The Baby Tribe
The Baby Tribe podcast is dedicated to providing parents and caregivers with the latest information and expert advice on maternal health and well-being during pregnancy and the postpartum period, in addition to infant health, nutrition, and growth. This podcast covers all the important topics to ensure both you and your little one get off to the best start. The podcast is hosted by the husband and wife duo, Professor Afif El-Khuffash, a neonatologist, paediatrician, and lactation consultant, and Doctor Anne Doherty, an obstetric anesthesiologist with expertise in maternal care. Both Anne and Afif work at the Rotunda Hospital in Dublin and together bring over 40 years of combined experience in newborn and maternal health. We share our knowledge and insights on everything from breastfeeding and formula feeding, to introducing solid foods, maternal recovery, and dealing with common health concerns for both mother and baby. We’ll have regular guests to share their expertise and experiences on various topics of interest, and we’ll also hear from real parents sharing their personal experiences and tips for raising healthy and happy families. Whether you're expecting your first child or navigating the postpartum period, this podcast is for you. Tune in each week for valuable information and practical advice to help you and your baby thrive. Please be sure to subscribe to our podcast, and follow us on Instagram! Thanks for joining us, and let’s continue this exciting journey together!
The Baby Tribe
127: When Birth Doesn’t Go to Plan: Understanding Postpartum Care
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This show is part of the Head Stuff Podcast Network.
SPEAKER_02Welcome to the Baby Tribe. I'm your host, Afi Felkafash, genatologist, pediatrician, and lactation consultant, and my co-host is Anne Doherty, obstetric anesthesiologist. Today we're talking about escalation of care after delivery, what doctors and midwives are watching for, how they spot when something's wrong, and what happens next, from the ward to high dependency to ICU. Because here's the thing: most women are completely fine, but when things go wrong, they can go wrong very quickly. And the difference is often how fast it's recognized and escalated. And thankfully, I am joined by somebody who actually knows what she's talking about. My lovely wife Anne, consultant anesthesiologist, specializing in obstetrics. She deals with this in real life while I just talk about it into a microphone and pretend I'm helping. Anne, welcome to the baby tribe.
SPEAKER_01Thanks, if you've now getting nervous. And I do this all the time.
SPEAKER_02You do this all the time and you get nervous. But anyway, I'm really enjoying spending a lot of time with you now. Ann and I have started watching something, a new series, which we haven't done in a long time. Margot's Got Fiscal Challenges.
SPEAKER_01Oh, I love it. Is it money money problems? Is that not what it's called?
SPEAKER_02I don't know. It's Margot's Got Fiscal Challenges. I think it's called Margot's Got Money Troubles.
SPEAKER_01I think that's what it's called. Fiscal challenges.
SPEAKER_02Well, it's true. Yeah.
SPEAKER_01Margot's Got a Monetary Conundrum.
SPEAKER_02Yeah, I know. It's got Nick Offerman, one of my favourite actors. Yeah, he's Michelle Pfeiffer. Yeah, she's a big one. Nicole Kidman. Yeah. And I forget who Margot is, sorry.
SPEAKER_01Elf El Fanning?
SPEAKER_02Yeah, maybe. Yeah.
SPEAKER_01Yeah.
SPEAKER_02It's really good. The first episode was quite.
SPEAKER_01It's not one to watch with the kids, though.
SPEAKER_02No. Yeah. Yeah. It's boobs in it.
SPEAKER_01Just boobs.
SPEAKER_02Yeah. But it's very funny because I heard a lot of people talking about how traumatizing the first episode was because it was a true representation of what it's like to have a newborn.
SPEAKER_01Yeah. That's actually very true, actually.
SPEAKER_02Yeah, and you know it was written by women because it was very real.
SPEAKER_01Oh, 100%.
SPEAKER_02Yeah.
SPEAKER_01You could tell immediately from the off that it was very like, yeah, this is just how it is. I'm not gonna Hollywood this up for you.
SPEAKER_02Yeah, no, it's very good. Really, really enjoyed it. It's four episodes in, it's a really easy watch, and it's on Apple TV.
SPEAKER_01Oh my god, you're like doing a whole little ad for it there.
SPEAKER_03I know, yeah.
SPEAKER_01The show is not sponsored by Margot's Got Fiscal issues.
SPEAKER_02Yeah. Anyway, today's episode, it's a very good one because do you remember, guys, when I did What to Expect When a Baby's Admitted to the ICU, and was like, what about the mothers? We need to actually do an episode informing mothers of what might happen or the sort of escalation care pathways.
SPEAKER_04Yeah.
SPEAKER_02That what might happen. And just to emphasize again, while most women are totally fine and don't need any escalation of care, there is a subset of women that will need some sort of escalation of care.
SPEAKER_01And generally they're also fine at the end of it.
SPEAKER_02So I have put together some questions that I would like to ask you.
SPEAKER_01Okay, hit me. We'll see how we go with this.
SPEAKER_02Okay, first of all, let's start simple. So after a straightforward delivery, what level of monitoring does a mother actually get?
SPEAKER_01So any person who's admitted to hospital in pregnancy, be they antenatal or postpartum.
SPEAKER_03Yeah.
SPEAKER_01Okay, um, if you're antenatal, the standard ward level of care is that your vitals would be checked twice in 24 hours and plotted on a standardized graph called an IMUS, which stands for Irish Maternal Early Warning System. And in the postpartum period, um on arrival to the postnatal ward, you get your vitals checked in uh the first 12 hours on the ward, and then once at least, at least once every 24 hours afterwards. Okay, just so that people have the minimum level of monitoring, but that is uh that can change even on the ward depending on what your readings are.
SPEAKER_02So just so people are aware, what are you checking for? What are vitals?
SPEAKER_01Okay, so that's temperature, blood pressure, heart rate, oxygenation. Okay, um, and that's all just plotted on a standardized chart that everybody's the same chart. It's colour-coded. So the early warning system, it's it's a Ireland actually did this really well. So I would just like to point out things that we have been doing well, probably earlier than other systems. Um ages ago, um, they implemented the early warning system, I can't remember, like at least a decade ago, if not longer. Um, and what that does is it's a standardized way of looking and reporting and communicating variations from what would be deemed as normal for women in pregnancy and the peripartum period in terms of their vital signs. Okay. Right? And what that did was it allowed us to identify and allow us to allow us to identify women who are deviating from expected pathways. For nurses on the ward and midwives on the ward to have a standardized way to communicate that to medical staff where necessary. So it just takes um a lot of the ambiguity out of it. Yeah, there is a standardized approach to it, it's auditable, it's reportable, it's examinable, therefore you can spot gaps in the system. It's really useful. And this is across all of our maternity units, no matter what maternity unit you're in. And even as recently as just before the pandemic, I remember going to a conference in another country and they were talking about how they were going to figure out how to implement this. And I was like, oh my god, this is like such a reflex for us in Ireland already, you know. I do like pointing out things that the Irish system does well, because I think it does get a lot of bad press, sometimes justifiably so, but as well, it doesn't hurt to have a balanced representation of what we do.
SPEAKER_02So when you walk on the ward and you assess a mother, you have the vitals that we spoke about. But what are the maybe subtle things that make you go, hmm, I don't like this?
SPEAKER_01So it really depends on what the underlying differential diagnosis is when you look at somebody. Say you're being called to a high, I've got a woman here who's 24 hours after having her baby, and her heart rate is persistently high.
SPEAKER_04Okay.
SPEAKER_01Okay. Um, so A, it'll depend on how high. If it's slightly elevated, but persistently, slightly elevated, you're going to start thinking about things like was blood loss a little bit more than anticipated at the time of delivery? Um, so therefore, she's kind of catching up still on some intravascular volume, and you that needs to be addressed. Could there potentially be like an underlying infection or something like that? Or could it be a cardiovascular issue like an evolving cardiomyopathy? But that would be, so that means like uh an evolving um kind of transient heart failure that women can go into that's rare, but it's in there as uh something that can present that subtly. Now, the most common thing would be either volume or a low-grade infection, which are both reasonably easy to fix, but you'll always have the other more rarer things there in a tick box. And this is how most doctors will approach a very simple thing. But the nice thing is about the early warning system is that it will be communicated, it will be picked up, it will be graphed in a standardized way. Yeah so some basic assessments will be done from then on, and then if it's warranted, so really what triggers escalated care, right? So movement from ward-level care to a more monitored environment like high dependency or even into uh ICU intensive care is the level of monitoring required because ward level monitoring for those vital signs can increase up to four hourly on the ward for a period of time if it's warranted. So somebody who's potentially got that persistent heart rate, we suspect it's down to like the early infection. She started her antibiotics, she's getting her IV fluids, the early interventions are being done, but she's actually pretty well and she has very little symptoms. It's just been picked up on early warning. Um, and maybe she'll go to more frequent blood pressure and vital signs monitoring for a period of time, and then she'll get better because the antibiotics and the IV fluids will kick in, and then that'll be de-escalated again without ever needing to go to high dependency.
SPEAKER_04Yeah.
SPEAKER_01But if somebody needs more frequently than four-hourly, or four-hourly for a prolonged period of time, because of the level of um kind of monitoring workload that that puts on a ward-based environment, you can't compromise that patient's care or another patient's care by kind of not supporting that. So they'll move to something like a high dependency environment where it's one-to-two nursing, so a one nurse for every two patients, and therefore it's much easier to support and monitor that patient.
SPEAKER_02Yes. So sometimes transferring to high dependency from ward level, it is due to we want to monitor more closely rather than you are getting sicker.
SPEAKER_01Yes, and it's just and again, it depends what's happening on the wards. High dependency isn't a geographical place. It it's off it's often easy and better to cohort sicker patients in one's own so that you can efficiently monitoring the monitor them and efficiently respond to higher levels of like required care.
SPEAKER_04Yeah.
SPEAKER_01But it's high dependency is about the the monitoring of the patient, not the geography.
SPEAKER_02Yeah. You said a couple of things that I want to go back and ask about. A high heart rate. What is a high heart rate in an adult human mother?
SPEAKER_01Okay, so in a normal adult human non-pregnant person, it's anything, oh, a normal heart rate is 60 to 100. Okay. Okay. In pregnancy, your baseline heart rate increases because you're moving more volume around to get to the baby. That metabolic demand is much higher. Yeah. As we all know, and social media is really spreading the message, and I love them for doing that sometimes. Um, because the the metabolic demand to grow child is huge. So heart rates can be kind of 80 to 100. Sometimes some people come through and they've been running at about 100, 110 for a lot of their pregnancy. Yeah. So it's about understanding what's normal for her and then deviating from that. But somebody who's got a persistent heart rate of about like say 115, 120, those kind of things, we would definitely be looking at it.
SPEAKER_04Yes.
SPEAKER_01Um, but usually they'll still trigger around 100, 105, where you're kind of going, that's on the higher end of what it would what I would expect.
SPEAKER_02And then you talked about estimating blood loss. How does one estimate blood loss around delivery?
SPEAKER_01Okay, so most guidelines and most maternity centres in Ireland are moving toward measuring blood loss, not estimating blood loss.
SPEAKER_04Okay.
SPEAKER_01There used to be kind of a kind of an estimate of X amount of blood on here is equivalent to 50 mils, X amount, this is equivalent to 100 mils, and it would be estimated that way. But most blood loss now in a lot of the bigger centres, and I would say most of the maternity centers are moving toward measuring blood loss for all kinds of deliveries. Okay. So, and that is literally weighing swabs, weighing absorbent sheets, weighing drapes. Um, so when a baby is delivered, the amount of amniotic fluid, so if you're having a C-section, the amount of amniotic fluid will be noted, and that volume will be taken away from the final weight of the swabs of suction of the drapes, all of that. So you get a a reasonably accurate, accurate quantitative assessment, not not estimate, but a quantitative assessment of blood loss. And we're moving to doing that now for vaginal deliveries as well, where um there is an under like the drapes and everything are weighed, and if somebody is starting to bleed in the postpartum period after delivery of the baby, after the amniotic fluid has all been accounted for, we'll go with, then they'll put in a what we call an under buttock drape, which literally collects the blood loss. So we actually can measure then exactly what the blood loss is and allows us to respond more accurately and more quickly and more appropriately.
SPEAKER_02What other things can you watch out for or you should potentially watch out for after delivery? Blood pressure changes, I guess?
SPEAKER_01Yeah, so any any deviation, so like fever, heart rate changes, blood pressure changes, any woman who just feels unwell, you know, they will have their vital signs checked, they will be plotted, they will be trended over time. So you can actually you can you can see the evolution of changes from baseline and from what that lady's baseline is. Also, whether or not she has any pre-existing condition. Okay, so somebody who's had high blood pressure in this pregnancy, is this now evolving into pre-eclampsia? Um, so with that you might see um a fall in urine output or even a change in oxygen saturations as they accumulate more fluid related to their pre-eclampsia, um, or persistent high blood pressure that was previously better controlled on their existing medications and all of that. Um, and then also what she herself will tell you she's experiencing also plays in, obviously, to history, you know, um, and her own sim reported symptoms. Uh the most common reasons for admission to an escalated care environment like high dependency or ICU are sepsis, okay, and by sepsis I don't mean like I she spiked a temperature, she might have a small like perineal or UTI or something like that that's easily managed with oral antibiotics. By sepsis I mean that she's got persistent um signs and symptoms of infection. Yes that warrants escalated monitoring.
SPEAKER_03Okay.
SPEAKER_01So the simple things like early antibiotics and some fluids aren't like like you would give yourself at home, aren't you cut aren't cutting it. Um so therefore she might need um escalated monitoring for that period of time until things kick in or to make sure that it's not uh disimproving. And then severe sepsis is sepsis with evidence of organ dysfunction. So a fall off in urine output or a change in your kidney function, a drop in your oxygen saturations, um, persistent fever despite getting your paracetamol and all those kind of things. Um, a change in your lactate, and lactate is very useful to look at because women tolerate all of these physiological changes so well that sometimes the lactate is what we will be going on. And what lactate really measures is Yes, so explain lactate to us. So lactate is a normal byproduct of lactate is people that get lactate in their muscles if they're exercising heavily because their muscle demand is greater than the oxygen they were supplying to their muscles. It's not harmful, it's just a measurement of of metabolic demand.
SPEAKER_04Yes.
SPEAKER_01And really what happens is if you have sepsis and then your lactate starts to go up, it means that your body's metabolic demand is not being met by the normal level of oxygen and perfusion and delivery of that oxygen. So it's not necessarily that your your breathing oxygen is going down, it's that your delivery of oxygen to your organs is being impaired by the infection.
SPEAKER_04Yeah.
SPEAKER_01Okay, so that's a perfusion issue. Um, and that means that then your lactate will start to go up, and it's called, I suppose, a distributive issue, you know, rather than an actual breathing issue, you know.
SPEAKER_02So let's talk a little bit more about the difference between HDU and ICU.
SPEAKER_01HDU, okay, and this is actually true regardless of pregnancy or not pregnancy. So it's it's actually useful healthcare literacy information for people in general. High dependency is a level of increased monitoring above ward level care with two patients to every nurse, ideally, okay. So one is to two nursing. There can be say vasopressor blood pressure support available.
SPEAKER_02So those are medications.
SPEAKER_01So a medication to support your blood pressure, sometimes with sepsis, sometimes with shock for various different causes, um, be it heart failure, be it a lot of different reasons for shock, um, your blood pressure can dip. And what you want to do is you need to go on medication to maintain your blood pressure at a good perfusion pressure for your vital organs and limit the amount of dysfunction that they're going to be suffering as a result. So you can be on vasopressor support in a high dependency area and increased level of monitoring.
SPEAKER_03Okay.
SPEAKER_01Um, and that's what that would provide for you there. So you're on continuous in if you're on vasopressor support, you're probably on continuous monitoring. But at a minimum, in a high dependency area, you'll have hourly blood pressures, hourly temperatures, hourly vital checks, hourly urine output assessment. So it's quite intensive nursing care.
SPEAKER_03Yeah. Okay.
SPEAKER_01Right? Um, and quite intensive level of monitoring, but um a minimum level of organ support is how I would describe it. So blood pressure support primarily. Yeah. Okay. ICU then intensive care is one of the highest levels of care. And that is where the multisystem organ support lives. Okay. So that is where people may be intubated and on a ventilator. People will be on blood pressure support and could be on multiple medications for that. People will have uh organ support such like dialysis, continuous low-level dialysis that is a bit more gentle than the intermittent dialysis that people who would be kind of at a better level of baseline health will be able to tolerate. Multiple different kinds of organ support required, and then it definitely that patient definitely needs to be in an ICU environment. Okay, and that's a one-to-one nursing care at all times, continuous monitoring, invasive monitoring. The patients are generally there for a longer period of time and are kind of have a much greater burden of illness.
SPEAKER_02Yeah. So what is invasive monitoring?
SPEAKER_01So invasive monitoring, so uh blood pressure, oxygenation, all of those kind of things, counting your breaths per minute, all of that is non-invasive monitoring. It happens from a little cuff that goes around your arm, it happens from a little peg that goes on your finger, and it happens from somebody with um, you know, uh a clever person at the end of the bed watching how you're breathing and doing all of that. Okay. Um, invasive monitoring is where, so for blood pressure monitoring, what we do is we put in, it's like a little drip line, but it goes into one of the arterial blood vessels. So it goes into your blood pressure. Into your artery, okay. And that tells us what your blood pressure is every single time your heart beats. Aneasiths love that, intensivists love that, because we love rapid, instantaneous information as soon as we look at a monitor. Yeah, we are instant gratification kind of people, but we love it because when there's a small or rapid change, we see it pretty much immediately and we can respond pretty much immediately. So we love that. The other reason why you might have an arterial line like that placed is if you need frequent blood serum analysis, so we can draw back blood samples and we don't have to go poking people with needles all the time.
SPEAKER_03Yeah.
SPEAKER_01So for somebody, say a diabetic who's got diabetic ketoacidosis or something like that, where they need serial electrolyte and uh blood pH checks um every, say, two to four hours, you do not want to go stabbing them every two to four hours for venous sampling. You can put it in an arterial line, draw back on that painlessly without without having to go in with it with a needle every time. So that's another reason for invasive molecular. Yeah, and ideally it shouldn't be that uncomfortable to be honest if you do it well. But um just to say, but um then the other thing that is is done invasively is it's called central venous access. Okay, so a central venous can uh catheter or cannula. Um and that can be put in for if there's a few different kinds that can be put in, um, but they go into the bigger blood vessels that are closer to the heart, and what we can do is we can measure your central venous pressure from them.
SPEAKER_02Where does that go in?
SPEAKER_01So it can go into a few different places actually. It can go into the groin, then not to get a lot of central venous pressure information from it, but it's useful to give very strong medications.
SPEAKER_04Okay.
SPEAKER_01Um, it goes into the or it's it can go into one of the veins in the neck or just at the top of the chest.
SPEAKER_02Can you do those?
SPEAKER_01We do them all the time, yeah. Oh now, I would most of the time people are asleep when they go in. Yeah, they can go in awake. Sometimes we do have to do them awake. Yeah. Um, but most of the time people are asleep. They go in ultra under ultrasound guidance nowadays.
SPEAKER_02God, your job's very complicated, isn't it?
SPEAKER_01Well, this is what I keep on telling you, Fife. Yeah, you just don't believe me.
SPEAKER_02I thought it was just knobs of gas, like you know, yeah, push the drugs and take out the sudoku.
SPEAKER_01Yeah. Uh no, no, that's not it.
SPEAKER_02Wow. Hey there, Baby Tribe listeners. Did you know that we've got some amazing bonus material just for you? Baby Tribe Shorts is here. Quick evidence-based breakdown of all things science when it comes to mum and baby. You can find it as part of the Headstuff Podcast Network. You can subscribe to Headstuff Plus for as little as five euro a month. We'll give you quick evidence-based takes on science behind maternal and infant health.
SPEAKER_01And the best part is it's just 5 euro a month, which helps support us and supports Headstuff and all the incredible shows they produce.
SPEAKER_02You can find all the details on Headstuff Podcasts.com. So how long does a woman typically stay in HDU or ICU?
SPEAKER_01It depends on the reason to be there.
SPEAKER_02Okay.
SPEAKER_01Okay. In an obstetric setting. So let's go back to obstetrics, okay? The most common reasons to go to an escalated care environment in obstetrics, as I said, is preeclampsia, hemorrhage, and sepsis. And I would say about 60% of people do not stay longer than maybe about two days.
SPEAKER_03Yeah. Okay.
SPEAKER_01So it tends to be, and it it's it's more power to the women that are there, to be honest. Um, because you know, these are generally young, healthy women who've had a setback in their perinatal journey that just needs a bit of extra help. Yeah. And they respond really well to medications and they're out of high dependency in just a couple of days and back to word-level care.
SPEAKER_03Okay.
SPEAKER_01Um so now it does mean that their recovery period in the peripartum is probably a little bit longer, right? Um, than just somebody who doesn't suffer those setbacks. Um, but it they they do recover quite quickly and they're amazing for that.
SPEAKER_02And how common is this? How common are women admitted to HDU and ICU?
SPEAKER_01Okay, so it's a between three and five percent of all pregnancies go into an escalated care pathway. So most of those women are high dependency. Yeah. Right? Only I think less than 0.5% of pregnancies in Ireland will end up with the mum and going to intensive care. And again, it's because these women are generally young, fit, and healthy, very robust women, their physiology and the adaptive changes in pregnancies are excellent and and they recover so well.
SPEAKER_03Yeah.
SPEAKER_01Um, and again, early warning, early intervention, spotting the changes early, intervening early, all of those things matter and they save lives. So it just to kind of talk about kind of over-medicalization of childbirth, you know, the monitoring is there for a reason, it works. We we ideally find you early if you're going to need that help.
SPEAKER_03Yeah.
SPEAKER_01And we intervene early, and that actually shortens the duration that you will need that help. I know it's not great, women just want to come in and have their babies go home, but ideally, if you do need that help, it's great to find you early.
SPEAKER_02I know 5% sounds like not a big number, but when you're actually in a hospital that delivers close to 9,000 babies, you're talking about 450 mothers that need escalated care.
SPEAKER_01Yeah.
SPEAKER_02So it's common enough.
SPEAKER_01And that hourly level of monitoring, which is is a lot like And that's roughly 10 women a week. Oh, yeah.
SPEAKER_02You know, if you think about it. So I mean it's not common, but it's common enough that every maternity hospital needs to be good at this.
SPEAKER_01Anesthetist in Ireland, we train in in our anesthetic training, firstly, in both ICU and anesthesia. So the mid-part of our anesthetic training is spent doing a lot of intensive care call.
SPEAKER_03Yes.
SPEAKER_01And it's really valuable to have that partnership. Now, not every intensivist in Ireland came from anesthesia, right? Um, and not every anaesthetist is an intensivist, okay, and they do diverge eventually. Um, but having a strong foothold in both fields initially is really, really beneficial to the Irish healthcare system.
SPEAKER_04Okay.
SPEAKER_01Because it means that for places that have standalone maternity units, or even for maternity units that are alongside or within normal kind of tertiary referral centre hospitals, right? It means that the ENISA, this looking after the maternity ward have the benefit and experience of having gained those skills, having watched people get sick and understand recognizing that turning point in illness and being able to rapidly escalate care is really useful. And there's other jurisdictions around the world that don't train in that way. That anesthesia and ICU are very, very separate. Yes. And I do think that it is we benefit hugely from that link.
SPEAKER_02I think it's great. What's it like for a mother to be in the HDU? So, for example, can um our partners allowed in? Can they see their baby? Can they breastfeed if they want to?
SPEAKER_01Um, for the most part, yes, yes, yes. Okay, okay, so some of this will depend on why mum is there and how well she is and what their plan was originally.
SPEAKER_04Yes.
SPEAKER_01You know? So there's a lot of different factors in this, but in general, the priority is always to keep mum, baby, and partner together, yeah, um, where at all possible. Um, and if if if mum is choosing to breastfeed to facilitate that, our maternity hospitals are set up with our medication pathways that will prioritize breastfeeding and allow breastfeeding safely. Um now, if if generally if the mother is requiring ICU admission or HDU admission um because of issues antenatally, often the baby will need to go to an escalated care. Well, the baby will have a higher chance of requiring escalated care as well, because there's a potential that that was a preterm delivery for both mother and baby reasons, or that you know, mum had some infection and therefore baby needs to be monitored for infection as well and may need intervention for that infection. So it's you know, there's other factors that come to bear on all of this, but generally, where it's possible for a baby to remain with mum, absolutely. Yeah, now it becomes a bit more complicated in an ICU setting, okay? Because automatically the mother is sicker, requiring organ support, she may be intubative ventilated, and if that is the case, she will be sedated.
SPEAKER_02What's it like for mum to be there? Um, you've seen this up close and you've been doing this for a long time.
SPEAKER_01Look, if if you're postpartum and you're on the ward and you get an infection and you require some escalated care, you know, you and you have your baby with you and you have your partner with you, I think that's an awful lot easier than if you have a rapid deterioration while you're pregnant that requires an emergency admission, an emergency C-section or an emergency induction, um, and you have a really difficult delivery, and you have some bleeding, and you're really not feeling well. Like, so I think it really depends on the circumstances. There's more and more recognition of birth trauma, and it's well-warranted recognition. There's more and more supports now becoming it coming into our system, and they are much needed. But definitely, and I always say to women when they're in the high dependency or the ICU or have come back down from ICU, um, that you know, just take the number of the mental health support team and have it on the fridge because it takes weeks to process everything that's happened. Yes. And sometimes months. And it may just be a case that in a few weeks or in a few months you go, God, you know, I might actually give them a call because I think I just need to start touching base and talk it out and debrief and contextualize my experience. And that happens all the time, and it's really useful. People's perceptions of what and why things were happening, especially in a hyper-acute event where everything is fine and then all of a sudden there's 10 people around you because something has rapidly changed. Yeah, you know, all of those times where you can sit down and talk to somebody while you're doing lines nice and slowly and really embed the context in the decision-making process, all of that isn't feasible in that situation. So it's a very rapid response situation. And they're the times when really we try and do it retrospectively where we contextualize everything and find the details, but all of those questions don't necessarily come to mind in the first few days afterwards while you're still in hospital. It might be six weeks down the road.
SPEAKER_02So tell me, are we getting better at this in general?
SPEAKER_01Yeah, our maternal morbidity numbers in Ireland are really good. Yeah, they really are comparative to other healthcare systems. Um there's a few things that we need to do in Ireland and across. So there's an embrace report that's done every triennium, um, and it's UK and Ireland combined.
SPEAKER_02What's the triennium?
SPEAKER_01So every three years, sorry. It looks at the last three numbers, three years, and it looks at the maternal morbidity and mortality numbers over those three years and looks at lessons to be learned. Okay. Um and consistently there's a few vulnerabilities. We are not good at recognizing that tipping point into illness in people of black ethnicity.
SPEAKER_02Yes.
SPEAKER_01We are not good at that.
SPEAKER_02What symptoms should mums never ignore at home?
SPEAKER_01First of all, if you have any concerns, you should seek help. Okay, your instincts are usually fairly good. Okay. Um, but things like so if you look at like the the primary admissions for escalated care, things that pre-eclampsia, so epigastric pain, so pain at the top of your tummy, really bad heartburn that's persistent, especially if it's associated with blurred vision or headache or dizziness, those kind of things, um, that could be potentially pre-eclampsia, and that can even happen in the postpartum as we've discussed. So anything like that where you just don't feel well, absolutely get it checked out. Um, chest pain, chest pain, please get it checked out. Okay, so thrombo embolic disease, I didn't discuss it in this because it's not a frequent admission to high dependency trigger necessarily, um, but it can be. Um, but thromboembolic disease in terms of severe maternal morbidity, and that's a clot that would move from either your legs or your pelvis to your lungs and can give you chest pain. Um, and also maternal cardiac disease is also a significant contributor to severe maternal morbidity. So chest pain, increasing shortness of breath.
SPEAKER_03Yeah.
SPEAKER_01Okay, shortness of breath when you're lying flat that wakes you up at night. Yeah. Always get those things checked out. Yeah. Absolutely. Um, and they're the primary ones. Fever, um, just pain, fever, breathlessness, chest pain, headache, and what about abdominal pain.
SPEAKER_02What about bleeding?
SPEAKER_01So any form of PV blood loss should be reported to the hospital or your obstetrician or your midwife or your GP and just get it checked out. Absolutely.
SPEAKER_02And finally, if someone's listening to this, what would you actually want them to take away from this episode?
SPEAKER_01If you do require escalated monitoring, it's likely to be for a very short period of time. And it's a good thing that we found you, even though it might be a pain in the butt at the time. Just because people want to kind of intervene in your plan to come in, have your baby and go home and maybe extend that. It's something that we're really trained well to do, and we've gone out of our way to try and find you and implement these things to find you early.
SPEAKER_02Excellent. And this has been a fantastic episode. You know so much about things.
SPEAKER_01I know.
SPEAKER_02And your job is very complicated.
SPEAKER_01Uh you see, he has to say this to me, or else, or else I won't do another episode.
SPEAKER_02Anyway, see you next week. Bye.
SPEAKER_00This show is part of the Headstuff Podcast Network, a hub for the creative and the curious. Shows are produced in association with Headstuff and the Podcast Studios Dublin. Find out more or become a member at Headstuff Podcasts.com.