsia or not, and what was the degree of growth restriction and what was the degree of the decline in the growth trajectory in the third trimester? So did the growth just really fall off dramatically in a way that they're worried about, or was it consistently just poorish growth? Or was it being caused by preeclampsia? And I think all of those things are kind of relevant. As to whether the evidence base for aspirin really applies, we don't know all that detail, but it doesn't really matter. We can discuss it anyway.
Speaker 1:The aspirin is a proven way. The aspirin is a proven benefit for this situation, especially when the preeclampsia is the cause of the poor growth to take in a preventative way in early pregnancy. The great part about it is that we don't believe there are basically any downsides to doing it. A small number of people can't tolerate aspirin, but most people can. We're talking about a low dose. It's a half of a tablet or even a 100 milligram cardio protection dose that an older person might take to prevent heart attack and stroke and that typically doesn't cause any problems in pregnancy, and the benefit is there. Exactly how much benefit is there for this patient really depends on the degree of what we're talking about. If they weren't even induced until 38 weeks and three days, I'm imagining it was a relatively non-concerning situation.
Speaker 1:I still think that for most people, why not take the aspirin? If there's some proven benefit and no known risks, then I would do that as a 1% or a 2% to nudge the odds in my favor. And lastly, anyone with a third trimester growth problem should have a third trimester growth scan done next time, whether or not they appear to be growing normally. So come see the obstetrician, get out the tape measure, have a feel of the tummy. It all looks good. But no, I had poor third trimester growth last time. I'm going to, even if I seem to be fine this time. I'm still going to have a third trimester growth scan, ideally done by a ultrasound facility with a lot of expertise in third trimester growth scanning, and I want to know where I sit and whether that's a concern.
Speaker 2:Yeah, so is she correct when she's been told that she takes the aspirin to support the placenta?
Speaker 1:Yeah, so the way this is supposed to work is that in the early phases of the pregnancy, the placenta will form better, more normally, in the presence of the blood thinning effect you get from aspirin.
Speaker 2:Yeah, right, okay, so I think we've answered those questions. One last question Is she likely, if you've had one growth restricted baby, are you likely to have a second?
Speaker 1:You're more likely than somebody else who's never had a growth restricted baby and therefore you're wise to be watched more closely. Okay, good.
Speaker 2:Good luck there. I hope that you end up having a perfect pregnancy. Yeah, there's every chance. There's every chance.
Speaker 1:Yeah, and aspirin or no aspirin? If careful ultrasound surveillance in the third trimester suggests there's no problem, then there's no problem.
Speaker 2:Yeah, All right, I'm going to go to a follow-up call from somebody. Ultrasound surveillance in the third trimester suggests there's no problem then there's no problem.
Speaker 7:Yeah, all right, I'm going to go to a follow-up call from somebody who's a second-time Q&A. Hello, dr Patton-Bridget. I just wanted to send a follow-up speak pipe. Over a year ago I had sent one in asking for your opinion on what a subsequent labour might look like after I had a pretty traumatic labour and delivery with my first daughter. She was just a little refreshed. She was 4.2 kilos, 36-hour labour. She was posterior and pretty much stuck in there, ended up in theatre with forceps to deliver her, ended up in theatre with forceps to deliver her, and I was curious if a similar thing might happen for a subsequent pregnancy and delivery. And I just wanted to follow up saying that I managed to have a 4.5 kilo baby, drug-free, intervention-free water birth four weeks ago, which was exactly what I wanted for my first. So, um, yeah, pretty stoked and I just wanted to say thank you so much for the podcast and listening to you guys really got me through my pregnancy and leading up to delivery and I can't thank you enough wow, how 4.5.
Speaker 1:I know Amazing. So these are big babies, right.
Speaker 2:Yeah, yeah.
Speaker 1:This is fantastic.
Speaker 2:How lovely. Thank you so much for taking the time to do that.
Speaker 1:So if I mean I can't I don't know precisely what- I think we talked about it a lot.
Speaker 2:I think there was a lot of anxiety about, you know, that the second birth would be exactly the same as the first. Yeah, yeah.
Speaker 1:So things that were of some concern this baby was even bigger things that went very well the labor was more efficient, as a typical second birth is. The pushing phase is briefer, with less resistance from the tissue surrounding the vagina and vagina opening, and out came a 4.5 kilo baby and probably with a labor. That good baby with a better sense of direction, looking away, looking down in a lying position, looking down at the floor rather than up at the ceiling, and everything went right this time. Everything went smoothly and well, so pleased.
Speaker 2:So pleased and I wanted to put it in, because often we see that people implement lots of different things for their second birth because they think, oh, it's because I didn't do XYZ in my first birth and I did that in my second birth and that's why I had a better birth. And I wanted to put it in, because this is a common story. We get, don't we, the second birth.
Speaker 1:Yeah. So I think if someone's had a complex first birth, which was chiefly because it was the first one and there's a relatively low risk of recurrence of those problems, then it's very likely to go better. And if that woman is still interested in trying again, then what she would potentially be best served by is just a expertly supervised second attempt at vaginal birth, rather than saying that sucked too badly, I'll have a season extra, for example, and this cause has done exactly that. It's gone way better because it was her second go and it was still a big baby. Still a big baby, but a terrific outcome for her.
Speaker 2:Congratulations. That is so great and, as I said, thanks for calling in and telling us that. We love hearing that, yeah.
Speaker 1:And look, you know we don't want to rain on people's parades if they have elaborate plans in their first baby for with their first baby, for these perfect labours. I hope you have a perfect labour, but I think one of our philosophies here is to say these sort of issues, when you're having your first baby are not uncommon, and here's some information about them to help you plan and cope with that. But so often what we hear from people is that the second baby or the third baby that's the one, that's the one they always had in mind yeah, that's often when people say that a birth, a second birth or a third birth can be therapeutic absolutely yeah, and restore your faith restore your faith
Speaker 2:yeah good, and it's not just because we run an obstetrics clinic and we want everybody to have more than two babies.
Speaker 1:No, but funny. You should say that If somebody has a very traumatic first birth experience, um, but the baby's ultimately okay and that person never comes back, despite wanting more than one baby, that is a failure of the follow-up process.
Speaker 2:Yeah.
Speaker 1:I think we could have done better for that person.
Speaker 2:Yep.
Speaker 1:Yeah, and by virtue of them never coming back. We don't know that they're out there, but we want to be able to say to that person things can go better.
Speaker 2:Yeah, and that might be the obstetrician or the midwife talking to them, but it also might be a psychologist, yeah.
Speaker 1:Maternal child care, health care, nurse all sorts of people, general practitioner, people who've got ongoing contact with that person. I think the message should be that some of these complexities are real. First, baby things.
Speaker 2:I'm going to move on to our next caller.
Speaker 8:I just have a question about postpartum intercourse. I had my baby four months ago and an IUD inserted During delivery. I did have an episiotomy cut. I'm finding intercourse quite painful, to the point that I do everything in my power to try and avoid it. Is there anything I can do to make it no longer painful? Thanks, Poor.
Speaker 2:Thing.
Speaker 1:This is a reasonably common problem and I think that when this is being discussed with the local doc, obstetrician or whatever, one of the things that's important I always find is to try and work out whether the pain is located in the healing scar or whether it is broadly painful throughout the vagina, or what we're dealing with is just somebody who doesn't want isn't ready.
Speaker 2:Yeah.
Speaker 1:Because people will quite rightly want to avoid intercourse if they just don't want it. Yeah, so covering those possibilities can help us work out what the best treatment is per se, and some people just need more time. If the scar itself has persistent tenderness in the episiotomy or tear scar, then I think a really careful examination of that scar is important to make sure it really does have complete healing and that the anatomy has come together properly and that the sutures have been expertly applied and so forth and that that really is a wound that's properly healed and if it seems to be really good, really anatomically well healed but it just doesn't it's still very sore. Time can help.
Speaker 1:Pelvic floor physiotherapy can help and in some cases estrogen cream rubbed into the area can help. I'm not sure that that last one has an enormous evidence base, but it's something that people do. In some cases estrogen cream rubbed into the area can help. I'm not sure that that last one has an enormous evidence base, but it's something that people do and it seems to help. And we'll often see this in someone who's breastfeeding full time and there's a lot of tenderness within the vagina and if you put in some estrogen cream it can really help.
Speaker 2:Because the vagina's dry. Yeah, yeah.
Speaker 1:Yeah, and the estrogen cream may also promote healthy healing within the scar, but we don't use it for everybody. We only use it for someone who's got a persistent problem.
Speaker 3:Yeah.
Speaker 1:And so this is one of those situations where, before just giving generic advice, we're going to work out exactly what's wrong.
Speaker 2:Yeah, yeah. So this person's four months postpartum, yeah, where's their first port of call? Do they? If they had an obstetrician, do they ring them up or do they go back to their GP? I think?
Speaker 1:they should go to their GP and see what the GP's got to say and if it's within the skill set of the GP, fantastic. Otherwise they could go back and see the obstetric team from the pregnancy and say, look, I've still got this. What can you do to help?
Speaker 2:Yeah, yeah. And we know that the pelvic floor physio, like our blender at our clinic, is amazing with this.
Speaker 1:So much can be done. I think one of the problems with people not being referred to pelvic floor physiotherapists is that not every other healthcare practitioner knows just how good these people are. So there might be patients with problems that could definitely be addressed by a good pelvic floor physio, but they're not being sent there. Um but um. So a good pelvic floor physio could deal with, can deal with this, can do it, can deal with problems of postpartum vaginal laxity, um, postpartum vaginal wind, with intercourse, which people find embarrassing and don't like, and um and uh, all sorts of other things like, like, um, the musculoskeletal problems within the pelvis, dehiscence of the abdominal muscles and even breast issues and mastitis.
Speaker 2:Yeah, yeah, yeah, I know Belinda works with ultrasound, with mastitis and cracked nipples which is not what this person's asking about but also tightness and bracing, and you know if you're fearing the pain, that's what she also works with. So you know, it's a psychological issue in a way, where you think that pain's coming, you brace everything.
Speaker 1:Yep.
Speaker 2:So she actually teaches people how to relax their pelvic floor as much as anything.
Speaker 1:And that is a common cause of dyspareunia. Painful intercourse in women will stop is problems with the tone of the pelvic floor muscles, and I think it's a cause that's potentially overlooked in postpartum. But if you've had a painful scar and you expect sexual penetration to be painful, then you will, to a certain extent, subconsciously clamp up to avoid. Your body doesn't want to be hurt. So then and the problem with that is that it's actually not a protective thing for your body to do, because penetration with the muscles very, very tight is painful in itself. So it doesn't actually work to protect you from pain, and the whole thing needs expert analysis, work out precisely what the problem is, and then some targeted therapies.
Speaker 2:We may not know this, but what is the average time for people to return to sex?
Speaker 1:Yeah, look, I don't know what the average is I really don't but I do know that there's no right or wrong answer, that there's no right or wrong time. We want people ultimately to return to a satisfactory sex life that suits them as a couple and that some people that might be one month and someone else it might be six months.
Speaker 2:Yeah, and there may be a role for a sex therapist or a psychologist as well.
Speaker 1:Yeah, we need a lot more sex therapists.
Speaker 2:Yes, If anyone's interested in training a sex therapist, we want one in Ballarat please.
Speaker 1:Sexual problems are a part of being a human being, and just because we don't like talking about them doesn't mean they don't exist. Yeah, and it would definitely be an underserviced area of healthcare.
Speaker 2:All right, I am going to move on to this caller, pat.
Speaker 4:Hi, dr. Pat and Bridget. My name's Nicole and I am not pregnant. My partner and I are trying to get pregnant. A little bit of background about me. I'm 32 years old, with no known medical histories or anything like that.
Speaker 4:My question today is around ovulation spotting or bleeding. This is something that I experienced last cycle. It was midway through my cycle and it was small spotting of blood which I can only assume is ovulation spotting or bleeding. My question is I've never, ever ever experienced this in my life before. I don't know whether it's something I just haven't noticed or haven't been paying attention in the past, but now that I'm trying, I'm more sort of in tune and looking out for things. I have also had a pregnancy test and blood test done since this and I'm not pregnant. So, ruling that out, I just wanted to know if ovulation spotting or bleeding is a cause of concern, particularly with someone with no medical history, not pregnant. Particularly with someone with no medical history, not pregnant, no severe cramps, and I have a regular sort of 28 to 30 day period as well. So, yeah, just wondering if this is a concern or if this is something that is totally fine. Yeah, looking for any advice. Thanks, dr Pat and Bridget.
Speaker 1:Well-crafted question, wasn't it yeah?
Speaker 2:Yeah, and like what a mystery our menstrual cycles are sometimes.
Speaker 1:They are.
Speaker 2:Sometimes you think you've nailed it and it's like 28 days textbook, stop, start. But then others you do get spotting. You think, well, what is this about? So many questions? And obviously she's got so many questions.
Speaker 1:I know my approach to this situation would be to try and work out. Firstly, the end goal here is pregnancy. So if I saw this couple, I'd be giving them some standard sort of pre-pregnancy advice and trying to establish on the history whether she was ovulating and it does sound like she is. The cycle's pretty regular 28, 29 days. Then we'd have a look at this mid-cycle bleeding and try and work out what it is.
Speaker 1:It is possible to have a small bleed with a normal ovulation, but that's not always. One isn't necessarily causing the other, so it's not always ovulatory bleeding. It could easily be from an abnormality, such as a polyp in the uterus or even a polyp on the cervix. And what appears to be mid-cycle bleeding ovulatory bleeding in a couple that are trying for a baby might actually be post-coital bleeding, because they're going to be having only intercourse in the middle of the cycle when they're trying to get pregnant, because they're going to be having only intercourse in the middle of the cycle when they're trying to get pregnant. So I would be recommending that, before we just assume that this was necessarily bleeding with ovulation, that this patient had a speculum examination to make sure there was nothing funny going on in the cervix, that the cervix looked normal, there was no polyp. That a pap smear was taken to make sure that cervical screeningix looked normal, there was no polyp. That a pap smear was taken to make sure that cervical screen test was normal. And then an expert ultrasound to look up into the uterine cavity and make sure there was no evidence of a problem up there.
Speaker 1:Otherwise, if all of that's normal and there's a little bit of bleeding with ovulation, that's not necessarily abnormal. Little bit of bleeding with ovulation, that's not necessarily abnormal and it's not necessarily standing in the way of um, of uh, a pregnancy. Once all of those other causes are excluded, one of the main reasons why someone might have bleeding with ovulation and never have, never having had it before, is that a lot of people have been on the pill for a long time and you don't know, yeah right um, so someone coming on?
Speaker 1:the pill for a long time and you don't know. If they're there, yeah right. So someone coming off the pill to get pregnant might experience some features to their menstrual cycle which they've never experienced before, but that's only because they were on the pill, sometimes for years and years and years.
Speaker 2:Fascinating. I didn't expect you to answer like that. Yeah, I don't know. I thought you'd just say, well, that's normal, but it needs to be investigated.
Speaker 1:No, there are abnormalities that need to be excluded.
Speaker 2:Yeah right.
Speaker 1:Good, it may ultimately be normal.
Speaker 2:Yeah, all right.
Speaker 1:So perhaps say off to the GP to get a referral to a gynecologist Plus or minus gynecologist, yeah, and see what they think.
Speaker 2:Thank you for sending that in. I'm sure lots, lots of us have got questions like that, so that's very, very useful. Let's move on to the next question, pat.
Speaker 3:My name's Sophie. I have had two babies now, and both times just after they've been born in the hospital. I've had met calls for my blood pressure a number of times, and so other doctors have come in and it's never really been explained to me what is happening or why it is happening, and I just wanted to know, if that is something you knew, what a MET call was. Thank you, Great question.
Speaker 2:Yeah. Can you maybe describe a MET call to begin with and who people should expect in the room if a MET call is called?
Speaker 1:Yeah. So within our hospitals we have systems to make sure that if something's going wrong, that the right people arrive at the right time, and the system is a thing called med calls, whereby carers on the scene can call a single number within the hospital and that person will then alert an appropriate team of people to come in a hurry to deal with whatever the problem is. So if it's someone's fallen out of bed and been injured, somebody's had a heart attack, somebody's having an obstetric emergency, then the appropriate team will be sent. And it's so that the people on the ground don't need to make six phone calls, they can just make one and then the MEC call and those people will be contacted by the switchboard people or via their mobile phones or by an overhead announcement within the hospital.
Speaker 1:What then happens is that people come running from all over the hospital to attend to that person who's got a time criticalcritical thing going on for them, and it's scary. People rush into the room and it's scary and there's a fair bit of yelling and hurrying and it's stressful. Now the problem is that sometimes a MET call gets called when the patient's observations their blood pressure, heart rate, respiratory rate, oxygen saturation, so forth have fallen outside safe guidelines, but not always does that constitute a lights and sirens medical emergency. Sometimes it's just for example, someone with a very, very low blood pressure gets a MET call because they are below the criteria of safe blood pressure, but in fact the person feels fine and doesn't know what all the fuss is about. And that's life in a big hospital and we like systems. In general they're safe.
Speaker 2:Yeah, protocols, yeah In general, they're safe.
Speaker 1:Yeah, protocols yeah, we would rather call a few fake, you know, a few unnecessary med calls than to have somebody with a very abnormal blood pressure go unmanaged.
Speaker 2:Yeah, so we might talk about that. Then why does well, what is low blood pressure for somebody that's just had a baby?
Speaker 1:Yeah. So, for example, if your blood pressure is very, very low and you've just had a baby, that could be. It could be because you are bleeding and that's a time critical emergency.
Speaker 1:It could be because something very, very serious internally has happened like a ruptured uterine scar or something and you might not be obviously bleeding, but you're bleeding internally. Super serious. It could be a severe complication of an epidural. Serious it could be nothing, it could be just because your cervix has been wide open and that can drop your blood pressure. So this is what happens within the system. Sometimes you get all the care and there's nothing terribly wrong with you and you might have been fine if we just waited. But that's often not how the system works in big hospitals. Ultimately, if everyone turns up to help you and we work through the diagnostic pathways and find out that there's nothing wrong and your blood pressure will come back in a few minutes and all it needs is time, then all the people who turned up to help just drift away. But we'd rather have them than not have them. It's based on criteria where, if your observations are abnormal enough for a MET call to be called, then it's probably not a normal phenomenon you're experiencing. It's probably something that needs attention.
Speaker 2:Yeah, yeah, and we don't know whether anything happened after your MET call was called. No, we don't even know why it was called.
Speaker 1:Yeah, but certainly in my experience, if people say, oh my God, everyone came and there was nothing wrong with me, the explanation is usually well, your observations were telling us that something may have been seriously wrong. We called all the expertise and when it was apparent that nothing was seriously wrong, we said to those people thanks for coming.
Speaker 2:This just highlights the disconnect that can happen sometimes for a patient, and I'm going to use myself as the person yes. So for me, when in my first birth and it was an emergency cesarean, and I do remember being run down the hallway on the gurney with the orderly sort of running- yeah. And for me that was petrifying.
Speaker 1:Yes, Like.
Speaker 2:I thought I was going to die.
Speaker 6:Yes.
Speaker 2:Yeah, but what everybody at the hospital was probably thinking is okay, time critical, let's get this done. What's our protocol? How do we enact it?
Speaker 1:Yeah, and for the hospital, that is just an ordinary day. Yeah, and for the person it's the day of the birth of your first baby is a game changing day. Yeah, and one of our obligations in our care of people is to try and imagine what it's like for the patient.
Speaker 2:Yeah.
Speaker 1:And people in healthcare. We need to remind ourselves nearly constantly of that.
Speaker 2:Yeah.
Speaker 1:Our little mantra yes, this is fine for me, but what's it like for the poor old patient? Yeah, so you know, I think we should be doing that when we do something as putting in an IV line, something as simple as taking a patient from the ward down for a test, what's that actually like to experience?
Speaker 2:Yeah.
Speaker 1:Yeah, and I think good hospitals worldwide look at the patient experience within their hospital and not just the healthcare worker experience.
Speaker 2:Yeah.
Speaker 1:Yeah, For this particular person who sent us the speak pipe, I think that if that's happened twice and on neither of occasion has it been a serious problem, it's just been an abnormal observation that's happened because that's how her body behaves in the immediate postpartum period then that is definitely something worth bringing up.
Speaker 3:Yes, okay.
Speaker 1:Because if you tell the carers around you that this has happened twice before, they're less likely to panic if it happens again. And secondly, those medical criteria you cannot alter them.
Speaker 2:Per patient? Yeah, you can, so for an individual.
Speaker 1:Yeah, it might be brave to alter one in the immediate postpartum period. But, for example, if the MET call in a hospital, is that you need a MET call if your systolic blood pressure is less than, say I don't know 90, and your blood pressure sits around 90 the whole time?
Speaker 1:and in the middle of the night, when you're lying down and warm in bed and your veins are dilated and your blood pressure sits around 90 the whole time. And in the middle of the night, when you're lying down and warm in bed and your veins are dilated and your blood pressure is sitting at 85, but you're just asleep. You're on a med call.
Speaker 2:Yeah, yeah.
Speaker 1:So you're allowed to alter the cutoff points when you think that the abnormal in inverted commas observation is normal for that person at that time that happened with us, didn't it?
Speaker 2:Because in the third birth, when Pat was on board and my blood pressure was really low and I had the IV, drip and I just blew up like a balloon, didn't I?
Speaker 1:Just kept giving you extra fluid and you were able to say look, this has happened to me twice before.
Speaker 2:This has happened twice before, and so in the fourth birth we didn't even get an IV fluid and everyone goes, okay, everyone it's okay. Her blood pressure is low, that's normal. Yeah, yeah, all right. Good luck with your third birth, if that's what you're choosing to do or you're just trying to work out what happened in their first two births. Thank you for calling in. Let's move to our next caller.
Speaker 9:Hi Dr Pat and Bridget. My name's Eva and I've been listening to your podcast for just over a month as I prepare to start trying for baby number two, 16 years after baby number one, and this time with a different father. My question is, as I'm having baby number two with a different father, my question is as I'm having baby number two with a different father to my first baby, I was shocked to learn from Dr Pat that this can increase my chances of preeclampsia. I'm making sure I go into pregnancy at a healthy weight and with healthy blood pressure levels, but what other complications can arise from having a baby with a different father? Thank you for all your work on the podcast. Your advice so far has been invaluable in my preconception phase.
Speaker 2:Now, that's an avid listener. I do remember you saying that I love it and God bless someone for going back 16 years later.
Speaker 6:Yes.
Speaker 1:I think I need to make a clarification here. I did not mean to. If it was unclear, I apologize. I did not mean to suggest that having a second pregnancy with a different partner increases your risk of preeclampsia. That's not quite right. If you have preeclampsia the first time around and you have another pregnancy with the same partner, your chances of getting preeclampsia in the second pregnancy are less. And if it's a new partner, I guess your risk goes back to where it used to be Not up Right, just the same. Yeah, and if you never had preeclampsia, it's not relevant at all whether you've got a new partner or not.
Speaker 2:Right, well, we might have to go back to that episode and have another listen.
Speaker 1:Yes, because I certainly didn't mean to suggest that you're at higher risk with a new partner if you didn't have it the first time. That would not be an accurate interpretation of the data at all.
Speaker 2:Yeah Good, all right. That would not be an accurate interpretation of the data at all. Yeah Good, all right. Well, I hope that that helps just calm your mind and go. Okay, there we go. You can probably, unless you've had a history of preeclampsia, you can tick that one off and just go this new partner, not new partner thing.
Speaker 1:It's relevant to people who've already had preeclampsia, yeah, and even then it's not that relevant. It's just an observation.
Speaker 2:It's not like you're going to not do it.
Speaker 1:Yes, or stay with the first partner, or stay with the first one if you don't want to, or dig him up 16 years later.
Speaker 2:Yeah, where were you now? Let's have another baby. Yeah, that's not that.
Speaker 1:So this is you know. It's just, it's something that has been observed by researchers. I've never seen anyone make a decision about it based on it. Yeah researchers.
Speaker 2:I've never seen anyone make a decision about it based on it. Yeah, good, all right, thank you for pointing that out, and definitely we'll go back and have a little listen and edit it if we need. Good, yeah, so, pat, we've got time for one more caller. All right, our last caller, lucky last caller. Here she is.
Speaker 6:I have two questions. The first question is to what extent does stress play a part in getting pregnant? Everyone says that stress affects your ability to get pregnant, but to what extent is that? Is that just you know, if you're working long hours? Is it, um, you know, if you're just constantly thinking about it, um? Or is it, like you know, real chronic stress, um? And the second question is to what extent does using lubricant affect your chances of becoming pregnant and what does it do to sperm? Is there any particular types of lubricant that would be recommended for becoming pregnant?
Speaker 2:I said one last question. She put two in.
Speaker 1:Yeah there's two. The lubricant one's easy. There are some that are suitable for trying for a pregnancy and some that aren't, and you've got to make sure that you buy the lubricant at a reputable place where they can tell you what's in it and make sure it's one that's suitable for a couple who are trying for a baby.
Speaker 2:Yeah, including, not using, say, coconut oil and things like that.
Speaker 1:Yeah. So there are some that they clearly say this is suitable. And then the question about stress is a fascinating one, isn't it? Because all of our body's systems work a little bit better when we are well and we feel well, and mental health is part of that, and it makes sense that our reproductive system would work better if we were well and felt well, if we were well and felt well. That's not necessarily. That's not to say that ordinary, normal levels of stress, which is part of being a person, being alive, are necessarily a big problem, and also that our life stresses, well managed, would be a problem. I think if we've got stresses in our life, which this caller has identified, but we are managing them in healthy ways, then I don't think that's a problem. We can't magic stress out of our lives, but we can manage it by sleeping well, meditation, therapy and counselling, exercise, or we can manage it with drugs, alcohol and smoking, and clearly one is more suitable for the person going for pregnancy. So magic can shit stress away, no Managing it well, great idea.
Speaker 2:Yeah.
Speaker 1:Yeah, Exactly how much is the quantifiable effect? Don't know. Presumably enormous variation. Would be enormous between different people. But at the end of the day, advice managing the inevitable stress that comes with being a person in a healthy way is appropriate for somebody trying for a pregnancy, and those are avoiding drugs, alcohol and smoking, sleeping well and exercising.
Speaker 2:Sometimes this question comes about because, say, you're trying for a pregnancy and you're not getting pregnant, and people go oh, you just need to relax more, or you need to like slow down at work or whatever Like, and I think that puts a lot of pressure on that person.
Speaker 1:Yeah.
Speaker 2:You know, they think well, maybe that is the cause of why I'm not getting pregnant.
Speaker 1:Yes, so we know a bit more now than we used to about the appropriate way to talk to somebody who's struggling with fertility.
Speaker 2:Yeah.
Speaker 1:And making suggestions is not considered helpful.
Speaker 2:No, yeah, no, that's right.
Speaker 1:So concentrating our response to their situation on empathy and saying that must be stressful, that must be stressful, that must be upsetting. I'd love to be able to support you. How can I help? Is they're all the good things and it's quite problematic and potentially making it worse, to start making suggestions. You've got to get rid of stress. You've got to go on a holiday. You've got to do this, you've got to do that I feel, stressed you even just saying that.
Speaker 1:Yeah, those they do not help. Yeah, the person's not an idiot. They are aware of some of the contribution of those things. But you just making that suggestion. It's the best of intentions but it doesn't help.
Speaker 2:Yeah, For what it's worth, Pat, my best stress relief is breathing. I know we breathe every day. That's what keeps us alive. But actually doing some focused breathing exercises, I love them.
Speaker 1:Little intervention like that, learning how to do that, what they call it square breathing little things that someone could do in the middle of the day in their stressful job. Not only does it help with people's reported levels of stress, but it gives you a feeling that you're the boss of the stress, not the other way around.
Speaker 2:Yeah, good, all right. Good luck on your quest to get pregnant caller. All the best, all the best, all right, everybody. We're going to wrap it up there. Thank you so much for listening this week. We hope that you've found some gold within those questions.
Speaker 1:The questions do bring up some terrific things, and not just what we think is important.
Speaker 2:But what the listener thinks is important. That's right.
Speaker 1:So keep them coming.
Speaker 2:Yeah, excellent. All right, everyone, have a great week. We'll see you next week.
Speaker 1:Thank you for listening.
Speaker 2:Thanks everyone. Have a great week. We'll see you next week. Thank you for listening. Thanks for listening. Bye for now.