WEBVTT Season 8 | Episode 215 — Third Trimester, Birth Prep and Your Baby's First Moments Host: Meg Faure | Guest: Dr. Nellie Balfour NOTE Timestamps are estimated from the original two-part transcript and must be verified against audio before publishing. 00:00:00.000 --> 00:01:12.000 [Meg Faure] You've made it to the third trimester. Your bag's not packed, the birth plan feels overwhelming, and your toddler has no idea what's coming. Does this sound familiar? Today I'm joined by Dr. Nellie Balfour. My name is Meg Faure, and in this episode we're tracking what's happening as Nellie approaches birth. We've been following Nellie, who's a paediatrician, all the way through since the first trimester — and now she's almost there. In this episode, Nellie and I get into everything you need to know about birth, and particularly C-section births, because she's having an elective C-section and is actively preparing right now. Here's what we cover. We talk about baby sensory personalities — whether you can actually tell what your baby's going to be like from their movements in utero. We also discuss what that sensory personality means for your older child. 00:01:13.000 --> 00:02:20.000 [Meg Faure] We also talk about the hospital bag. I asked Nellie to walk us through what she's packed, what you actually need, what you can leave at home — and I was fascinated by her sleepwear choice. If you're thinking about what to pack, this is one to hear. Then we get into those first moments straight after birth. What is an APGAR score? Why is cord clamping timing important? And what is a paediatrician doing in the room when your baby is born in a C-section? This is a warm, practical, and reassuring episode from a doctor who is living every single moment alongside you. Do share it with any mum you know who is pregnant. 00:02:22.000 --> 00:02:43.000 [Meg Faure] Welcome to Sense by Meg Faure, where we make sense of the science and art of parenting. Parenting is grey, gritty, and beautiful all at once. My life's work as a healthcare professional is helping parents feel more confident in a season that can feel really overwhelming. In each episode we share honest conversations with real mums, explore the science with experts, and simply make sense of it all in practical ways. 00:02:44.000 --> 00:05:05.000 [Meg Faure] This is your space. You're not alone. You're held. So let's begin. Right, so we are here with Nellie, and we're going to jump right in. Nellie, it's so lovely to have you with us today. How many weeks are you? [Dr. Nellie Balfour] Thanks, Meg. I love being back. I love these sessions. I'm 35 weeks and three days. [Meg Faure] Oh my goodness, you are right into that last stretch. How are you feeling? [Dr. Nellie Balfour] I'm feeling good. I'm feeling ready to meet this little guy. I'm tired, but weirdly I have enough energy for all the nesting. I'm excited. I always get excited near the end of my pregnancies. [Meg Faure] That's wonderful. So the first trimester was really hectic — you physically lost weight, which you never think about when someone is that sick. And then your second trimester, you were glowing. What would you say about this third trimester? [Dr. Nellie Balfour] I'm excited and anticipating his arrival. I want to see how he looks, who he looks like between me and my husband. I want to get a feel of his personality. There have been ups and downs, which we'll speak about too. [Meg Faure] It is such an exciting phase. There was a psychologist who did a study many years ago and looked at what parents focus on through each stage of pregnancy. At this stage, the focus is: who is this little human? That's exactly what you're thinking about. And obviously, how is he going to come out? Do you have a sense of that? [Dr. Nellie Balfour] Yes, I'm having a caesarean section — an elective one. My firstborn was also born by elective C-section. I know there are lots of different opinions about how babies should be born. But from my job as a paediatrician, having seen babies born by both routes, I don't think there's much difference in outcome. There are studies about the microbiome and vaginal delivery, but elective C-section is safe and it's the right choice for me. 00:05:05.000 --> 00:07:05.000 [Meg Faure] I think you allude to something there — that every single birth comes with opinions from all over the place about what's good and what's bad. It's such a personal journey. It does make for predictability, though. Are you going to 40 weeks? [Dr. Nellie Balfour] No, 38 weeks. For elective C-sections, we generally schedule at 38 weeks — you can push to 39 if your gynaecologist recommends it. And I always say, it doesn't matter how your baby comes out, as long as you and your baby are safe. You're still a mum at the end of the day — you carried this little one for nine months and brought them into the world. [Meg Faure] Absolutely. Let's talk a bit about his personality. Because you're right — we won't really know it in the newborn phase. But we already have a few indicators in utero. How busy has he been compared to your firstborn? [Dr. Nellie Balfour] Very busy. My firstborn kicked often, obviously, every day — but this little guy is doing somersaults, tumbling around. He's a little acrobat. I feel him very, very often throughout the day. I think that might point towards how he could be different from his brother. 00:07:06.000 --> 00:08:29.000 [Dr. Nellie Balfour] Firstborns and secondborns tend to differ quite a lot. Not just from my job, but from personal experience. In my own family, there are three of us girls and we're all very different. I think he's going to be quite a firecracker. [Meg Faure] So interesting. I have a theory — it's purely anecdotal, there's no scientific evidence for it — but I do see that little ones who are very busy in utero tend to be busier sensory seekers afterwards. I love to think about the development of personality based on how babies engage with their world through their senses. **SENSORY PERSONALITIES** You get your sensory seekers, who I call the social butterflies. Those little ones are very social, wired for interaction, and they love a lot of sensory input. They can be quite exhausting babies and toddlers, because they're always looking for stimulation. When we understand our baby's sensory personality, it helps us with everything from weaning to sleep in those early days. 00:08:30.000 --> 00:10:44.000 [Dr. Nellie Balfour] I love all your work on sensory personalities. I watched your webinars with my first one when he was a newborn, literally holding him and watching on the computer. He's always been slow to warm. That's just how he is. He's been quite an easy baby and toddler. I can travel with him without worry — he's calm, and he just likes the people he likes. But I do feel like maybe number two might be the social butterfly. We'll see. [Meg Faure] I had a slow to warm as well — my third. It's a very precious personality because they observe the world before they throw themselves in. And once they're comfortable, they look just like social butterflies. **SLOW TO WARM: A PRECIOUS PERSONALITY** When I was naming the four sensory personalities for one of my books, I called them settled, slow to warm up, social butterfly, and sensitive. Someone said to me that the names are somewhat leading — it sounds like everyone should want a social butterfly. But having had both, I can tell you that slow to warm children are very precious souls. They're observers, and once they're comfortable, they're an utter delight. What does happen is that slow to warm little ones' worlds get disrupted quite significantly when anything new happens. And the newness of a new baby — particularly if the baby's a busy social butterfly — is potentially going to be disruptive for your firstborn. 00:10:44.000 --> 00:12:28.000 [Meg Faure] The little strategies really do help. Talking through what's coming, preparing the room, showing him the room, talking about what's going to happen each day. Slow to warm children often use their verbal intelligence quite strongly. They pattern their world intellectually, and then they're fine. Does that sound like him? [Dr. Nellie Balfour] Exactly like him. I saw from early on that he was slow to warm. Now at two years and two months, I see it almost every day. He's very observant and watches people in his environment before he feels comfortable. But once he does, his personality really comes out. He makes us laugh and fascinates us. I do have concerns about how he's going to adjust to his baby brother, because I think his brother might be a social butterfly. Almost everyone on my side of the family is a social butterfly, and on my husband's side, almost everyone is slow to warm. So we'll see. He does get a little overwhelmed with other kids who are very out there, social, in-your-face, running around. I'm looking forward to seeing the dynamic. 00:12:28.000 --> 00:15:43.000 [Meg Faure] What makes things a lot easier is when a parent has insight. You can co-regulate for him — recognise when he's becoming overstimulated, take him for a walk while you settle the baby if the baby's colicky, and then turn your full attention back to him. Is your husband with you? I know you're living between the Middle East and South Africa. [Dr. Nellie Balfour] He's arriving tomorrow. We're super excited. He'll be here for the birth and for a significant amount of time afterwards. My mum is arriving in about a week and a half too. [Meg Faure] Wonderful. So let's talk about birth prep. Have you packed the hospital bag? [Dr. Nellie Balfour] Hospital bag is packed for me. I still need to pack baby's bag this week. But mine is done. For me, it's one of the most exciting parts of the third trimester. It feels real. In my first pregnancy, there was a day I wasn't feeling great, texted my gynae, she said come in, bring your bag — and that turned out to be the day I gave birth, even though it wasn't the scheduled date. So I stay packed. 00:15:44.000 --> 00:17:23.000 **THE HOSPITAL BAG** [Dr. Nellie Balfour] So for mum: I'm a huge fan of a range called Carrywell — they do maternity products for before and after birth. Linen savers for the hospital bed, maternity bras for easy breastfeeding, maternity pads, and maternity underwear that won't irritate the C-section scar. People also forget a phone charger. Always pack a phone charger. [Meg Faure] I saw on your Instagram that there was a little bulb-shaped product with a spout. What is that? [Dr. Nellie Balfour] That's a peri bottle — mainly used for natural births to gently clean and soothe the area after vaginal delivery. You can use cool water or add soothing ingredients. Carrywell do brilliant products for every type of birth and every type of mum. [Meg Faure] I can confirm — my son is 27 and I used Carrywell products. Those maternity pants were just brilliant. 00:17:23.000 --> 00:20:29.000 [Dr. Nellie Balfour] Also in the bag: a breastfeeding pillow, because positioning really matters and it's harder than it looks. Slippers to keep feet warm. Flip flops for the shower — it's a shared space, so hygiene matters. Nightwear in the form of a front-button nightie rather than pyjama pants, especially for a C-section. The elastic on pyjama pants can irritate the scar and bending down or getting up is difficult. The buttons are for quick breastfeeding access. A gown. A breast pump. And breast pads — on day two or three your milk comes through like a tap, so those pads are essential between feeds. I'm not bringing a speaker. Some people do for natural births, to play music. But for me, I just slept. When I was awake, I was with my baby. No laptop, no iPad, nothing to watch. Just rest and baby. [Meg Faure] That's such an interesting contrast. With natural births, a third of your bag is for labour. With a C-section, it's almost entirely postnatal. [Dr. Nellie Balfour] Exactly. The C-section itself is 20 to 30 minutes and then you're back in your room. You're not labouring for hours needing things to keep you comfortable and sane. 00:20:47.000 --> 00:26:33.000 **THE BABY BAG** [Dr. Nellie Balfour] The baby bag is my favourite to pack — this is what I advise parents on all the time. Nappies — and I suggest two sizes. Newborn size for one to three kilos, and size one for two to five kilos. You don't always know how big your baby will be, and estimated weights from ultrasound aren't always accurate. Wet wipes, unscented and free of ingredients that might irritate newborn skin. Cotton wool with surgical spirits for the umbilical stump — clean it with each nappy change to help it heal and prevent infection. Outfits and beanies — babies lose a lot of heat from their heads because the head is their largest surface area. Swaddles, because they give the feeling of being back in the womb, help with containment and comfort, and help baby sleep a little longer. And a dummy or pacifier — sometimes when they can't be soothed, that sucking motion really helps them calm down or drift off. [Meg Faure] There's so much conflicting advice on dummies. I'm a big fan of them, as you are. What's interesting is that with premature babies, we actually insist on dummies because they need to develop their suck reflex in order to breastfeed. So rather than being a problem for breastfeeding, dummies can be fine. The one caveat is this: in the early days, when your baby cries, prioritise the breast. It helps establish milk supply. The risk with dummies isn't really nipple confusion — it's whether a mum is skipping a feed by offering the dummy instead. Feed regularly, and then use the dummy after the feed for non-nutritive sucking, which also helps move gas through their gut. [Dr. Nellie Balfour] One hundred per cent agree. [Dr. Nellie Balfour] And then blankets, toiletries, and a gentle fragrance-free, foam-free cleanser for baby's skin — newborn skin is very sensitive, and they'll take their first bath in hospital. Moisturiser too. And vests and warm layers, because this baby is a winter baby and it's 13 degrees in Johannesburg today. 00:26:33.000 --> 00:28:32.000 **DELAYED CORD CLAMPING** [Meg Faure] I remember being terrified bathing my firstborn in hospital. There's also quite a bit of research showing that not bathing early is beneficial — it gives the skin time to absorb the vernix, and there's some evidence that babies who aren't bathed immediately get their hands to their mouth sooner, because they can still taste something familiar from the womb. So the idea would be not to bath before day three. [Dr. Nellie Balfour] That's exactly what happens in private and public hospitals now. On day three, or 72 hours, baby gets the first bath. It's great to see hospitals following the evidence. [Meg Faure] And speaking of evidence-based practice — delayed cord clamping. Is that possible with a C-section? [Dr. Nellie Balfour] Yes, we do it with elective C-sections, and as far as possible with emergency C-sections too, as long as baby is breathing. Delayed cord clamping means not clamping the umbilical cord within 30 to 60 seconds of birth, so that as much blood as possible can transfer from mum to baby. The benefits include a lower risk of anaemia and a lower risk of jaundice, among others. I wanted it for my firstborn, they did it, and I want it again for this one. For emergency sections, as long as it's safe and baby is breathing and active, we promote it. If baby needs oxygen or resuscitation, then we clamp immediately so baby can come straight to me. 00:28:32.000 --> 00:29:59.000 **THOSE FIRST MOMENTS** [Meg Faure] And in terms of the sequence of those first moments — baby comes out, delayed cord clamping, does he go straight onto your chest or to the paediatrician? [Dr. Nellie Balfour] It depends on how the baby is and what you request. If mum requests skin-to-skin after cord clamping, and baby is breathing and healthy and pink, that's completely fine. Then baby comes to the paediatrician for the examination, and goes right back to mum afterwards. If baby is compromised in any way and needs resuscitation, then baby comes straight to us. [Meg Faure] Now let me turn it around. You as the paediatrician — you've assisted at births, you've been in the C-section room. Tell me exactly what you're looking for. Why does the baby get passed to a paediatrician? Talk us through it. 00:30:00.000 --> 00:32:49.000 **THE PAEDIATRICIAN'S EXAMINATION** [Dr. Nellie Balfour] The baby gets passed to a paediatrician so we can check baby out and make sure everything is as it should be. We basically examine the baby from head to toe. But there are things we look out for immediately — because we've been doing this for a long time, and we know what should and shouldn't happen. We want baby to cry. It doesn't have to be a long, sustained cry — it can be a whimper, as long as baby is breathing. The reason we want the cry is because crying tells us oxygen is going in and out of those little lungs. The louder and longer the cry, the more oxygen we know baby is taking in. After that, we look at colour and movement. We expect baby to be blue or purplish at first — depending on skin colour. Usually after about five to ten minutes, we want to see baby become pink. A lot of dads get a real fright seeing the colour of their baby for the first time, but it's completely normal. The hands and feet may stay a little blue a bit longer — that also resolves on its own. We look at activity — is baby nicely flexed, limbs active? We don't want a floppy baby. We don't want a quiet baby. We don't want a baby that stays blue for a long time. Baby is shown to mum and dad briefly first — this is your brand new bundle of joy — and then passed to us. We examine from head to toe: shape of the head, face, neck, chest, we listen to the heart, check breathing sounds, the little abdomen and umbilical stump, legs, hands and toes — ten fingers, ten toes — the back, and the genitalia, just to make sure everything is as expected. Once we're happy, baby goes right back to mum and dad. 00:32:49.000 --> 00:35:02.000 **APGAR SCORES** [Meg Faure] Very interesting. And do you rank the APGAR, or does the nurse? [Dr. Nellie Balfour] It's the paediatricians who do the APGAR. Paediatricians are present at every C-section — whether elective or emergency. If it's a natural delivery with no complications, the nurse present will score it. The APGAR is a score out of 10. It gives us an indication using several parameters — appearance, breathing, activity, colour, and heart rate. The score tells us whether we're happy with how baby is doing, or whether baby needs more attention: extra oxygen, monitoring, or a trip to the ICU. Basically it gives us an indication of the prognosis going forward. [Meg Faure] I remember learning about APGAR scores at university as an OT — a very low APGAR can indicate problems later on, for example with cerebral palsy. What I found interesting is that it's not "7 out of 10" — it's 7 at one minute and 10 at five minutes. A fairly low first number, like 5, is not that alarming if the five-minute score is 10. But if the score is 6 at one minute and still 6 at five minutes, that's much more worrying because baby isn't picking up. [Dr. Nellie Balfour] One hundred per cent. It's the five-minute APGAR that counts for more. Your one-minute APGAR can be 5, your five-minute can be 8, and we're happy. And then there's a ten-minute APGAR as well — if it was 8 at five minutes, it should be higher at ten. But yes, the five-minute score is the key one. 00:35:02.000 --> 00:36:41.000 [Meg Faure] Excellent. And I think most mums who've just heard that conversation probably didn't even know about any of that. One of the challenges you have as a paediatrician is that you know so much. Going into birth takes on a different lens for you — you know exactly what happens at every step of this process, and you've also seen things go wrong. But by far the majority go right. I can imagine your anxiety might rise a little over the next two weeks. We are wishing you so much love and a wonderful birth and delivery. And those first beautiful moments with your baby — I truly wish those to be beautiful for you. [Dr. Nellie Balfour] Thank you so much, Meg. I really appreciate it. I'm looking forward to it, and you will hear when he has arrived. I'll let you know. [Meg Faure] Definitely. And we would love to touch base again within two weeks after he's born — give you a little time and space to regroup — and then we'll hear all about how the birth actually went. So good luck! [Dr. Nellie Balfour] Absolutely. Thank you so much, Meg. 00:36:41.000 --> 00:36:55.000 [Meg Faure] Thank you for joining me today. I hope today's conversation brought you a little more clarity, calm, and confidence on your parenting journey. If you enjoyed the episode, please share it with a friend who needs to hear it, and go and subscribe to the podcast so you never miss an episode. I'll be back next week — same time, same place, and always here to support you. In the meantime, download the Parent Sense app to take the guesswork out of feeding, sleep, weaning, routines, and everything in between.