Transcript: Body Changes During Pregnancy: Your Uterus
Preggie Pals
Body Changes During Pregnancy: Your Uterus
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Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
[Theme Music]
DR. RAY KAMALI: Your uterus is a home for your baby for nine months then actively pushes a baby out to be born. How much do you really know about this amazing organ? I’m Dr. Kamali a board certified OB/GYN and today we’re continuing the series on your changing pregnant body. This is Preggie Pals.
[Theme Music/Intro]
ANNIE LAIRD: Welcome to Preggie Pals, broadcasting from the birth education centre of San Diego. Preggie Pals is your weekly online on-the-go-support group for expecting parents or even if you’re not pregnant but you want to be pregnant, go ahead and go to our website www.preggiepals.com and learn up on all of our pregnancy topics, birth topics, anything that you want to know.
I’m your host Annie Laird. Thanks to all of our loyal listeners who’ve joined the Preggie Pals club. Our members get special episodes after each new show, there’s bonus content you can listen to plus special giveaways and discounts. See the website for more information.
Another way for you to stay connected is by downloading our free Preggie Pals app. Now thanks to a listener who chimed in on our website, it’s also available on the Windows market place. We’ve been saying for weeks and weeks and weeks that it’s available in Android and iTunes market places which it is but it’s also available on the Windows market place.
So whatever platform you’re using for your phone, go ahead and download that. It’s absolutely free. So when you’re going around town, you’re waiting at your OB’s office for your appointment, your pushing your older toddler or in Sunny’s case your three other kids or four other kids around in a multi-stroller you know you can listen and catch up on all of our topics and all of our episodes.
Now Sam our producer she’s going to be giving us some more information about our virtual panellist program.
SAMANTHA EKLUND: Thanks Annie. So if you don’t live in San Diego but you’d like to be a panellist on our show you can still participate through our virtual panellist program. Just like us on Facebook and follow us on Twitter using #preggiepalsvp. And also now you can follow us on Instagram in New Mommy Media and check out the #preggiepals.
We’ll post questions throughout the week to prior to our taping and we’d love for you to comment so we can incorporate your thought into our episodes. You can also submit your questions directly to our experts. Learn more about our VP program through the community section on our website www.preggiepals.com
ANNIE LAIRD: Great! Thanks Sam. Alright let’s go around the horn here and introduce ourselves. I’m Annie. I’m the host. I don’t have a due date. I have three little girls and they are 8, and almost 2 and a 6 months old so I’m a busy mom. This is my break right now so I’m having a great time. I’m like eating my lunch…
SUNNY GAULT: Like the two kids around...
ANNIE LAIRD: I’ve use both of my hands I know like what are these things. They’re not holding children right now so awesome.
SAMANTHA EKLUND: I’m Samantha. I’m 22. I’m mostly stay at home mom besides being a producer at Preggie Pals. I have one 18 month old daughter named Olivia and I currently don’t have a due day although I wish that I did. I had an unplanned caesarean with her and I’m hoping for a VBAC next time around.
ANNIE LAIRD: See you always say I wish I did but then like they’re going to go by like and our listeners are listening to these episodes on our website like you’re from now I’ll be like she’s still not pregnant. She’s only 22 that’s sure taking a long time.
SAMANTHA EKLUND: I know right.
SUNNY GAULT: Hey everyone I’m Sunny. I am the owner of New Mommy Media which produces Preggie Pals, Parent Savers, The Boob Group and Twin Talks and I am joining as a panellist today because I love to talk about my uterus. It has been through a lot. I have four children at home…
ANNIE LAIRD: You’ve a super uterus.
SUNNY GAULT: I have two boys and two girls. My boy who’s the oldest is almost 4, my middle guy just turned 2 and then I have identical twin girls who are will be 6 months tomorrow.
ANNIE LAIRD: I know.
SUNNY GAULT: Crazy.
ANNIE LAIRD: You know it’s funny because I see the pictures that you post on Facebook of your girls and I still think of them when they because they don’t come in the studio anymore.
SUNNY GAULT: Yeah
ANNIE LAIRD: It’s kind of hard you know when you’re kids are really little…
SUNNY GAULT: Yeah.
ANNIE LAIRD: It’s easy to bring them in the studio here and they were so little when they were and was like under 10 pounds which isn’t really in my comprehension
SUNNY GAULT: I know.
ANNIE LAIRD: Because my kids come out of ten pounds.
SUNNY GAULT: You’re right.
ANNIE LAIRD: But yeah they’re growing big…
SUNNY GAULT: They are.
ANNIE LAIRD: They’re eating like crazy.
SUNNY GAULT: They are. They’re doing really good.
ANNIE LAIRD: And I love the little earrings that you put on them…
SUNNY GAULT: Oh yeah. They just got their ears pierced. It’s nice because like you said they’re identical and even I was having a hard time telling them apart and so it was nice because just you know few weeks ago we got their ears pierced…
ANNIE LAIRD: So cute.
SUNNY GAULT: One has blue earrings the other one has pink.
ANNIE LAIRD: Oh perfect.
SUNNY GAULT: So now everybody can kind of tell them apart. It’s like genius. So…
ANNIE LAIRD: Yeah because I’m not really big into ear piercing for little kids but you know what I think if I had identical twin girls, easy.
SUNNY GAULT: Exactly.
ANNIE LAIRD: I don’t know.
SUNNY GAULT: No brainer for me.
ANNIE LAIRD: Yeah exactly I’ll be I don’t know how my homebirth midwife will be feeling about that... really can’t we wait a couple of months? No…
SUNNY GAULT: No. Right away.
ANNIE LAIRD: No.
SUNNY GAULT: Out of the birth canal...
ANNIE LAIRD: Well yeah because you had a hospital band for a while…
SUNNY GAULT: Yeah and I was…
ANNIE LAIRD: And you said there was a period of time were like the hospital band wasn’t on you anymore and you were like oh crap.
SUNNY GAULT: Well first of all those hospital bands they’re really hard and you know…
ANNIE LAIRD: Yeah.
SUNNY GAULT: They’re just newborn and they were preemies and they just didn’t want to keep the bands on them so we started to do like ribbons like different coloured ribbons around their wrist and they did that…
ANNIE LAIRD: I thought the ribbon fell off at one time.
SUNNY GAULT: Yeah it did. I was changing the twins and you know it fell off and then I had two babies without any wristbands and I went oh my gosh. So for a few days I really didn’t know who was who until we got them to see their paediatrician and weight them and one had always been who does a little bit more than the other…
ANNIE LAIRD: Yeah.
SUNNY GAULT: Now I can tell them apart believe it or not but my husband still has a hard time and you know other people they don’t really know.
ANNIE LAIRD: There’s identical set of twins in my youngest daughter’s day care.
SUNNY GAULT: Oh really.
ANNIE LAIRD: And yeah I can’t tell the difference but I guess she says one is that they’re ears are a little bit different…
SUNNY GAULT: Yeah. Yeah.
ANNIE LAIRD: Or something like that. So it’s like…
SUNNY GAULT: Moms always know that there’s little new answers...
ANNIE LAIRD: Yeah.
SUNNY GAULT: But still it’s tough.
ANNIE LAIRD: Yeah.
[Theme Music]
ANNIE LAIRD: Alright for our featured segment today we’re going to be talking about a news article that just came out just recently. The title of the article is “Tennessee just became the first state that will jail pregnant woman for their pregnancy outcomes”.
I think it’s a little interesting I think pregnancy outcomes I think oh did you have a vaginal birth or do you have a caesarean birth you know but that’s not what they’re talking about here. They’re talking about that Tennessee became the first in the nation that if you as a pregnant women are taking drugs you know these are illegal drugs, illicit drugs, we’re not talking about you know something that your doctor prescribes you that you as a pregnant woman can be get charged with criminal assault if you use these illegal drugs during pregnancy and the foetus or the newborn is harmed as a result.
So a lot of controversy about this you know is it okay to and I guess it goes in into is it are you kind of with the mom here you know that she’s free to do what she wants to do or you kind of with the baby or both. It’s a really tough thing. One really affects the other so it has lot of the controversy but American Medical Association, American Academy of Paediatrics, American College of Obstetrician and Gynaecologists and other major medical associations they’re a little bit concern.
They’re warning the Tennessee legislature that by criminalizing pregnant women is discouraging them from seeking prenatal care which you know maybe would help them get off these drugs or even in getting off you know drug treatment. So maybe they’ll be taking the drugs even longer because they know they’re going to be getting criminalize. I mean what do you guys think about this?
SAMANTHA EKLUND: I think it’s interesting that in a way in when you tell a woman you know if in outcome is going to become the certain way after you deliver I think it almost takes away a woman’s autonomy because you do have the right to do with what you want with your own body but again you don’t have the right to harm other people in that choice. So I think it’s interesting kind of as a double edge sword. It’s tough.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: It’s been a slippery slope also because then would you say alcohol use during pregnancy is a criminal activity because in some ways theoretically can harm the baby if you over consume.
ANNIE LAIRD: Right.
DR. RAY KAMALI: And then you know and then we just basically go from there but it already happens were you know I covered a hospital every Monday for patients that are drop in meaning that they don’t have prenatal care and they just walk in to the hospital and you know we routinely do a urine drug screen on those patients you know because they don’t have any prenatal care and we just want to make sure we know as much about them as possible. And you know I would say somewhere around 1 in 10 of those patients come out positive from nymphetamines or you know marijuana or you know other drugs. So it does happen that patients you know they have insurance so it’s not an insurance issue it’s that they don’t get prenatal care because they don’t want to be told not to use or not to…
ANNIE LAIRD: Right. Yeah and I guess another thing the article brings up is saying that only 2 in Tennessee there’s a 177 addiction treatment facilities but only 2 of them allow the older children to stay with their mothers when they’re undergoing treatment. So that really makes things hard in you telling a woman you know hey you won’t be criminalize, go and get the help you need but if you got a 2 year old and you know dad is either not in the picture or he’s working then that really ties his mother’s hands you know.
How do they get the treatment and help they need you telling them on one hand you go to jail go get treatment but there’s not a facility for them to go and realistically get that treatment.
DR. RAY KAMALI: I wonder how much they’re intending on enforcing or just a threat to…
SUNNY GAULT: Yeah just a threat.
DR. RAY KAMALI: Yeah just you know if you don’t stop using this you know you’re going to go to jail so…
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: You know but I don’t know.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: It’s interesting though.
[Theme Music]
ANNIE LAIRD: Hi today on Preggie Pals we’re continuing our series on your changing pregnant body. So if you remember we did an episode that was all about the placenta so now today we’re going to be focusing on the uterus. Joining us today as our expert is Dr. Kamali. He’s a board certified OB/GYN. He mainly practices at Sharp Chula Vista Medical Centre. Is that right Dr. Kamali?
DR. RAY KAMALI: That is correct.
ANNIE LAIRD: Alright! He just finished up last year as the chairman of the Department of Obstetrics and Gynaecology. So spending more time with your kids that’s great.
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: It’s awesome. Dr. Kamali welcome to the show thanks for joining us today.
DR. RAY KAMALI: Thanks for having me.
ANNIE LAIRD: Alright well to start off this interview, let’s talk about like what is a uterus? It’s like where is it in the body?
DR. RAY KAMALI: Uterus is located in the woman’s pelvis it consistent of two parts the top it actually is a shape like a pear the top of the uterus are the fundus basically its attached to the fallopian tubes and attached in proximity to the ovaries. The bottom of the pear or the uterus is basically the cervix which is attached to the vagina.
ANNIE LAIRD: Right so it’s in a woman’s pelvis and so what is the purpose of the uterus?
DR. RAY KAMALI: Okay. The purpose of the uterus is basically as an incubator for the babies so during from the time of a conception were the egg and the sperm meet in the fallopian tubes it travel and the actual pregnancy implants itself in the uterus and through the 9 to 10 months the pregnancy the nourishment the placenta and attachment to the uterus basically helps the growing baby develop.
ANNIE LAIRD: So it’s the baby’s home and is too the delivery system as well. Yeah.
DR. RAY KAMALI: I would like to say room service.
ANNIE LAIRD: Room service.
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: Let’s get started. So today we’re talking about the uterus so when the pregnancy starts how small is the uterus? Does it depend on the size of the woman?
DR. RAY KAMALI: Yes and no but you know the best way to think about it is actually the size of the woman’s fist or a size of an orange basically.
ANNIE LAIRD: That’s pretty small.
DR. RAY KAMALI: It is pretty small.
ANNIE LAIRD: Wow.
DR. RAY KAMALI: Most of us you know when we think about a uterus we think about a gravid uterus or a pregnant uterus which is you know a lot bigger.
ANNIE LAIRD: Yeah it’s like the size of a watermelon.
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: Yeah. But it starts off that small.
ANNIE LAIRD: Yeah. Now if a woman gains too much weight, what is the normal weight gain for like a regular pregnant woman would you say?
DR. RAY KAMALI: That’s at 20 to 25 pounds.
ANNIE LAIRD: Oh okay. Do you see that often?
SUNNY GAULT: That was not me.
ANNIE LAIRD: No. You had twins Sunny it’s a little bit different.
SUNNY GAULT: It was not me with my singletons either.
DR. RAY KAMALI: In Europe.
SUNNY GAULT: Right.
ANNIE LAIRD: In Japan yeah.
DR. RAY KAMALI: There we go.
ANNIE LAIRD: Yeah. So the pregnancy weight gain does it have an effect on how big the uterus is going to be?
DR. RAY KAMALI: For most parts no. I mean the size of the baby, you know the uterus basically accommodates the pregnancy and the baby so the pregnancy weight gain increase sometimes can affect the baby’s weight and then it turned out it increases the size of the uterus but doesn’t actually directly make the uterus bigger it just as the baby is bigger, then the uterus expands to accommodate the baby.
ANNIE LAIRD: So does the uterus actually like have cells that grow or does it just get like it’s really small and kind of thick and then it just like thins out. Is that how it works?
DR. RAY KAMALI: Exactly.
ANNIE LAIRD: Okay.
DR. RAY KAMALI: It kind of like a balloon if you think about it just blowing up a balloon so initially it’s kind of small but then when you blow it just kind of stretches out a little bit.
ANNIE LAIRD: Yeah. Is the uterus is it one muscle or is it several muscles at work yeah in conjunction with each other?
DR. RAY KAMALI: Yes and no both of those. It’s a type of muscle called smooth muscle which is a little bit different than our, you know for example skeletal muscles biceps…
ANNIE LAIRD: Yeah like your biceps or something.
DR. RAY KAMALI: Exactly.
ANNIE LAIRD: Okay.
DR. RAY KAMALI: So their all basically group of cells that are stack on top of each other and they work together so they you know they contract as one unit so yeah it’s a group of cells that are just kind of stack on top of each other.
ANNIE LAIRD: Now with a smooth muscle, correct me if I’m wrong, that works involuntarily basically…
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: So you don’t have to think having a contraction.
DR. RAY KAMALI: Exactly.
ANNIE LAIRD: Although I’m sure many of our listeners you know they have a baby before probably wish they could kind of willingly [inaudible]
DR. RAY KAMALI: Come up with the contraction?
ANNIE LAIRD: So that is always kind of hard so when you’re giving birth of like oh you know I just wish this contraction would go away but unfortunately that’s what brings the babies.
SUNNY GAULT: Yes. Exactly.
ANNIE LAIRD: Yeah. So Sam how many hours where you in labor with Olivia?
SAMANTHA EKLUND: I was in labor for 29 hours. Yeah. Although it was…
ANNIE LAIRD: Plenty of contractions, right?
SAMANTHA EKLUND: Yeah. Right. Yeah. Although it was medically induce so there was many more steps to it and many much of it I did not feel…
ANNIE LAIRD: Yeah.
SAMANTHA EKLUND: So it’s not as horrid as it may seem.
ANNIE LAIRD: Yeah because you had an epidural it’s like it sounds like your epidural worked well so…
SAMANTHA EKLUND: Yeah it did.
ANNIE LAIRD: Yeah. How does something like a drug like Pitocin that used for a lot of women they need to augmented or induced so how does Pitocin how does it affect the muscle of the uterus?
DR. RAY KAMALI: Okay well Pitocin is a drug that’s similar to a hormone that our own body produces which is oxytocin so you know when the time comes and we really don’t understand a lot about what brings on labor but when that happens…
ANNIE LAIRD: It’s kind of odd isn’t it…
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: Of like here…
DR. RAY KAMALI: It’s everything we know.
ANNIE LAIRD: It’s technological age and all of a sudden the uterus starts contracting. We have no idea what the catalyst is.
DR. RAY KAMALI: Exactly.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: I mean we know that it’s a communication between the baby’s you know baby’s body and you know through the placenta and the mom’s body but yeah we don’t know a lot about all the biochemical markers. But in any case yeah our body produces oxytocin and Pitocin is similar to oxytocin, it stimulates you know the uterine contraction by stimulating electric signal that basically goes through the smooth muscles and makes them contract.
ANNIE LAIRD: Oh okay. Now is the cervix is that part of the uterus as well?
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: Okay.
DR. RAY KAMALI: The actual uterus it is composed of two parts it’s actually the body of the uterus or the uterine corpus and then the cervix which is again part of the uterus and it’s just basically is cylindrical shape part of the uterus basically bottom part.
ANNIE LAIRD: Okay.
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: We’ve talk on VBAC several times so the last episode we did on VBAC I can’t remember it must have been a couple of months ago, we touch a bit on the uterine rupture. Now so how common is something like that? How often have you seen that in your practice?
DR. RAY KAMALI: Of a luckily I’ve only seen it once in the last 9 years so that’s great…
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: But part of that is also because you know VBAC is you know again there’s a pendulum that swings back and forth and we started to see a lot more but you know VBAC was discourage and a lot of patients that you know there’s concern and they are scared about the possible poor outcomes so they have shy away from VBAC and also the convenience of C-section unfortunately some more patients just like the convenience of being able like to schedule their repeat C-section or they went through a difficult you know first pregnancy and ended up with labor and a C-section so they just wanted to you know go in and do have a C-section.
ANNIE LAIRD: [inaudible] predictable yeah.
DR. RAY KAMALI: Absolutely. So you know but again like I said the pendulum is swinging and now we’re doing a lot more VBAC…
ANNIE LAIRD: It sounds like when you entered in practice what nine years ago…
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: That it wasn’t kind of a thing.
DR. RAY KAMALI: Right.
ANNIE LAIRD: Yeah so...
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: And then also in our community you know because the hospital has very strict criteria and they’re trying to and that was partially dictated by you know some of the you know the ACOGs and all those different agencies.
The hospital had strict criteria on you know what the physician had to do or where to be or what medication to use and so a lot of physicians didn’t offer that also so that also was a little obstacle. But in any case yeah we’ve ha it’s not that common but the incidence and literature is about 1% of patients that attempt TOLAC which stands for Trial of Labor after C-section.
ANNIE LAIRD: Okay.
DR. RAY KAMALI: 1% of those patients end up with uterine rupture and again it also depends on the type of incision on the uterus itself so and incision on the uterus is different in incision on the skin so a patient could have a bikini cut on her skin but on the uterus they can have up and down on what’s called the vertical incision and those have a significantly higher risk of uterine rupture the uterus opening up so that’s somewhere about 4 to 9% depending on which study you look at. So that’s a lot higher.
So if the patient has had a vertical incision most of the time they are discouraged from trying a…
ANNIE LAIRD: TOLAC.
DR. RAY KAMALI: A TOLAC.
ANNIE LAIRD: Yeah okay. Now are most ruptures are they catastrophic or do most of them in the literature that it’s like they tried a vaginal birth they’ve tried trial of labor but it’s not working, okay lets go in for the caesarean and then there’s a little bit of separation.
DR. RAY KAMALI: Right. Well so uterine rupture by definition is when all the layers of the uterus basically are disrupted or opened up so that includes so the uterus is made up of 3 layers, the muscle tissue which we have talked about, the lining of the uterus called the endometrium and there was a little thin layer called the serosa on top. If all those open up at the side of the scar then that’s called a uterine rupture.
The baby at a lot of times either some part of the baby’s body depending on how big the opening is comes out or actual whole baby sometimes floats around in the abdomen.
So if that happens which is you know complete uterine rupture and the baby comes out, sometimes the placenta separates then that can be you know pretty dangerous both for mom and the baby because the mom can start haemorrhaging then the baby doesn’t get oxygen for that certain period of time.
Luckily when that happens it usually happens in labor when the patient is already in the hospital and…
ANNIE LAIRD: I had to say how can you tell as an obstetrician what’s going on with the uterus? Obviously there’s no x-ray machines…
DR. RAY KAMALI: No.
ANNIE LAIRD: And say oh I think there’s a rupture in about to happen here.
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: So if a patient does not have an epidural, it’s accompanied by severe pain in the abdomen but sometimes the epidural masks that so we don’t know that but also during labor patients are connected to the foetal heart monitor so the baby’s heart rate you know will drop its called bradycardia or the baby’s heart rate goes down so that’s one sign.
Another sign is severe bleeding from below because sometimes you see a lot of bleeding and then another sign is that a baby’s head that you know that we use to be able to examine and was right there in the pelvis or you know during cervical exam all of a sudden is no longer there so when we examined it...
ANNIE LAIRD: Where’d he go?
DR. RAY KAMALI: There’s no head.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: So those are some of the signs but you also have a lower index of suspicion so if any of those things happen you know on a patient with a VBAC then you know you’re quicker to kind of act.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: But luckily when it does happen it happens in a hospital and most hospital have you know emergency C-section or emergency intervention drills set in place were you know for example at our hospital, Sharp Chula Vista you know from a time that there’s deceleration with it has to do with VBAC or any other emergency to delivery we get it done less than 10 minutes basically moved the patient from their birthing room to the operating room, give them anaesthesia, get their belly prep and then get the baby out within or less than 10 minutes so…
ANNIE LAIRD: Yeah. You probably are talking general anaesthesia at this point right.
DR. RAY KAMALI: Yes and no, for most parts yes. Sometimes patients have really good working epidural so sometimes while at their getting prep they can get a quick dose.
ANNIE LAIRD: Dose up.
DR. RAY KAMALI: Exactly.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: But most often yes, general because he’s trying to get this done as quickly as possible.
ANNIE LAIRD: Oh okay.
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: Yeah great. When we comeback we’re going to be discussing more about the uterus, about actually what happens during the birth process with it. We’ll be right back.
[Theme Music]
ANNIE LAIRD: Welcome back. Today we’re talking about your changing pregnant body and today focusing all about the uterus. So Dr. Kamali, I saw some friend, some pictures from my friend’s C-section recently and the photographer was actually allowed in the OR. It was really kind of cool. Well I think really it’s up to the anaesthesiologist really more than anything else so but anyway so the doctor actually took the uterus out of the body…
DR. RAY KAMALI: Right.
ANNIE LAIRD: So is that common?
DR. RAY KAMALI: So yeah actually yeah when the baby is born, a lot of times we take out the uterus out of the body just because it helps us repair or re-proximate the incision on the uterus so a lot easier and then while we’re doing that we actually you know look at the ovaries and kind of look inside just to make sure there is no other pathology. So it allows us to kind of do everything a little easier. It does sound a little weird…
ANNIE LAIRD: Yeah. So I say Sam you said oh I didn’t know they do that…
SAMANTHA EKLUND: So strange yeah I was not awake during my C-section so in a small a little bit of ignorance is bliss in this case. Other things I want to know a 100% but that I can do without.
DR. RAY KAMALI: And that’s interesting because I forget what it’s called there’s a term for it but they’re advocating having drapes that are transparent so the mom can see you know through…
ANNIE LAIRD: Oh like family friendly caesarean yeah.
SAMANTHA EKLUND: Yes.
DR. RAY KAMALI: There you go exactly yes.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: So you can actually see the, and some patients you know really don’t want to see because you know there’s you know blood and fluid and all that stuff.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: Instruments you know that we’re moving around and stuff so a lot of people don’t want to see any of that…
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: But some do so...
ANNIE LAIRD: You know I don’t know I think if it was me I think you know if I have a fourth pregnancy and it’s determined that it’s a C-section is needed, I don’t know I think I wanted to I know I want to see the baby born but then once I had my baby then I’m thinking the opaque drapes will be awesome really I don’t want to see that you know.
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: You know I usually just ask the person that’s accompany…
ANNIE LAIRD: Can you then lower the drapes?
DR. RAY KAMALI: Yeah what I do is you know they actually the father or whoever is with the patient stands up and if they want to film the baby actually coming out of the uterus and you know first cry and all that stuff you know they get to film that if they want…
ANNIE LAIRD: That’s awesome.
DR. RAY KAMALI: To take picture of it and then also kind of you know put the baby over the drapes…
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: So the mom can see it.
ANNIE LAIRD: That’s how [inaudible] stop. Sunny you posted that video of your twins being born and like of course I was like at work like I’m in my computer watching this birth video like oh no one will mind I’ll just put on my headphone and I was balling oh my gosh that was just so beautiful.
SUNNY GAULT: Yeah. Well so I had 2 caesareans and so technically speaking my uterus has been out of my body twice and what is interesting though is the first time I had a caesarean with my son, they had told me I started you know they tell you know when you’re having a C-section if you feel any discomfort or your nervous about anything you just let us know, talk to us. And so there’s someone up on my head they were kind of stitching me up and stuff and I said I’m starting to feel like a lot of it feels like pressure on my chest and it was explained to me and hopefully Dr. Kamali you can kind of shed some light on this but if the uterus is higher than your heart, something about the blood flow or something I mean it really felt like someone was sitting on my chest and then they said just you know bear with us bear with us it’s because your uterus was higher than your heart.
I’m thinking oh my gosh that my uterus is on top of my body and so you know I’m just on this casual conversation. And but then when once they fix it up and everything then the pain went away but have you heard of that before?
DR. RAY KAMALI: Well I think it probably had to do with not necessarily actually the location of it but it’s just that when you take out the uterus especially if you had twins, uterus is a little bit chunkier…
SUNNY GAULT: Yeah.
DR. RAY KAMALI: So and they took it out you know and they’re holding it, it was probably just kind of pushing right on your sternum or around that area of your...
SUNNY GAULT: Is it heavy? How much…
DR. RAY KAMALI: Well it that plus the we’re kind of pull a little bit to give it traction so that we can suture it and then so the assistance’s hands are probably there holding it too so that also…
SUNNY GAULT: Interesting.
DR. RAY KAMALI: All together could just kind of put a little pressure on your chest.
SUNNY GAULT: Yeah.
DR. RAY KAMALI: So we hear that commonly that patients feel a little pressure on their chest…
SUNNY GAULT: Yeah.
DR. RAY KAMALI: While we do that.
SUNNY GAULT: It didn’t happen with the girls.
DR. RAY KAMALI: Okay.
SUNNY GAULT: I had it with my first C-section and I was waiting for that pressure…
DR. RAY KAMALI: Right.
SUNNY GAULT: Because it was very uncomfortable.
DR. RAY KAMALI: Yeah.
SUNNY GAULT: So I was waiting for that and I didn’t get it at all with the girls.
DR. RAY KAMALI: Okay.
SAMANTHA EKLUND: Lucky you.
SUNNY GAULT: I know right?
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: Sometimes we don’t take out the uterus I mean you know depending on what the environment looks like sometimes we just suture right inside the abdomen so it sort of depends on the physician also.
ANNIE LAIRD: So after the baby’s born then you have you know lochia for you know hopefully, hopefully a week but usually I like my I have lochia for like....
SUNNY GAULT: Wait what is lochia?
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: Lochia is the endometrial layer basically after the pregnancy. Endometrium is actually the lining of the uterus…
SUNNY GAULT: Okay.
DR. RAY KAMALI: Let’s start with that and during pregnancy the lining of the uterus basically has become thicker to be able to support the pregnancy and attach to the placenta.
So once the placenta is delivered, all that extra lining your uterus basically tries to let all the which shed all that extra lining and slowly that fluid and that the extra blood the cells are shed. That usually happens the first 24 up to 48 hours. There’s different types of lochia. There’s lochia rubra which is red and red brown kind of wined coloured and that’s the first 24 to 48 hours. After that it becomes a little bit kind of lighter or whitish and then it becomes kind of watery. It’s over in the next 4 to 6 weeks you’ll have some sort of lochia but they’re bread and wine color red at the first 48 hours.
ANNIE LAIRD: Oh okay.
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: So it sounds like the first 48 hours that’s the lining of the uterus.
DR. RAY KAMALI: That’s right.
ANNIE LAIRD: After that is it were is it kind of the placenta wound kind of healing up or is it sill the lining of the uterus?
DR. RAY KAMALI: Yeah it’s lining of the uterus but the bleeding itself sometimes is from those little vessels that were connecting the uterus to your to the placenta and when the placenta detached, there’s all those little blood vessels are all of a sudden just kind of detached and your body’s coagulation system tries to you know stop the bleeding and close up those vessels and also the contraction of the uterus also helps with that so some of the bleeding is from you know from those little vessels while they’re trying to heal up and close up then you will have some bleeding.
ANNIE LAIRD: Okay.
DR. RAY KAMALI: And then it depends on when you stop breastfeeding or if you’re planning on breastfeeding hopefully you are you know then that also helps with the bleeding.
ANNIE LAIRD: Well let’s talk about that so after the birth and this was my second birth the nurse pressed on something fierce like on the top of my uterus and I just it hurt a lot.
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: So I mean why is she doing that? Is that something common like a common standard of practice if they do it like pummel on your pummel on your abdomen like rocky you know just like...
DR. RAY KAMALI: Well usually we tried to do no harm so we’re trying not to hurt you but no what it is a they’re checking to see if your uterus is contracting and so we talked about uterus being as big as a watermelon and towards the end of the pregnancy…
ANNIE LAIRD: Also it doesn’t stay like that…
DR. RAY KAMALI: It doesn’t stay. No…
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: As soon as the baby comes out, then all the sudden those little smooth muscles that we’re talking about all of a sudden they start contracting and the uterus start the process of ebullition which is when it tries to shrink back to the regular you know size of your fist…
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: Or original size so it starts right after the birth of the child and when that those muscles start contracting the uterus will become very firm as hard as a rock and it’s even harder than when your uterus was contracting. The purpose of that basically as we talk about those little blood vessels, once the placenta detaches, those blood vessels need to contract and close down or else you’re going to be bleeding.
So those that contraction is going to be very important. So the nurse is basically checking to make sure your uterus is contracting adequately and also sometimes your uterus accumulates some clots inside and when they press on it those clots come out. So sometimes it is hidden so you don’t know the patients bleeding but when you push on it the clots comes out then you know the patients going to be…
ANNIE LAIRD: And you don’t want them hanging around on your uterus.
DR. RAY KAMALI: Exactly. Right!
ANNIE LAIRD: Yeah. Well Sam, I think we had a question online about this didn’t we? It’s something related to this?
SAMANTHA EKLUND: Yes so Stacy was asking so I’ll be interested to know how it changes after pregnancy too. How long does it take to go back down to regular size? Does it ever go back 100% or there are things about it that change after carrying a baby?
DR. RAY KAMALI: Sure so it takes up to about six weeks for it to completely go back to normal size by immediately after birth the uterus is around the area of the umbilicus so it shrinks down significantly right away and then…
ANNIE LAIRD: So basically they’re by your like belly button.
DR. RAY KAMALI: Right. Exactly!
ANNIE LAIRD: Yeah okay.
DR. RAY KAMALI: And then within about 48 to 72 hours and sometimes as long as a week it’s half-way you know between your belly button and the pubic bone the line there and then by about 4 weeks it’s in your pelvis again and then it just shrinks down by 6 weeks down. Does it ever go back 100% the same size, probably not but you know we don’t really understand much about all of that stuff if you know why woman shoes size change you know why does the uterus… but you know the thinking is when yeah those muscles stretch sometimes 100% they don’t go back you know to the exact same size but they get pretty close to the size of what’s before the pregnancy.
ANNIE LAIRD: Oh okay.
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: Well thanks Dr. Kamali for joining us today.
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: For more information about Dr. Kamali and his practice as well as information about any of us on the panel today, visit the episode page on our website. This conversation continues for members of our Preggie Pals club. After the show our expert will be discussing about bicornuate uteruses and what that means for your pregnancy if you have one. To join our club, visit our website www.preggiepals.com .
[Theme Music]
ANNIE LAIRD: Got a Pregnancy Oops story, funny story here from Jessica from New York. She writes “I caught my husband trying on my belly band. He said he was going to get a watermelon and strap it to himself for a while to experience a fraction of what I’m going through. I told him I would purposely give him food poison to feel morning sickness as well as kick him in the genitals to make it feel more real if he wanted. He didn’t. He gets to get a good hubby award for trying to see what it felt like though and I didn’t ask him to. Well I loved that guy. If you get your own Pregnancy Oops, you can share it on our Facebook page or call our voicemail at 619-866-4775.
[Theme Music]
ANNIE LAIRD: That wraps up our show for today. We appreciate you listening to Preggie Pals.
Don’t forget to check out our sister shows:
• Parent Savers for parents with newborns, infants and toddlers
• Twin Talks for parents of multiples.
• The Boob Group for moms who breastfeed their babies
Next week we’ll be continuing our series on hiring your care provider. What is a postpartum doula and how do you go about interviewing one?
This is Preggie Pals, your pregnancy, your way.
[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
SUNNY GAULT: New Mommy Media is expanding our line up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or organization interested in joining our network of shows through a co-branded podcast, visit www.NewMommyMedia.com .
[00:33:13]
[End of Audio]
Episode Transcript
Preggie Pals
Body Changes During Pregnancy: Your Uterus
[00:00:00]
Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
[Theme Music]
DR. RAY KAMALI: Your uterus is a home for your baby for nine months then actively pushes a baby out to be born. How much do you really know about this amazing organ? I’m Dr. Kamali a board certified OB/GYN and today we’re continuing the series on your changing pregnant body. This is Preggie Pals.
[Theme Music/Intro]
ANNIE LAIRD: Welcome to Preggie Pals, broadcasting from the birth education centre of San Diego. Preggie Pals is your weekly online on-the-go-support group for expecting parents or even if you’re not pregnant but you want to be pregnant, go ahead and go to our website www.preggiepals.com and learn up on all of our pregnancy topics, birth topics, anything that you want to know.
I’m your host Annie Laird. Thanks to all of our loyal listeners who’ve joined the Preggie Pals club. Our members get special episodes after each new show, there’s bonus content you can listen to plus special giveaways and discounts. See the website for more information.
Another way for you to stay connected is by downloading our free Preggie Pals app. Now thanks to a listener who chimed in on our website, it’s also available on the Windows market place. We’ve been saying for weeks and weeks and weeks that it’s available in Android and iTunes market places which it is but it’s also available on the Windows market place.
So whatever platform you’re using for your phone, go ahead and download that. It’s absolutely free. So when you’re going around town, you’re waiting at your OB’s office for your appointment, your pushing your older toddler or in Sunny’s case your three other kids or four other kids around in a multi-stroller you know you can listen and catch up on all of our topics and all of our episodes.
Now Sam our producer she’s going to be giving us some more information about our virtual panellist program.
SAMANTHA EKLUND: Thanks Annie. So if you don’t live in San Diego but you’d like to be a panellist on our show you can still participate through our virtual panellist program. Just like us on Facebook and follow us on Twitter using #preggiepalsvp. And also now you can follow us on Instagram in New Mommy Media and check out the #preggiepals.
We’ll post questions throughout the week to prior to our taping and we’d love for you to comment so we can incorporate your thought into our episodes. You can also submit your questions directly to our experts. Learn more about our VP program through the community section on our website www.preggiepals.com
ANNIE LAIRD: Great! Thanks Sam. Alright let’s go around the horn here and introduce ourselves. I’m Annie. I’m the host. I don’t have a due date. I have three little girls and they are 8, and almost 2 and a 6 months old so I’m a busy mom. This is my break right now so I’m having a great time. I’m like eating my lunch…
SUNNY GAULT: Like the two kids around...
ANNIE LAIRD: I’ve use both of my hands I know like what are these things. They’re not holding children right now so awesome.
SAMANTHA EKLUND: I’m Samantha. I’m 22. I’m mostly stay at home mom besides being a producer at Preggie Pals. I have one 18 month old daughter named Olivia and I currently don’t have a due day although I wish that I did. I had an unplanned caesarean with her and I’m hoping for a VBAC next time around.
ANNIE LAIRD: See you always say I wish I did but then like they’re going to go by like and our listeners are listening to these episodes on our website like you’re from now I’ll be like she’s still not pregnant. She’s only 22 that’s sure taking a long time.
SAMANTHA EKLUND: I know right.
SUNNY GAULT: Hey everyone I’m Sunny. I am the owner of New Mommy Media which produces Preggie Pals, Parent Savers, The Boob Group and Twin Talks and I am joining as a panellist today because I love to talk about my uterus. It has been through a lot. I have four children at home…
ANNIE LAIRD: You’ve a super uterus.
SUNNY GAULT: I have two boys and two girls. My boy who’s the oldest is almost 4, my middle guy just turned 2 and then I have identical twin girls who are will be 6 months tomorrow.
ANNIE LAIRD: I know.
SUNNY GAULT: Crazy.
ANNIE LAIRD: You know it’s funny because I see the pictures that you post on Facebook of your girls and I still think of them when they because they don’t come in the studio anymore.
SUNNY GAULT: Yeah
ANNIE LAIRD: It’s kind of hard you know when you’re kids are really little…
SUNNY GAULT: Yeah.
ANNIE LAIRD: It’s easy to bring them in the studio here and they were so little when they were and was like under 10 pounds which isn’t really in my comprehension
SUNNY GAULT: I know.
ANNIE LAIRD: Because my kids come out of ten pounds.
SUNNY GAULT: You’re right.
ANNIE LAIRD: But yeah they’re growing big…
SUNNY GAULT: They are.
ANNIE LAIRD: They’re eating like crazy.
SUNNY GAULT: They are. They’re doing really good.
ANNIE LAIRD: And I love the little earrings that you put on them…
SUNNY GAULT: Oh yeah. They just got their ears pierced. It’s nice because like you said they’re identical and even I was having a hard time telling them apart and so it was nice because just you know few weeks ago we got their ears pierced…
ANNIE LAIRD: So cute.
SUNNY GAULT: One has blue earrings the other one has pink.
ANNIE LAIRD: Oh perfect.
SUNNY GAULT: So now everybody can kind of tell them apart. It’s like genius. So…
ANNIE LAIRD: Yeah because I’m not really big into ear piercing for little kids but you know what I think if I had identical twin girls, easy.
SUNNY GAULT: Exactly.
ANNIE LAIRD: I don’t know.
SUNNY GAULT: No brainer for me.
ANNIE LAIRD: Yeah exactly I’ll be I don’t know how my homebirth midwife will be feeling about that... really can’t we wait a couple of months? No…
SUNNY GAULT: No. Right away.
ANNIE LAIRD: No.
SUNNY GAULT: Out of the birth canal...
ANNIE LAIRD: Well yeah because you had a hospital band for a while…
SUNNY GAULT: Yeah and I was…
ANNIE LAIRD: And you said there was a period of time were like the hospital band wasn’t on you anymore and you were like oh crap.
SUNNY GAULT: Well first of all those hospital bands they’re really hard and you know…
ANNIE LAIRD: Yeah.
SUNNY GAULT: They’re just newborn and they were preemies and they just didn’t want to keep the bands on them so we started to do like ribbons like different coloured ribbons around their wrist and they did that…
ANNIE LAIRD: I thought the ribbon fell off at one time.
SUNNY GAULT: Yeah it did. I was changing the twins and you know it fell off and then I had two babies without any wristbands and I went oh my gosh. So for a few days I really didn’t know who was who until we got them to see their paediatrician and weight them and one had always been who does a little bit more than the other…
ANNIE LAIRD: Yeah.
SUNNY GAULT: Now I can tell them apart believe it or not but my husband still has a hard time and you know other people they don’t really know.
ANNIE LAIRD: There’s identical set of twins in my youngest daughter’s day care.
SUNNY GAULT: Oh really.
ANNIE LAIRD: And yeah I can’t tell the difference but I guess she says one is that they’re ears are a little bit different…
SUNNY GAULT: Yeah. Yeah.
ANNIE LAIRD: Or something like that. So it’s like…
SUNNY GAULT: Moms always know that there’s little new answers...
ANNIE LAIRD: Yeah.
SUNNY GAULT: But still it’s tough.
ANNIE LAIRD: Yeah.
[Theme Music]
ANNIE LAIRD: Alright for our featured segment today we’re going to be talking about a news article that just came out just recently. The title of the article is “Tennessee just became the first state that will jail pregnant woman for their pregnancy outcomes”.
I think it’s a little interesting I think pregnancy outcomes I think oh did you have a vaginal birth or do you have a caesarean birth you know but that’s not what they’re talking about here. They’re talking about that Tennessee became the first in the nation that if you as a pregnant women are taking drugs you know these are illegal drugs, illicit drugs, we’re not talking about you know something that your doctor prescribes you that you as a pregnant woman can be get charged with criminal assault if you use these illegal drugs during pregnancy and the foetus or the newborn is harmed as a result.
So a lot of controversy about this you know is it okay to and I guess it goes in into is it are you kind of with the mom here you know that she’s free to do what she wants to do or you kind of with the baby or both. It’s a really tough thing. One really affects the other so it has lot of the controversy but American Medical Association, American Academy of Paediatrics, American College of Obstetrician and Gynaecologists and other major medical associations they’re a little bit concern.
They’re warning the Tennessee legislature that by criminalizing pregnant women is discouraging them from seeking prenatal care which you know maybe would help them get off these drugs or even in getting off you know drug treatment. So maybe they’ll be taking the drugs even longer because they know they’re going to be getting criminalize. I mean what do you guys think about this?
SAMANTHA EKLUND: I think it’s interesting that in a way in when you tell a woman you know if in outcome is going to become the certain way after you deliver I think it almost takes away a woman’s autonomy because you do have the right to do with what you want with your own body but again you don’t have the right to harm other people in that choice. So I think it’s interesting kind of as a double edge sword. It’s tough.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: It’s been a slippery slope also because then would you say alcohol use during pregnancy is a criminal activity because in some ways theoretically can harm the baby if you over consume.
ANNIE LAIRD: Right.
DR. RAY KAMALI: And then you know and then we just basically go from there but it already happens were you know I covered a hospital every Monday for patients that are drop in meaning that they don’t have prenatal care and they just walk in to the hospital and you know we routinely do a urine drug screen on those patients you know because they don’t have any prenatal care and we just want to make sure we know as much about them as possible. And you know I would say somewhere around 1 in 10 of those patients come out positive from nymphetamines or you know marijuana or you know other drugs. So it does happen that patients you know they have insurance so it’s not an insurance issue it’s that they don’t get prenatal care because they don’t want to be told not to use or not to…
ANNIE LAIRD: Right. Yeah and I guess another thing the article brings up is saying that only 2 in Tennessee there’s a 177 addiction treatment facilities but only 2 of them allow the older children to stay with their mothers when they’re undergoing treatment. So that really makes things hard in you telling a woman you know hey you won’t be criminalize, go and get the help you need but if you got a 2 year old and you know dad is either not in the picture or he’s working then that really ties his mother’s hands you know.
How do they get the treatment and help they need you telling them on one hand you go to jail go get treatment but there’s not a facility for them to go and realistically get that treatment.
DR. RAY KAMALI: I wonder how much they’re intending on enforcing or just a threat to…
SUNNY GAULT: Yeah just a threat.
DR. RAY KAMALI: Yeah just you know if you don’t stop using this you know you’re going to go to jail so…
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: You know but I don’t know.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: It’s interesting though.
[Theme Music]
ANNIE LAIRD: Hi today on Preggie Pals we’re continuing our series on your changing pregnant body. So if you remember we did an episode that was all about the placenta so now today we’re going to be focusing on the uterus. Joining us today as our expert is Dr. Kamali. He’s a board certified OB/GYN. He mainly practices at Sharp Chula Vista Medical Centre. Is that right Dr. Kamali?
DR. RAY KAMALI: That is correct.
ANNIE LAIRD: Alright! He just finished up last year as the chairman of the Department of Obstetrics and Gynaecology. So spending more time with your kids that’s great.
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: It’s awesome. Dr. Kamali welcome to the show thanks for joining us today.
DR. RAY KAMALI: Thanks for having me.
ANNIE LAIRD: Alright well to start off this interview, let’s talk about like what is a uterus? It’s like where is it in the body?
DR. RAY KAMALI: Uterus is located in the woman’s pelvis it consistent of two parts the top it actually is a shape like a pear the top of the uterus are the fundus basically its attached to the fallopian tubes and attached in proximity to the ovaries. The bottom of the pear or the uterus is basically the cervix which is attached to the vagina.
ANNIE LAIRD: Right so it’s in a woman’s pelvis and so what is the purpose of the uterus?
DR. RAY KAMALI: Okay. The purpose of the uterus is basically as an incubator for the babies so during from the time of a conception were the egg and the sperm meet in the fallopian tubes it travel and the actual pregnancy implants itself in the uterus and through the 9 to 10 months the pregnancy the nourishment the placenta and attachment to the uterus basically helps the growing baby develop.
ANNIE LAIRD: So it’s the baby’s home and is too the delivery system as well. Yeah.
DR. RAY KAMALI: I would like to say room service.
ANNIE LAIRD: Room service.
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: Let’s get started. So today we’re talking about the uterus so when the pregnancy starts how small is the uterus? Does it depend on the size of the woman?
DR. RAY KAMALI: Yes and no but you know the best way to think about it is actually the size of the woman’s fist or a size of an orange basically.
ANNIE LAIRD: That’s pretty small.
DR. RAY KAMALI: It is pretty small.
ANNIE LAIRD: Wow.
DR. RAY KAMALI: Most of us you know when we think about a uterus we think about a gravid uterus or a pregnant uterus which is you know a lot bigger.
ANNIE LAIRD: Yeah it’s like the size of a watermelon.
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: Yeah. But it starts off that small.
ANNIE LAIRD: Yeah. Now if a woman gains too much weight, what is the normal weight gain for like a regular pregnant woman would you say?
DR. RAY KAMALI: That’s at 20 to 25 pounds.
ANNIE LAIRD: Oh okay. Do you see that often?
SUNNY GAULT: That was not me.
ANNIE LAIRD: No. You had twins Sunny it’s a little bit different.
SUNNY GAULT: It was not me with my singletons either.
DR. RAY KAMALI: In Europe.
SUNNY GAULT: Right.
ANNIE LAIRD: In Japan yeah.
DR. RAY KAMALI: There we go.
ANNIE LAIRD: Yeah. So the pregnancy weight gain does it have an effect on how big the uterus is going to be?
DR. RAY KAMALI: For most parts no. I mean the size of the baby, you know the uterus basically accommodates the pregnancy and the baby so the pregnancy weight gain increase sometimes can affect the baby’s weight and then it turned out it increases the size of the uterus but doesn’t actually directly make the uterus bigger it just as the baby is bigger, then the uterus expands to accommodate the baby.
ANNIE LAIRD: So does the uterus actually like have cells that grow or does it just get like it’s really small and kind of thick and then it just like thins out. Is that how it works?
DR. RAY KAMALI: Exactly.
ANNIE LAIRD: Okay.
DR. RAY KAMALI: It kind of like a balloon if you think about it just blowing up a balloon so initially it’s kind of small but then when you blow it just kind of stretches out a little bit.
ANNIE LAIRD: Yeah. Is the uterus is it one muscle or is it several muscles at work yeah in conjunction with each other?
DR. RAY KAMALI: Yes and no both of those. It’s a type of muscle called smooth muscle which is a little bit different than our, you know for example skeletal muscles biceps…
ANNIE LAIRD: Yeah like your biceps or something.
DR. RAY KAMALI: Exactly.
ANNIE LAIRD: Okay.
DR. RAY KAMALI: So their all basically group of cells that are stack on top of each other and they work together so they you know they contract as one unit so yeah it’s a group of cells that are just kind of stack on top of each other.
ANNIE LAIRD: Now with a smooth muscle, correct me if I’m wrong, that works involuntarily basically…
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: So you don’t have to think having a contraction.
DR. RAY KAMALI: Exactly.
ANNIE LAIRD: Although I’m sure many of our listeners you know they have a baby before probably wish they could kind of willingly [inaudible]
DR. RAY KAMALI: Come up with the contraction?
ANNIE LAIRD: So that is always kind of hard so when you’re giving birth of like oh you know I just wish this contraction would go away but unfortunately that’s what brings the babies.
SUNNY GAULT: Yes. Exactly.
ANNIE LAIRD: Yeah. So Sam how many hours where you in labor with Olivia?
SAMANTHA EKLUND: I was in labor for 29 hours. Yeah. Although it was…
ANNIE LAIRD: Plenty of contractions, right?
SAMANTHA EKLUND: Yeah. Right. Yeah. Although it was medically induce so there was many more steps to it and many much of it I did not feel…
ANNIE LAIRD: Yeah.
SAMANTHA EKLUND: So it’s not as horrid as it may seem.
ANNIE LAIRD: Yeah because you had an epidural it’s like it sounds like your epidural worked well so…
SAMANTHA EKLUND: Yeah it did.
ANNIE LAIRD: Yeah. How does something like a drug like Pitocin that used for a lot of women they need to augmented or induced so how does Pitocin how does it affect the muscle of the uterus?
DR. RAY KAMALI: Okay well Pitocin is a drug that’s similar to a hormone that our own body produces which is oxytocin so you know when the time comes and we really don’t understand a lot about what brings on labor but when that happens…
ANNIE LAIRD: It’s kind of odd isn’t it…
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: Of like here…
DR. RAY KAMALI: It’s everything we know.
ANNIE LAIRD: It’s technological age and all of a sudden the uterus starts contracting. We have no idea what the catalyst is.
DR. RAY KAMALI: Exactly.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: I mean we know that it’s a communication between the baby’s you know baby’s body and you know through the placenta and the mom’s body but yeah we don’t know a lot about all the biochemical markers. But in any case yeah our body produces oxytocin and Pitocin is similar to oxytocin, it stimulates you know the uterine contraction by stimulating electric signal that basically goes through the smooth muscles and makes them contract.
ANNIE LAIRD: Oh okay. Now is the cervix is that part of the uterus as well?
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: Okay.
DR. RAY KAMALI: The actual uterus it is composed of two parts it’s actually the body of the uterus or the uterine corpus and then the cervix which is again part of the uterus and it’s just basically is cylindrical shape part of the uterus basically bottom part.
ANNIE LAIRD: Okay.
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: We’ve talk on VBAC several times so the last episode we did on VBAC I can’t remember it must have been a couple of months ago, we touch a bit on the uterine rupture. Now so how common is something like that? How often have you seen that in your practice?
DR. RAY KAMALI: Of a luckily I’ve only seen it once in the last 9 years so that’s great…
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: But part of that is also because you know VBAC is you know again there’s a pendulum that swings back and forth and we started to see a lot more but you know VBAC was discourage and a lot of patients that you know there’s concern and they are scared about the possible poor outcomes so they have shy away from VBAC and also the convenience of C-section unfortunately some more patients just like the convenience of being able like to schedule their repeat C-section or they went through a difficult you know first pregnancy and ended up with labor and a C-section so they just wanted to you know go in and do have a C-section.
ANNIE LAIRD: [inaudible] predictable yeah.
DR. RAY KAMALI: Absolutely. So you know but again like I said the pendulum is swinging and now we’re doing a lot more VBAC…
ANNIE LAIRD: It sounds like when you entered in practice what nine years ago…
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: That it wasn’t kind of a thing.
DR. RAY KAMALI: Right.
ANNIE LAIRD: Yeah so...
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: And then also in our community you know because the hospital has very strict criteria and they’re trying to and that was partially dictated by you know some of the you know the ACOGs and all those different agencies.
The hospital had strict criteria on you know what the physician had to do or where to be or what medication to use and so a lot of physicians didn’t offer that also so that also was a little obstacle. But in any case yeah we’ve ha it’s not that common but the incidence and literature is about 1% of patients that attempt TOLAC which stands for Trial of Labor after C-section.
ANNIE LAIRD: Okay.
DR. RAY KAMALI: 1% of those patients end up with uterine rupture and again it also depends on the type of incision on the uterus itself so and incision on the uterus is different in incision on the skin so a patient could have a bikini cut on her skin but on the uterus they can have up and down on what’s called the vertical incision and those have a significantly higher risk of uterine rupture the uterus opening up so that’s somewhere about 4 to 9% depending on which study you look at. So that’s a lot higher.
So if the patient has had a vertical incision most of the time they are discouraged from trying a…
ANNIE LAIRD: TOLAC.
DR. RAY KAMALI: A TOLAC.
ANNIE LAIRD: Yeah okay. Now are most ruptures are they catastrophic or do most of them in the literature that it’s like they tried a vaginal birth they’ve tried trial of labor but it’s not working, okay lets go in for the caesarean and then there’s a little bit of separation.
DR. RAY KAMALI: Right. Well so uterine rupture by definition is when all the layers of the uterus basically are disrupted or opened up so that includes so the uterus is made up of 3 layers, the muscle tissue which we have talked about, the lining of the uterus called the endometrium and there was a little thin layer called the serosa on top. If all those open up at the side of the scar then that’s called a uterine rupture.
The baby at a lot of times either some part of the baby’s body depending on how big the opening is comes out or actual whole baby sometimes floats around in the abdomen.
So if that happens which is you know complete uterine rupture and the baby comes out, sometimes the placenta separates then that can be you know pretty dangerous both for mom and the baby because the mom can start haemorrhaging then the baby doesn’t get oxygen for that certain period of time.
Luckily when that happens it usually happens in labor when the patient is already in the hospital and…
ANNIE LAIRD: I had to say how can you tell as an obstetrician what’s going on with the uterus? Obviously there’s no x-ray machines…
DR. RAY KAMALI: No.
ANNIE LAIRD: And say oh I think there’s a rupture in about to happen here.
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: So if a patient does not have an epidural, it’s accompanied by severe pain in the abdomen but sometimes the epidural masks that so we don’t know that but also during labor patients are connected to the foetal heart monitor so the baby’s heart rate you know will drop its called bradycardia or the baby’s heart rate goes down so that’s one sign.
Another sign is severe bleeding from below because sometimes you see a lot of bleeding and then another sign is that a baby’s head that you know that we use to be able to examine and was right there in the pelvis or you know during cervical exam all of a sudden is no longer there so when we examined it...
ANNIE LAIRD: Where’d he go?
DR. RAY KAMALI: There’s no head.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: So those are some of the signs but you also have a lower index of suspicion so if any of those things happen you know on a patient with a VBAC then you know you’re quicker to kind of act.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: But luckily when it does happen it happens in a hospital and most hospital have you know emergency C-section or emergency intervention drills set in place were you know for example at our hospital, Sharp Chula Vista you know from a time that there’s deceleration with it has to do with VBAC or any other emergency to delivery we get it done less than 10 minutes basically moved the patient from their birthing room to the operating room, give them anaesthesia, get their belly prep and then get the baby out within or less than 10 minutes so…
ANNIE LAIRD: Yeah. You probably are talking general anaesthesia at this point right.
DR. RAY KAMALI: Yes and no, for most parts yes. Sometimes patients have really good working epidural so sometimes while at their getting prep they can get a quick dose.
ANNIE LAIRD: Dose up.
DR. RAY KAMALI: Exactly.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: But most often yes, general because he’s trying to get this done as quickly as possible.
ANNIE LAIRD: Oh okay.
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: Yeah great. When we comeback we’re going to be discussing more about the uterus, about actually what happens during the birth process with it. We’ll be right back.
[Theme Music]
ANNIE LAIRD: Welcome back. Today we’re talking about your changing pregnant body and today focusing all about the uterus. So Dr. Kamali, I saw some friend, some pictures from my friend’s C-section recently and the photographer was actually allowed in the OR. It was really kind of cool. Well I think really it’s up to the anaesthesiologist really more than anything else so but anyway so the doctor actually took the uterus out of the body…
DR. RAY KAMALI: Right.
ANNIE LAIRD: So is that common?
DR. RAY KAMALI: So yeah actually yeah when the baby is born, a lot of times we take out the uterus out of the body just because it helps us repair or re-proximate the incision on the uterus so a lot easier and then while we’re doing that we actually you know look at the ovaries and kind of look inside just to make sure there is no other pathology. So it allows us to kind of do everything a little easier. It does sound a little weird…
ANNIE LAIRD: Yeah. So I say Sam you said oh I didn’t know they do that…
SAMANTHA EKLUND: So strange yeah I was not awake during my C-section so in a small a little bit of ignorance is bliss in this case. Other things I want to know a 100% but that I can do without.
DR. RAY KAMALI: And that’s interesting because I forget what it’s called there’s a term for it but they’re advocating having drapes that are transparent so the mom can see you know through…
ANNIE LAIRD: Oh like family friendly caesarean yeah.
SAMANTHA EKLUND: Yes.
DR. RAY KAMALI: There you go exactly yes.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: So you can actually see the, and some patients you know really don’t want to see because you know there’s you know blood and fluid and all that stuff.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: Instruments you know that we’re moving around and stuff so a lot of people don’t want to see any of that…
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: But some do so...
ANNIE LAIRD: You know I don’t know I think if it was me I think you know if I have a fourth pregnancy and it’s determined that it’s a C-section is needed, I don’t know I think I wanted to I know I want to see the baby born but then once I had my baby then I’m thinking the opaque drapes will be awesome really I don’t want to see that you know.
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: You know I usually just ask the person that’s accompany…
ANNIE LAIRD: Can you then lower the drapes?
DR. RAY KAMALI: Yeah what I do is you know they actually the father or whoever is with the patient stands up and if they want to film the baby actually coming out of the uterus and you know first cry and all that stuff you know they get to film that if they want…
ANNIE LAIRD: That’s awesome.
DR. RAY KAMALI: To take picture of it and then also kind of you know put the baby over the drapes…
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: So the mom can see it.
ANNIE LAIRD: That’s how [inaudible] stop. Sunny you posted that video of your twins being born and like of course I was like at work like I’m in my computer watching this birth video like oh no one will mind I’ll just put on my headphone and I was balling oh my gosh that was just so beautiful.
SUNNY GAULT: Yeah. Well so I had 2 caesareans and so technically speaking my uterus has been out of my body twice and what is interesting though is the first time I had a caesarean with my son, they had told me I started you know they tell you know when you’re having a C-section if you feel any discomfort or your nervous about anything you just let us know, talk to us. And so there’s someone up on my head they were kind of stitching me up and stuff and I said I’m starting to feel like a lot of it feels like pressure on my chest and it was explained to me and hopefully Dr. Kamali you can kind of shed some light on this but if the uterus is higher than your heart, something about the blood flow or something I mean it really felt like someone was sitting on my chest and then they said just you know bear with us bear with us it’s because your uterus was higher than your heart.
I’m thinking oh my gosh that my uterus is on top of my body and so you know I’m just on this casual conversation. And but then when once they fix it up and everything then the pain went away but have you heard of that before?
DR. RAY KAMALI: Well I think it probably had to do with not necessarily actually the location of it but it’s just that when you take out the uterus especially if you had twins, uterus is a little bit chunkier…
SUNNY GAULT: Yeah.
DR. RAY KAMALI: So and they took it out you know and they’re holding it, it was probably just kind of pushing right on your sternum or around that area of your...
SUNNY GAULT: Is it heavy? How much…
DR. RAY KAMALI: Well it that plus the we’re kind of pull a little bit to give it traction so that we can suture it and then so the assistance’s hands are probably there holding it too so that also…
SUNNY GAULT: Interesting.
DR. RAY KAMALI: All together could just kind of put a little pressure on your chest.
SUNNY GAULT: Yeah.
DR. RAY KAMALI: So we hear that commonly that patients feel a little pressure on their chest…
SUNNY GAULT: Yeah.
DR. RAY KAMALI: While we do that.
SUNNY GAULT: It didn’t happen with the girls.
DR. RAY KAMALI: Okay.
SUNNY GAULT: I had it with my first C-section and I was waiting for that pressure…
DR. RAY KAMALI: Right.
SUNNY GAULT: Because it was very uncomfortable.
DR. RAY KAMALI: Yeah.
SUNNY GAULT: So I was waiting for that and I didn’t get it at all with the girls.
DR. RAY KAMALI: Okay.
SAMANTHA EKLUND: Lucky you.
SUNNY GAULT: I know right?
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: Sometimes we don’t take out the uterus I mean you know depending on what the environment looks like sometimes we just suture right inside the abdomen so it sort of depends on the physician also.
ANNIE LAIRD: So after the baby’s born then you have you know lochia for you know hopefully, hopefully a week but usually I like my I have lochia for like....
SUNNY GAULT: Wait what is lochia?
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: Lochia is the endometrial layer basically after the pregnancy. Endometrium is actually the lining of the uterus…
SUNNY GAULT: Okay.
DR. RAY KAMALI: Let’s start with that and during pregnancy the lining of the uterus basically has become thicker to be able to support the pregnancy and attach to the placenta.
So once the placenta is delivered, all that extra lining your uterus basically tries to let all the which shed all that extra lining and slowly that fluid and that the extra blood the cells are shed. That usually happens the first 24 up to 48 hours. There’s different types of lochia. There’s lochia rubra which is red and red brown kind of wined coloured and that’s the first 24 to 48 hours. After that it becomes a little bit kind of lighter or whitish and then it becomes kind of watery. It’s over in the next 4 to 6 weeks you’ll have some sort of lochia but they’re bread and wine color red at the first 48 hours.
ANNIE LAIRD: Oh okay.
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: So it sounds like the first 48 hours that’s the lining of the uterus.
DR. RAY KAMALI: That’s right.
ANNIE LAIRD: After that is it were is it kind of the placenta wound kind of healing up or is it sill the lining of the uterus?
DR. RAY KAMALI: Yeah it’s lining of the uterus but the bleeding itself sometimes is from those little vessels that were connecting the uterus to your to the placenta and when the placenta detached, there’s all those little blood vessels are all of a sudden just kind of detached and your body’s coagulation system tries to you know stop the bleeding and close up those vessels and also the contraction of the uterus also helps with that so some of the bleeding is from you know from those little vessels while they’re trying to heal up and close up then you will have some bleeding.
ANNIE LAIRD: Okay.
DR. RAY KAMALI: And then it depends on when you stop breastfeeding or if you’re planning on breastfeeding hopefully you are you know then that also helps with the bleeding.
ANNIE LAIRD: Well let’s talk about that so after the birth and this was my second birth the nurse pressed on something fierce like on the top of my uterus and I just it hurt a lot.
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: So I mean why is she doing that? Is that something common like a common standard of practice if they do it like pummel on your pummel on your abdomen like rocky you know just like...
DR. RAY KAMALI: Well usually we tried to do no harm so we’re trying not to hurt you but no what it is a they’re checking to see if your uterus is contracting and so we talked about uterus being as big as a watermelon and towards the end of the pregnancy…
ANNIE LAIRD: Also it doesn’t stay like that…
DR. RAY KAMALI: It doesn’t stay. No…
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: As soon as the baby comes out, then all the sudden those little smooth muscles that we’re talking about all of a sudden they start contracting and the uterus start the process of ebullition which is when it tries to shrink back to the regular you know size of your fist…
ANNIE LAIRD: Yeah.
DR. RAY KAMALI: Or original size so it starts right after the birth of the child and when that those muscles start contracting the uterus will become very firm as hard as a rock and it’s even harder than when your uterus was contracting. The purpose of that basically as we talk about those little blood vessels, once the placenta detaches, those blood vessels need to contract and close down or else you’re going to be bleeding.
So those that contraction is going to be very important. So the nurse is basically checking to make sure your uterus is contracting adequately and also sometimes your uterus accumulates some clots inside and when they press on it those clots come out. So sometimes it is hidden so you don’t know the patients bleeding but when you push on it the clots comes out then you know the patients going to be…
ANNIE LAIRD: And you don’t want them hanging around on your uterus.
DR. RAY KAMALI: Exactly. Right!
ANNIE LAIRD: Yeah. Well Sam, I think we had a question online about this didn’t we? It’s something related to this?
SAMANTHA EKLUND: Yes so Stacy was asking so I’ll be interested to know how it changes after pregnancy too. How long does it take to go back down to regular size? Does it ever go back 100% or there are things about it that change after carrying a baby?
DR. RAY KAMALI: Sure so it takes up to about six weeks for it to completely go back to normal size by immediately after birth the uterus is around the area of the umbilicus so it shrinks down significantly right away and then…
ANNIE LAIRD: So basically they’re by your like belly button.
DR. RAY KAMALI: Right. Exactly!
ANNIE LAIRD: Yeah okay.
DR. RAY KAMALI: And then within about 48 to 72 hours and sometimes as long as a week it’s half-way you know between your belly button and the pubic bone the line there and then by about 4 weeks it’s in your pelvis again and then it just shrinks down by 6 weeks down. Does it ever go back 100% the same size, probably not but you know we don’t really understand much about all of that stuff if you know why woman shoes size change you know why does the uterus… but you know the thinking is when yeah those muscles stretch sometimes 100% they don’t go back you know to the exact same size but they get pretty close to the size of what’s before the pregnancy.
ANNIE LAIRD: Oh okay.
DR. RAY KAMALI: Yeah.
ANNIE LAIRD: Well thanks Dr. Kamali for joining us today.
DR. RAY KAMALI: Absolutely.
ANNIE LAIRD: For more information about Dr. Kamali and his practice as well as information about any of us on the panel today, visit the episode page on our website. This conversation continues for members of our Preggie Pals club. After the show our expert will be discussing about bicornuate uteruses and what that means for your pregnancy if you have one. To join our club, visit our website www.preggiepals.com .
[Theme Music]
ANNIE LAIRD: Got a Pregnancy Oops story, funny story here from Jessica from New York. She writes “I caught my husband trying on my belly band. He said he was going to get a watermelon and strap it to himself for a while to experience a fraction of what I’m going through. I told him I would purposely give him food poison to feel morning sickness as well as kick him in the genitals to make it feel more real if he wanted. He didn’t. He gets to get a good hubby award for trying to see what it felt like though and I didn’t ask him to. Well I loved that guy. If you get your own Pregnancy Oops, you can share it on our Facebook page or call our voicemail at 619-866-4775.
[Theme Music]
ANNIE LAIRD: That wraps up our show for today. We appreciate you listening to Preggie Pals.
Don’t forget to check out our sister shows:
• Parent Savers for parents with newborns, infants and toddlers
• Twin Talks for parents of multiples.
• The Boob Group for moms who breastfeed their babies
Next week we’ll be continuing our series on hiring your care provider. What is a postpartum doula and how do you go about interviewing one?
This is Preggie Pals, your pregnancy, your way.
[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.
SUNNY GAULT: New Mommy Media is expanding our line up of shows for new and expecting parents. If you have an idea for a new series or if you’re a business or organization interested in joining our network of shows through a co-branded podcast, visit www.NewMommyMedia.com .
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