Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OBGYN and maternal fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.
Hey, everyone. Welcome to our “Mailbag” podcast number 21, “What does the Fox say?” Our first question is from Cassie. “I’m a very healthy, almost 34-year-old, that had an incomplete miscarriage with MVA at about nine weeks. This was my first experience with pregnancy, and I’m just wondering what your advice is on how to manage anxiety with subsequent pregnancies.” Cassie, great question. I’m sorry you had the loss. I hope you’re doing well.
So, it’s a really interesting question and a good one. And I’m glad you asked me this question because it’s something that does not get talked about a lot, and is very important. So, I think the instinct that most doctors have, and maybe most patients have, regarding a miscarriage and the subsequent pregnancy is sort of the medical side of it. Am I at increased risk of a miscarriage again? Do I have to do any tests? Are there any things I need to do different in next pregnancy to prevent it, which is obviously very valuable as a conversation. And, you know, we’ve had podcasts on this, and we’ve had questions about this on “Mailbag” podcasts. And, you know, it’s its own topic.
But I think what you’re bringing up is such a relevant point, and not just relevant, but prevalent. I think that for many, most, or all people, who’ve had a miscarriage in their previous pregnancy, the next pregnancy is going to have a tremendous amount of anxiety over what’s going to happen with this pregnancy. Now, obviously, different people process this differently, and different people have varying levels of anxiety at baseline and about this. And it is quite complex to sort of know who’s going to have more or less anxiety in the next pregnancy and why they might be. But your question is what to do about it.
And I think the first thing that I would say, which is the most important, is for everyone to recognize that it’s normal and it’s okay to have anxiety in a pregnancy about any complication, but certainly about one that you just experienced. And so, whether it’s miscarriage that you asked about, or whether it’s a preterm birth, or whether it’s something, you know, preeclampsia or hemorrhage or, you know, God forbid, a stillbirth or something that happened in the next pregnancy, there’s going to be anxiety. And based on what the event was or what the outcome was that someone’s going to be anxious about, it’s often going to dictate sort of the pattern of that anxiety.
So, for example, when you’re talking about anxiety over miscarriages, where…so, whether it’s someone who had a miscarriage last pregnancy or someone has a history of multiple miscarriages or whatever it might be related to miscarriage, that’s obviously an early pregnancy complication. So, what tends to happen in my experience, which makes a lot of sense, is that in the very beginning of pregnancy, anxiety is extremely high. And then with each week or month that passes, that anxiety becomes less, which makes sense, because as you’re pregnant and you don’t miscarry, the anxiety over miscarriage is going to be reduced.
Now, obviously, some people might have anxiety over other issues coming up from pregnancy, but the pattern tends to be high at the beginning and diminishing with time, versus if the event we’re talking about happens at the end of pregnancy. So, let’s say someone had a preterm birth or someone had a hemorrhage or something like that. Usually, it’s the opposite pattern where anxiety at the beginning of pregnancy is relatively low. And then by the time you get to the end of pregnancy, it’s obviously going up and up until that point happens. And so, that’s number one to recognize what it might be like.
And of course, it’s normal. A lot of people sort of have, I like to call and I’ve called it in prior podcasts, this, like, meta anxiety, which is I am upset or worried about the fact that I am anxious. Right? There’s the anxiety itself. And then there’s sort of, like, the feelings about your feelings. And I think that the feelings themselves, right, the anxiety over miscarriage is something that is obviously normal. It’s something that it’s…it’s expected. It’s something that’s predominantly not preventable because that’s normal. You’ve been through something terrible, and you’re possibly going to have that again. So, you’re going to be anxious about it. And so, that part of it is sort of, like, the normal physiologic response to an event that happened and possibly happening again.
But the meta level, the feelings about the anxiety, I think that’s the part where we can really help to say it’s normal to have these feelings. It’s okay if you’re kind of a wreck in the beginning of pregnancy. It is acceptable to be anxious and to sort of worry about that this is going to happen again. And then…so, that’s number one, just to recognize it, and sort of talk about it, and not have it be hidden, and to sort of… I have found that, for a lot of people, removing that, like, guilt over my feelings has been very helpful that people can just focus on the feelings themselves.
Now, how can we actually reduce the anxiety? Well, you know, at the end of the day, you’re not going to take it away. And that’s sort of understandable. But I do think that, for some people, they find it to be very helpful maybe to have more frequent visits early in pregnancy, maybe more frequent ultrasounds early in pregnancy that they can sort of see and track that things are going well. Other people don’t want that. Other people are like, listen, I just want to get pregnant and not think about it, and come to 6 weeks later when I’m, you know, 10 weeks. And if everything’s well, great. And if not, I’ll deal with it. And that’s fine, too. And so, a lot of it is sort of self-awareness of what is going to help you be less anxious or as low anxiety as possible under the circumstances. And for some people, that means very frequent visits, which is great. And for other people, it means fewer visits, which, again, if medically okay, is also fine.
And so, I usually will leave it to the person. I’ll say, like, what is it that you would like in order to reduce your anxiety over the possibility of a miscarriage? And people will…if given choices, they’ll usually be able to know which choice is best for them. I think that sometimes we don’t give people choices, which is unfortunate. I think, sometimes in medicine, we’re very one-size-fits-all, which is…it’s understandable because sometimes with big systems, it’s hard to individualize. And so, I get it. But it is a little unfortunate because ideally we should be able at least to try to individualize for each person what is the best option for her in this pregnancy, and try to be as accommodating as humanly possible under the circumstances.
For some people who have severe anxiety, sometimes they need to be in therapy, and sometimes they need to be, you know, taking medications. And that’s okay. If it reaches that level, it reaches that level. And again, it’s not…you know, when we remove the judgment over the feelings, we can just address the feelings themselves. Are they affecting, you know, the ability to do day-to-day things? Are they not affecting that ability? And so, these are sort of the kinds of questions we go through to determine what is the level of response that’s needed to help you get through those feelings, particularly in the first trimester.
All right. Next question is from Ellie. “Thank you very much for a terrific, informative podcast. I recently found it. And even though this is my sixth pregnancy,” nice job, Ellie, “I’ve learned so much. It was especially beneficial when I went through some complications at the start of pregnancy. I’m now 36 weeks pregnant, and I’m wondering about postpartum hypothyroidism. When I was in my 20s, before I had children, I had hypothyroidism. The endocrinologist suggested I wait a little bit before starting medication. And eventually, my thyroid levels return to normal. Then in all of my pregnancies, I’ve had my thyroid levels checked, and they’ve always been normal. After my fourth pregnancy, I was having some symptoms. And my doctor decided to do a thyroid workup, and it came back positive for hypothyroidism. And because of my past history, we waited before starting medication. And again, my thyroid returned to normal. I assume what I have is postpartum hypothyroidism, as I heard it can occur after pregnancy and go away on its own.”
All right. “So, I was wondering a few things. Is getting my thyroid levels checked at my six-week postpartum visit enough, or should I do it more regularly? And if so, for how long? Number two, is it true that postpartum hypothyroidism goes away on its own, and should therefore not be treated? And how would I know? And lastly, am I at risk for developing hypothyroidism in the future? Thank you so much.”
Okay. So, a lot there. But I think that there’s a few things to talk about. The thyroid, right, which is a gland that’s in our neck and controls a lot of things in our body related to metabolism. You can have something called hypothyroidism where your thyroid is underactive, hence the word hypo. Symptoms of that tend to be things with lower metabolism. People are tired. People are sluggish. People can gain some weight. Right? That’s hypothyroidism versus hyperthyroidism, when your thyroid is overactive, and you have sort of the opposite. People could be jittery. They could be losing weight. They could have a high heart rate. They could be sweaty. They can lose hair. Sometimes, if it’s due to a condition called Graves’ disease, which is autoimmune, sort of their eyes start bulging a little bit. So, you can have either.
And I think what you were describing in your question, Ellie, is specifically hypoth [SP], which can frequently present very borderline. And I think that sometimes that’s where the confusion lies. When someone is borderline, it doesn’t always have to be treated. In general in life, it doesn’t always have to be treated. And in pregnancy, it doesn’t always have to be treated. And postpartum, it doesn’t always have to be treated. So, sometimes there’s a wait-and-see approach for hypothyroidism specifically. And when it says that it resolves, it could just mean that it stays stable or it gets a little bit better and fine.
So, you are correct that, in certain instances, in all circumstances, you know, whether related to pregnancy or not, hypothyroidism sometimes is treated and sometimes is not. And it depends on the specifics of whether you’re having symptoms or not of it, and what are the numbers like specifically, meaning is it…how borderline is it versus overt and whatnot.
Hyperthyroidism is a little bit different because whether it’s treated or not is also different whether you’re pregnant or whether you’re not. But I think what might have happened — and I’m not sure, obviously, Ellie, because I don’t believe I was taking care of you — after delivery, there is a specific condition called postpartum thyroiditis. Itis is, like, inflammation where your thyroid gets inflamed. We think it’s an autoimmune phenomenon specifically after delivery. And in postpartum thyroiditis, what happens, interestingly, is your thyroid first becomes overactive, hyperthyroid for a while. Then it flips and becomes hypoactive, right, underactive or hypothyroid. And then it often resolves. And so, it’s sort of like a swing. You go too fast, too slow, then it gets back to normal. So, for postpartum thyroiditis, frequently, there is a wait-and-see approach because it could be transient. The fast part could be transient, then the slow part can be transient, and come back to normal.
People who have postpartum thyroiditis doesn’t always turn out that way. Sometimes it stays fast. Sometimes it stays slow. Sometimes it needs treatment in either direction. And so, it does need to be followed. It’s often followed by an endocrinologist. It doesn’t have to be. If you have a good primary care doctor or internist, they could do it. Sometimes the OBGYN is comfortable doing it, but someone needs to follow to see, is your thyroid fast, is your thyroid slow, has it come back to normal? Do you have symptoms? Again, do we have to treat this? Do we have to treat that or not? And people who get it do tend to have a higher chance of getting it with subsequent deliveries.
And so, to answer your questions specifically, unfortunately, I have to say, it depends, right? For some people who have this, they need to be treated. For some people who have this, they don’t need to be treated, and they can wait and see. For some people who have this, they have to continue to check their thyroid levels at various intervals. And for some people, they either don’t or they do it at less frequent intervals, or maybe just after their next delivery.
People with thyroid conditions tend to need to be followed for their whole life in one way or another. But if it’s truly just a postpartum event of thyroiditis, for many people, it goes away, and stays away forever. So, I know that didn’t answer your question directly because I don’t think I can, but hopefully that covered the topic to some degree to give you and our listeners some insight into it.
All right. Our next question is from an anonymous listener. Again, reminder for those of you sending in questions, you can just ask me, “Please don’t use my name,” and I won’t. All right. “My questions. Is augmentation always needed for failed BPP during labor? My feeling is that I made progress while the Pitocin was at a low level, and stalled when the Pitocin kept being raised higher to speed things up by the next doctor in the following shift. I went from being okay and making it to an eight, and then suddenly I had all this energy snapped out of me and started regressing, and then made no progress for 12 hours. My baby was still sunny side up and on my right side. These are the impressions that I have, but I’m curious if there’s any medical information that would support this idea, and it’s better to keep Pitocin at a low, steady rate to give the body a chance to adjust, or is it just my feelings? Next question. I’d love to get an epidural later in the game next time, but understand that that is strongly suggested to have one with a VBAC.”
All right. So, there’s sort of two topics here. The first is about how do we use and dose Pitocin in labor for people if they need it? And number two is related to the next pregnancy about an epidural. So, let’s talk about the first question first. So, Pitocin, which is the sort of synthetic version of oxytocin, which is a hormone that’s made in our brains in labor naturally, Pitocin looks exactly like it. And it’s sort of we give it to people in labor for various reasons. We pretty much always give it after delivery to lower the risk of bleeding because it contracts the uterus. We almost always give it for people being induced because it sort of stimulates the uterus to have contractions from not having them. And then for people in labor, who are sort of contracting on their own already, we will sometimes use it. And what we call it is augmentation, meaning someone’s already in labor in some way or another, and we’re giving Pitocin.
So, why would we do that? There is a misconception out there that we do it as doctors because we’re impatient. And somehow this is harming people left and right. And I suppose there may be people out there on the planet who are using it because they’re impatient, but it’s actually not the reason. The idea is when we give Pitocin, it’s to either lower the chance of a C-section. Yes, lower the chance of a C-section. People think, by giving Pitocin, we increase the chance of a C-section. That’s not true. It lowers the chance. Or number two, if there is a reason that we think the labor should be going faster than it is.
Like sometimes if people have preeclampsia, want them to deliver earlier, or we think that they have a risk of getting infected, want them to deliver earlier, or we think that the way things are going, the labor contractions are not strong enough or frequent enough for the cervix to dilate. And therefore, we give Pitocin to get into that pattern, again, to lower the chance of a C-section because if someone’s laboring sort of indefinitely and the cervix has an opening, the baby’s actually gonna come out. And so, they’re going to end up with C-section. So, when we do it, it’s to augment the labor.
And the way we do it, we give Pitocin, it’s given intravenously, right through an IV, and it’s given on a very precise dosing regimen because if you just poured Pitocin into somebody, that would be dangerous, right? Because then the uterus would just contract indefinitely, and would not be good for the baby or the mother. So, the way we do it is at very, very low doses. You give it for a while at a certain dose, and it’s given as a drip. And then you increase it slowly. X amount of…we sort of dose it in milliunits per minute, whatever, but certain amount of those. And we increase it slowly every X amount of minutes. The word we use in medicine is titrate. We’re titrating it. So, you give a little bit more, wait and see the effect, give a little bit more, wait and see the effect.
So, that’s sort of different from a lot of medications. Like, for example, you take an antibiotic, they just say, take this three times a day for a week. You don’t titrate it. You don’t say…but the things that people sometimes titrate on their own are like pain medicine. Right? You know, take this every six hours for pain. But if you’re having less pain, maybe only take it twice a day, or don’t take it at all. That’s sort of a rough way to titrate things. But with this, it’s very, very precise. Give a certain amount, check the effect, increase the dose slowly, check the effect, increase the dose slowly, check the effect until you get to your desired effect.
What is the desired effect in labor? It’s different based on who you ask, but basically approximately contractions about every three minutes or so, give or take. Right? And so, that’s sort of what we’re looking for. Sometimes people will use an internal pressure monitor to actually check the strength of the contractions. That’s not standard. You don’t have to do that. You could do by the timing. And sometimes you’re doing that and also titrating based on whether cervix is dilating or not. So, that’s the background.
So, in terms of your question about is it better to stay at just sort of a slow, steady dose, and wait, and let the body sort of kick in on its own versus to keep going up on the dose till you reach the desired effect? I would say, it’s not clear whether one is better than the other, so to speak, but it’s also clear…it’s not clear whether one is worse than the other. So, if someone’s philosophy is, I’m going to give a very low dose and wait a very long time to see what the body does, that might work. But you may also end up being in labor for a much longer time or it may not work versus if you go up sort of…and titrate it so you get the desired dose, that tends to be what most people will do. And I don’t think that what happened to you is related to being on a higher dose of Pitocin. Meaning, I don’t think that putting you on a higher dose of Pitocin or titrating up caused you to not labor. It would be the opposite.
The downside, the only potential downside in going up is if you somehow overshoot, and get too much and too many contractions, and then the baby’s heart rate starts to drop because of that. And then we can obviously back off on the Pitocin. But that’s sort of the potential concern. So, it does not sound like that’s what happened to you. So, I think that going on the higher dose did not cause any sort of stalling in your labor. If anything, it would be the opposite.
So, I would say, in our practice, what we typically do, and this is how most people do it, is if you make a decision to start Pitocin in labor, you start at a low dose, and you just go up slowly until you get the desired effect, and then you stop going up. And again, if the body kicks into its own labor, and your body starts producing its own oxytocin, we would see that because the contractions at the same dose of Pitocin, the contractions would start getting more frequent, in which case, we can do the opposite and titrate down on what we’re giving, and lower the dose as long as the contractions are staying the same.
The second part of your question is related to the next pregnancy in epidural. And I would say, the short answer is that, in epidural next time in terms of the labor will not affect when you deliver how fast your labor is. The data indicates it does not impact the length of labor. It does not impact whether you’ll have a vaginal delivery or a C-section. It just reduces your pain. So, in general, you should just get it if you want it, and not get it if you don’t want it. The wrinkle you said about having one with the VBAC is real that a lot of doctors and midwives would prefer that patients who are trying to VBAC have an epidural.
And the reason for that is not because of the success of the VBAC, but it’s if there were an emergency and you needed a repeat C-section in labor quickly, if you had an epidural, they can do that without putting you to sleep. And so, that’s the reason people prefer an epidural in labor for a VBAC. It’s not because it makes the labor better or the VBAC better, or the labor worse or anything like that. So, that is a discussion to have with your doctor or midwife next time. How much do they really prefer you have an epidural if you’re trying to VBAC? All right. Good stuff.
The next question is from Maggie. “Hi, Dr. Fox. Love the podcast. Thank you for all the helpful information. I’m currently pregnant with my fourth child.” Nice. “This time around, I’m a bit older, and I’m wondering at what point I will be considered geriatric. I’m currently 34. Almost exactly halfway through this pregnancy, I will turn 35. Because I will deliver when I’m 35, is this entire pregnancy considered geriatric? Or because I conceived when I was 34, is this not considered geriatric, or will I literally turn geriatric on my birthday?”
All right. So, first of all, Maggie, you used the word geriatric, like, 46 times in that question. I’m sorry you felt the need to use that term. We don’t use the term geriatric medically. That is something that’s more of a colloquial thing. The medical term, I’m not sure it’s much better. We call it advanced maternal age or AMA. And essentially, it just means that someone is 35 or over. To answer your question specifically about how do we define it, it’s defined as by the date you deliver. So, if you are going to be 35 on the date you are due when you’re pregnant or on the date you delivered, we call that advanced maternal age. And if you are not, then we call it less. So, for someone like you who’s 34 when you conceive, you turn 35 in the middle of pregnancy, and then you’re due later, we would call that advanced maternal age. So, that’s the answer to your question.
The reason we try not to use the term geriatric is it’s just…you know, first of all, it’s wrong, right? Obviously, someone who’s 35 is young, right? And as I get older, 35 seems younger and younger, but it’s really just…the reason this whole concept exists with advanced maternal age originally was because of the risk of genetic abnormalities. And nothing happens at 35, but that was sort of where people drew the line in the sand — this is 20, 30, 40 years ago — about when to do an amniocentesis and when not to do an amniocentesis. If you were 35 and over, it was recommended. And if you’re under, it wasn’t. That’s sort of not how we do things nowadays. And we’ve done a bunch of podcasts on that, but that’s where it originally came from.
And then, subsequently, there’s been other data that shows that, as women get older, there are other risks in pregnancy that get a little bit higher. And so, we watch for them a little bit closely. Most notably, things like preeclampsia is more likely if you’re over 35 than under, or the risk of C-section is higher if you’re over 35 or under. But again, for all these things, it’s not that you’re perfectly fine when you’re 34 years, 11 months, and 31 days, and then something happens when you turn 35. It’s just as women get older, these risks go up. And so, 35 is just a line in the sand. We tend to use it much, much less in pregnancy. And it’s not as relevant whether someone does or does not have the label of advanced maternal age. All right. Great question, Maggie. You’re still young. Enjoy your youth.
All right. Next question is from Victoria. “Big fan of the podcast, and loving the ‘Mailbag’ episodes. Curious what Dr. Fox’s opinion is on drinking the occasional Red Bull. My OBGYN told me it was fine if I keep it in moderation, usually just one per week when I have a migraine. I do not consume any other caffeine. I do not drink coffee, eat chocolate, drink tea or anything like that. She said the caffeine was well below the limit for pregnant women, and that it shouldn’t cause any issues. Curious on what Dr. Fox’s opinion is. Is it okay in moderation or not worth the risk? Also, what would the potential risks be? What harm could it do? Really, really,” two reallys, “Appreciate your opinion in this, and can’t wait to listen to more ‘Mailbag’ episodes.”
Thank you, Victoria. Thank you for the plug. We are going to continue to have more “Mailbag” episodes. In terms of your question, so, caffeine in pregnancy, you know, it’s interesting because it’s hard to get great data on this, right? Because how would you get great data on this? You would basically have to take, I don’t know, thousands of pregnant women, and randomly divide them into groups and say, “All right. You take X amount of caffeine. You take this higher dose. And you take this highest dose. And let’s see what happens to them.” That’s not been done. That’s not going to be done.
And so, what ends up happening is they sort of, like, look back and try to figure out how much caffeine did people consume in pregnancy, which is also quite hard to ascertain. People don’t always remember what they had, how much…you know, how much caffeine is in this coffee versus this. It’s not easy to get that part. And then, also, sometimes people have caffeine for various reasons. Sometimes people have caffeine because it helps certain symptoms. And maybe it’s not the caffeine consumption that affects the outcome, but sort of the symptoms that are a sign of the outcome. Or sometimes people who drink caffeine are also more likely to do A, B, or C.
And so, these studies are all very muddy. But based on the preponderance of data that we have, moderate levels of caffeine, lower levels of caffeine seem to have no impact whatsoever on the pregnancy, on the baby, on risk of miscarriage, on anything. And which is why we say it’s generally fine to have caffeine in moderation. What is moderation? You can go by milligrams of caffeine or just in general, I tell people normal human consumption, like one to two, whatever, a day, whether that’s a coffee, whether that’s a tea, whether that’s a Diet Coke, a Snapple, whatever it is. You know, if you’re having one or one to two a day, that’s generally below the line and has not been associated with issues.
In terms of high caffeine, someone’s having six, seven cups of coffee a day, whatever it is. It’s not known that that’s going to cause problems, but the concern from some of the studies, which, again, are flawed, is that that level slightly increased the risk of miscarriage. And so, we’re saying, it’s this sort of, like, it might, might, might, might. So, it’s very, very unclear. But that is the potential possible concern. We don’t know if it’s a real thing or not a real thing. Again, in my experience, in my practice, the vast majority of people who have caffeine in pregnancy or in life are under that threshold and are not having to change their caffeine consumption habits when they get pregnant. Some people find something online, and they tell me, “Hey. I cut all my caffeine out. What do you think?” And I’ll say, ‘Well, how do you feel?” And some would say, “I feel the same.” All right. Like, whatever. That’s cool.
But other people actually, it impacts them because they are more tired or they get headaches. Right? Some people, they get headaches when they don’t have caffeine, like you were talking about. And so, generally, the normal levels that we’re talking about, as far as we know, are perfectly safe in pregnancy, and should be fine.
Next question from Amelia, our last question. “Big fan of the podcast. Thank you for sharing your expertise. My question is regarding fetal movement. I’m currently 26 weeks, and I’m loving feeling my baby move. It is so reassuring that he’s doing okay in there. At my 20-week ultrasound, he was breach. At my 24-week ultrasound, he was cephalic,” that’s head down. “I still feel like his kicks and movements are very low, below my belly button. Could this mean he’s back to being breached? And I feel his feet down low. I would be interested to learn more about baby’s positioning and movements in the womb, and how that changes from late second trimester to third trimester.”
All right. So, Amelia, great question. I get asked this all the time. It’s actually great. I’m really happy you asked this because, literally, this comes, like, almost every day. So, we do routine ultrasounds at 20 weeks. Most people in pregnancy are going to have a routine ultrasound around 20 weeks. The anatomy ultrasound, the 20-week ultrasound, the level two ultrasound. It’s got a lot of names to it. And people ask all the time about the position of the baby. Is the head down? Is the head up? Does it matter? And at 20 weeks, it does not matter what the position of the baby is, for several reasons.
Number one, it just doesn’t matter. It’s not healthier to be one way or another at 20 weeks. Number two, the position of the baby early in pregnancy changes a lot. The babies are small. They got a lot of room to swim around in there. And so, what I tell people is, the baby might be in a different position tomorrow. It might be in a different position 10 minutes from now. Right? Sometimes we’ll do ultrasounds, in the middle of ultrasound, the baby goes from head down to head up to head down. They move around a lot in there. So, it really does not matter.
And when you’re in the second trimester and early third trimester, definitely, the babies turn around a lot. And so, we don’t really focus on it. We barely even comment on what the position of the baby is at that point. It becomes relevant later in pregnancy what the position is, because nowadays, we really only deliver babies when it’s singleton, head first, right? Cephalic. So, if the baby’s breached, there’s a concern. Is it going to be breached? Do I need a C-section. Do I need to turn the baby? This or this.
The babies move enough that we really don’t even comment on it before, like, 28 to 32 weeks. And then after that point, it’s sort of, oh, of note, what is the position of the baby? And I would say, by 32 weeks, the position of the baby, if it’s head down, usually stays that way. And if it’s breached at 32 weeks, probably there’s still, you know, at least a 50% chance it’s going to turn to head down by the end of pregnancy.
And so, in terms of your question, under 28 weeks, we rarely comment on the position of the baby unless maybe someone who’s at high risk for delivering early, maybe their cervix is short or dilated, in which case it matters more. But in a typical pregnancy, we don’t usually comment on the position. After that point, it’s like, of note, but we don’t really start thinking about it, and earnest, as they say, till probably 32 plus weeks. And those that are head first usually stay that way. Those that are feet first will frequently turn to head first by the time it matters, which as we get closer to your due date.
In terms of the kicks, yes, definitely, people will sometimes feel the kicks based on the position of the baby. So, if the baby’s head down, frequently, that means the feet are up. So, you’ll feel the kicks higher up. And if the baby’s head up, frequently, the kicks are lower down by the bladder. But that’s not always true because babies sometimes, you know, fold in half. And so, their feet are sometimes near their head. And so, it’s also not perfectly aligned with where the kicks are to figure out what the position is. But sometimes that’s the case.
All right. Everyone, thank you for your questions. We’ll see you all next week.
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