Patrick O'Brien discusses some General Pregnancy questions and answers.
Emma Howard: Now pregnancy brings with it a whole host of aches, pains and worries. Luckily, help is at hand. Thanks to Patrick O'Brien, a consultant Obstetrician and Gynecologist who has joined us at the Baby Channel to answer some of the questions that you've sent in and we've got quite a lot Patrick. Let me get going with the first one. Dr. Patrick O'Brien: Okay. Emma Howard: I'm 36 weeks pregnant with my first baby and I'm really finding it hard to walk about as I'm tired and breathless. And she wants to know, should I still be trying to exercise or should she just sit down? Dr. Patrick O'Brien: Well, what she is feeling of course is very common at this stage of pregnancy. The baby is big. Could you imagine, if the baby was born and you walk around carrying this baby in your arms all day? Yeah, you will be absolutely exhausted by the end of the day. So it's perhaps not surprising that she is feeling like that. It is good to try to stay reasonably active until the end of pregnancy, getting some exercise everyday even if that's just a walk for half an hour or something like that. Emma Howard: Does exercise helps you in labor? Dr. Patrick O'Brien: It helps you bit in labor. It's good to keep aerobically fit, it's good to keep supple, and it's good to keep active. But not to the point of exhaustion and there is no doubt that it can be pretty uncomfortable at that stage. And also the baby is pushing down and it can be a lot of pressure down here. So I think what she is feeling is normal but to try to stay a bit active is good. Emma Howard: I'll remember climbing steps was an absolute nightmare. I felt like an asthmatic but climbing steps is quite good if you take it slowly. Isn't it? Dr. Patrick O'Brien: Absolutely. A certain amount of breathlessness is of course is normal in pregnancy. It's partly because you're breathing for the baby, it's partly because the baby is getting big and squashing the lungs from underneath so there is no much space. On the other hand, if you get very breathless in pregnancy, it's worth going to see a doctor just to check that their heart and lungs are working okay. Emma Howard: Right. Now we have another question from somebody who is 13 and half weeks pregnant, so well not even a half way there -- this woman is being getting a discharge. She says its light green in color and wants to know if it's normal. She also says that she is being really sick and most of the time she is feeling nauseous. She would be great if you could help. What is that? Dr. Patrick O'Brien: Well, they are two separate things there. The first is the discharge. There is no doubt that an increased amount of discharge is normal in pregnancy. Emma Howard: What about the color there, light green? Dr. Patrick O'Brien: Yeah, that's the big concern I have to say. The hormones of pregnancy stimulate all the glands in that area to produce a lot more discharge. So that's normal. The color is a bit concerning though and certainly if there are any problems like color or itching or soreness, then it certainly would be advisable to see a doctor and have a swab test taken because there might just be some infection there. If there is infection, there are many antibiotics that are safe to take in pregnancy that should be successfully - that's just successfully treated. Emma Howard: And even that's different to her feeling sick. Dr. Patrick O'Brien: I think that's a completely separate issue. Emma Howard: Right, because she is obviously bringing the both together and that would be normal at 13 and half a weeks, wouldn't it? Dr. Patrick O'Brien: The good news is that for most women no matter how about the sickness usually 13-14 weeks, it tends to disappear so if she can hang in there another week or two, she probably would be a lot better. Emma Howard: Yeah, I'm feeling like a new person. Yes, I hope so, anyway. Is bleeding common during pregnancy? This woman wants to know because I started bleeding at nine weeks and I'm now 12 and I'm still bleeding very lightly. Dr. Patrick O'Brien: Yes. It is nice to not to see any bleeding in pregnancy of course because it is always worrying when you see bleeding. Having said that, bleeding is a very common thing especially in the early weeks, so in the first 12 weeks or so, and for most women who have bleeding in their early pregnancy, it will settle down, the pregnancy will carry on and the baby would be absolutely fine. Certainly, if there is heavy bleeding or repeated bleeding, it's worth coming to the hospital and have a scan. Emma Howard: Yeah and get a check up. Dr. Patrick O'Brien: Have a scan. I mean we have an early pregnancy in our University College Hospital where we have, we seen perhaps 14-16 women everyday who've had bleeding in their early pregnancy and most of them would be absolutely fine and we having a scan and we can be reassuring of that. Emma Howard: I mean it is important to reassure, doesn't it? Dr. Patrick O'Brien: Absolutely. Emma Howard: It will recover you and it's better for the baby, it's better for you, so no harm in asking. Dr. Patrick O'Brien: I think that's true. I think there is no point of being stressed. Emma Howard: Here is the fascinating question. What makes a baby become breech? I'd love to hear your answer to that. Do you know? Dr. Patrick O'Brien: Well, in early pregnancy, babies just turn. They've got lots of space. It is liked they're in their own swimming pool and they just summer salt round and round. So in early 20 weeks, halfway through pregnancy, if you do a scan, you find about half a babies are breech but the other half, so they moving round in really. Emma Howard: Yeah, so you don't take any notice of that. Dr. Patrick O'Brien: We're taking no notice before a birth 36-37 weeks so that's about three or four weeks before the due date. There is no point really and in even getting concerned about it because the baby still has plenty of room to turn. At that stage in the last few weeks, that's when you need to start hoping that the baby has read the books and gets his down either and stays in the right position but until then it's not worth losing a sleepover. Emma Howard: Do we know why that they adopt to a certain position because there was a common position, isn't there, which is the head down and that's what you wanted to see that beautiful sort of a posterior position. Dr. Patrick O'Brien: Yeah. Emma Howard: But why is it that they don't want to adopt the same position, is that just nature? Dr. Patrick O'Brien: Well, the theory is that the baby is turning round and round and round. And at certain point their head get stuck down there. If the bottom is down if the breech is down there, then it kicks and it can kick itself out again. But at some point their head gets stuck down there and it's get little bit fixed and then no matter how much the baby kicks, it's just stuck and it can't move, that's the theory. Emma Howard: That's the theory we're working on still today. Here is a really interesting question from all of our viewers, can diabetes cause miscarriage? Dr. Patrick O'Brien: Yes, definitely. Emma Howard: So what do you do then to take steps to try and hopefully that won't happen? Dr. Patrick O'Brien: Yeah, if you are somebody who has diabetes and you are thinking about getting pregnant, it is really important to get the control of your diabetes. In other words, the levels of blood sugar as tight as low as possible, as much in the normal range as possible even before you become pregnant at the time that you conceive and for the first 12 weeks of pregnancy. If you're thinking about getting pregnant and you have diabetes, go and see your diabetic physician and go through it in great detail. Get things as tight as you can and that is the best way, the best chance that there is reducing miscarriage. Unfortunately, diabetes in pregnancy, if it's not well controlled can lead to increased risk of chromosome problems like Down Syndrome in the baby, increased risk of miscarriage, increased risk later on if the baby growing too big and having difficulty in being delivered. Emma Howard: So do you advice an amniocentesis for women with diabetes? Dr. Patrick O'Brien: No, not necessarily. Certainly, it's worth thinking about the screening test for the risk of Down syndrome like the nuchal thickness, where we measure the skin thickness at the back of the babies. Emma Howard: Basically, they're about 13-14 weeks. Dr. Patrick O'Brien: That's right. Between 11 and 14 weeks you can do that and that can work out a risk whether the baby might have down syndrome or not. So certainly it's worth bearing in mind but the key issue is getting the diabetes under control as much as possible even before you're pregnant at around the time that you conceive. Emma Howard: Well, a very unusual question, very unusual circumstance here. I need some advice about giving birth. I've got a steel rod in my back. Do you think I should go for a normal birth or go for cesarean? Dr. Patrick O'Brien: That depends a lot on a lot of things actually. It depends on how straight her back is now, it depends on how long the rod is, it depends on what part of her back it's in - whether it's high or low. But actually all things been equal, there is no reason that she should have a cesarean section, the actual process of labor and pushing and delivering the baby probably would be absolutely fine unless she has real problems with mobility. What might be more of an issue is if she wants to have an epidural in labor or for a cesarean section, so she is certainly be well advised to see an anesthetist definitely during her pregnancy, in advance of the labor. But it would also be a good idea to see somebody before she is pregnant because ideally we're try not to do x-rays in pregnancy but the anesthetist and we would we love to see some x-rays of her back, so it'll be ideal to have some x-rays done before she is even pregnant. Emma Howard: So people with unusual conditions always need to do a lot more preparation when they want to get pregnant? Dr. Patrick O'Brien: Ideally. It's so much better. If you have got an unusual or medical condition, it is so much better to see somebody before you even get pregnant so that we can sort of plan for the pregnancy a bit better. Emma Howard: Here is another question about the early stages of pregnancy. What are the signs and symptoms of an ectopic pregnancy? There are lots of women who fear a lot in the early weeks. Dr. Patrick O'Brien: Yes. Well, it's not that common first of all. It's only about sort to half to one percent. Emma Howard: I think that's what we say fearful, we might think things that hardly ever happen to anybody, have a fear factor about it. Dr. Patrick O'Brien: That's true. I think the typical symptoms of an ectopic pregnancy would be pain on one side. So ectopic pregnancy means a pregnancy in the wrong place, not in the uterus and typically that will be in the fallopian tube. Emma Howard: That's before the egg traveled right down to where it should have got to? Dr. Patrick O'Brien: Yeah, the egg becomes fertilized somewhere in the fallopian tube and then instead of traveling along and into the uterus, into the womb, it gets stuck in the fallopian tube and it starts to develop there. But because the wall of the fallopian tube is not prepared to accept the pregnancy, it's too thin, then eventually the wall will be damaged and that would be bleeding and pain and so on. Emma Howard: Right. Dr. Patrick O'Brien: So often the symptoms will be pain on one side, the side of the tube where the ectopic is. And bleeding, typically not heavy fresh red bleeding, it's typically brown bleeding often not that much. But the bottom line is that if you have pain or bleeding and you think you might be pregnant, you should see a doctor, have a pregnancy test and then have a scan to see exactly where the pregnancy is? Emma Howard: And a scan would see it. Dr. Patrick O'Brien: Yes, usually. The scan can see if the pregnancy is in the right place or not. Emma Howard: An interesting question here, I had my placenta manually removed with my last two children. Is there any chance this could reoccur if I felt pregnant again and that's opposed to most women's experience where there is injection in the spine and the placenta is going to yanked out and comes out hopefully quite smoothly. Dr. Patrick O'Brien: Yes. Emma Howard: What does manually recovered mean? Does that literally mean that the hand inside pulling it out? Dr. Patrick O'Brien: It's a bit like it sounds but usually almost always somebody would need to have anesthetic for that either general anesthetic or an epidural or spinal type anesthetic? Emma Howard: What would the reasons be for that to help it? Dr. Patrick O'Brien: Well, sometimes, normally within a few minutes to half an hour of the baby being born the placenta, the after birth where it's stuck on to the wall of the womb inside, usually it will separate off and then it usually slip out quite easily. But in some women it just tends to get stuck on for some reason. Often we don't know the reason. It's common in women who have had an operation on the womb like a cesarean section for example but often we don't know the reason. And then if that happens, yes it means actually putting a hand into the womb, separating the placenta from the wall of the womb and then just lifting it out. Emma Howard: And the question again, it's happened to her twice. She is obviously pregnant again. She is hoping it's not going to happen again. Do you think? Dr. Patrick O'Brien: Well, the chances are it won't happen. I mean statistically, it's more likely to happen to her because it's happened to her twice before that it is a bit more likely that it will happen to her this time than another woman having a baby. But still overall it's more likely that everything will happen absolutely fine. Emma Howard: Oh! We're not getting it. That's actually quite related. When will I start to feel my baby moving? I've had this question so many times. All the books give you quite a definitive answer. Dr. Patrick O'Brien: Yes. Emma Howard: But I've met women who've had very different experiences. Dr. Patrick O'Brien: You're right. It's not like that. It's not like the suddenly at 20 weeks you will feel your baby moving and if you don't you should be worried. It depends on whether it's your first baby or you've had babies before. Emma Howard: Right. Dr. Patrick O'Brien: Usually with the first baby, it's around 20 weeks, so that's about half way through the pregnancy but it might not. It might be 21 weeks, 22 weeks. What I would say is certainly wouldn't start to worry until you reach 21-22 weeks and if you don't feel a baby move at that stage, almost certainly everything is fine. It's just that you haven't felt that you're unlucky, your baby hasn't been that active but if you have had a baby before, then sometimes women will say they feel the baby will move as early as 15 week, 14 weeks. Emma Howard: It's like she is into it heavily -- Dr. Patrick O'Brien: I think so. I think it's partly because they know what they're feeling for maybe it's because the wall of the womb is a little bit more relaxed and a bit more sensitive as well. But I think it's something normal what they are looking for. Emma Howard: This question is quite close to my heart because I was one of those women who didn't feel my baby move and absolutely nothing wrong -- I have a wild little boy now who moves about all the time. That too much for my liking, I must say. Didn't really feel him move at all, as I've got about 30 weeks before I felt anything? None of the books supported that at all since that I've met a lot of women with the same experience, so people get still worried about the fact, they don't feel any movement. Dr. Patrick O'Brien: I think it's place full of that, I think if we got worried in the early stages when it's normal not to feel the baby move. I think a little later stage of pregnancy, it's really important to keep an eye on the baby's movements. And if there is any day where you're worried, then it's important to have it checked up because most times it's just that the baby is a bit sleepy that day but sometimes -- Emma Howard: Because there is a child, they can sort of kick so that you can feel it? Isn't that? Dr. Patrick O'Brien: Exactly. Emma Howard: Is it ten movements a day? Dr. Patrick O'Brien: A good rule of thumb is that the baby should move at least ten times a day. Although many will move more than that but if it's the day that the baby is not moving. Occasionally, it'll be a sign that the baby is a bit unhappy, getting a bit tired and the sooner that's picked up the better in the same day. So I think after about 26, 28 weeks of pregnancy, a good rule is, don't go to sleep, if you are still worried about the baby's movements. Don't say I'll check tomorrow. If you're still worried at night, come and have it checked. Emma Howard: Right. Go down to the hospital. Let's end on the plan one when people ask all the time Patrick, safe exercise in pregnancy. What is safe exercise in pregnancy? Dr. Patrick O'Brien: I think the evidence is that just about any type of exercise is safe in pregnancy. It has been traditional to advice women to avoid too much exercise in the first 12 weeks because miscarriage is more common in the first 12 weeks but actually there isn't the huge amount of evidence that exercise increases the risk. Emma Howard: Right. Dr. Patrick O'Brien: On the other hand, there are plenty of advantages to exercises as we mentioned early, it keeps you fit, it makes pushing in labor easier, keeps you supple and it keeps you I think a bit more relaxed during the pregnancy. Also reduces the chances later on in pregnancy of things like diabetes in pregnancy. So by and large, exercise is good. We tend to say well, avoid the really violent things like horse riding or skiing or water skiing. Emma Howard: But you think running is okay? Dr. Patrick O'Brien: Running is okay. I looked after somebody last year who ran a marathon just a few days before she had a baby. So -- Emma Howard: Oh my goodness! Dr. Patrick O'Brien: That's a bit extreme. Emma Howard: I think, well, I will have to get on the safer. I want to meet this woman. So it's not a good idea to sit down with a box of chocolates even though that's really what you want to do when you're pregnant. Isn't it? Dr. Patrick O'Brien: Definitely not. Emma Howard: Patrick O'Brien thanks very much. Dr. Patrick O'Brien: Thank you.