#127 | September Q&A: Pediatricians, Shoulder Dystocia, Family Dynamics & Birth Choices, Fundal Massage, Preventing Big Babies, Using the Haaka, Fetal Hiccups, Fourth Degree Tears, Changing Your Mind in Birth

Both of them, particularly my mother in law, freaked out and berated us for making this choice. I knew in that instance, my mother in law was reacting out of fear.

Can you talk more about the use of fundal massage after birth, I just found out that I'm pregnant again, and I'm terrified of tearing any advice to help avoid tearing the second time around.

A lot of people say they have shoulder dystocia, when really the shoulders just took a minute to make their way through, like, that's normal. That's normal, very casual. It's all worked up about the vaccine comments. God would have been what are they really thinking? We said, but we're really thinking, you're in charge.

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Good morning. Good morning, and welcome everyone to our September q&a episode. Trisha, do you remember when we started our podcast? And I said, Let's do a q&a episode every month. And I remember you saying Don't you think we're gonna run out of questions? Don’t you think people are going to ask the same questions. And I was like a watch. We're gonna get like, hundreds of unique questions.

Yeah, they're really, really amazing. We love it. We get a lot of questions on the same topic, but there's always enough of a variation that it makes it worthwhile to talk about it again.

There's so many nuances. So Alright, so let's get started. Or did you have something else today?

Well, no, I think we have so many questions today that we are going to just jump right into the questions except I would love to read the most recent review we received on Apple podcasts because I think those are always fun to share.

Okay, let's hear it.

So let's go. I take careful time to select the best references and resources as I grow in my doula work, down to birth podcast is by far one of the best podcasts out there to empower women and to help inform anyone interested in birth. Trisha and Cynthia are obviously very passionate and serious about their work and have done outstanding work curating topics on pregnancy and beyond. I often find myself nodding my head vigorously as if I'm in the room with them. I've taken them as virtual peers in the birth world and value and respect the information and encouragement they share. doulas send this podcast to your clients now exclamation point, exclamation point.

Nice. Yeah, this is a good one, huh? All right. Let's start with our questions. Hello, wonderful. Ladies. I've been binging your show since I first discovered it a few weeks ago. And I've already learned so much. I'm expecting my first and you've completely changed my mindset about birth. I am so thankful to you for sharing your knowledge with me. My question, however, is about care for my baby postpartum. I hear so much about finding a high quality evidence based provider for the actual birth, but not much for the baby afterwards. Any advice on the search for a pediatrician? I have no clue how to begin. Thank you again for your lovely podcast. All right. Thank you April for your question. You are right. We have not really talked about that a whole heck of a lot.

I have one thought what one important thought. Very hard to find. But if you can find a pediatrician who does home visits in the first two weeks, go there and never look back.

Ooh, set that bar high. I wonder how many still do that?

Very few. And I don't understand why I mean it how it would not be that difficult to have a home health nurse. It doesn't even have to be the pediatrician in the first you know, the baby's been examined at birth. It's had to fold newborn exam in the first couple of weeks. We're mostly just looking at wait any enters could do an A newborn exam.

I just had a new friend to dinner this week. And she had her first baby in London. And she said when she had her baby, she said that she got a home visit every day for two weeks. Two weeks? No, can you imagine? Because what's so great. I mean, it's under this whole premise of checking on the baby. But what's happening is that mom is getting contact interaction, the chance to ask questions, you know, these things are a great way to combat mood disorders like anxiety and depression. But let's answer this this woman's question. So I think the first thing is become aware of your values. What are your values? I mean, do you know if you are for example, more naturally inclined. So one way to first get a list of pediatricians that you might hear about in your area? And you might want to ask some logistical questions like Do you have a certified lactation consultant? On your staff? Do you take Saturday walk in hours or do you have every morning walk in hours in case the baby is sick? That is a really big advantage. But think about your values. So for downfall, you could ask if my baby or toddler were to have an ear infection, what do you typically prescribe? Some pediatricians are going to say, antibiotics, some are going to say chiropractic and garlic oil. And you have to just see what seems to fit better for you. Certainly, when it comes to vaccines, I think everyone can agree on many things related to vaccines, no matter how controversial and hotly debated they are. That choice is important. You are this child's parent and no one's opinion matters as much as yours. So pediatricians who respect that you will always be the person to make every decision related to your baby, I would personally put at the top.

I totally agree with everything. I mean, the interesting thing is there's so much research and evidence, although there still is insufficient, but there's so much more on evidence based care around birth and less on evidence based care around newborns and children. Right. So I think everything you said, I completely agree with, I think vaccination is probably the hottest variable, the hottest topic that's going to differentiate who you choose. I mean, if you are opposed to vaccines, you can't go to a pediatrician who's going to be pro vaccine, that's just not going to work out. Yeah, I mean, or you have to understand that things are usually worth controversies are usually worth diving into. When your grandparents were born, there were between one and three vaccines depending on when they were born, the 70s, there were 23 vaccines now there are 70, for every child from infant through high school, and in the next generation, based on the pipeline of vaccines in the making, it's estimated there will be between two and 300 per child. So you know, maybe there's no limit to how many you would want to do. But many people have some kind of limit, right? So if you're expected as a parent not to question not to research, not to make up your own mind consciously about what you are willing to do there, then you're not being respected as the parent of this child. There are parents there, pediatricians out there who are fully respectful of whatever you want to do a full schedule a partial schedule, a delayed schedule are nothing at all, it is your decision to make, we're here for informed consent, and informed consent and the right to your own body. You know, it's either we grant it to people, or we don't. And that's what we're here for. So we hope you will find a pediatrician who respects that they're not the final decision maker on everything related to your child you are. And just as I said before, if your provider takes you late to every appointment, I think it speaks volumes about whether they respect you, that's my opinion. And this is just more for you to consider what speaks volumes to you about whether you're being respected as a client. And I think even more important as the parent of this child, you and your partner have to agree on these things. But you and your pediatrician, don't. So, you know, you want to make sure it's a relationship you really feel comfortable with and where you're respected and where you have autonomy.

The other thing too, is it's always okay to change pediatricians, you might start with somebody and change later based on you know how your ideas change as you raise your kids.

Yeah. And you might find that some of them do meet and greets and have opportunities for you to talk with them and ask questions. So don't be afraid to ask them those questions.

That's all she wrote for that one thing? Yeah, I guess that's it for that one. Now, everyone's all worried about the vaccine comments. Oh, my God, what do they mean? What are they really thinking? We said, what we're really thinking, you're in charge. It's your body, and then it's your baby's body, period, end of story. That's how we feel.

You know, they want more than that.

Yeah, they're not getting it because they're the parent. And it's funny. Sometimes I have clients who, who say to me, but Cynthia, did you do the vitamin K shot for your baby? Or Cynthia? Did you do erythromycin? And I'm like, Look, I am very happy to answer that question. But I'm very concerned that you're asking because you've trusted that I did my research and you're just going to go by without whatever my husband and I decided what was right for us, but then you're not taking responsibility for your baby. So the what our role is here is to have you step into that role. So we're happy to have all the conversations but not so you can abdicate responsibility over to your over to us, I mean, more than we would want you to turn it over to your provider. So that is all she wrote on that one. And it's not an easy one. It's not nice leaving it that it's not it's only easy when you look back and realize all the work is behind you. But the is very tough, very tough. It feels like it's endless. All the questions you have and all the research you have to do. But don't be pressured into anything. These are all important decisions and they're yours to make.

Alright, next one says, Hi. Do you have any advice for a mom who has a history of shoulder dystocia and hemorrhage? I've been trying to find good honest info but it's hard to find. Well, it is hard to find my advice for a mom who has history of shoulder dystocia and hemorrhage is to trust that there were probably some contributing factors in the labor that contributed to both of those things and modifiable factors for a future birth. So we know that hemorrhage is the risk of hemorrhages increased with very long Labor's with induced Labor's with long Labor's that have high amounts of Pitocin just because you had a shoulder dystocia and I have no idea the severity of the shoulder dystocia that that does, there's a difference between snug shoulders and a true shoulder dystocia.

You know, Mecanoo showing up going, does my baby have snug shoulders? They're gonna be like, What do you know? And who have you been listening to? Max just gonna worry about whether they're snug. So a lot of people say they have shoulder dystocia, when really the shoulders just took a minute to make their way through. Like, that's normal. That's a normal variation. Is this all based on ultrasound? No, this is probably based on your Yeah, history. But But was it a true shoulder dissection because I think that when shoulders even take a minute to come out, often people will say that your baby had shoulder dystocia a minute. Yeah, so the technical definition of shoulder dystocia is a delivery time between the head and the rest of the body of greater than 60 seconds. That's sort of like the standard definition. But if the shoulders take a minute, sometimes or if the provider has to provide any amount of traction to get the shoulders or any type of hand maneuvering to get the shoulders come out, they may call it Shoulder Dystocia. But we know that the position you're giving birth in is a contributing factor. And as I said, hemorrhage is also a modifiable risk factor because the number one reason that women have hemorrhage postpartum is uterine at knee or a poor uterine tone, which can happen with very long labors which can happen with moms who are having, you know, multiple gestations twins, or they're having their multi gravity, meaning they are pregnant 4/3, fourth, fifth time. So yeah, if you had a history of it, I think it's important to make sure that you are upright, mobile, active, not in the bed, utilizing your body's natural movements to help the baby be aligned in the best position and maximizing your pelvic outlet at the time of birth.

I always feel for women who are pregnant the second time, and they had some challenge in their first birth. And I've seen this so many times. And so many are coming to mind where they feel they start to form a belief like I give birth this way, or this happens to me like, if the first baby goes to 42 and a half weeks, they think they give birth late, you know, and when one friend slash client of mine, her baby was breech and started coming out breech, and they gave her C section after the baby started coming out breech if you can believe that. And then she was so worried about it the next time or if they have preeclampsia, they think they're going to get that again. I had a client who had a fourth degree tear, it was brutal. It was so much for her to go through postpartum, her second baby flew right out. And there was no tearing. I, my first client who had six hours of pushing spent her second pregnancy worried about pushing the second baby flew out. So my thinking is always be mindful of any beliefs you're forming. This is a really useful question. And I'm glad you asked it now move forward with the preparation that Trisha recommended. But be careful that you don't form any beliefs that will drive up any likelihood of how you might give birth a second time or what the conditions may be. It really does have an impact.

Yeah, it's important to remember too, that on paper, the most predictable thing for shoulder distorted the thing that gets every provider worked up his big babies, right babies more than 4000 grams. But he also know that most cases of shoulder desertion, it's it's really about 5050 The statistic is actually 48% of births that are complicated by Shoulder Dystocia occur with infants who weigh less than 4000 grams. If you had shoulder dystocia. Yes, there is a slight increased risk of it happening again. But should that mean that you go to a cesarean birth automatically? I would say no. This one's for you.

All right. My question is in regard to handling family dynamics. At 10 weeks pregnant, we told my husband's family that we plan to give birth at the center at the birth center with midwives and a doula. Both of them, particularly my mother in law, freaked out and berated us for making this choice. I knew in Men instance my mother in law was reacting out of fear and ignorance as to what a birth center is and what skills and credentials certified nurse midwives have. Fast forward to now, I'm 27 weeks and there's still tension between my mother in law and me regarding that conversation and other hurtful comments she has made toward me. My question is, I feel torn. On the one hand, I don't want to mention anything about my pregnancy or birth to my in laws as to avoid further confrontation. But then I also feel the urge to educate them as to why I'm going to midwife birth center route and perhaps ease their minds on how safe out of hospital birth is. I would love your feedback on this. I've thoroughly enjoyed your podcast, and I've gained so much from you, ladies, keep up the wonderful work. Thank you, Amanda. Okay. This is interesting, because on one hand, you can have that conversation. If her mind isn't made up, I just heard a quote that I agreed with so much I forgot what it is it was very famous quote someone who was it, I think it's like the one of the biggest things to fear or avoid is someone who has their mind made up. If their mind is made up, you're in for a lot of potential self doubt and a lot of stress if they perceive themselves as having an opinion that should weigh more than yours. Or if they don't respect that you and your husband are capable of making your own decisions, and they're not open minded, then I would say don't waste your heart, your energy, your time on this. If they are even a little bit open, you can educate them, you could invite them to a prenatal and let them ask the midwife directly. I think that would be the best thing just to kind of remove you from it all. But you did say two things in your question that jumped out at me. And I think that we should pay some attention to one you said berated, we don't berate people that we respect. So if that word came from you when you're typing, I mean, I don't want you to second guess it. And thank you didn't mean that, you know, you said Bereta, you felt braided, even if that wasn't your mother in law's intention, that was your experience. And I think that says a lot about the nature of the relationship. And the second thing you said was other hurtful comments she has made toward me hurtful comments. My biggest observation in reading this is that she has a lovely daughter in law, because you haven't said anything disrespectful about her. You sound very mature and very understanding. And I feel like most people could work out a problem with you probably very well. I'm just not so sure that your mother in law is one of those people.

Yeah, my advice would be very simple here. Go on to have your beautiful birth center midwife attended birth and then educate them later?

Well, what's maddening is, you know that in that case, the if this mother in law is close minded and respectful, she's going to say you got lucky. And that's someone who remains fixed, and is not going to understand and that's going to be really an unfair comment. If it comes. So we're just preparing you, you might hear that. But your disposition is a blessing to you, because you're not taking this personally very clearly. And now, that's a good thing.

But the evidence speak for itself.

Nothing anyone says or does is because of you. Something you seem to understand very well.

Four Agreements right there. Yep, four agreements. That comes up a lot in her podcasts. It does.

Well, you know, stuff to live by. Exactly. Exactly. Okay, translate into like, 70. Something like that's an amazing book. Have y'all read it if you haven't picked it up? Okay, next one. Can you talk more about the use of fundal massage after birth? So yes, absolutely. We had an interesting conversation on Instagram around a post we did on the use of funnel massage after birth. So let's just remind our listeners what it is. Funnel massage is the use of basically your provider, checking your abdomen after birth to check the tone of your uterus. So there's a difference between checking and then massaging. So checking your uterus after birth is normal and necessary, massaging the fundus after birth, which is pretty routinely done is not necessary, in most cases, especially if you've had Pitocin. So this is what the post was about that the evidence actually says that if you've had Pitocin, a dose of Pitocin for postpartum active management of third stage, whether that's IM or IV, there is no additional benefit to massaging the fundus after birth and massaging the fundus is very uncomfortable. If anyone of you listening has had it done, you know what I mean? And it isn't necessary. Now if you haven't had Pitocin and your uterus is a little bit baggy or your bleeding is a little bit much it is not unreasonable to use your hand to just gently massage the fundus briefly to try to get it to contract. Better yet is to put your baby to The breasts keep your baby's skin on skin. But I think it's just important to distinguish between checking the fundus and Misha massaging the fundus, you absolutely have to check the fundus after birth, you do not have to massage unless there is indication to do so in if there is Pitocin onboard, it's not helpful.

And that shouldn't be done without your consent.

Absolutely. I mean, nothing hands on the body should never happen without your consent. I think a lot of that happens.

It definitely does. I mean, it's because it's such a routine thing. It's just, oh, I'm going to check your uterus now. And then in the checking of the uterus, it be quickly becomes, you know, turns into a massage if the provider doesn't feel like the uterus is contracting the way they want to, or if the tone is not the way they want it.

I understand implied consent, if it's if it's truly implied, I think being there doesn't qualify us as implied consent, oh, you're in the room. So that means we can do whatever we want to you.

I think anytime you're initiating some type of manipulation of the body, you need to ask you need or you need to explain and make sure perfectly put, yeah, so perfectly put manipulation of the body.

That's my feeling on it. Do you have any tips for preventing having a big baby, this has to be someone who hasn't listened to the podcast yet. birth weight is just a special category. I've heard that it's linked to things. So that's what I teach that it's linked to age genetics, like we're babies big at birth in your family and in your partner's family and be how nutrient dense is the food that you eat. And the more nutrient dense your food, the more your baby is going to thrive and pack on weight. If small babies run in your family, then you can have an absolute perfect baby who's on the small side, but all things equal a big baby is indication of it's a healthy scenario, right? Yes, I mean, I just had a client. Go ahead. And there are just so many factors that go into the size of your baby that I don't think that worrying about, there should be no reason to worry about having a big baby, that's for sure. And big, we know so big baby. Giving birth to a big baby is not the problem that we're the fear around a big baby is not really over the size of the baby. It's all around this disproportion of the head and the shoulders and the risk of shoulder dystocia. But that doesn't come from growing a healthy big baby that comes from an imbalance in the development of the baby based on how your body's managing your blood sugar.

This conversation reminded me that I just got a text from a client. I just found it on August 24. See the picture? I can't see her name is Kate. Yeah, I have client of mine named Veronica. She wrote Hi, Cynthia, I just wanted to share that our baby boy arrived last week. He's a big guy, nine pounds, nine pounds, 10 ounces. And you're right. Everyone laughed when he was born. So and joke that we could just throw away the newborn diapers. Because I've always said, All that happens when you have a big baby is everyone laughs when you have a small baby, they take the baby away for testing. So it's really good to embrace the idea of trusting whatever size your baby is meant to be and put your energy where it counts, which is on fetal positioning and spinning babies. That is one thing not to be afraid of. Yes, take it from take it from a small frame woman who had a nine and a half pound baby herself. I mean, they're born all the time. That's not an anomaly. And it's not luck. It's normal. It's everyday stuff. Yes. One in 12 babies is quote, big. I mean, that's over 813 One and 12. That's hardly an anomaly. That's like 8% of the time. Remember, it's not those just we just said this in the prior question. Those aren't. Most of the time. Those aren't the babies that are getting stuck. Anyway.

Isn't that interesting? It's fetal positioning, and maternal positioning. That's why being upright and unmedicated in labor has so many positive benefits to birth.

So contact us and let us know how you feel now after hearing that, because if you still have that fear, we want to hear about it.

And then we want to know the size of your baby when they're babies born.

Yeah, we want to know that.

Okay, next one is a breast feeding question which reads I've been using the haka during all breastfeeds. And things have been going really well until recently. I hate to waste any milk and I want to collect it all. But recently my breastfeed extra full when my baby's feeding. And I have to use the haka, actually, at the start of a feed just to make it easier for my baby to latch. I saw your post on Instagram about oversupply and the use of a haka, and I'm wondering if I should stop using it. If I don't use it, I get soaked every time I feed, please advise. Thank you. So the hacker wasn't around when we were breastfeeding.

What's the haka? Is that that Yep, so a haka is a little suction device that Basically you compress it and you put it on your breast. And when you're, you know, when you're breastfeeding on one side, you leak on the other side, you're leaking. So it was developed to catch the leaking milk, so that you wouldn't waste any of the precious drops of breast milk. Oh, boy. Right. A great tool, a great concept. But I have seen it create a lot of issues with oversupply. Oh over. Really? Yes. And I because it's sectioning, why would it create over? Well, because once you're, once it's on in your milk start flowing, your milk starts flowing, if you're have the continued suction going, your breasts will just keep flowing milk out. So while so it is a suction. It's a suction. Yes, but it's not like a pump, it's on a mechanical section. It's just like reverse pressure, but it's sustained. So it will continue to draw the milk out No, not for everyone. And this is why it doesn't cause a problem for everyone. But if you're really responsive, your letdowns happen really easily it can, you can be nursing on one side and filling the haka with two or three ounces on the other side. So then when your baby goes to switch shot, switch sides, now we've taken the milk out of the breast. Right? And a lot of times babies need both breasts to feed them.

I did not see that coming, right, but they've collected it. So then the question is, are they storing it? Or are they feeding it to the baby. And if you're feeding it to the baby, then it seems sort of like a waste of effort, because now you got to get a bottle and feed it to the baby. And if you're storing it, you're actually taking milk that the baby needed at that feed or the next feed. But if your body's really responsive to making milk, it will just keep making more, and now you're storing an ounce or two every time you feed. And now we have an oversupply issue.

You know, I see another challenge with this only because I'm trying to imagine if I had one of these hackers when I was breastfeeding, my son, I used to leak on the other breasts, I'd have to hold something there and absorb the milk that was coming out. But on the flow easiest day, it probably wasn't, I probably wasn't secreting more than, like a half tablespoon or tablespoon of milk on the other side, right?

That's not unreasonable. That's normal.

So what I'm thinking is just for me, because I was always going to be prone to any kind of postpartum anxiety. It's like, if you're trying to treasure and capture, I know it is liquid gold. And I know that feeling of wishing you had more milk stored and everything. But if we're at the point where we're trying to save her, like a thimble full or half teaspoon full of milk, and go and save it, I just worry about the kind of pressure and anxiety that puts on women. I mean, what happens when you spill breast milk? It's It's so upsetting, right? We've proven it women cry when they spilled breast milk, understandably, but this notion of it's almost like if you're trying to build wealth by like saving a penny at a time, I worry about the mentality of saving every drop because of the anxiety that can come with that and feeling you waste. If we're thinking of wasting breast milk, because a few drops, or even a tablespoon gets out. That's a lot of pressure that a woman is putting on myself. Yeah, it almost sets you up for the scarcity mentality. Like that's exactly my point. And then the comparison pressure too. Well, my friends haka, she gets two ounces every time she has and I only get a couple milliliters, like what's wrong. My feeling is just keep the milk in the breast and let your baby remove it. It's easier now i do i We're not going to get into all the ways in which you can strategically use a haka to increase your supply if need be. That's another discussion. But I do think it's a great tool when used correctly. But if this in this case, if this mom is needing to use the haka at a start of a feed to relieve the pressure in her breast just so that her baby can latch, she clearly is overproducing. And that's just keeping her in a cycle of having to remove milk to get her baby on when really what you want to do is get the supply and demand in sync. I mean, that's always the goal with breastfeeding. We want your supply to meet your baby's demand. And really, you know, a little bit of variation on the plus side is okay, but not a lot.

And it's just worth mentioning that we have many episodes, always coming out on Mondays and Trisha has a trove of good little mini episodes out there on breastfeeding. So definitely check those out for a lot more of Trisha has incredible wisdom and experience as an ibclc there's a really good episode thanks for that.

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Okay, this is sort of a silly funny one. Have you ever heard that hiccups in the womb can be related to cord compression?

No, I haven't had anything I think so.

I haven't heard that either.

Like as if the baby isn't getting enough air. or something? Yeah, that doesn't sound good. I don't think hiccups are any concern. They're not any concern. Oh, well, then it can't be cord compression.

That's what I mean. I mean, is it possible that a bout of hiccups could be triggered because the baby squeeze their cord for a little bit? Because sometimes they do that? You know they grip the grip whatever. Maybe. But who cares? Hiccups

Oh, they grip it with their own finger hands. Yeah, they can. Yeah. Oh, I thought you meant like if it's all twisted, and they're just not getting air. Okay, know,

nothing pathologic or dangerous about hiccups in the womb. So we can eliminate that right there. Hiccups in the womb are totally a normal part of their neurological development. And you'll see that when the baby comes out. They hiccup constantly, right? Also not a problem. Their digestive systems are so neurologically immature. And hiccups are just part of the developmental process.

That's when you teach your baby to hold their nose uncounted. goes away.

That's when you put your baby to the breast and you breastfeed them and they go away.

Alright, um, let's see. Moving right along.

Oh, here we go. Again, it's another Shoulder Dystocia. What? We got a lot of worry about this. Okay, here. This is a perfect example of what I meant about snug shoulders. The question says, I had a 10 second shoulder dystocia with my second and my doctor alluded to a C section for my third, how do I avoid this? Well, I don't think a 10 second shoulder dystocia is a real Shoulder Dystocia. That to me would be what I call snug shoulders. You know, maybe they just took a minute, but not not a minute, they took 10 seconds to maneuver.

Yeah, so what I want to know is who told you it was Shoulder Dystocia? Her doctor who I want to talk to? Right? And why? Because they so here's the question, are they uninformed? Or did they have a reason for saying so to cause you doubt or fear? I mean, let's that's the part I want to talk well, probably this mother had a in quotes, big baby, and shoulders were slightly snug and, you know, took a minute or took of maybe moving the mom a little bit or maybe took the provider had to manipulate the baby, just a smidge. And so now, she's been told that, you know, she's likely to have a shoulder dystocia the next time around, and she consider a C section. preventatively

well, so she's formed a belief that she had shoulder dystocia and now we're rocking her world by saying that isn't Shoulder Dystocia. So now, the work that that you have to do now is to change your belief into one that is aligned with the fact that you did not have shoulder dystocia and you don't want to say I did not have shoulder dystocia because then you're putting Shoulder Dystocia in your mind. And this is a HypnoBirthing thing. But you would want to say my baby came through me perfectly and easily. Because that is exactly what it sounds like is the case.

And regardless of size, my baby knows how to navigate my pelvis.

Alright. Hello, I have recently started listening to your podcast and it is totally awesome. I have a question which I'd love to have you weigh in on. I had my first child two years ago, and I had a home delivery with a midwife very hands off, and birth to my baby. Naturally, everything was fine. I ended up with a fourth degree tear which included a quote buttonhole tear through my vaginal wall and into my rectum. I had to have an OB repair post birth, as it was too bad of a tear for my midwife to repair at home. This led to about nine months of extreme pain with bowel movements difficulty sitting and general pain I'm assuming with sex as well. I just found out that I'm pregnant again and I'm terrified of tearing any advice to help avoid tearing the second time around. Here are things I plan on doing differently. I'm birthing in a tub and I'll be birthing on all fours. I was sitting on a birthing stool for my first birth. Okay, this is exactly what I was saying earlier about forming a belief after our first even think I said a fourth degree tear in that example. This is exactly what happens. You spend the second pregnancy just terrified that it will happen again. I think the best thing you can do. Birthing on all fours is fantastic and a tub. Great. I think the most important thing to do is see a pelvic floor specialist

You mean in this pregnancy, I mean, in this pregnancy, now they can evaluate it look, this does not mean you'll tear at all the second time around, you likely tore because of the baby's position. And because of the position you are in, it's possible that you have a pelvic floor that could use some toning that would serve you to do some exercises in your pregnancy, you will know that by contacting a pelvic floor, physical therapist, and if you work with them in person, they can evaluate scar tissue, they can teach you things. But some are even doing work virtually now. But I think it will really help to get past the fear and to make you realize that you're taking matters into your own hands and reducing the likelihood of tearing again, your midwife didn't do that, because midwives are trained and only doing first and second degree terrorists. So it is normal and customary that you would have had to go to a surgeon for a terror of that significance.

Absolutely. Yeah, I would avoid the barstool. I would also I would say that I mean, the burst tool is a great, the burst tool is a great tool for for helping moms get the sense of pushing, but it does seem to be associated with increased risk of tearing. So I would stay off the birth stool, I would the hands and knees, as you said is great. We know that being in water decreases the risk of a third or fourth injury or fourth degree tear. And it's I think, you know, it's not likely it is not likely that that would happen. Again, it could be it's very likely related to your baby's position, there could have been a hand up at the head or something like that. But this is you know, I can understand why she feels this way that is a hard recovery. But we have to trust that we have to trust that it can be different, we have to trust that you know, just because something happened wants does not mean it's going to happen again.

And the last thing I'll say just again from a HypnoBirthing slant here is create affirmations you can pin them up around your house, if that makes you feel good. Some people really like to do that. But be able to recite to yourself affirmations such as my baby comes through me easily and gently my baby comes through me smoothly making making sure you don't use the word tearing in your affirmations. You want to say that what you do want in your affirmations. Nothing you have to negate. So when you get in bed at night, just visualize your baby coming through you so easily visualize yourself laughing visualize yourself saying, oh my gosh, my perineum is intact, I can't believe it. Just really get that deep in yourself that you look forward to birthing this time because it's going to go so smoothly. It can only serve you to actually prepare by working with a pelvic floor specialist. But also to really get into the mind that this is how it's going to go the second time.

Nutrition is also really important for perineal integrity. So making sure that you are doing everything and anything you can to have a very balanced healthy nutrition and diet in this pregnancy.

Yeah, especially minerals. Yes. Get all the minerals.

To answer this last one real fast. Sure. If someone is planning a natural birth, how often do you see them change their mind in the middle and go for the epidural?

That is something I rarely hear about. However, I can tell you in the vast majority of those instances, if not every one that's coming to mind. It's because of a very long labor and the woman just feeling like she needs a break. I have taught a ton of people. No one is coming to mind. No one who said oh my gosh, that was so much harder than I thought and I got the epidural. But I have heard net many births stories, where the woman said I was exhausted, I needed a rest. I needed a break. I got an epidural and it was the right thing because I needed to recoup so just if you do visualize getting an epidural envision doing it feeling like you're welcoming the rest, rather than like oh my god, I couldn't take it. I couldn't just let's get that out of the mind. And viewing it as a good tool that it is for rest when you need one exactly.

I mean my best if you know we want to put a number on it, my best gauge would be the transfer rate of homebirth, which is around 10%. And most of the time it is for almost all the time is for epidural and rest or hydration and rest. So all right, cool. All right, another q&a down.

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