Emma Howard: Welcome back to Baby Talk, I am Emma Howard and I am delighted to say that joining me now is Midwife's Sue McDonald to go through the mail box and also some of your pregnancy questions. Hello!
Sue McDonald: Hi! Emma.
Emma Howard: Nice to see you again lots of questions for you as always Sue. Let's start with this one I had a third degree tear with my first baby, what should I do with my next pregnancy? She is asking should it be a natural, labor natural birth or a C section and that's from Angelus Hamilton. Now first of all for people who don't know tell us what a third degree tear is?
Sue McDonald: Now I was going to say, I will start by saying that about 85% women will have some sort of trauma to their perineum and that can be anything from a little grace to a full third degree tear.
Emma Howard: Yes because trauma doesn't mean to say its terrible doesn't that.
Sue McDonald: And obviously in the majority women it's quite straight forward. For those women who get a third degree tear, this is a tear that extends from the vagina along the perineum right to the anal sphincter. So obviously it's extremely painful, it has to very carefully sutured, and expertly sutured and monitored afterwards to make sure there is no problems in that.
Emma Howard: How long will it take to recover?
Sue McDonald: Well it's the same sort of time as an ordinary tear so it can -- there is a sort of skin on top heals fairly quickly, but the muscles underneath will take a little time to get back to be healed.
Emma Howard: I am moving around and sitting, that must be so painful.
Sue McDonald: Well that's the worst thing I mean I think the difficulty is you are uncomfortable, it's painful, you don't feel like doing anything, you don't feel like moving because every move it pulls. And going to the loo it can be a problem the first few time and that sort of thing.
Emma Howard: And of course you have got this new life that you are dealing with, so the last thing.
Sue McDonald: And you are expected to be happy and comfortable and lovely, it's very-very difficult. And it's difficult to say to Angela that you can have a normal birth, natural birth but I would say in a lot of cases that's possible, you really need to look at what happened last time, whether the skin and the muscle healed with no problems and how big was the baby first time round, how big the baby this time round, because the reasons for having a third degree tear are either you have got a very large baby over 4 kilograms, or you have had a cut that's gone in a wrong direction straight down.
Or you have had required a forceps delivery so if those factors are there you run a better risk of having -- not a risk but you have run the chance of having a normal birth.
Emma Howard: But you need to sort of do it as a team, you talk to your obstetrician, talk to the doctors.
Sue McDonald: Absolutely and look at what happen last time.
Emma Howard: Yeah and you certainly unabashed about people looking down there.
Sue McDonald: Absolutely and the other thing is to make sure for next time around you are really well nourished you have make sure your vitamins and nourishes the diet. Make sure you are fit, do your swimming, to make sure you are in that optimum position and optimum condition for the next time.
Emma Howard: And is swimming very good for that time around, of course it is.
Sue McDonald: It's excellent because it really make sure you kegel your -- well for one thing you are weightless in water and another thing it really allows all your muscles to be well exercised.
Emma Howard: Now going back to labor when it kicks off and it starts, should the TENS machine pads be placed to give relief during labor Suzy from Leicester wants to know, where should they be placed she is asking.
Sue McDonald: Usually with the TENS machine and it's a fantastic machine from those people who haven't used it it's like a little control board so then you have little wires to four little pads which go on the back.
Emma Howard: He should place them on your lower back.
Sue McDonald: Yeah they go on -- you have two -- on either side of the spine and you have them to your upper back so down a bit, just I suppose just over the waist and then just above the dimples in your bottom.
Emma Howard: And I know basically.
Sue McDonald: I am glad you do.
Emma Howard: Too many women I know --
Sue McDonald: There should be quite good instructions with the whole package but you might need to have a look in your pregnancy book.
Emma McDonald: I mean you are fine with TENS machine because some women say oh, they didn't affect me, another women saying they are fantastic, what do you think?
Sue McDonald: I think it's very individual looked after lots of women using TENS and it's being absolutely fantastic because it's bit like it tricks the body into producing the natural pain relieving agent enkephalins and endorphins.
Emma Howard: So that's how it works.
Sue McDonald: It does and it's a bit like if you knock yourself and you rub yourself and that releases endorphins and takes care of some of the pain, the sort of feeling you get from the TENS machine it's like a buzzing pulsating which can be really soothing for woman during labor and can be tremendous and I guess it's a story from my own practice, I was always carrying for a women who have this machine on and her partner didn't think it was working, because she was like a few months, but it was quite cool. He switched off the machine and then he really knew that it was working and he was punished.
Emma Howard: Switched it back -- so he is a huge advocator of it.
Sue McDonald: Absolutely.
Emma Howard: Now we have a question here actually I don't know who it's from and where in the country but this is quite a common question, also having an emergency C section with my first pregnancy, she is asking you would it be dangerous to try for vaginal delivery with the second, I mean lots of people think once the C section and always a C section.
Sue McDonald: A high proportion women can have a normal birth after Cesarean section, but obviously you need to monitor that pregnancy and the labor very carefully and actually plan what's going to happen because if you had a Cesarean Section because of some problem with our pelvis or the birth from that point of view then you may need the Cesarean section next time. If it was because the baby was distressed than you may not and so you just need to be very carefully monitored.
Emma Howard: Hazel from Essex has written and said that she had a C section 11 weeks ago and now she has lumps under the skin along the skin along the scar she is asking should she worry about that.
Sue McDonald: It's something that does happen and is part of the healing process. I mean sometimes you can have these little lumps sort of quarterized and got rid of it sometimes they just diminish it with time, it's useful if she goes to speak to her obstetrician about that.
Emma Howard: Right but it's not something that's you haven't heard of. If we take this process right back to the beginning, hey, I got somebody, I am sure they are very keen right from the beginning from conception how quickly because you are doing pregnancy test with a right result or true result I should say, we don't know what our right result would be. So what would you say that how soon could you do it.
Sue McDonalds: The very-very accurate these days, these pregnancy tests.
Emma Howard: They are sensitive aren't they.
Sue McDonalds: Absolutely but there is round about 80 types of test and that they are pretty accurate, I would say, if you have a normal sort of cycle probably once two weeks after you have missed your period, you may get it a test result but you have to treat it with a little caution, so because you basically start to putting out human chorionic gonadotropin which is what tells you, you are pregnant.
Emma Howard: Don't when they are telling you how it works.
Sue McDonalds: HCG that's what you want.
Emma Howard: But what about these first predictor kits where they say that before your periods due a few days before you periods due, we will give you a true result.
Sue McDonalds: They are getting more accurate everyday basically, I mean are more familiar with the pregnancy testing and post one.
Emma Howard: So you would be happy if it was all for a missed period one day, two days. One woman has written in to say that she is has just found out that she is pregnant and she is terrified of miscarriage and I am sure that's true for many thousands of women, she is asking, will her midwife refer her for an early pregnancy scan before the 12 weeks if she requests one.
Sue McDonalds: It depends on the unit that she goes I think it's useful to say her Midwife and really discuss her fears about this.
Emma Howard: Because this is really about her anxiety and nothing else, isn't it? Would that be something that people would listen to do you think do you think?
Sue McDonalds: The Midwife would listen to and if it's possible then it should be referred, it also depends on whether there is a cue for the ultrasound test, its bit of a waiting list that might be more of a problem. But generally if you have that sort of concern and you express it, the Midwife will try her best to get you into -- to have a scan.
Emma Howard: I will have to just move to another question here so going on from what we have already answer the question if I have a C section can I have a vaginal birth next time, as one lady has written and said that she has had two C sections, does that automatically mean that you couldn't have a vaginal birth that time or is it a bit like your previous answer.
Sue McDonalds: It's a bit like the previous answer, if you have really have to look at each pregnancy and each labor or each birth as an individual, as why she had a Caesarean section, how things went, did she heal well, were any problems and then this pregnancy would be monitored very closely because obviously there is a concern.
Emma Howard: Yes-yes of course.
Sue McDonalds: About the scar being damaged through labor.
Emma Howard: But not as sort of a no a definite no it is something that you can look into.
Sue McDonalds: It's definitely, now a day it's definitely not a no.
Emma Howard: It's really encouraging there are so many more options that women have. Some body has written and say can they have periods through their pregnancies, with their bleedings of their monthly cycle does that happen they say.
Sue McDonalds: Very occasionally it's unusual.
Emma Howard: Would it be light do you think, it wouldn't be the normal.
Sue McDonalds: Oh! It would be alighted, but generally we would advice if any women have any vaginal bleeding during pregnancy they should see that Midwife and obstetrician because it obviously you would think it could be a miscarriage and you want to deal with the situation as soon possible and later on in pregnancy it can be a sign that there is a bleed from the placenta so it's very important. It's not a normal feature at normal pregnancy.
Emma Howard: Yeah very unusual, I haven't come across it at all, but as you keep saying very unusual things that happen and each person is individual. Now is it possible to work out the date when you conceived your baby from the due date you are given.
Sue McDonalds: Well you cant do and that in fact it comes from the date that you have provided or you may have provided to your Midwife for your obstetrician because you give the date of first over your last menstrual period then we had seven days and then we had a nine months to work out your expected date of delivery.
Emma Howard: But that's the women who know and have regular periods.
Sue McDonalds: That's for the if you are knew your cycle but also I have to emphasize that that's an estimate based on normal your average 28 days cycle which not all women have, because women aren't like text books and if you don't know the date of your last period because some women don't keep track of that period, it can be quite difficult. So what you can to from your date your EDD that you have been given either by scan or by the dates we have worked out, it's just basically take 38 weeks off. That's how it's done.
Emma Howard: Right very simple, take the-
Sue McDonalds: And there is about 280 days is estimated to be just the station time. But I have to emphasize that is a sort of fairly loose time because you are always given even if you are given your expected date, we always will say to you that give or take two weeks because babies don't necessarily come, when we say they should.
Emma Howard: And first baby is often ten days later on average there are some statistics I would say.
Sue McDonalds: And also some women know when they have conceived. And I have witnessed an argument between a women and her obstetrician because he was using the ultra sound scan, she knew the only time she could got pregnant was a particular night when her partner was in vicinity and no other partners were involved.
Emma Howard: A very easy one to pin point. How lovely, so really we should end I that, but we have so many more questions so I may will be seeing you again soon. Thank you very much Sue.
Sue McDonalds: Thanks.
Emma Howard: Now if you have got any questions or comments prompted by anything in today's show we would love to hear from your, you can call us on 09050280090 and leave us a voice mail, that's 09050280090 or you can send us a text message, just text the word Baby plus your message to 82540. So thanks very much to the two series four legged advice today and we will leave you know with a look at some of your beautiful baby photos.
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