218. Q&A: Vomiting in Labour & Birth Options After a Bladder Prolapse

0:13 Welcome to the Kick, your expert-led podcast, helping you explore and learn everything about getting pregnant, pregnancy, birth, and becoming a parent.

0:21 On the podcast and our online pregnancy program Grow My Baby, we share my experience of helping more than 4,000 babies to be born.

0:29 And our experience of running a women's health clinic and parenting for boys.

0:34 We're here to help everyone to feel empowered in pregnancy and birth with real-life practical information.

0:43 Welcome everyone. I'm Bridget Maloney.

0:45 And I'm obstetrician Dr. Patrick Maloney.

0:48 And today we're feeling very spoiled because we are here in our own podcast studio.

0:52 I know. Feels great, doesn't it? It does. We have converted a room in our house.

0:58 Yes, we kicked one of the boys out.

1:00 He's only like five a week. And we just kicked him out so that we can um turn his room into a studio.

1:08 I don't want people to feel like we're horrible people. He wasn't five, he's 21.

1:13 He'll cope. He will cope. He doesn't even live here anymore.

1:17 No, this just feels really good. And we're sitting here with a cupper. We haven't quite got our act into gear to have video yet. So that's next episode. Um, so it's very early in the morning. We're not ready for video.

1:29 And or dressed. Or dressed.

1:31 No, no, we have clothes on.

1:32 Not but not dressed for video.

1:34 Yeah, that's an image no one wanted. Anyway, uh, we are really excited today because we are going to have another QA.

1:44 Perfect for the first visit to our news studio.

1:47 Exactly. All right. So, you know, uh, we have uh had a little chat already, which is quite unusual for us. You really do like to get down to the brass tacks and get straight into it. So uh here we go.

1:57 Here we go.

1:59 Hi team. I'm wondering if you could do a segment about the glucose tolerance test. I'm uh 18 weeks pregnant and I got told to do one just on the weekend um and another one at 28 weeks, but unfortunately I felt really nauseous and sweaty at the one hour post-drink stage and ended up vomiting in the sink at the collection centre, which is super embarrassing.

2:26 But I'm just wondering if I had the fasting level and the one hour, is that still useful? Um, am I gonna have to do it again? And is there any other option in pregnancy or is that kind of it? Thank you.

2:43 Poor thing, I want to say something first. Don't be embarrassed. Wouldn't be the first time.

2:47 Oh my god, don't be embarrassed. That happened that happens a bit. Uh and it it's a it's a fair load of sugar in a way that we aren't used to taking in sugar. So um it you know, even though it's a similar amount of sugar to a chocolate bar, for some reason it's a lot more tolerable in chocolate bar form.

3:07 Uh whereas the drink uh the best, the closest comparison would be undiluted cordial.

3:14 And who likes that?

3:16 Nobody.

3:16 No.

3:17 Uh so so that so sometimes it's just too much. It's a really good question because it raises a few issues. The first one is why would we do it twice? Um early oral glucose tolerance tests are typically recommended for people who are thought to be at higher risk. So the most common scenario would be someone who had gestational diabetes in a previous pregnancy or who was otherwise at higher risk.

3:46 Strong family history, uh, history of certain medications or uh obesity. And then uh the benefit of that, of course, is that we can find out whether that woman has gestational diabetes much earlier than the usually recommended 28-week test and potentially treat that person for all of the weeks between when the test was done and uh and twenty-eight.

4:11 The additional weeks. So that that's why you might be recommended to have it twice. And of course, if we pass the first one with flying colours, uh the reason why it's done again at twenty-eight weeks is because just because you didn't have it at twelve, you might have it by the time you're twenty-eight.

4:31 And that's very much uh common recommendation. Of course, if you uh are diagnosed with gestational diabetes on the first test, you don't need to have it again. You've got it for the pregnancy. Um and there's no no point in doing it a test twice if the first test is positive. So uh uh in answer to the to the other question about uh is a little bit you know, is a is a fasting level and a one-hour level better than nothing?

4:57 Course. 100% that's that is better than nothing. And sometimes people, as an alternative to the oral glucose tolerance test, if they just can't manage it, we'll just get some random blood sugars uh done, or even better, a fasting blood sugar done with no food all night. Now the very first bloods done in a proper oral glucose tolerance test, the first one is a fasting one.

5:24 So you've still got that data, and that's as good that that's a lot better than nothing. Then you drink the sugar, if you can get to one hour mark without uh vomiting and get some bloods at one hour, that is also way better than nothing. It's just that the full test with all the information is a is a two-hour test.

5:43 Do you think she'll be asked to come back and have the rest of that test?

5:47 Well, you have to start you can't have the rest, you have to start again. Start again, sorry. Yeah, so so that would be um offered. But the the treatment team might say, well, we're happy with what we've got. A zero and a one hour, the fasting and the one hour post-drinking the sugars, and that might be adequate information, particularly if the woman was low risk.

6:07 But she doesn't sound low risk because she's been asked to have have it early. Yeah, so they may be particularly concerned. Other alternatives, you could take a series of fasting tests, um, which would be again better than nothing. And I've had some people at very high risk before who couldn't manage the test for various reasons, but I was next to certain that the test was going to be positive if we'd done it.

6:39 So we actually just treated the person as if they were positive. Uh because what really happens if you get a positive oral glucose tolerance test? Well, we uh send you to a diabetes educator, we get a glucometer, and we start recording sugars through finger prick, fasting, and post-meals for two weeks.

7:02 And then we use all of that information to see, hang on a minute, does this woman need some dietary interventions or some insulin? And or both. And uh you could just assume that the test was positive, get the glucometer, do that testing and and and carry on on that basis. Because if the it's inconvenient to do it that way, but you could.

7:28 Um and the if the sugars um were normal, being tested four times a day, then uh that is just as good as a negative result. If they were positive and needed treatment, you can just use all of those sugars as the basis for treatment. You don't actually have to go back and do a a full test. Why don't we always do it that way?

7:51 It's actually more expensive and less convenient than just doing one test that rules it in or out.

7:56 I was just about to say, because there's there's people that do object to taking that amount of sugar and you know they feel like they're harming the baby. And you see it on Instagram where people are going, you know, we wouldn't do this under normal circumstances. Why do they make us put all this into our body?

8:10 It's artificial, it's yeah.

8:12 Yeah, so that is inaccurate. That that there is not an enormous amount of sugar in it. It's we're just taking it in as in a way that we're not used to. Yeah. Now there might be someone out there who never have a chocolate bar in their life. Um, but but uh it is a is it it's a dose of sugar that your body under normal circumstances should have no dramas whatsoever, uh taking it in.

8:34 Um it's um it's glucose, it's not um toxic. Um they could have done better with the colour.

8:43 Yeah. Yeah, why does it need to be coloured? Yeah. In fact, I think the ones that we've got at work now aren't coloured.

8:48 Yeah, I think that's a good idea because uh some people feel strongly about colourings. Um but it's um i it's not a it's not toxic, it's not an unusually high amount of sugar, it's just a way that we would never otherwise drink that much sugar.

9:03 Well, you'd hope not, yeah. In a way, like, you know, if you're addicted to drinking neat cordial, then then that would be an unusual circumstance.

9:11 Absolutely. So uh I think the the understanding the point of the test is important to know why it needs to be done that way. Because we have to be giving everyone the exact same amount, and that that is uh one of the reasons why the test is done as it is. And the other reason is that nobody's uh pancreas and uh and uh insulin resistance um in their tissues, it's not an all-or-nothing test.

9:38 It's a test on which we perform well or poorly, uh, but it's not uh past fail. Um and it's done in a scientifically validated way so that we can rely on the result. And it is important to know whether you have gestational diabetes or not.

9:55 I know. And for somebody that's listening to this and and thinking, well, I've got no symptoms, I've got no um family history, no prior reason to think that I might have gestational diabetes. And I I've had people say this to me that, you know, I'm not gonna have the test because I don't have any reason to.

10:13 But if they go back and listen to our original episode on gestational diabetes, everybody needs to be tested at some point in some way for gestational diabetes, don't they?

10:23 Yes, it doesn't work that way, unfortunately. Um uh pregnancy itself is a diabetogenic condition. It it it can give you diabetes. A temporary form related to the pregnancy, but it doesn't you don't need a strong family history, you don't need to be overweight, and you don't need and you certainly don't need a poor diet.

10:47 It's uh the there there is abundant evidence that it's important to know whether you have diabetes um in pregnancy or not, and it affects obstetric outcomes.

10:57 Great. Uh okay, so we'll link the episode in the show notes because I can't remember which one it is. It was a very, very early on one, uh maybe our twelfth episode or something. So you'll hear a very young Dr. Pat and Bridget.

11:09 From from sounding young and carefree, uh, when we were going through the obstetric textbook in the early episodes.

11:47 One by one. All right, let's move on to our next caller.

11:51 Hi, Bridget and Dr. Pat. Uh my name's Quinn, and I'm currently 27 weeks pregnant with my third. I've been listening to your show um since my first baby back in 2021. Uh my question is about labor and delivery. So, with my last delivery, um, I had nausea and vomiting throughout the active labor phase.

12:15 Even though it wasn't very long, it did mean that I went for an epi. Um, I'm just wondering uh how likely that is to occur again. So I have gotten nausea and vomiting throughout my pregnancies, but um usually it does ease up in that third trimester for me. Um so it's very surprised it came out again during Labour.

12:37 And I yeah, I haven't been able to find too much on that online. I'm hoping to go in a little bit more informed this time. So any insights you guys have would be much appreciated. Thank you.

12:50 Is nausea and vomiting in Labour the same as caused by the same reason that nausea and vomiting happening happens during your pregnancy? So she was surprised that you know she got rid of her nausea and vomiting and then it came back in the labour. But are they related?

13:05 Not really. It's a different thing. Yeah. So this is not um uh give or take a an effect of pregnancy hormones like it is in the first trimester. Uh this it's due to signals coming from the cervix through the vagus nerve as the cervix opens. Um so it's it's it's quite different. Um and uh as the cervix uh opens, that stimulates um nausea and vomiting in in some people.

13:34 It's very common when the cervix is all the way open. It's one of the ways we know the baby's about to come, um, which is one of the little cheats we've got. If someone if someone is not doing much but suddenly vomits, that's that's uh a hint that they might be cracking on faster than we think.

13:50 Wow. How undignified. I mean, people are worried about, you know, doing a poo during labour, and now people are gonna worry about now they might actually vomit.

13:59 It can happen. It can happen. And uh I think sometimes the the if the person feels embarrassed or it's undignified, they're worried about everybody else being worried about that. Whereas of course we're not worried. The only thing we're worried is it's not a very nice thing to happen when you're about to meet your baby.

14:15 But a good sign that you know a baby's coming. So hold on to that.

14:19 We would be kind of pleased. Nothing but you know, nothing grosses us out, and and we have to, you know, it'd be it'd be that's one thing we wish our patients understood more, is that it's it's we're not troubled.

14:31 And what Quinn's really worried about is will it happen again?

14:34 Yeah, look, it might. Um so there are a couple of things to uh consider. If you have a second or subsequent vaginal birth, the labor is more efficient in a number of ways. Um, including there's less time between the cervix being fully open and the baby coming out. Uh if you are having your first baby, you might get to fully dilate it and the baby you might not see the baby's smiling face for two hours.

14:59 Uh about an hour for the head to come down further and perhaps an hour of pushing. But between being fully dilated and having the baby in your arms with a second or subsequent vaginal birth might take two minutes. So you're less likely to have all sorts of troubles, including nausea and vomiting, uh, because the whole the whole time frame is just way more, way more comp compacted.

15:23 The other thing we can do is go to school a little bit on what happened last time and look at things like intravenous fluids and anti-nausea medications in labor. If that's uh if it's if it's important to the patient to try and treat that preventatively, or you could just see how you go. If you spew, you spew, and and and that is okay.

15:48 And uh uh trust the trust trust your body that the that the birth is going to be briefer in the first place.

15:55 And um did she say what how how much like if it if it's just uh one big purge, then I suppose you know you can't really uh manage for that. But if if she was vomiting the whole labor, I could imagine that that would be something that you would want to manage in the second and subsequent labor.

16:12 The whole labor you definitely would. Yeah. Uh so that so um that would be you know wisely managed uh with um things that help maintain a normal blood pressure like intravenous fluids, anti-nausea medications, uh perhaps concentrating on things given intravenously, so you don't even have to swallow something, uh pill.

16:33 Uh and if an epidural is used, one of the one of the things that we experience with epidurals from time to time, and and we've done an episode on this, is that when the epidural first goes in, uh it blocks some of the signal down to your legs. That's one of the ways that it blocks pain, but it can block some of the signals down to your legs that keep the blood press blood vessels nice and uh tight, and there can be a relaxation of blood vessels which can cause a drop in blood pressure.

17:03 And that in itself uh can make you feel very sick and and trigger nausea and vomiting. And it's one of the reasons why prior to putting in an epidural, the the anethatus will often run in some intravenous fluid to keep the to keep the blood vessels nice and full. If you um if you were have if you'd had that before, then we might pay particular attention to to not letting that happen again.

17:29 And there are things the anethatist can do. We're getting a touch outside my area of expertise here, but there are clever things the anaethetist can do to try and really avoid that happening. Uh so uh preloading with intravenous uh fluids, um, anti nausea medications, and some medications that they can give you to keep the blood pressure high, if it was a drop in blood pressure last time that caused the nausea and vomiting.

17:55 And they're very good at that, uh treating that uh preventatively, particularly in someone who's had a real problem with that before. The other benefit, of course, if it's if it's your second or subsequent vaginal birth, you may not need the epidural at all. Lots of people have an epidural with their first labour because it's gonna take a long time.

18:13 They're in a lot of pain and they might be in pain for nine hours, whereas they might be able to manage fine if the painful part of their second labour was only two hours.

18:25 How interesting. Uh I want to ask two questions. I've got my fingers crossed. Uh, one is I just want to pick you up on a point you said where uh it might be a couple of hours before you see the smiling face of your baby. Like it's not the baby that's smiling, it's you that's smiling.

18:40 They come out cross as hell, don't they?

18:42 Yeah, yeah, and they don't smile for what, six weeks or something. Um that was one. The second is people are a bit nervous about uh taking extra medication. So i uh is the anti-vomiting medication safe?

18:56 Yes.

18:57 Yeah.

18:57 Is it the same sort of thing as on dancer trial or something? Yeah, yeah. Okay.

19:01 Um and then uh the medication used to bolster blood pressure in a epidural situation is also safe for use in pregnancy. Great.

19:10 And a spinal, is it the same mechanism?

19:13 Well, a spinal is different in that it well, yes, the sp a spinal can trigger all that as well. Um, but a spinal anesthetic certainly is in Australia is much more likely to be given in in an operating theatre scenario when we're either going to do a cesarean section or a forceps or vacuum delivery under spinal block.

19:34 And if a spinal is being used, we're likely to be in theatre. And in theatre, we've got an intravenous line, there's a culture of giving lots of fluids, uh, so all of that is um uh more you know, better managed probably. But also when we've put in a spinal, it's not to sit around and wait for the baby to come and have the woman push over several hours.

19:57 It's because we need to get that baby out now, either by caesarean section or by instrumental birth. So there isn't very long between the spinal being effective and the baby being out nonetheless.

20:07 But people still vomit during cesareans as well, don't they? They do for similar reasons. Yes. Good. Well, best of luck, uh Quinn, and I hope I hope that this labor is easier for you in terms of uh nausea and vomiting.

20:19 So do I. Well done for coming back.

20:21 Okay, let's move to this caller, Patty. Hi, Dr. Pat and Bridget. My name is Lindsay. I absolutely love your podcast, and I listened to it so much during my first pregnancy. I'm about a year postpartum now and will hopefully start trying for my second baby soon. My first birth was vaginal, and unfortunately, I developed I developed a systal cell or a bladder prolapse afterwards.

20:47 I was in a lot of pain for about six weeks after I've worked with the pelvic fluorotherapist, and things are much better now, but I still have a grade one systal cell. So my question is: should I consider having a planned C-section for my second baby if I have another vaginal birth? How likely is it that my prolapse will be uh significantly worse than what it is right now?

21:13 I am honestly quite traumatized by my first postpartum recovery. So a C-section is appealing to me, but I also know it's a major surgery and comes with uh its own recovery. So, how would you weigh vaginal birth versus C-section in my situation? And is there anything I can do before or during pregnancy to reduce risk of uh worsening my prolapse?

21:39 Thank you so much.

21:41 This is my favorite question ever.

21:44 I know. I just feel for people that, you know, this is the this is the result, they got a a baby and a bladder prolapse.

21:51 Yeah, yeah. I think that the question is perfect because it it it outlines the problem. Um, but the reason I like the question is no nobody knows the answer. Um this is this people don't want to hear that. No, it it's true. This is a this is a this is obstetric. Exactly what to do in this scenario is one of the remaining mysteries.

22:14 Nobody knows the exact way to play this. And that's good and bad. Um the the good news about it is because we don't know, we can't say, right, based on a million studies of a million women each, we can be extremely confident, madam, that what you should do is blah, blah, blah. The good news is that the the the advice can very, very Legitimately be personalized to that individual patient.

22:43 Because the you know, if there ever was an answer based on trial evidence, we certainly don't have it.

22:50 And before somebody says, well, this is terrible, there's never enough research on women's health, and why don't we have this research?

22:56 This one would be hard to do. You could have all the money and all the goodwill in the world, and it would be very hard to construct a study that proved this one way or the other, because the pr the concept of prolapse is so multifactorial. You can have uh tiny women give vaginal birth to huge babies and never get a a spot of prolapse in their life, and we see severe prolapse in people who've never been pregnant, let alone had a vaginal birth.

23:27 So it's just a difficult um condition to predict. And the forces that might cause a prolapse in an individual woman are not confined to childbirth. They are it's uh multifactorial, and we know a fair bit about treatment, but we d we don't have a capacity to predict it in any in any individual woman. So what should what should she do?

23:53 Um firstly, what have we done right so far? Um an active approach to the recovery from the first vaginal birth. And uh and that has worked, hasn't it? She mentioned that the prolapse now is less severe than it was at the start.

24:09 And a grade one, I don't know, what's that mean?

24:12 There's a grading system as to how far the prolapse comes down. So if we examine the woman in the appropriate condition and in particular ask her to push down like she's like she's opening her bowels, that that downward pushing motion, you can see the prolapse revealed at its maximum intensity. Um and the vaginal wall, instead of sitting up tall and strong like it did before she had her first baby, is sagging down a little bit, and there are degrees of that which we can take note of.

24:37 And can you see the difference between a bladder and a bowel prolapse?

24:41 You can see that if you examine the woman appropriately.

24:45 Right.

24:45 Yeah. The um the uh front wall of the vagina has the bladder behind it, and you can see that sag down. The back wall of the vagina has the the bowel behind it, and you and you can your rectum behind it and you can see that bulge down. And then the third thing we take note of is the descent of the cervix.

25:03 So the ceiling of the vagina, if you like, the top is the cervix, and it should be well supported up in the pelvis. But uh if there's a degree of uterine prolapse where the uterus itself is sagging down, then uh the cervix will descend down towards the vaginal opening, and in a severe case will pop out through the vaginal opening and and and and dangle outside.

25:27 And that those are the things that a proper assessment of prolapse would record. Yeah.

25:34 Yeah. And this caller I mean, she's she's gone off and she's done her physio and and it and it's come to a grade one.

25:41 Yes, yeah. So grade one is the is the least severe, but it is still problematic. Yeah, and people would often still have symptoms related to that. They might have an unpleasant dragging sensation, uh, it particularly experienced when rising from a seat, or there might be difficulties with sexual intercourse, there might be uh uh a leaking bladder.

26:06 And all of those things would be taken into consideration in giving the woman some appropriate advice. It seems like in the case of this woman, it was the the the event that triggered her to go from having no prolapse to some prolapse was clearly that vaginal birth. And while she has made a good recovery with pelvic floor physiotherapy and would expect to continue to improve, she's found the development of that problem to be traumatic.

26:33 Uh some people will accept a small amount of vaginal prolapse as a as a battle scar of vaginal birth, like a in the same column as their stretch marks, and other people will will not. Uh they're they are highly unhappy with with that with that uh development. But they can see that passing a you know three and a half kilogram uh baby through their no previous births vagina was bound to cause some trauma to that tissue.

27:04 So uh what to do continue with the pelvic floor physiotherapist is is is uh is is definitely good advice. And the physios have excellent um data showing that that that that works. The reason why you have to see uh see a pelvic physiotherapist is it's not intuitive. Uh it's a bit like your golf game, it doesn't happen automatically, and what you're supposed to do is not what you think you're supposed to do.

27:38 So you have to be taught by an expert. You can't really read it out of a book or off a pamphlet or off or off uh social media. Uh it's a hands-on affair, it's it's an examination and uh an internal examination and a bit of work with the physio before you can get the knack of of correctly doing the exercises.

27:58 And then they start to work.

28:00 That's fascinating. Because I mean I've I've done that and I just I thought that I kind of knew exactly what I was doing, but instead of contracting, I was bearing down and you know, like it was it was just uh uh illuminating for me to have that done.

28:14 You can make it worse by doing it wrong. But but but more importantly, you you might if you're not doing it properly, you might put in an awful amount of effort over many years and and not get the benefit that you could have got had you been doing it correctly. Yeah. So uh definitely that. So there are two major schools of thought about what to do next.

28:37 One is could we avoid further trauma to the pelvic floor by having the next baby by caesarean section? The answer to that is both yes and no. Uh you can avoid labour trauma, so labor and delivery trauma to the pelvic floor by having the next baby by caesarean section, but you can't avoid the pelvic floor damage that occurs just by being pregnant again.

29:01 So some of it is just because you were pregnant, the weight of the pregnancy on the pelvic floor, the combination of that plus hormonal change, and some of it is just that um inherent trauma that the tissue might go through uh in the birth process. So you can if you have a cesarean section that can be partially protective, somewhat protective, but not entirely protective of further damage.

29:34 I see um Arphizio uses pessaries a lot.

29:37 Yeah.

29:38 In in a pregnancy, is that something that she would be advised to do?

29:43 Yeah, so pessaries are these are these rubber rings that you can sort of uh uh uh fold in half, push into the vagina, and when it's in the vagina, it springs out back out to a rubber ring again, uh uh to a ring shape again, and it helps hold everything up. And that that'll give someone with a a mild to moderate prolapse a lot of extra comfort.

30:01 A feeling like the pelvic floor isn't about to give way, a feeling like your your insides won't fall out. Um and they can be very, very effectively used, sometimes forever, sometimes temporarily, sometimes whilst the woman is finishing her family with a plan that she'll have surgery for her prolapse at the end of her um obstetric time.

30:23 And sometimes when people don't want surgery, uh we often use those rings in elderly women who aren't perhaps suitable for surgery. Uh, but they they are used in that obstetric group temporarily mostly. So you mentioned that there are other risks involved in a cesarean section. Whilst that's true, uh most people would would uh tolerate an ex a cesarean section extremely well.

30:46 It does have some other risks um related to the anesthetic, the incision, but uh cesarean sections performed uh in 2026 are typically extremely safe. So I would not be worried so much about the risks involved in having a cesarean section. I'd be more interested in whether having that cesarean section was going to prevent further trauma to your pelvic floor.

31:12 So who might consider a cesarean section and uh j just to do that? It would be somebody who was very concerned about the about the trauma that they had already experienced to their pelvic floor, and somebody who saw cesarean section um as being a better alternative. Uh so if I had someone who was so troubled by trauma to the pelvic floor from their first birth that they thought, I'm not gonna have any more babies if that's the price I have to pay, then that person, if they had more babies in their heart, might say, that might be the person who says, fine, I'll have the rest by cesarean section.

31:50 Um there is another point of view that's entirely valid, and we don't exactly know which is the best one to do. Um, and that is you might say, well, that first birth has done most of the damage. And if I have some more vaginal births, they are unlikely the damage has been done and I might find those second and subsequent births much easier.

32:18 They may not actually add significant extra trauma. And at the end of the day, I might wind up after my third birth with a similar amount of prolapse than I had after my first. And in that scenario, you might say, fine, if most of the damage has been done, let's have the other babies vaginally, because that's my preference to have it vaginally.

32:39 Go back to the pelvic floor physiotherapist after my last baby. Get my pelvic floor as good as I can. And if I'm happy with that, fine. And if I'm unhappy with that, consider long-term ring pestery use or surgery to correct the prolapse.

32:56 It's interesting, isn't it? So I'm hearing, and tell me if this is a fair assumption, that uh she is weighing up the options between a vaginal birth or a plan section. And medically, there's pros and cons for both. Yes. So it's not the driver of her decision making. What perhaps is the driver of her decision making is how is she feeling?

33:20 Yes, that's as valid as any other driver in the absence of more evidence.

33:24 Yeah.

33:25 Um, and we would take how someone's feeling into consideration every time. But uh sometimes you might say to somebody in the medical world, well, I understand you're feeling this way, but the evidence is highly supportive of a different decision. But in this scenario, we don't really know.

33:44 No. And I wonder whether some of it is wanting some validation around a choice. And um, it sucks that as women who are having babies, we can't make these individual choices sometimes. You know, we've got the pressure from uh society, um, ourselves, like all of that is sort of a bit implicit in our decision making.

34:07 Uh, but you know, if you need validation, just do what you want to do and what's in your heart and what will help you have a happy labor and delivery and recovery.

34:17 100%. Talk to your team, talk to them about your concerns, and work on a team decision that works for you. That addresses your major concerns. And if if uh you know this this this is your health issue and the consequences down the track will be yours, and and we've got to try and shut out some of that, some of that noise.

34:41 Great. Well, I hope that helps. Thanks for listening again in your next pregnancy. Um, it's so great when people come back after listening the first time with their first pregnancy and they're back again, listening again. We do love it. All right. Well, uh, that's us for today, Pat. Um, how comfy are these chairs?

34:57 I know, right? Uh I just I looked up and I thought, wow, we've been talking for quite some time, but I've noticed. Um I'm so comfortable here.

35:04 When we get the video going, you'll see how cool our studio is.

35:06 Yeah, yeah. We're very proud of it. All right, everyone. Uh, thank you as always for joining in to our podcast. We love hearing from you, and we love hearing that you know you've been listening and you've been getting so much from the episodes, um, and or you've listened to all of the episodes, which deserves its own little medal.

35:23 I think it's a good idea. Champions for this. Um, we've now got 200 and something. Uh so yes, we're very, very grateful and uh we don't take that privilege of having you along um for granted. Um, as usual, if you love our podcast, how you can help us is by two things. Sharing it with a friend. That's that's so vital to keep us uh going.

35:47 Um and also uh whatever app you're listening to us on, uh just hit that follow button because actually what that does is it it helps the algorithm push it out to other people that are just like you wanting the same sort of information. All right, everyone, until next week, keep growing those babies and uh we'll be in your ears next week.

36:06 Thanks for listening, everybody.

36:07 Okay, bye for now. Hey, even though Dr. Pat is, well, a doctor, and we get lots of other doctors and other experts on our podcast, I just need to remind you that this podcast is for informational purposes only. We share lots of medical insights and experience, but everything we talk about is general in nature and may not apply to your specific situation.

36:31 Please always consult with your own healthcare provider for your individual medical advice when you grow your baby.