Keira Rumble: ectopic pregnancy, miscarriage, endometriosis and waiting for a baby
In this episode we talk to Keira Rumble, founder of Krumbled foods and Beauty Bites. She candidly, and calmly, walks us through her 5 pregnancy losses as she continues on her rollercoaster journey to having a baby.
She has experienced miscarriages, an ectopic pregnancy, a loss of a fallopian tube, endometriosis surgery and the possibility of IVF to help her get to her goal of starting her family.
We talk about:
Ectopic pregnancy diagnosis, treatment and recovery
What we can do better to support women through pregnancy loss both medically and via our social supports.
We define a heterogenic pregnancy
The importance of women knowing what a normal and abnormal period is
How to manage your emotional and mental health dealing with fertility trauma
Brigid: [00:00:36] So welcome everyone to episode 38 of the kick. And we've got a very special guest today. It's Keira Rumble. Now for those of you who don't know Keira, Keira is a food blogger. She's in the health food business with her Krumbled foods, which are Beauty Bites. And you've got those into Priceline now.
Keira: [00:00:56] Yeah. Priceline and Coles.
Brigid: [00:00:58] that's an amazing feat. Well done. Congratulations. So you've got other feathers to your bow too. So you're a model. You also have a massive Instagram presence.
You're really a dynamo at 28. I'm going to say
Keira: [00:01:12] 29, nearly 29. Thank you.
Brigid: [00:01:18] Now you've done all this while dealing with pregnancy losses. Constant pain and a recent diagnosis of endometriosis. And you've really put yourself out there and have decided to talk about it, to help others. And so thank you for putting your hand up and coming onto our podcast to talk about it.
Keira: [00:01:36] Yeah, my pleasure. I think it's just, you guys have got such an amazing. Community, and I love what you guys are doing, so I'm very happy with it, you know.
Patrick: [00:01:47] Fantastic. Thanks for coming on. You've shared your experience with ectopic pregnancy in particular and here on the kick, you know, we tend to just get right to it and talk to people about their real experience and to have someone like yourself.
Come on. Who's happy to talk about that is a, is a terrific thing for people listening. So tell us a bit about that ectopic pregnancy. When did you find out you're pregnant?
Keira: [00:02:12] Yeah, sure. So I found out that I was pregnant last year, so I've had five pregnancy losses, two were very early and then in January last year, I found out I was pregnant.
And instantly I knew something was wrong. So I went up to the hospital within days of finding out that I was pregnant and I was presenting to the emergency with classic textbook ectopic pregnancies. I mean, I diagnose myself before the doctors even diagnosed me.
Brigid: [00:02:42] And was that through pain Keira? Or how did you know?
Keira: [00:02:45] so I had sharp lefthand side pain and shoulder tip pain. I was feeling out of breath. I just knew that something was wrong and they scanned me. They said it looks like you've got a cyst, a Corpus luteum cyst and it's nothing. Um, your HCG levels seemed fine. So go home and just rest.
And I did and got worse and worse and worse. I went up to the hospital four times in total and I had what you call a heterotopic pregnancy. So I had a duel pregnancy, so I had a pregnancy in my uterus. And then a pregnancy in my tube. So it was a little confusing for me because I miscarried and, you know, I started documenting my miscarriage because.
I just felt like it was the right time. And so I was going through all the emotional trauma and physical trauma of passing the miscarriage, and then I just still wasn't getting better. And so I kept on going up to the doctors or the hospitals saying, I might need, you know, surgery. I might need to, you know, you guys to make sure that I'm not having any retained products and they kept on saying go home, there's nothing wrong with you, you know?
You might need to see a psychologist. And that was really hard for me. And I think that that was probably the hardest thing was not being heard with my pain. And it wasn't until on my fourth visit to the hospital. I've said, I'm not leaving until I get scanned. There's something really wrong with me at that point, I couldn't stand up.
Properlu I had really bad diarrhea. I was just, everything was just ectopic, ectopic. And even in the hospital summary reports, you can see patient admitted thinks that she's got an ectopic pregnancy have ruled out ectopic pregnancy. And in the next day, patient admitted with ectopic pregnancy. Yeah. So I wouldn't, you know, Made sure that I got scanned and said, I said, Oh, we're not going to scan here, but we'll send you off to your local diagnostic center and you can get scanned.
And then the next day I went and got scanned and literally rushed up to hospital emergency. And then that's when they said that it was a heterotopic pregnancy, which is essentially twins, but just one stuck in the wrong place. So I think for me, it was a combination of the emotional, but also the physical pain that was really.
Hard to deal with. And then just that whole not being heard. And I really lost faith in the medical system and it wasn't until recently that I've come across some really amazing doctors and even finding comfort, listening to you guys online was just, it was nice to feel safe and to feel heard. Even though you werent it listening directly to me.
Patrick: [00:05:34] So, yeah. Yeah. That's terrific. I think so for people who don't know heterotopic pregnancy is a, is quite a rare situation where there's a pregnancy, both within the uterus and an ectopic. So usually in the tube and it's a trap for young players. If somebody's got ongoing pain pregnancy, hormone levels that don't resolve.
Even after the intra pregnancy has either a miscarried and come out by itself or come out with a curate. And the thing that Keira mentioned, which was most telling was that she had a lot of ongoing pain and shoulder tip pain and shoulder tip pain indicates internal bleeding until proven otherwise.
And a normal miscarriage that's in the uterus will bleed down the vagina, but won't bleed out into your belly. Yeah, pretty much only an ectopic we'll do that. So looking back there were signs that something more significant was wrong at that point.
Brigid: [00:06:30] Did you have an ultrasound at all? Like when they knew that you were having the miscarriage, did they also
Patrick: [00:06:36] ultrasound then?
Keira: [00:06:38] was a lot of lack of care from the hospital on their part. You know, I understand that hospitals are busy and I think once someone miscarriages. You know, not an emergency in their in, you know, in some hospital eyes, which I totally respect, but at the same time, I probably should have been scanned more, especially after the miscarriage.
And now I've had to find, you know, I've had to research myself and I was never offered a D&C when I got out, I was miscarried. You know miscarrying and things like that. And so it's just, you know, trying to keep myself as informed, but also not writing into the, you know, the hype and the scare some of these online forums have.
So I think there's a fine line between, and actually being informed. So yeah.
Brigid: [00:07:25] And was that at like a hospital emergency department? Yeah. Yeah. So in, in hindsight, could Keira have then gone to see maybe a GP or a private obstetrician or?
Patrick: [00:07:37] Yeah. So I think there were some of these situations which are dealt well.
Within hospital emergency departments, but for sometimes for example, in an unusual complex situation, like a heterotopic pregnancy person, seeing you in the emergency department, might've been a very capable emergency doctor, but may not have been fully on top of the possibility of that diagnosis. The interesting thing for you will be what happens next time, because having had a heterotopic pregnancy still counts as an it ectopic.
And whatever reason you got that ectopic, you are at higher risk of another ectopic than, than somebody else. So the key to your management next time is going to be early scanning. Yeah, totally. Yeah, because we really should see in somebody who's got an intrauterine pregnancy, a pregnancy that it's at home in the right place in the uterus.
We should see a SAC within the uterine cavity at five weeks and a fetal pole at six weeks and a heartbeat very shortly after that. And in anybody who's known to be five or six weeks pregnant with a history of an ectopic where there's nothing in the uterus at five or six weeks. And we're starting to think we might be in trouble again.
Keira: [00:08:46] Yeah. And that's something that I've really put in place now is find the obstetrician. That's, you know, the best in the area. And it's funny, I called up just saying, we're trying to conceive a, I'm just wondering what the timeline is for being able to get in. And they're like, Oh, you know, once you get to about 10 to 12 weeks come in, I'm like, sorry.
I thought I forgot to mention, I've had an ectopic. I've had 4 miscarriages and it's like, Oh, she's like, as soon as you find out you're
Brigid: [00:09:13] pregnant call us and we'll
Keira: [00:09:14] get you in straight away. And. Sorry. It's just that, yeah. It's that high risk that I probably, realistically, it's probably more peace of mind for
Brigid: [00:09:22] myself too, to be getting
Keira: [00:09:24] scanned regularly writing.
Brigid: [00:09:26] So yeah, we're finding at the moment in our clinic, there's lots of people coming in for like the five to six week appointment. Normally that's what we say to come in at 10 weeks.
Patrick: [00:09:36] Yeah. They usually people with a history of first trimester losses, or there are people who've had. Known tubal disease, like a history of chlamydia, or there are people with severe endometriosis who might be at higher risk as well.
And all of those groups should have early scanning.
So Keira, when
Brigid: [00:09:54] did they finally sort of nut out that it was an ectopic and what did you have done then?
Keira: [00:09:58] I was, I had a ruptured ectopic fallopian tube at the time when they rushed me in for surgery, I had a tubal removal. I can't even pronounce what it's called.
Patrick: [00:10:08] A salpingectomy
Keira: [00:10:11] Yeah, there
you go. Yeah. So I had one of them and I was about. Eight to nine weeks along at that point.
Brigid: [00:10:20] Wow. Gosh. And how was sort of like your pain managed at that point too? Cause I could imagine an ectopic rupture is quite painful.
Keira: [00:10:28] Oh yeah. I think that one of my biggest issues is when I present to a hospital, I put on a brave face and recently.
Before my endometriosis surgery, I had a rupture cyst and I was in a lot of pain and I went up to the hospital again and I couldn't, I could barely, barely stand up and they're like, Oh God, wait out in the waiting room. I'm like, no, no. I feel like something's ruptured inside my stomach. I've had this happened to me before.
I need to go get seen now. So I think it's time to put on a brave face, but then people don't realize how serious it is. But yeah, the pain was horrific recovery physically. It wasn't too bad, but it's. More the emotional recovery that you know is obviously a journey. Yeah.
Patrick: [00:11:11] And what were you told at the time of having a tube removed about the effect that that had on your future fertility?
Keira: [00:11:18] I remember I was lying in the emergency ward. And what I said was, we're going to have to remove you tube. And I sadly didn't know what that meant. And so I freaked out thinking that I was going to be in fertile and I wasnt going to be able to have kids. And one nurse said to me, she was all honey, do you know the beautiful thing about having only one tube on the one side you can actually swipe over and collect the egg and go back and just hearing that gave me so much more comfort.
And I think, yeah, so that's obviously. I'm down one tube. So my fertility chances do get lower, but, but
Patrick: [00:11:56] only a little bit, only a little bit,
Keira: [00:11:58] which is incredible to know that that's the way that our bodies can work and react. So, yeah.
Patrick: [00:12:03] Yeah. It's less than you think. I liken it for people to, you know, if you lost one kidney.
You know, most of the time your overall kidney function is actually normal. One once plenty and losing a tube is not nearly as significant on in terms of people's chances of having the family size that they want, that you might expect. Yeah. And so then, sorry, don't care.
Keira: [00:12:24] Oh, no, I was just going to say one thing that I wish I had known a little bit more about it and I wish we had picked up the ectopic earlier ones I could have.
Possibly potentially you've had methotrexate, which is that injection that helps to help pass it because I've had longterm pain is what's really, really mess me up is I've had chronic pelvic pain. I've had left hand adhesion, my ovary was stuck to my uterus and my bowel. And then obviously the subsequential endometriosis diagnosis.
So I think the longterm effects that I've had from that rushed surgery I live with every day. So that's. Quite hard so that sort of really has encouraged me to, if I feel pain, I really need to speak up about it because no one knows your body better than you do.
Patrick: [00:13:10] Yeah, that's right. Were you already known to have endometriosis or did they find the endometriosis at the time of the laparoscopic?
Keira: [00:13:18] it's funny you ask. I had never had any painful periods or anything like that. It was only recently for my, um, I went in for surgery. A couple months ago for my chronic pelvic pain for my Haitian pain. And that's when they found in the endometrious riddled within my body. So there is question marks to see whether or not I actually had endo before hand, my tube wasn't removed entirely during the tubal removal.
So I had a stump. So the endometriosis is almost grown from the stump or around it. So. We've got a lot of question marks about when I've actually developed endo,
Brigid: [00:13:56] actually, I don't know, can you develop endo from trauma, like from surgical trauma?
Patrick: [00:14:00] Well, we don't know where, why anybody gets into, so that's an open question.
Yeah, I think certainly it's certainly not uncommon for somebody to have a, an operation done as part of a fertility issue. And for us to find endometriosis when the woman had never complained of the typical endometriosis symptoms in her life. And yet there it is when you look and typically that's a laparoscopy done for infertility purposes and it needs to be removed because of the, of the trouble that it can cause.
Brigid: [00:14:34] you had some laparoscopic surgery since?
Keira: [00:14:37] Yeah. So a few months, a few weeks ago, I think I'm 12. 10 weeks post surgery, because I kept on having chronic pelvic pain, actually on my left hand side. But over the months I started getting chronic back level crampy, back pain, correct. My whole cycle. I looked six months pregnant.
I was extremely swollen, extremely uncomfortable. I'll send you some photos. It was just, I don't think I realized how bad it was until now that my stomach is completely deflated, but yeah, so we were going in there. The surgery was booked in for one to two hours. Very basic that we're going to put a little gauze on my ovary to help unstick from the uterus.
And that was it, you know, one night and surgery. And then my surgeon come in after and he's like, yeah, we found a lot of endometriosis. It was over your bowels bladder, uterus, sidewall, nerves. It was everywhere. I was like, what really? And he was like, yeah. And you know, I was paying out of pocket because my, um, Health insurance doesn't kick over for the 12 months until September.
Brigid: [00:15:46] And so it's a common problem
Keira: [00:15:50] triple over the budget.
Patrick: [00:15:52] Uh, did you have to stay in the hospital longer because of the extra work that was done?
Keira: [00:15:56] Yeah, yeah, yeah. Wow. Yeah. So it was pretty full on, but you know, it explains so much because it's not normal to have a painful period and it's not to be swollen and bloated and.
It just explains so much. So when I thought we were going in there for, you know, small little adhesion removal, changing to full blown surgery, but I just feel so much better now.
Brigid: [00:16:18] So that's one thing that we've been talking about a little bit, isn't it about women's ability to self identify as having a painful period.
And, you know, there's studies done that we're pretty bad at sort of putting our hand up and saying, actually my period is a lot worse than my peer or my sister or whatever. Yeah. We sort of normalize it somehow. Yeah.
Keira: [00:16:39] So I w I read somewhere that it takes an average 10 years for a woman to be diagnosed with endometriosis.
And it just covered that stat. And I was so heartbroken because I felt very fortunate that. I'd had these symptoms for 12 to 18 months. And I surgically and physically looked like, okay, well she's adhesion pain. So that's the reason why pain is there so they could operate. But. Oh, it just would break my heart to know that these women live with so much pain and they only get diagnosed years later of going into their doctors saying I'm in pain.
Patrick: [00:17:13] Yeah. It's something that we're really trying to get a lot better at. I've been working on a project with the college of gynecologists this year, where we've produced, um, Two resources. One is a, uh, educational guide for GPs about exactly that. How to make an early diagnosis of endometriosis. How do identify the woman who's likely to have endometriosis has in their teens or early twenties, because we've got to dramatically reduce that waiting time between the onset of convincing symptoms and the ultimate diagnosis.
And the other tool is a, a tool for young women. To sort of benchmark their pain, their period, and their pain with sex against what's normally expected from other women. And so that they can be their own advocate and go in and say to no, this is way worse than it should.
Keira: [00:18:00] Absolutely. And even I had scans, so I had the date penetrating scan to see if I had endometriosis just to rule
And then there was nothing, nothing came out and that will say it was my ovary stopped my bow and my uterus. And that was it. So. I went on going, okay, well, I don't have endo. This is just chronic pain from the adhesion. So it just really goes to show you that the, unfortunately the only way to get properly diagnosed is surgically.
Patrick: [00:18:27] Yeah. That's that is still absolutely true. The scan can be useful. That's this is called a, a scan for deep infiltrating endometriosis. And there are some women whose endometriosis is so bad. You can literally see it on an ultrasound in particular, it will identify women who have bad endometriosis in the, in what's called the pouch of Douglas, which is the area between the uterus and the bowel.
And if you've got very bad in endometriosis in there, the barrel is stuck to the back of the uterus. And that pouch of Douglas area is what's called obliterated. It's not there. And you can see that on a certain type of ultrasound. The only problem is it's not perfect. And if the ultrasound is normal, all it really rules out.
Is that particular type of endometriosis. It doesn't rule out all the other types, the ordinary types, or if it's on a different bit of bowel, that's further up or if it's on the bladder or if it's on the pelvic wall or the ligaments, it doesn't really test for those ones at all.
How many times have you Googled something about your pregnancy? When I was pregnant all the time. Dr. Pat? Yeah, we get it. You may be confused or overwhelmed. It's normal to want information, but where's the reliable stuff from experts. Yeah. Now, if you like our podcast, dr. Pat and I have developed an online program to help guide you through whatever stage of pregnancy you're at, it's taken us literally two years to put it together long, hard years.
Wasn't it? But, you know, it is a game changer in how pregnancy information is given. Yeah. How it works is, uh, you get to sign up at whatever stage of pregnancy you're at. Like, so you could be pre pregnant and your very early stages of pregnancy, late pregnancy preparing for birth, or maybe you've just brought your baby home.
And you get lots of information around that. And then you also get to join our closed Facebook group. So we'll have some Q and A's and some lives happening in there. So we really get to interact with you. We've called in all our contacts too. So we've got a dietician and neath test physiotherapists. Who else?
A pediatric nurse obstetrician, mother of four, just all the people you need to hear from that's you come and join us at www dot. Grow my baby.com today. You see you in the course.
Brigid: [00:20:41] Keira you touched a little bit about physically your adapting or your coping. And I don't know now, maybe you're, you're starting to see the other side and don't feel as bloated, but you did talk about the mental anguish and the stigma around pregnancy loss.
And I just wondered if you could sort of touch on that a little bit.
Keira: [00:21:00] I think one of the biggest challenges for me was not speaking about what I was going through, but it was so, you know, it will happen for a reason, you know, me not speaking about it for the first two. And then for the subsequent ones after I started speaking about it and I felt that it was extremely important to start speaking about it because I knew that.
If I was going through this I knew a lot of other women were too. And so I think it's one in four women experience in pregnancy loss or something ridiculous. Hi, which just breaks my heart. But. It's really hard. And I'm looking at doing IVF and conceiving, and it's just really hard to stay happy and positive.
When people around you seem to fall pregnant really easily and, you know, have a perfect pregnancy. And it's just really hard some days. And especially when it's really fresh after a pregnancy loss seeing, you know, pregnant women and you can get triggered by people. I think. The biggest thing that has helped me is speaking about it and joining networks of women that are going through it.
And I'm extremely fortunate. And I have a plan where I can speak about it because I get inundated with women every day. Saying, I'm sitting in the hospital bed. I've just found out that I've got an ectopic pregnancy or I've just miscarried. I don't know what what to do, and it's just such a lonely experience to go through, but it really upset me even more that it was such a common thing to go through, but it was one of the most loneliest things I've ever been through.
So I think it's just, it takes, time. You never feel good about it, but over time it just gets easier.
Patrick: [00:22:46] Yeah. I say to people it'll always be there, but it won't always, it won't always hurt that the pain will fade, but the memory of it will be there your whole life.
Keira: [00:22:56] Yeah. And I think that will just make, you know, when I do fall pregnant, just that little bit better because I know how cherished and how loved.
The baby will be. So yeah, there's no easy way to go through it, but I think speaking about it because I guarantee you you'll know somebody else that's been through it.
Brigid: [00:23:17] Absolutely. And I think even within families, I mean, you also say that you, if you were to mention it to your family, you know, your grandma might pop up or your mum might pop up and say, yeah, that was my experience too.
I had a miscarriage in between you and your brother or whatever it might be. And yet it hadn't been talked in about in the family, like. We've got this thing where we do believe that people should be able to talk to their core people, whether it's, you know, your partner and a core group of friends, or maybe it's colleagues or family members or whatever.
Well before that precious sort of 10 week, 12 week Mark, because of this very reason and we all need to be supported and I reckon we could all get so much better about supporting each other through pregnancy loss. One out of four, that's a very common occurrence.
Patrick: [00:24:02] Yeah. And if you haven't told anybody and then you miscarry, sometimes people think it's easier just to carry on, not telling anybody.
And then you go through the miscarriage in isolation yeah.
Brigid: [00:24:15] you can't, you know, people are thinking what's wrong with her. Well, you're going through the whole grief cycle. Yeah. And it's not just you, I know that your partner isn't much on your Instagram feed. Yeah. Yeah. By choice his choice, not mine. And maybe it's something you don't wanna talk about, but like how have you gone through it that as a couple, like, how has he coped with, with all of this?
Keira: [00:24:38] Yeah. It's so hard for a partner during it all, because they say, well, except for my example, he saw me in physical pain. And once that physical pain had gone, it's very hard to remind yourself that I'm still going here. I still going through that, that emotional pain. And I think it's really hard for a man or any partner to be able to identify the.
emotional loss, because women do get more involved to start with because it's their body and I spent your hormones are going crazy. So I think it was, it was really hard for him, but more hard for him to see me in pain. And for me to go through these questions of unknown, then to actually associate.
He's upset in sadness with a loss, if that makes sense.
Patrick: [00:25:28] And that the fertility model, uh, it doesn't often fit the sort of linear male model of thinking, which is problem solution. Move on. The problem of fertility is often ongoing it's up and down, and there are good days and bad.
Keira: [00:25:48] especially now, you know, tracking cycles and going in and getting blood ovulation tracking and things like that.
That's, it's front of mind for me, but for him, he supports me no matter what, but it's just very hard. To be completely aware of what I'm going through on a day to day basis.
Brigid: [00:26:07] And so one of, well, a little while ago, you thought that you would be giving your body a break for a minute. Um, but it sounds like you've started on that course now.
Keira: [00:26:16] Yeah. So I thought to myself after surgery, I thought. Trying to give myself a break, but, uh, my surgeon, I had a pretty upfront discussion and he said to me that he thinks that my endo is pretty aggressive and based off if I didn't have endo last year in January and it's grown from there, he thought that it was going to grow back pretty quickly.
So it's pretty much this window of opportunity, I guess, for us to look at it. But I'm not know, honestly, I'm emotionally involved, but. if that doesn't happen. It doesn't happen in IVF is a solution and a perfect solution. And it could be really, it could be the great path and need to go down, but it's just really hard not to get caught up in it, especially when I've got so much.
Going on in my business to have a reminder, all of that. I'm really thankful that I do have my thesis to through myself into and focus on too. So yeah, we do do that though.
Brigid: [00:27:18] Like we there's so many of us that sort of tend to have lots of balls up in the air and I suppose that's the same when you go into parenting as well, but like, As you said, your business's just sort of escalating and taking off the beauty bites and then you're dealing with this as well.
And then sometimes you're doing that in a environment where you're in pain. It's tough. That is a big choice to then go. Okay.
Keira: [00:27:43] Yeah. And I think I found, I honestly found it harder going through the physical pain. Wow. Doing my business. Emotional. I'm very good at up again in a box and, you know, dealing with it, you know, with my psychologist and dealing with it when I want to.
But with physical pain, The only solution for me during the really bad time was to take heavy painkillers, which would then mean that I was in bed asleep.
Patrick: [00:28:06] So Keira, you mentioned your psychologist at other thing we're really big on here is simultaneously managing your mental, that mental health aspect of obstetric and gynecological illness at the same time as the physical aspect.
Tell us about that. What's that been like
Keira: [00:28:23] My psychologist is. Such an important person and such an important tool for me to lean on, but I've essentially, I've got PTSD from something that happened to me as a child, but I've been diagnosed now with PTSD, with what happened in January, because I kept on thinking that I was essentially dying and no one was listening to me.
And it was extremely traumatic for me. And to have somebody to talk to, that's not part of my class, his family, or even my network has just been so vital because it's really reassuring to have a medical practitioner would be able to tell you that what you're experiencing is normal and teaching me different ways to cope with it.
So she's been amazing. She's taught me breathing techniques and that whole putting things in a box and dealing with it when you need to and trying to, you know, move on with your day and not letting things build up because I have a great ability to just let things build up until my kettle becomes over full.
So. A hundred percent. I think that that's the most important thing for you to experience is speak to a grief counselor. I speak to a counselor, speak to a psychologist, psychiatrist, you know, so important.
Brigid: [00:29:33] And how did
Keira: [00:29:33] he get to go to a psychologist?
Brigid: [00:29:37] Was that a referral from your GP or from your obstetrician or?
Keira: [00:29:40] Uh, I think it was a referral. I just woke up one morning and I, I knew that I needed to go see a psychologist. I have seen multiple psychologists throughout my life, and I've never felt that stigma associated with it. I think it's extremely empowering for you to be able to speak to somebody, to give you the tools, to be able to deal with what life throws at you.
I mean, life throws, you incredible hurdles. And if you don't have those tools to speak to somebody. Yeah, life can be really hard. So yeah, I think I got that, um, uh, 10, 10 free sessions for by Medicare, which is, is available to everybody. Yeah. To everybody. And especially, it becomes at that point, you know, do I have that money?
To work out the trauma or workout what I'm feeling. And being able to have that support by Medicare is pretty good.
Brigid: [00:30:28] And so if anyone doesn't know what that is put, you might like to say, how does somebody go and get that 10 free referrals?
Patrick: [00:30:35] Or it has to be, excuse me, as a referral from your GP.
So you go along and talk to the GP about the issue. It doesn't have to be related to any of this stuff we've discussed today. And if the GP feels that your issue would benefit from clinical psychology, then it's a plan to, uh, Cover some all, or some of the cost of it for 10 visits and it's fantastic. And a lot of people, there are barriers to accessing psychological care and some of those are from within, like, we don't feel like going or we all, we've got an unrealistic image of what it's going to be like.
And some of it is financial. And, uh, yeah, one of the things we've talked about here before is what it is like, and it's not an old fashioned, a Freudian model of lying on a couch and telling the therapist about your mother, that's all out. It's actually about exercises that you can do in your mind. To turn a positive thoughts into a positive mood rather than negative thoughts into a negative spiral.
Um, and it's we also in our grow my baby program. I'm not sure I've talked to you about that Keira, but we've got all throughout. We've actually got one of the modules is always on mindset. And to help us with that. We've got Nicole Highet from cope and they've also got a directory cause it's important to get the right person if it's about.
Keira: [00:31:55] Just about to say that I have been to many. In my whole life. I've been to a psychiatrist who just looks at me and 15 minutes ago. Okay. I'm going to write you this, anti depressant, and I'm going to take any of the questions every day. So there's nothing wrong with antidepressants, but a is about finding the right person.
And my psychologist now has his beautiful groodle that. He is a therapy dog and he sits on my lap. He is just so beautiful and she's just such a calm person. And it's just about finding the right person for you. And if you don't feel great and you don't have that connection after the first session, find someone else.
Brigid: [00:32:33] Yeah, that's exactly right. And we know you're a dog person.
Keira: [00:32:37] Ah, honestly, throughout everything, I wouldn't have been able to get through what I experienced in my life
Brigid: [00:32:44] without them.
I don't know pets aren't for everybody, but where we got a little bagel just yeah. As the lockdown happened. Yeah. Our four boys and us.
Probably me. It's just been brilliant, even though he's super naughty, any choose everything, but it's just been so brilliant. Yeah. I know. But apparently beagles that lasts for quite some time, so we'll wait and see. Mmm. So I want to sort of end the podcast unless you've got other questions Pat
I just wanted
Patrick: [00:33:14] to say thanks for coming on and talking so openly and generously about let me let's face it.
It is still a private. Issue for people. So I, I really think that it's remarkable that you've had that generosity to talk publicly about these issues. It makes a huge difference. There are honestly, there are going to be people out there who will listen, will go, well, you know, if Keira can manage this then, so can I, and if she can come on on the podcast and talk about it, then at least I can tell my friends, my sister, my mother.
Yeah. That's exactly right.
Keira: [00:33:49] It's about being okay with the journey that you're dealt with. I mean, I was messaging a girl this morning who has been trying to conceive for months. Yeah. She found at that she had an ectopic pregnancy last week and just had surgery. And she was, she had been following me for a while and she's just like, I feel like such a failure.
And I just said to her listen we're not far from a failure. It's just what life throws at us. And you've got to take this. Terrible situation that's happened to you and, you know, there's some sort of journey that you're on and we've just got to be okay with that. But it's easy, you know me saying that in retrospect, but when you're living and breathing this loss and the physical loss and the physical pain that you're going through, and sometimes you just need a big cry.
And I think so me. Crying so powerful when you're going through it. And they're a days that I've burst into tears for no reason, but it's okay. But it's just about learning to be okay with the journey that you're on and
Brigid: [00:34:53] you are you're on the grief cycle. And sometimes that means that you need to spend the day in bed.
Yup. You know, I've done that. Haven't I paid, uh, yeah. Spend the day in bed, go through your Netflix or whatever it is. I just think I scrolled through, uh, meaningless videos on Facebook one day for pretty much the whole day after we were dealing with a bit of grief. And it just is recognizing that sometimes you just need that and that's okay.
And that's what, as a society, it'd be fabulous if we just understood that too. Yeah.
Keira: [00:35:22] And it also is about finding the right medical practitioner. If you genuinely don't feel well and you genuinely don't feel right mentally, physically, or whatever, you're experiencing finding that right person, because there are good eggs out there.
Like you two. It's just about trying to find the right people and yeah. Trusting your gut
Brigid: [00:35:46] and feeling okay to move on to the next one. Yeah. Yeah. Thank you again for coming on. It's been terrific to have you and, uh, you know, our best wishes for the rest. Good luck of your journey here. Yeah. We're sending our best thoughts to you.
Lots of baby wishes. Okay. See you now.
Brigid: [00:00:36] Welcome everyone. This is episode 37.
Dr Pat: [00:00:39] Welcome back everybody.
Brigid: [00:00:40] Yes. And we're going to talk everything about the umbilical cord
Dr Pat: [00:00:43] We've got this far without talking about the cord?
Brigid: [00:00:45] Yes. You know why? Because when we were very much starting out and we were recording in our bedroom. Yeah, we did an umbilical cord ep.
Dr Pat: [00:00:54] Oh, that's the one we did back then?
Brigid: [00:00:56] Yeah. But, um, it was all badly recorded
Dr Pat: [00:01:00] technical issues.
Brigid: [00:01:01] Yep. That's where we think, well, we're not experts at this. So we come to this incredible studio and have Tom help us out.
Yeah. It also gets us here too. Doesn't it Pat
Dr Pat: [00:01:09] Been for the best all round!
Brigid: [00:01:10] Yes. Alright good. So what we're going to get straight into, I think is because the umbilical cord is fascinating. I love looking at the umbilical cord. If I had to get over my slight phobia about looking at sort of bloody pictures, but yeah.
Nice. And it's Vital
Dr Pat: [00:01:25] Well, of course that's the connection.
Brigid: [00:01:27] Yep. So Pat, let's start at the anatomy of the umbilical cord.
Dr Pat: [00:01:32] Yeah, it's actually, it's quite an interesting structure and sort of beautifully adapted or designed to do exactly what it needs to do. In that cord is a vein, usually a vein in two arteries.
And the vein is for bringing oxygenated blood from the placenta down to the baby. And then the two arteries pump blood back the other way back up towards the placenta, deoxygenated blood. So the opposite of what it's like in you and I, yeah. So the vein is larger and soft and the two arteries are smaller and hard and they're surrounded by some stuff called Wharton's jelly, which is like a shock absorber.
Cause the cord gets a little bit battered at around. Baby grabs it and squeezes it.
Brigid: [00:02:17] It would be like a little toy in utero. Wouldn't it?
Dr Pat: [00:02:19] Yeah. We've seen that on ultrasound all the time. They'll grab the cord if it comes past them, they'll grab it. Oh, wow. And so it needs to be a little bit of a shock absorber. We don't want the babies squeezing, cutting off their own lifeline and it gets a little bit battered around by fetal movements and in labor.
Yeah. So it's got that nice shock absorption to it. And of course it runs from the placenta, ideally from somewhere around the middle of the placenta, but occasionally over near the edge, down to the baby's belly button.
Brigid: [00:02:45] And does the strength of the attachment of the umbilical cord to the placenta? Does that differ or does that matter?
Dr Pat: Some variations in anatomy and some of those are related to poor fetal growth. Yeah, right. So if he gave you a 20 week scan and they can see that the cord inserts right into the middle of the placenta and everything looks for a standard and normal, then typically we wouldn't really need to rescan that woman unless there was another problem.
But if you've got something called a peripheral cord insertion, where the cord inserts right over on the edge of the placenta, then there's some association between that and third trimester growth problems, we typically will have another look.
Brigid: [00:03:23] And so that's definitely picked up on ultrasound.
Dr Pat: [00:03:25] Yeah. It's part of what they should be looking for in a second trimester, part of the worksheet that the sonographer goes through, tick off that they've got all the boxes ticked and where the cord inserts is important.
Brigid: [00:03:37] I've got a beautiful photo of an incredible thick, healthy looking umbilical cord.
Dr Pat: [00:03:47] Yeah. So that's, they're the ones we like to see, and it can be really quite thick sometimes remarkably so, the cord is much bigger than you think.
And then there are sometimes when we see the cord unusually small
Brigid: [00:04:04] You mean thin?
Dr Pat: [00:04:05] Yeah, exactly.
And sometimes that's just normal, just the way it is. But other times it can be associated with other problems. So babies with a smaller cord might be too small as well.
Brigid: Right. Okay. And so how do you assess, like, if, is that sometimes when you say it could be a problem, like what is the problem around thin sort of scrawny looking cord?
Dr Pat: Well, the cord is normal if it's doing what it's supposed to do. So if the baby's happy and growing well, and remember we can measure the blood flow in the cord with ultrasound using Doppler technology. Doppler is technology related to how moving things reflect sound. And ultrasound is sound waves. And if we pointed at the cord, we can graph how the sound waves are reflected by movement within the cord. And that can tell us a lot about how the flow is and the flow in those arteries in the cord will change.
If the placenta is too gritty, too small, too high resistance. And we often will see that in conditions like pregnancy induced hypertension. So mum's blood pressure's too high or preeclampsia. That's potentially too small or not being well nourished by the placenta and in the third trimester, that's part of that whole process.
If we're worried about a baby, if the baby's not growing properly we are continually asking ourselves in the third trimester, is this baby better off, out than in.
Brigid: [00:05:34] So what is a cord accident? I've heard you talk about cord accidents before
Dr Pat: [00:05:39] ah, cord accidents. That's different. That's a, that's a, um, a very, very sad situation where the baby can get tangled up in their own cord
Brigid: [00:05:47] during the birth or
Dr Pat: [00:05:48] no, during the pregnancy itself.
Yeah. So it's a rare, but still seen and is a cause of stillbirth.
Brigid: [00:05:56] Wow. And so how can a baby get tangled up in their cord?
Dr Pat: [00:06:01] Well, I think probably what happens is that the cord might get looped around the baby's neck and maybe twice, and then maybe it gets tight and then the fetus kind of panics and move even more, arms and legs can get involved in the baby can get wound up tightly caught up in their own cord.
Brigid: [00:06:19] No, God, I can just imagine there's a wave of panic. That's just gone over all of our listeners, right?
Dr Pat: [00:06:22] That's right. It's, it's a sort of a nightmarish scenario. It is real, but it's rare.
Brigid: [00:06:28] Yeah. Uh, are some people more prone to having a cord accident.
Dr Pat: [00:06:33] Look, I don't think so. I just think that it's just one of those things that might be seen.
And occasionally the cord around the neck might be picked up on ultrasound. But remember that the complexity is that that's not always abnormal.
Brigid: [00:06:46] Yes, that's right. Some people that some babies are born with the cord around their neck every day.
Dr Pat: [00:06:50] Yeah. Yeah. So that's, if it's not tight and it's not troubling the baby, then it's not really an abnormality.
Brigid: [00:06:57] Is it a problem with the, again, back to the anatomy? Is it a problem? If somebody has got a really super long umbilical cord?
Dr Pat: [00:07:03]
Yeah. Cord length is an interesting thing. It might relate to the risk of complications. If it's super long, the baby might be more likely to get tied up in it. And if it's very short, it might also be related to another rare complication, which is something called a uterine inversion where the baby comes out and then we'd try to get the placenta out.
And if the cord is very short, then excessive traction on the cord might cause the uterus to kind of turn inside out. Yeah. Yeah. Wow. And that's associated with postpartum haemorrhage
Brigid: [00:07:35] and you keep saying rare, like, do you know the stats on that?
Dr Pat: [00:07:38] Look, these are things that we, both of those problems are things we might see once a year, once a year.
Brigid: [00:07:42] Yeah. Yeah. And I mean, gosh, you're delivering hundreds of babies a year.
Dr Pat: [00:07:47] Yeah. Yes. But also in all of Ballarat. So, you know, a once a year occurrence, in a 2000 baby town. Yeah.
Brigid: [00:07:56] Is there anything a woman can do to keep her cord healthy?
Dr Pat: [00:08:00] I don't think specifically. It's a good question.
I don't think specifically, I think just, um, it's part of being well in pregnancy. So managing blood pressure. Yeah. If it's there having the blood pressure checked. Yeah. Eating well, exercising, those sorts of things that we know. Non-smokers. So the really thin, potentially insufficient cord is something we might see in a heavy smoker who also had a correspondingly small and insufficient placenta, and unfortunately, a correspondingly small and potentially unwell baby.
Brigid: [00:08:34] Oh, dear. Okay. And what about cord knots? Like I've seen pictures of cord knots.
Dr Pat: [00:08:40] Yeah. That's another thing that people worry about, but it is less serious than it looks. So there's something called a true knot where it baby swim around and actually tied a knot in the cord. Yeah. But they're not often very tight.
Brigid: [00:08:51] Yep. And they can slip. I've seen it, it slips up and down the umbilical cord.
Dr Pat: [00:08:55] Yeah, that's right. When the baby's out, cord is clamped, you can put your finger into it and just slide it up and down the cord. So that's how loose it is. Yeah. And a loose cord knot is something we'll note and that's called a true knot.
It's an actual knot and yes, they can be a cause of problems in labour. So for example, if the knot was tight-ish and it was affecting the flow of blood down the cord, then we might see that represented as an abnormal, fetal heart rate tracing with a CTG. And sometimes if we had a very abnormal CTG in labour and we knew that everything else was okay - it was a well grown baby at term, mum was laboring well, and contractions weren't coming too hard or fast, but nonetheless, yes, the CTG was highly abnormal. At the subsequent birth by Caesarean section, you might notice a knot in the cord. So that's a true knot. And then there's another, there's another thing called a false knot, which is just a lump in the cord that looks like a knot, but it's not.
Brigid: [00:09:54] And all of these things, you kind of wouldn't know so much until the baby was born and you we're able to look at the umbilical cord.
Dr Pat: [00:10:00] Yeah. So we examined the cord, just like we examine the placenta.
It's always cool to have a look at the cord and the placenta, but also there's a potential that we might find abnormalities. It might be worth sending the cord and the placenta off for a pathological examination and all of that might be relevant to the woman's plan for next time.
Brigid: [00:10:18] Yeah. Okay. My brain is still back stuck on the cord accident because that I did have that fear during my pregnancy.
I don't know. It's, it's something that you kind of know whether it's a myth. I remember my mum saying, look, Brigid, what are you doing? Hanging your washing up. Cause if you put your arms above your head, you're going to make a knot!
Dr Pat: [00:10:38] yeah. Some of those sort of, you know, myths about pregnancy. Some of them seem to be rooted in common sense. And some of them, you have no idea how that got started. Yeah. So I can't imagine how that would make any difference at all. And I'm sure that's not true.
Brigid: [00:10:51] Oh, it got me out of doing washing so happy!
Dr Pat: [00:10:52] Yeah. But I think some of these things, rare complications that are kind of everyone's at the same risk.
It's very rare and we just hope it doesn't happen to us. I think we sometimes look for ways. Around that, like, if I do this, I'll be at lower risk and that might be how some of those things got started. People thinking, well, I need, I need something to make me feel like I'm at less risk, but, uh, I don't think there's anything that you can do or not to that the decreases that chance.
One of the things I guess you can do is that it's part of the importance of knowing better baby's movements. So we've covered in another episode. It was,
Brigid: [00:11:31] I looked it up episode 11.
Dr Pat: [00:11:32] Yeah. About fetal movements. And these days we've moved away a little bit from being obsessed with how many there are to the pattern and what we really want women to do after about 20 weeks is to become aware of the pattern of fetal movements. That seems to be very important and a healthy baby that's not tied up in its own cord should ideally have a pattern of movement that the woman can rely on. So if my baby always moves when I'm having breakfast and it always does.
Then things are fine. If it doesn't, I better start provoking some movements. And if I still can't, I better call my care providers. And that's what we were looking for. So theoretically, if a baby had a cord problem that might manifest itself in its early phases as decreased fetal movements, and theoretically might only progress to stillbirth if we didn't do anything about it.
Brigid: [00:12:25] And I think we've said it before in that just go back and have it listen to that episode, episode 11.
Brigid: [00:12:30] it's pretty, Oh man, it's vital. And also between pregnancies. So you can't really compare yourself to other people and their pregnancies and you can't really compare each pregnancy because all are different. Between our third and fourth boy was so marked.
And I think I might've even said that in the ep and what the difference was was the third boy. He was just a gymnast and I was always reassured. He was always flipping around and, you know, kind of making a nuisance of himself, but the fourth boy, I think he slept most of the time. He just didn't move did he? And so I'd say, okay, Pat at lunchtime can we have a little listen?
Uh, yeah, so it, but one thing that did provoke movement always with Rex was a shower. He would always move in the shower.
Dr Pat: [00:13:15] So that's perfect, that's what I'm talking about.
Brigid: [00:13:17] Yeah. That's pretty important that we get that right. Well, I'm going to move on then. I feel a bit more better. Yep. Yep.
So the other thing that is a bit of an exciting lights and sirens sort of moment is a cord prolapse, isn't it?
Dr Pat: [00:13:31] Yeah. So that's a sort of a, hopefully an end of pregnancy thing. It's rare. It's potentially dangerous, but yeah. Usually well managed and that's where, waters break and that cord comes out instead of the head.
Brigid: [00:13:46] And why is that a problem?
Dr Pat: [00:13:47] Well, it's not always a huge problem for the baby in that it's obvious if the cord's hanging out. You know, if she's in the hospital, we deal with her immediately. If she's out of the hospital to come straight to the hospital, cause everyone knows it's not normal for the cord to be hanging out and things tend to get managed quickly and well, but what the cord will do, if it's outside the body is get cold and spasm and that can affect the flow down the cord and really upset the baby.
Brigid: [00:14:13] Yeah. Yeah. And sometimes that happens in really fast labours and sometimes those really fast labours can happen at home accidentally.
Dr Pat: [00:14:21] Yes, theoretically it is something that could happen at home and, you know, the appropriate management of that would be to put it back in the vagina. So great loops of it don't tend to come out just a little bit. Yeah. And the warmest placed for the cord to be, would be back in the vagina. So, so you can push it back in and hold it there and call the ambulance
Brigid: [00:14:39] And the ambos are excellent.
Dr Pat: [00:14:42] If it happens in the hospital, it's all always terribly exciting. Well, usually it can't really be fixed. We need to have birth by Caesarean section. Yeah. You can't push it. Back up past the head enough. Exactly. So, um, so the midwife that finds the cord hanging out will typically push it back in and then sit there on the trolley, keeping it in a while we run around, whiz around to theater and do a Caesarean section.
Brigid: [00:15:05] Wow. What up on the trolley with the woman? Yeah.
Dr Pat: [00:15:07] Oh my God. Very dramatic,
Brigid: [00:15:08] very dramatic.
Dr Pat: [00:15:09] Sometimes a cord prolapse will happen in the setting of a premature birth. Yes.
Brigid: [00:15:14] Cause there's more room?
Dr Pat: [00:15:16] Yeah, that's right. The head isn't down, maybe. It's not down at all or maybe it's down, but still floating really high.
Yeah. So the head hasn't formed a nice plug in the pelvis, like a term baby does. And there's plenty of room for the cord to flop around in front of the head and come down the vagina.
Brigid: [00:15:31] Yep. And so in your career, how many times would you have dealt with a cord prolapse
Dr Pat: [00:15:37] three or four?
Brigid: [00:15:38] Yeah.
And people like, I mean, what do we work out the other day? You've nearly delivered 3000.
Dr Pat: [00:15:42] Plus babies, something like that. So, you know, there's yeah. So you can see that it's a, you know, even in all my time at the teaching hospital where I did my training, it's, you know, busy hospital, like the Royal women's back then about 6,000 births a year.
And it wasn't something we saw that often. Yeah.
Brigid: [00:15:58] But what you do see a lot of is the cord wrapped around the neck.
Dr Pat: [00:16:03] Absolutely. Yeah. And that's really a normal thing for the cord to be loosely around the baby's neck. When the head comes out at a vaginal birth and, you know, people sort of worry about that, but if everything's been going good, the fetal heart rate trace in labour or intermittent listening to the fetal heart with a handheld Doppler, that's all been normal.
Then what it means is the cord's around the neck, but it's not tight and it's not upsetting the baby. And
Brigid: [00:16:29] And it’s not as if it’s cutting their throat off, that's not where they're getting their oxygen from anyway.
Dr Pat: [00:16:34] That's right. So we're not, it's not a matter of compressing the airway. It's that the cord, if it's very tight around the neck a few times one, yeah.
Brigid: [00:16:42] Yes. It might not have the oxygen and the oxygenated blood running in it
Dr Pat: [00:16:46] Flowing properly. That's right. So the cord is actually really quite beautifully designed though, so that even if your head comes out and the cord, even if the cord is trapped between the baby's front shoulder and the mother's pubic bone.
If you can imagine that the way that the two arteries within the cord run in a sort of a helical structure, sort of twisted structure, they're able to keep pumping. So it's hard to obstruct the cord or altogether, which has got stuck, because it gives you plenty of time then to feel over the head to see if there's any cord there
yeah. And if there is, yeah. Loosen it off and flop it over the baby's head so that it's no longer around the neck and then ask the woman to push again and free the front shoulder.
Brigid: [00:17:26] So Pat's moving his hands around again people. We might have to make this visual one day.
Dr Pat: [00:17:31] So that's, um, that is something that a daily event on labor ward and.
And not a pathological thing.
Brigid: [00:17:36] Yeah. Right. I mean, that does become family folklore a little bit. What about if it's wrapped, say twice, which we've seen,
Dr Pat: [00:17:42] Even so, if it's not tight, it shouldn't be a problem. But it's interesting if someone, if there's an abnormal, fetal heart rate trace during the pushing phase. Yes.
But the woman is fully dilated, so she doesn't need a Caesarean section she'd be better having an instrumental birth to bring the pushing phase to a close quicker. Yeah, because we're worried about the baby, but the baby is so far down and almost out that an instrumental birth is better than a Caesar.
Then you go ahead and do that instrumental birth, vacuum, forceps whatever's required. It's interesting how often cord around the neck once or twice is the presumed explanation for the poor fetal heart rate trace. Yeah. Yeah. And you’ll realise, that's why we're struggling. Yeah.
So, because we are talking about the cord, I thought it'd be interesting to then talk about delayed cord clamping, because this seems to be, I mean, gosh, we talk about a woman being empowered with knowledge, and this is definitely one thing that a woman can advocate for just.
Talk us through what happens.
Dr Pat: [00:19:57] So delayed cord clamping is just the practice of basically waiting until the cord stopped pumping blood in the direction of the baby before you clamp it and cut it. And, uh, you know, we used to, we used to be in too much of a hurry to do that, I think, and, and there's plenty of good blood inside the cord, and it's rich in STEM cells.
And it turns out that they're better off in the baby than in the bin with the cord. So,
Brigid: [00:20:24] or if someone's chosen to take it home,
Dr Pat: [00:20:26] Well, yes, that's right, but the baby can use it. So when it first sort of started happening, I guess maybe seven, eight years ago, a lot of obstetricians, including myself thought that it was fine.There wasn't a downside to do it, but we didn't really think there was going to be much upside. We're also worried that might've increased the rate of jaundice. If you've got a baby, that's got if you like too much blood, then the excess blood will break open and release the yellow pigment. And that's what jaundice is, so we thought that if we gave the baby too much blood, by that way, that we've increased the rate of jaundice and it's turned out to not have a very important effect on the number of babies with jaundice.
And any extra jaundice that it does cause it's relatively easy to treat with those lights.
Brigid: [00:21:11] The benefits outweigh the risks.
Dr Pat: [00:21:13] Yes, absolutely. And the benefits are probably something we're just starting to learn more about.
Brigid: [00:21:18] Yeah. If it's something I've got, the stats all wrong, but it can have that baby's iron stores for the first few months of life?
Dr Pat: [00:21:25] Yeah. More iron, more blood volume is a fair bit of volume in that. Cause there's not that much blood in a newborn baby anyway. So what's sitting in the cord, it's actually a useful tool, a
Brigid: [00:21:33] big percentage of the baby's blood
Dr Pat: [00:21:35] then exactly the benefit of the STEM cells? Watch this space!
Yeah. So it's easy to do. And really the only scenario where it really can't theoretically be done is if the parents wish to donate or collect the cord blood for storage.
Brigid: [00:21:49] Yeah. That was my next question.
Dr Pat: [00:21:51] Cause you can't empty it into the baby AND store it. It's one of the other. Yeah. So that's a problem. And then the other scenario that makes it difficult is if there's some other sort of emergency going on.
Yeah. So for example, if the woman's having a postpartum hemorrhage, then the first thing you can do to get that hemorrhage under control is to get the placenta out. And that's difficult to do if the baby's still attached. So you might clamp and cut the cord, forego the benefits of the delayed cord clamp, and then put traction on the remaining bit of the cord to help the placenta come out.
And that's a scenario that can happen at vaginal birth. And unfortunately it's a bit more common at a Caesarean section birth because the Caesarean section is a bloody operation. You know, there's, there's blood around and, and if the uterus is bleeding too much at Caesar immediately after the baby comes out, then again, the way to stop that is to get the placenta out.
So that might require the baby to be the cord clamped. And the baby passed over the pediatrician a little earlier than we wanted, but if we can control that bleeding by other means by putting clamps on things, then we can wait. Did that last night had a Caesar last night just waited until the, um, the cord had stopped pumping and all of the blood was as much as possible of the cord blood was down in the baby.
Maybe took a minute and
Brigid: [00:23:07] It's not long, that't the other thing is,
Dr Pat: [00:23:09] and then a clamp and cut and as long, and the baby was crying and mum wasn't bleeding. So what's the rush.
Brigid: [00:23:15] Yeah. Yeah, yeah.
Dr Pat: [00:23:17] And that's becoming a standard at vaginal births and increasingly acceptable at Caesarean section.
Brigid: [00:23:22] Yeah. Yeah. And it's still worthwhile the woman putting it in a birth plan though.
Isn't it? Absolutely sure that everybody's on that page.
Dr Pat: [00:23:29] Yeah, absolutely. Because when I say standard, I mean not everywhere and not every day. So if it's something that mums have read something about and like the sound of as a potential healthy thing that can do for the baby, that's not risky, then we should do that.
So let us know.
Brigid: [00:23:44] Yup. So this, you mentioned just briefly about the cord blood. So there's two things you can do with the cord blood. You can either donate the cord blood, and then that goes into like a public cord blood bank.
Dr Pat: [00:23:55] Yes. So they collect some for each research purposes and some for a publicly run cord bank.
Brigid: [00:24:01] Yep. Yep. Which can be used later on for?
Dr Pat: [00:24:05] matched donations. So potentially if a child had a leukemia or something, then it may be possible in some circumstances to use a donation of cord blood STEM cells from a bank.
Brigid: [00:24:18] Yeah. And body doing that might be motivated by altruism or why would somebody want to do that?
Dr Pat: [00:24:26] Yeah. Altruistic donation. That's what it's all about. And not every hospital collects for that purpose though. Yeah. So collections tend to be done in big city hospitals where they're set up for it and where they've got a huge number of births per year and can collect a lot of blood. Yeah. So if you are at a smaller community hospital, a regional country hospital, or whatever, and they don't offer that service don't panic because the service has enough blood.
Yes. Yeah. They're getting enough from city hospitals for that purpose.
Brigid: [00:24:51] But somebody might have it in their birth plan that if for some reason I can't have delayed cord clamping, then I'm willing to do cord blood donation. Is it something that you have to consent for?
Dr Pat: [00:25:02] Yes, but don't panic if it's not offered at your hospitals.
Brigid: [00:25:05] Yeah. Yeah. That's important. And then some, you know, you see it advertised some people there's big companies that will store your cord blood.
Dr Pat: [00:25:13] Yeah. This is the one I'm probably least in favor of. I don't mind saying. I don't usually try to talk people out of it, but I do suggest that they think carefully about the likely return on that investment.
This costs a lot of money and of all the cord blood that's privately banked. I think that you have to have a look at how many people have actually needed to use it, and whether that's value for money. It's one of those insurance things that if you've done it. Yeah. And your baby runs into trouble later on.
You'll be glad you had it, but for most people who never use it, it's very expensive.
Brigid: [00:25:48] It is very expensive. I did look it up. And so I think these are prices from a company. And I think it's, if you want 20 years of storage, it's about three and a half thousand dollars upfront. Yeah. But if you're paying it off in payments over those 20 years, it's like nearly six grand.
Dr Pat: [00:26:04] If you pay it off in installments. Yeah. And I think one of the potential problems is if you've paid a lot of money, for example, to store it over the first 10 years, then you might think that there's a fair bit of sunk cost in that. So you might keep going. Yeah,
Brigid: [00:26:18] but this is a choice again,
Dr Pat: [00:26:19] like if this is,
Brigid: [00:26:20] if this is something, maybe you've had a family member with leukemia, I don't know whether, is leukemia hereditary.
Dr Pat: [00:26:25] Oh, well in kids, mostly not so. I think that if you go into spending that sort of money on that sort of product, it might be wise to learn a little bit about the frequency of these diseases so that you're not buying an expensive insurance policy for something that's actually terribly rare. Yeah.
Brigid: [00:26:43] Cause there's, you know, there's expenses all along the way and you've just gotta weigh everything up and say, well, what's important for me and our family.
Dr Pat: [00:26:49] Absolutely. So I'm not against it per se, but I am in favor of some critical thinking about whether that's the right way to go.
Brigid: [00:26:56] Yup. Yep. Great. Well, I hope everybody has enjoyed listening to everything about the umbilical cord.
Dr Pat: [00:27:01] We’ve thrown a few things in there that aren't sort of strictly related, but they've all got the cord in common!
So it just seemed like a neat way of discussing that amazing structure. That that is the cord, that connection between mother and baby and covering some of those things that people read about and come up.
Brigid: [00:27:17] Yep. All right. So, uh, continue with the conversation with us when we post this let's chat over on Instagram, which is at grow underscore my underscore baby.
Dr Pat: [00:27:26] We love hearing from you guys.
Brigid: [00:27:27] Yeah. Send us a DM. Tell us what you think about everything the umbilical cord
Dr Pat: [00:27:31] and we'll talk to you next time. See you now.