But, you know, it is worth maybe highlighting some of the symptoms that people should look out for.

Yeah, well, until you've had your first ultrasound scan, you won't be certain as to where the pregnancy is and whether it's well or not.

And that's why a lot of patients will go for early pregnancy scans at eight or 10 weeks just to give them that reassurance.

But typically the symptoms associated with that type of complication would be pain in your lower tummy, cramping.

and some bleeding.

And if you have either of those symptoms and you've missed a period and you have a positive test, then it is important that you go to your local maternity unit, to the early pregnancy service there and get a scan to establish whether the pregnancy is viable and to establish if it's in the right place.

I suppose singling ectopic pregnancies out, if you have pain in either the left lower tummy or the right lower tummy, it's even more important that you go and get the pregnancy assessed because that's a pain typically associated with an ectopic pregnancy where the pregnancy is developing outside the body of the uterus and most commonly we find it in the fallopian tube.

And why does that happen?

But, you know, it is worth maybe highlighting some of the symptoms that people should look out for.

Yeah, well, until you've had your first ultrasound scan, you won't be certain as to where the pregnancy is and whether it's well or not.

And that's why a lot of patients will go for early pregnancy scans at eight or 10 weeks just to give them that reassurance.

But typically the symptoms associated with that type of complication would be pain in your lower tummy, cramping.

And some bleeding.

And if you have either of those symptoms and you've missed a period and you have a positive test, then it is important that you go to your local maternity unit to the early pregnancy service there and get a scan to establish whether the pregnancy is viable and to establish if it's in the right place.

And I suppose.

And why does that happen?

Yeah, and should anybody who's trying to get pregnant, is it something that they should be using or only if they're struggling with that?

Yeah, look, I don't think you should seek to put additional pressure on yourself when it comes to conceiving.

So if you have a regular, certainly a 28-day cycle, if your menstrual cycle is 28 days, then you're almost certainly going to ovulate on day 14.

The second half of your cycle from ovulation to the start of your period, is typically 14 days, regardless of the length of your cycle.

So if you have a 30 day cycle, you're going to ovulate on day 16.

If you have a 26 day cycle, you're going to ovulate on day 12.

So just if you have a regular cycle and you know the length of it, just count 14 days back from the first period that will predict when you're ovulating.

Would be interested to get his opinion on the impact of the removal of the consultant-led clinical pathway option for women, current private option.

Yeah, and should anybody who's trying to get pregnant, is it something that they should be using or only if they're struggling with that?

Yeah, look, I don't think you should seek to put additional pressure on yourself when it comes to conceiving.

So if you have a regular, certainly a 28-day cycle, if your menstrual cycle is 28 days, then you're almost certainly going to ovulate on day 14.

The second half of your cycle from ovulation to the start of your period, is typically 14 days, regardless of the length of your cycle.

So if you have a 30 day cycle, you're going to ovulate on day 16.

If you have a 26 day cycle, you're going to ovulate on day 12.

So just if you have a regular cycle and you know the length of it, just count 14 days back from the first period.

another listener shane got in touch and i was a patient of shane's last year i'm actually getting weepy listening to him today because my son is nearly one years of age he was a great physician would be interested to get his opinion on the impact of the removal of the consultant-led clinical pathway option for women current private option

But you're going to tell us a little bit about this iconic building, because from the moment we arrived with the team here this morning, you can nearly feel the history, Shane, when you come in the door.

Absolutely, Andrea.

And I think the National Maternity Hospital has been part of not just the Dublin landscape, but the Irish landscape for well over 100 years.

There was a hospital on this site in 1883 and it only survived nine years.

It ran out of funding and therefore it closed in 1893.

And then as a consequence of that loss, the Catholic community and the religious individuals in this area felt that there was a need for a Catholic hospital.

to look after particularly the women who lived in the tenement slums in Irish Town, Ringsend and Sandymount.

And you notice to the odd picture of some famous faces along the way.

What's the first thing that happens?

Well, so you deliver the baby, the next thing that has to happen is delivery of the placenta, and if, and this is assuming it's a vaginal birth, and if there's an episiotomy or a tear, then that would be repaired as well.

So that all takes place in that 10, 15 minutes after the birth of the baby.

[smacks lips] The baby is often taken away, um, to the resuscitator, which is a, a, just a c- in the corner of the room.

And it allows the staff that are present, whether they're midwifery or neonatal staff, to assess the baby, make sure that its breathing is established, that its heart rate is good, that its color and its tone, so that the baby has responded appropriately to being delivered and life outside the uterus.

Mom, meanwhile, is, uh, anything that needs to be done in terms of the placenta, as I said, episiotomy tear is repaired.

And then, uh, everything kind of settles down to the b- mom and baby and dad all having an opportunity to bond skin to skin, establish feeding, have maybe some tea and toast.

When you're doing the checks on the baby though, what are you looking out for?

What's the first thing that happens?

Well, so you deliver the baby.

The next thing that has to happen is delivery of the placenta.

And this is assuming it's a vaginal birth.

And if there's an episiotomy or a tear, then that would be repaired as well.

So that all takes place in that 10, 15 minutes after the birth of the baby.

The baby is often taken away to the resuscitaire, which is just in the corner of the room.

So these are the tests that happen in the subsequent days after birth.

do you expect then?

Well, I suppose the key thing once you arrive at the hospital is, are you in labour or are you not? And there are other things that might be happening at this time.

You might have a show, your waters might have gone, and that doesn't necessarily mean that you're in labour.

So all these things are part of the constellation of features that occur around labour.

But When you come in, pains are strong.

You'll be examined and a decision will be made.

Yes, you are in labour, in which case you'll be in the labour ward and you'll have a single room and the opportunity to hydrotherapy, if you wish, whether it's a shower or a pool.

Is it true that the public are put off getting a planned C-section?

And that, so just on, like how, and it's probably a stupid question, but how will you know that that pain is their pain? Do you know what I mean?

Okay.

So I suppose the type of pain that you're talking about that would reflect good uterine activity would be pains that would stop you in your tracks.

So you wouldn't be able to walk, you'd be probably bracing yourself on a piece of furniture.

You wouldn't be able to have a conversation with somebody.

They, they, they, they become increasingly frequent and more regular and stronger as the, uh, onset of labor, uh, commences or continues.

So for patients who are pregnant for the first time, we would say, "You know, you can stay at home as long as everything else is okay, until the pains are maybe every four or five minutes apart," and they're typically lasting 30, 40 seconds at that point in time, but they are really strong pains.

What do you expect then?

Why is that?

So multiple pregnancies have certain risks.

They've got a greater risk of certain things happening than, say, a patient who's pregnant.

with a singleton pregnancy.

So you're more likely to deliver the babies prematurely.

So the risk of preterm birth is higher with multiples.

The risk of gestational diabetes is higher with multiples.

How will my body change to adapt to this baby? And is it more likely to move around with extra space? What are the chances the baby will be breech actually at full term?

Why is that?

So multiple pregnancies have certain risks.

They've got a greater risk of certain things happening than, say, a patient who's pregnant.

with a singleton pregnancy.

So you're more likely to deliver the babies prematurely.

So the risk of preterm birth is higher with multiples.

The risk of gestational diabetes is higher with multiples.

How will my body change to adapt to this baby? And is it more likely to move around with extra space? What are the chances the baby will be breech actually at full term?

Mm

... that are, are very important for their wellbeing.

And I, and I think it's very important that patients, you know, liaise with, A, their, their, their primary provider when it comes to the o- other medical conditions, but when they come to a hospital like Holles Street, they'll be referred to the Maternal Medical Disorders Clinic, which is a clinic we run every week, um, and there's a number of consultants that attend this clinic, where we look after patients who are pregnant with these comorbidities.

And if they are on medications, then we would liaise very closely with their, uh, like, the consultant looking after their disease to ensure that they're on safe medication.

If it needs to be star- started or stopped at certain times during the pregnancy, we'll do so.

We have a very good pharmacy department in the National Maternity Hospital that help us when it comes to making decisions about the safety and efficacy of medications in pregnancy, preg- uh, uh, dosages that might need to change, et cetera.

So, uh, we are seeing more and more of, um, more and more patients coming to the hospital who are on medications.

Should I be worried?"

Mm

... that are, are very important for their wellbeing.

And I, and, and I think it's very important that patients, you know, liaise with, A, their, their, their primary provider when it comes to the o- other medical conditions, but when they come to a hospital like Holles Street, they'll be referred to the Maternal Medical Disorders Clinic, which is a clinic we run every week.

Um, and there's a number of consultants that attend this clinic, where we look after patients who are pregnant with these comorbidities.

And if they are on medications, then we would liaise very closely with their, uh, like, the consultant looking after their disease to ensure that they're on safe medication.

If it needs to be star- started or stopped at certain times during the pregnancy, we'll do so.

We have a very good pharmacy department in the National Maternity Hospital that help us when it comes to making decisions about the safety and efficacy of medications in pregnancy, preg- uh, uh, dosages that might need to change, et cetera.

Should I be worried?"

Mm.

You might have it because you have a breech presentation.

You might have it because you've had a previous cesarean section or previous surgery in your uterus.

So you know well in advance.

Emergencies, uh, are, are essentially the same surgery but that they're not scheduled.

You come in, you might be in labor, the baby's not d- tolerating labor well, you might have had a bleed, you might not be making progress.

They're an emergency cesarean section, and they're the same surgery, but the reality is there's no real preparation for those.

... panic.

We're talking, I suppose, more specifically about C-sections and emergency C-sections, Shane, this afternoon and really the things that people need to know in advance.

Yeah, look, I mean, we use different terms to describe caesarean sections, but essentially the surgery is the same almost all the time.

There is a type of caesarean section called a classical, which occurs very, very rarely, most commonly in very premature cases.

But for the most part, you have what's called a lower uterine segment caesarean section.

And the use of the term scheduled emergency refers more to the timing.

So if you have a scheduled caesarean section, it's planned in advance.

You might have it because you have a breech presentation.

What can I expect from the planned section? And actually, how will my day look?

Yeah.

But very important.

And there's not that much written about the partner's role in pregnancy.

And I use the term pregnancy because it's not just about labour.

I see partners now, and I've seen it over my career more and more, that they're involved really from the word go.

They come to all the antenatal visits.

They're as excited about the scans.

Yeah.

Yeah.

But very important.

And there's not that much written about the partner's role in pregnancy.

And I use the term pregnancy because it's not just about labour.

I see partners now, and I've seen it over my career more and more, that they're involved really from the word go.

They come to all the antenatal visits.

They're as excited about the scans.

Yeah.

I'm wondering what are the chances of having another preterm baby?

Well, that's a very good question.

So your risks are increased because you've had one preterm baby, and, uh, it's very important if you've had a preterm birth that you are referred to a preterm clinic, a preterm, a dedicated preterm service, again, one we have at Holles Street, where they will take a very detailed history, perhaps do some investigations, some scans of your uterus for the shape, of your cervix for the length, um, either before or early on in a subsequent pregnancy to see if there's any underlying reason why you might have delivered early.

So there's lo- again, like, like with miscarriage, there are lots of reasons why somebody might have a pregnancy, an early, a pregnancy delivered early.

Uh, one of the conditions that we specifically look for is a condition called cervical incompetence, where the cervix is weak, and therefore, once you get to a certain gestational age, the pregnancy essentially just falls out.

And it's very important that if that was suspected in the previous pregnancy, then you're monitored very closely with cervical-

Yeah.

We, we refer to it as an ERPC, which is an evacuation of retained products of conception, and that's the surgical approach to managing a miscarriage or, uh, whether it's complete or incomplete.

If you've had an early preterm baby, I'm wondering what are the chances of having another preterm baby?

Well, that's a very good question.

So your risks are increased because you've had one preterm baby.

And it's very important if you've had a preterm birth that you are referred to a preterm clinic, a dedicated preterm service.

Again, one we have at Hollis Street.

where they will take a very detailed history, perhaps do some investigations, some scans of your uterus for the shape, of your cervix for the length, either before or early on in a subsequent pregnancy to see if there's any underlying reason why you might have delivered early.

So there's, again, like with miscarriage, there are lots of reasons why somebody might have a pregnancy deliver early.

Is there anything I can do or take?

So if you have any of those symptoms and you present at A&E or you go into the maternity hospital and it's discovered that you're having the ectopic pregnancy, is surgery then the next step?

Not always.

So I suppose, first of all, it's trying to get to the diagnosis.

And if you have a positive test, if you're very early in pregnancy and you might not be able to see anything in the uterus by way of an ongoing intrauterine pregnancy, then you monitor blood levels of HCG to see if they're rising in accordance with an ongoing pregnancy.

If they're not rising to the levels that you would expect over a 48-hour period, then your suspicion is raised.

But there are ultrasound features that you would look for.

So you might see the ectopic in the fallopian tube.

Has Shane any advice on what I might do or what I can do to help me conceive again or if I now need to start seeking medical help?

So if you have any of those symptoms and you present at A&E or you go into the maternity hospital and it's discovered that you're having the ectopic pregnancy, is surgery then the next step?

Not always.

So I suppose, first of all, it's trying to get to the diagnosis.

And if you have a positive test, if you're very early in pregnancy and you might not be able to see anything in the uterus by way of an ongoing intrauterine pregnancy, then you monitor blood levels of HCG to see if they're rising in accordance with an ongoing pregnancy.

If they're not rising to the levels that you would expect over a 48-hour period, then your suspicion is raised.

But there are ultrasound features that you would look for.

So you might see the ectopic in the fallopian tube.

Has Shane any advice on what I might do or what I can do to help me conceive again or if I now need to start seeking medical help?

Yeah,

so gynae, typically gynecological complaints that might have a bearing on either getting pregnant or the impact they might have on pregnancy.

I suppose the three that spring to mind that most people will have heard of would be endometriosis, which has been very much in the news with the minister's announcement of an endometriosis strategy in the last probably six, eight months.

So patients with endometriosis often feel that their voice isn't heard because they can complain of... perhaps less specific, more vague symptoms, but nonetheless have quite significant disease.

And the disease is largely going to be diagnosed on the basis of a laparoscopy, where you actually visualise the endometriotic lesions in the pelvic sidewalls around the ovaries.

So depending on how the endometriosis is impacting on the patient, it might affect how the fallopian tubes work.

and therefore the transport of the egg, fertilised egg, to the uterine cavity.

Oh yeah,

Yeah,

so gynae, typically gynecological complaints that might have a bearing on either getting pregnant or the impact they might have on pregnancy.

I suppose the three that spring to mind that most people will have heard of would be endometriosis, which has been very much in the news with the minister's announcement of an endometriosis strategy in the last probably six, eight months.

So patients with endometriosis often feel that their voice isn't heard because they can complain of... perhaps less specific, more vague symptoms, but nonetheless have quite significant disease.

And the disease is largely going to be diagnosed on the basis of a laparoscopy, where you actually visualise the endometriotic lesions in the pelvic sidewalls around the ovaries.

So depending on how the endometriosis is impacting on the patient, it might affect how the fallopian tubes work.

and therefore the transport of the egg, fertilised egg, to the uterine cavity.

Oh yeah,

Well, what, what myths do people have, I suppose, with labor, firstly? What are those kind of misconceptions you have to?

Oh, I, I, well, okay, there's, there's, there's ones that are really, have no foundation, and they're the kind of things that might start labor off, and dates, all of that.

Now, when it comes to, uh, the application of evidence, we, we kind of look at the quality of the evidence that supports, uh, the use or not use of something, and we try to use evidence-based practice in, in all disciplines of medicine.

And there's a hierarchy of studies and trials that tell you, "This works.

This doesn't work," and a lot of what patients will have heard from friends, relatives about these things, there is no scientific evidence to support them.

And a lot of people think that if you get your bowel moving, and that's what these things do, they increase the transit time of the gut, that it's going to have a knock-on effect on the uterus and make it, uh, make you go into labor.

It doesn't.

What happens?

Right, well, what myths do people have, I suppose, about labour firstly? What are those kind of misconceptions you have to...

Well, OK, there's ones that really have no foundation and they're the kind of things that might start labour off and dates, all of that.

When it comes to the application of evidence, we kind of look at the quality of the evidence that supports the use or not use of something.

And we try to use evidence based practice in all disciplines of medicine.

And there's a hierarchy of studies and trials that tell you this works, this doesn't work.

And a lot of what patients will have heard from friends, relatives about these things, there is no scientific evidence to support them.

And a lot of people think that if you get your bowel moving, and that's what these things do, they increase the transit time of the gut, that it's going to have a knock-on effect on the uterus and make you go into labour.

I find pregnancy very difficult.