#141 | December Q&A: Increasing Breastmilk; Urge to Push; Cervadil; Posterior Cervix; PP Anxiety; Big Placentas; The Purple Line; Amusement Parks in Pregnancy

December 29, 2021

Our December Q&A is here and loaded with entertaining and informative questions: We begin with a question around increasing supply without pumping: Is it possible? Next we dive into expectations around pushing as it relates to hypnobirthing and the urge to push. We discuss Cervadil and the subsequent cascade of interventions and what happens with a posterior cervix? How do you know if you have postpartum anxiety? What are placental lakes and will a large placenta cause a big baby? Is the purple line a good indicator of cervical dilation? And finally, is it safe to go to Disney and go on amusement park rides in pregnancy? Play now on all podcast platforms! Check chapter markers to skip to a specific question. 

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View Episode Transcript

Hi ladies, I don't know what to do my baby's two weeks old and I'm not making much milk.

How do I know if I have postpartum anxiety? I feel like I'm constantly terrified something will happen to my husband when he's at work. And I have been having thoughts that make me wonder if I'm going crazy - cervidil didn’t cause this, your obstetrician followed every single classic routine intervention, none of which should be used without medical indication? Well, you know, when you attend a lot of births, you start to see the same patterns show up and you can you know, it's always the thing you're looking at the other midwife, you'll just have these glances across the room to be like, You know what we're thinking, you know what we just heard you know what that means? The most amusing part of this publication from the American pregnancy association is that it says, just to be safe, go on all the rides after you deliver your baby.

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.

Happy holidays - here we go. Welcome everyone to our December episode, it is the week between Christmas and New Year's you're gonna sing us a Christmas carol I don't sing I mean I did karaoke so yeah, I actually do in a circumstance the circumstances have to be very very special for me to sing. I mean, you know I the shower and karaoke in front of any number of people are basically my two extremes for singing.I don't sing in the shower. No, I sing in the when I'm cooking and all my kids see me sing and dance a lot. Actually.

I say in the car. I see in the car a lot. You sing a lot now that I think about it. Yeah, in the car. It's easy because you're singing along with the radio. Yeah, yeah, it's that works. Well.

Did you ever did you ever record yourself singing when you had like headphones on and then you hear yourself?

No, I don't want to put myself through that misery.

I did that as a team and I was like, what is bad? Don't sound as good as the person singing the song. Alright, Trisha, I've got to read. I have to read these two last two reviews we got they're both so special. One of them is really? Let me read this one. This is this is really unusual. And it's so touching. Look at this one. It's called a love letter to Cynthia and Trisha, I will venture a guess that most of your listeners and social media followers are young, expectant mothers or new mothers. Well, I'm a 72 year old now single mother and grandmother who savers each podcast and each post. All three of my children now 3835 and 31 were born at home with midwives in three different states. Each was nursed for over three years, I devoured every issue of the event in print mothering magazine and became a la leche league leader. My son and daughter in law live on our land with my now three year old grandson whose birth I was privileged to attend and who is a daily joy in my life. What you offer in your podcast is a gift to the world of prenatal care, birthing and postpartum. My daughter and son in law are hoping to start a family soon and she is now a listener too. I feel a strong connection to you both like none I have experienced since way back when the miracle of birth needs more strong, Sweet Savvy advocates like you too. I cannot praise your work enough and will continue to spread the word.

Did she compare us to mothering magazine? Is that what I heard? That's so incredible, a 72 year old woman.

Can you believe that? And while she sounds amazing. I mean we had I hope she's listening. Well, we know she's listening. Thank you. Well, first of all, we want to know who you are. Thank you messaged us on Instagram one so I want to remember who you are. So reach out again. And yeah, we had Peggy o'mara of mothering magazine. We had her on the podcast in our first quarter around man, like three minutes. And yeah, that was super cool.

I was my favorite magazine when I was pregnant. That's for sure. I mean not to be compared to that is an incredible honor.

I still haven't thrown a line out. It's they're really hard to throw out. I say read them from cover to cover their special. There's a lot of good information in there. Don't turn amazing.

Absolutely. And then we got this one just a couple days ago. That is so nice as well. It says thank you so much for collecting the experiences in this podcast. Each episode is an aha moment for me. And I'm so unbelievably grateful. I found this before birthing my first baby in a few weeks. We've pivoted from OB care to a midwifery model with a doula and plan for home birth and I feel so informed, awake, excited, ready and passionate about birthing now Thank you. Thank you. Thank you. I cannot express my gratitude for all the work you do to put this podcast together. I say this genuinely, I love you too. Oh, wow. It's not precious. I don't want to be the disingenuous person who's like, I love you. All. Right, we're so grateful. It's just so like, I wish I could bet a lot. A lot to write that in a review. You know, if you guys are ever in Connecticut, we absolutely promise you a lunch out together. It doesn't take anything to get you interested.

You got to say is the day you're here we'll show up. Lunch thing we like more than doing lunch?

Absolutely, we should definitely someday plan a local event. For anyone who's even remotely in or visiting the New York metro area.

Be fun, we can have like a standing open lunch date once a month amazing.

Meet at a restaurant. That'd be really fun.

I like that idea.

A goal - I'll add it to the list. Okay, we'll get to it. So um, thank you both so much reach out to us on Instagram. So we can personally and more sincerely thank you for these reviews. But I'm really, really lovely. Thank you, Trisha, I think we need to start diving in. We've got a whole lot of questions we've got to get to are you ready? Or do you have anything you want to say? No, let's do it. Already. The The first one is for you. It says I'm desperately seeking breastfeeding advice, please help. And then it's and then it says Hi, ladies. So it's got a little teaser. Hi, ladies, I don't know what to do. My baby is two weeks old. And I'm not making much milk. He loves to breastfeed, but he's getting 90% or more a formula and bottles. I enjoy the bonding with breastfeeding. But I really don't like pumping. And I don't want to pump just to increase my supply. I breastfeed him two times during the night. And then the Night Nurse gives him a bottle during the day, he just gets bottles. I don't want to change my daytime schedule or routine. However, my husband feels very strongly about the baby having breast milk. And he really wants me to increase my supply. Is there any way my supply will increase without pumping?

Well, so there's a couple things here one, No, there isn't really a great way to increase supply without the baby breastfeeding more or pumping. But this is an interesting question, because it's very rare that I come across situations where the mother doesn't reach out because she doesn't want to breastfeed and the husband is really pushing the issue. So that's a whole nother piece, the whole, that's a whole nother piece of this that we have to take into consideration. So as far as ways to increase supply without pumping, I mean, if she is bottle feeding during the day, and doesn't really want to change that routine, then she's probably not interested in adding more breastfeeding to the daytime routine, which could be helpful in increasing supply. So babies can increase your supply if you are willing to start to kind of wean off the formula and give the breast instead. But if you're giving the same amount of formula and still offering the breast, they're not going to demand more from the breast. So it's either pumping or more breastfeeding and starting to kind of wean down off the formula. But this mother sounds pretty committed to the routine she is in and doesn't really want to make that change. It sounds like there could be some challenges with the partner in this and, you know, that's, that's something that isn't really that's really outside the scope, probably of lactation work and more for the work of a family counselor or therapist, but I do understand why the husband is wanting her to, you know, give the baby breast milk. Right? That's, it's kind of like what we deal with when in birth when the just gonna say that one partner wants to have a home birth and the other one doesn't, or you know, the mom doesn't want to have a home birth. The husband really wants it. I mean, we always say in the end we always have to side more with the mother, she is the one doing all this work and the husband's opinions about breast milk are valid. His feelings of wanting to give the baby breast milk for the overall health and well being of the baby are certainly valid, but the mother's feelings about how breastfeeding works for her and, you know, being hooked up to a pump to increase her supply are also really valid. What do you think?

Well, yeah, I mean, it's, it doesn't matter that we are very pro breastfeeding, it matters more that her husband is but it still matters less that she isn't feeling that way. If you if if if he got all the relatives together and she were looking at two dozen people, a male took a vote and said you should exclusively or more frequently breastfeed your baby. It wouldn't matter. It's her body. There's nothing to be done about that. He just has to relinquish to what works for her. And the worst thing that can happen is to make her feel guilty or pressured about it. Really. These things are always hard because because the baby is mutually yours, right. But the breastfeeding is only hers.

And she has the final say. I mean, it just it is just is that way she's not going to be enjoying the experience if she doesn't want to do it. I mean it is, it's a hard process to try to increase your milk supply with pumping or weaning off formula. And if you aren't committed to it, and you don't want to do it, it's not going to be good for anybody.

She's just finding the balance that works for her. There's just like I said, there's nothing to be done. She deserves to feel at peace with her decision.

Yeah, and I would say just as a final statement, if you you know, really, if the pumping is the aversion, then forget the pump, just get rid of the pump. But if you are willing to modify the routine a little bit during the day, and put the baby to the breast a little bit more during the day because your baby enjoys that. You might actually find that that's a lot easier and your milk supply does start to increase.

Alright, next question.

All right. So in HypnoBirthing the Mickey Mongan is that is it manga.

She's famous Trisha. My name is Maria Meaghan she went by Mickey. And she, I think she tried to make it catchy. HypnoBirthing the Mongan method, but I mean, I like most people, I just say HypnoBirthing so yes, and she does have a trademark. So HypnoBirthing does mean the Marie mungkin method. Oh, really. So that's so some people write to me.

I ever think I actually had never even heard of HypnoBirthing when I became a midwife isn't an interesting.

Well, you became a midwife eons ago. That's true. I'm just kidding.

You're silicone been a while. Alright, anyway. In HypnoBirthing, the Mongan method which you teach Cynthia, they say to resist the urge to push. But I saw a recent post by you amazing women, that says that you will know when to push because you will no longer be able to not push. So what are your thoughts on pushing?

Yeah, I've got thoughts on pushing. So when you know when you get certified or trained in HypnoBirthing, there is a very strong message that says you will not push you will not push, you will breathe the baby out.

Like you're not supposed to push ever, you're not going to push and Mickey Meaghan goes so far as to say that this is bold. So just brace yourself. She goes so far as to say I think women have been conditioned to believe they need to push and I'm just like what? So I took HypnoBirthing when I was pregnant with my son in 2004. And just being the student that I am, I dutifully learned everything. And I told myself, I'm just going to breathe the baby out. I had a very calm stage of thinning an opening, which we call it and HypnoBirthing dilating, very calm and then all of a sudden, natural transition. I was like working so hard, and I was very vocal, I was making fists and I thought, what's going on? Why am I making fists? Why are my arms tense because in HypnoBirthing, my instructor who I adored, didn't know and didn't teach me that you get this awesome surge of adrenaline when you are pushing. So I was pushing and I was doing everything absolutely, efficiently and wonderfully, imperfectly, and feeling in the back of my crazy mind. What am I doing wrong? And I was doing everything exactly right. Because I was following the lead of my body. I was vocal I was working, I was pushing there was no way not to push. I birthed my son. Fast forward two years when I met Mickey Mangan, and my son's birth story had been published in mothering magazine among others. She said, Ah, Cynthia, you're the poster child for HypnoBirthing and big babies fast birth and I guiltily confessed and that was how I felt I guiltily confessed. I actually am not the poster child. I was really loud. Birthing my baby. I was making fists like this. The day after I gave birth, my biceps were the most sore part of my body because for 45 minutes of pushing, I was making these tense arms. And she said to me, you did it perfectly, you followed the lead of your body. When I learned this method to teach it. I am going to teach this saying you will almost definitely not definitely. My guess. And my theory is like 99% of women get that urge maybe 98%. And for one or 2%? Yes, the babies slip out. i It's happened to a few dozen of my clients. It too happens. But I say if you get the urge, the emphasis on the is on the word, breathe the baby out. Don't hold your breath as you're bearing down. So I hope that gives you permission because I didn't give myself permission really I was I was conflicted. You have permission to birth your baby how ever you want. There's no way to do this wrong. But if we have to grasp or a wrong way to give birth in that stage, it would be to say, just don't hold your breath. Whatever you do. Keep breathing. That's it. That's it.

I can understand incorporating birth breathing into your urge to push, but sometimes that foot it for me, it's literally like, it's like the urge to vomit. It's like the urge to sneeze when it's happening. It's happening. There's no stopping it.

It's irrefutable. So when we're clients, when clients have asked me what if I give birth in the car? Or what if you feel like you're pushing in the car, I'm like, Well, you know what, that almost happened to me. And I thought, well, I guess we'll just get a new car.

And there's no stopping it, you cannot stop it. So we stand by you are saying you will know when to push because you will no longer be able to not push.

These are tools that are available to you. And that's all it is. It's an art. It's not a science. So we don't want your doctor turning him into science, you have to give birth. This quickly. This many hours, this is what we want to see. Nor do you want a phenomenal life changing, you know, little humanity altering woman of like making Mongan and so many others in this field, telling women how to birth either. These are just tools that are available to you.

And that's exactly right. I think the one thing we can all agree on is that directed pushing should be discarded.

Right. And what I say is, I think what what I like to believe making Mangan meant to say was, we don't want any indiscriminate pushing. We don't want you pushing for the sake of pushing or because someone is screaming at you to push. That's what I feel. She is trying to say while she's emphasizing the need to breathe rather than hold your breath, which some nurses might tell you to do. And we don't want to do that. Perfect. Next one is Hey, guys, I'm nine months postpartum. I've just found you. And I wish I knew this existed before. I listened to the podcast and was hoping you can talk about the medication surveill used to ripen the cervix. I received it because the doctor told me I needed to but she wouldn't tell me about it. And really, my birth was very complicated with that Pitocin a 48 hour labor then they broke my water on purpose. They got two bags of antibiotics. Wonder if she was Group B strep, positive? Or what would that was what that was about? Then they cut to a three slash four degree tear. Could any of this have been related to the induction and survival? The survival was literally the most painful part of the whole thing. And the doctor pushed that statement aside, and it was off the charts on the fetal monitor. Any thoughts or info would truly help? Boy, do we have thoughts around this? I don't think it's going to be exactly the answer.

It started with Cervidil. But let's talk about a few things about serving Well, yeah, sure, let's just define it serve as a prostaglandin. It's used to ripen the cervix when the cervix is not ready for induction. So when we started Pitocin induction, we need the cervix to be at a certain level of ripeness or readiness to be receptive to pin to Pitocin inductions tend to go better if the cervix is more ready for the induction, right. So we don't want to long close the service.

Because in nature, before you would have uterine contractions, your cervix would thin and soften and ripen and that's the role of survival. It's mirroring what nature would do before you have your first contraction anyway.

Exactly. So it's a synthetic prostaglandin the same thing that actually gets your cervix ripe and ready in natural labor the same thing that's in semen, which is the reason that we always tell women to have intercourse. If they're backwaters in tax, you know, when they're trying to bring on labor the same reason that evening primrose oil works well to soften and ripen and ready the cervix. This is just the pharmaceutical grade version of your natural prostaglandin. And it of course comes with significant risk.

Yep. And Cervidil is FDA approved for this for this job. Unlike Pitocin if you heard our Pitocin episode, what was it number 134 In early November Pitocin hasn't been FDA approved for the elective induction of labor but cervical is FDA approved. And it should not be used in cases of there are contraindications. One of the most important ones is any uterine scar. So if you've had fibroid surgery, and certainly if you've had a C section, rule number one of having a successful VBAC is not to be induced, that doesn't just mean Pitocin that includes Cervidil it can cause hyperstimulation of the uterus. And here's what's interesting, and I learned something new here. It should be removed at least 30 minutes prior to the introduction of Pitocin. Did you know that? I don't think they're doing that.

Um, I think that that probably is happening or it's or completely dissolved and absorbed. As far as the very significant side effects, it can make your contractions be too strong and too close together. And this actually happens in one in 20. Women. That's a lot. Yes I am. And it cause it can cause distress in the baby. But it is still very commonly used. And it still is part of an induction process if you if your cervix isn't ready, and if your cervix isn't ready, you're probably not ready to have a baby.

Yeah, so back to this woman's question. What she experienced wasn't necessarily the effects of survival. It was the classic cascade of interventions and highly aggressive obstetricians.

Well, I think it's the same old story, it's the being induced before your baby in your body are ready, followed by the cascade of interventions, and she probably ended up with a third or fourth degree laceration that sounds like from an episiotomy because there was fetal distress at the end from all this time of having hyperstimulated uterus from starting the server till then to Pitocin, then likely she had an epidural like they she was fixed in bed and couldn't move very well, or wasn't moving. And this is just how it happens. And this is why the first intervention leads to the very common outcome of Cesarean birth, and fetal distress. And then it gets written off as well. We saved your baby like all as well, the baby.

Thank God, we were here. Right, thank you. So we're here to save your baby.

She ended up with a vaginal birth. But I think she's feeling unsettled because she's feeling frustrated and thinking, oh, gosh, to serve a deal cause all cause all this. But unfortunately, I think what we can surmise from her story is surveil did not cause this your obstetrician did your obstetrician followed every single classic routine intervention, that none of which should be used without medical indication? Pitocin rupture of membranes cutting an episiotomy? I shouldn't say go through so much.

I would say serverless. Part of that though, I would say server is part of causing all of this because it's how it started. It's how it started, but without the server dill, right, you're right. But it wasn't a side effect of survival that she needed. Pitocin or then she needed an idea and was not a side effect. That's right. It was all under that umbrella of cascade of interventions. It just so happened that surveill was the first of the interventions. That's, that's it.

And I think it's worth mentioning too, that there are life threatening, rare, very, very, very rare, thank God, but there are life threatening side effects of cervical one of which is an amniotic fluid embolism.

Oh, I didn't know that. Trisha. Well, always ask, they are supposed to provide you with informed consent. But always asked, what is the drug? Ask how to spell it, write it down, take your time, go research it, and then ask what the medical indication is?

Yeah, you know, it's so commonly used just like Pitocin. It's the same thing, where it's just this is what we do. This is how we get babies ready to be born.

Let's move on to this question, Trisha. I'm curious to hear what you say to it. It's about a cervical lip. And I didn't know a lot about this. And I'm interested in hearing your response. It says Hi, ladies, I have a question if you don't mind my asking. I went in for a Foley bulb induction on Tuesday for abnormal labs indicating preeclampsia and went to five and a half to six centimeters within two hours. I did a few hours of Pitocin and didn't change anything and thankfully was sent home when my labs came back normal. My blood pressure stopped right there, indicating preeclampsia. She went in and started in induction because she had the possibility of preeclampsia. And then two hours later, normal labs can you believe that? That is what's this gets thrown around so much. You have what you have what appears to be preeclampsia, you either have preeclampsia, or you don't now it's not that you can't wash away. It is a progressive illness so you can have signs of it and it can progress to preeclampsia, but you don't have it if two hours later you have normal labs. That's right. Anyway, sorry, keep going.

My blood pressure stayed normal. The entire induction and baby stayed healthy also. Anyway, I learned during the process that baby is negative one station, but my cervix is behind the baby's head. I have no idea what that means. I can't wait to explain that behind the baby's head. My question is, is this something that will work itself out once baby activates labor? I'm confident it will. I just thought y'all would have cannot believe the number of yells we get. It's we must be in a bubble in the Northeast. Right?

Yeah, it's not commonly used up here, but maybe it is never used. I love it. Maybe it's an auto I don't think it's an autocorrect I'm confident it will I just thought y'all would have better insight. I'm 38 weeks today. Oh my gosh, Trisha, these women are asking us for fast turnarounds.

She's there she's had her baby already.

Oh god. I hope not. I'm 38 weeks today and both of my brothers Babies arrived at 40 weeks. So it's not this one's time yet. Oh, go ahead.

Well, I'm glad she left that induction. So first of all a fully bald is a mechanical way of inducing. So this is interesting that it comes right after the cervical because the cervical is the prostaglandin that helps ripen and prepare the cervix for birth and a fully bald is an alternative to that so long as your cervix is actually open enough to get the fully bowled in there. So they put a little device into the cervix, and then it's literally a little balloon, and they put air into the balloon, and it blows up inside your cervix and mechanically dilates your cervix. So that again, this is helping you to get ready for a Pitocin most likely Pitocin induction. Maybe not. You don't always have to have that but I do it is would be my first choice if I were going to have my cervix manipulated and labor. In some other alternative worlds universe. Yeah. But I would wait take that over anything else. So second thing is her cervix is behind the baby's head, which is exactly where it belongs. That's why.

Wait a minute. Wait, wait, wait, wait, wait, wait a minute, wait a minute. It's in front of the baby's head in a neighbor and won't wait a minute in the front. Let's make sure we have this straight through all of pregnancy. The baby's head is behind the cervix, the cervix is in front of the baby's head.

So we think of the cervix as being directly over the birth canal, right? Because that's how it is in labor. The cervix is right over your birth canal. And as it opens, your baby comes down and through in pregnancy, your cervix very smartly and secretly moves back a little bit toward your spine. And that no way. Yes, it's called a posterior cervix. So throughout pregnancy, your cervix should be a little bit posterior keeps it safer. As you get ready to give birth, it moves anteriorly. And that's one of the very, very early signs of knowing that it's getting to be about time to have your baby. So the fact that her cervix was still posterior behind her baby's head indicates that she was not ready to have her baby. What did she mean it was behind the baby's head?

It just means that it's posterior. That's all she meant. Yes.

Oh, I thought she meant the head had like slipped through and the cervix was behind the head like toward the neck. And now this is just probably how her provider explained it to her we a posterior is a little bit behind your baby's head. your cervix is a little bit behind your baby said it just means it's a posterior cervix. Okay, so yes. Is that something that will work itself out? Once baby activates labor? Absolutely. The cervix has to move forward and get directly over the birth canal so it can dilate and the baby can come through. No big deal.

No big deal. It's what is supposed to do those darn providers.

The problem here is that they're trying to give her a fully bald when her cervix is behind the baby's head. I don't even know how they would do that.

I don't need their they have to accept Well, they didn't do it. They sent her home. They didn't when they tried, Trisha they tried. Well, they wouldn't have been able to read your service, quote monkey labs that could point to right. I'm making jokes about the term wonky labs because of the episode released on December 8 with her mean haze Klein, and incredible attorney and a remarkable episode, where she said there's just there's so much rhetoric, and sometimes they'll do these things to women. And they'll be like, Oh, well, your labs are wonky. You know what, that's not speaking the language I need you to speak. I'm looking for medical indications here. So can't just come to a woman and say, Well, you've got wonky labs, we're going to have to induce you. You say, Wait a minute, slow down. Show me what you're talking about.

Right. I'm just looking back at the question. It does look like she did actually She did say she got Pitocin. And she was sent home with her labs. But her blood pressure stayed normal through the induction and her baby stayed healthy. And so she did actually get induced.

Thank you for a few hours of Pitocin I can't believe that it's really odd that they gave her fewer few hours of Pitocin and send her home. That doesn't mean like no, we knew this was a mistake from the start but the speaker was take than we thought so just go home before we really make a huge mistake here. It's all I can think. I don't know. I'm an optimist.

That doesn't usually happen. I don't think but the optimist thinks but of course with the new guidelines, if you're not six centimeters, you're not an active labor they send you home, so that's great, but I don't know why they first gave her Pitocin.

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How do you know if I have postpartum anxiety? I feel like I'm constantly terrified something will happen to my husband when he's at work. And I have been having thoughts that make me wonder if I'm going crazy. Or how would I know if I'm actually going crazy.

So there's so many thoughts, I'll give some signs as to whether you know you're having postpartum anxiety. First of all, it's four times more common than postpartum depression. It's really common. And I personally believe that just about every single one of us ends up somewhere on that scale. Maybe it's very, very mild. Maybe it's very severe. But anxiety after you have a baby is a very common emotion that you don't see coming.

I think it's built in. We're meant to have that heightened sense of awareness and prolactin, the hormone that makes milk does create that heightened sense of awareness. So everybody does have a little bit more anxiety after having a baby you're meant to your it's just how far it goes.

It's how far it goes. Stress thoughts, a lot stress dreams, worried about the baby all the time. So these are some common symptoms, racing thoughts, feeling that something bad is going to happen. That's a big one. disturbance in your appetite. You might not notice till 2pm That you haven't eaten all day. Really important to get your partner involved to make sure that they get breakfast ready for you before they head out. If they head out to work, water out in a big picture on the table. They've got to check in and make sure you do eat even if they have to call you at 10 o'clock every morning to make sure you've eaten inability to sit still inability to sleep when the baby is sleeping. Physical symptoms can manifest in some cases, if it gets quite severe it can manifest into postpartum OCD which happens. It can also manifest into postpartum panic disorder, a fear of knives I have a mom in my current and my past postpartum group, we have an episode with her with Lisa from many months ago. severe fear of knives, nail clippers, scissors, fear of staircases fear of driving when mom confessed in the group mom of three to said I'm saying it for the first time I have three children, my oldest is six. I'm always afraid when I'm driving. So and a fear of mortality is also really normal. Sometimes we bring it up when we say whose mortality Do you fear the most your partners or yours? Because if your mortality is so common, the closest to quote going crazy would be if you're having hallucinations. And if you're having hallucinations, that is an absolute full on crisis, and you should never be left alone by yourself or with the baby that would be considered postpartum psychosis, postpartum psychosis. Thank you. Yes, that's if you're having hallucinations, that affects about one woman per 1000 to 2000 women. But for all the rest. It's an incredible problem. For example, I have a mom in my current group who, in springtime, it took her about three weeks. I think we brought it up. I think we said you know, how come you're always in a dark room? What's going on? Because we were very close in that group when we can really talk. And there's like, how come you're in a dark room? You're always in that dark room and she confessed? I have basically not left my upstairs bedroom since the baby was born. I said what she's was afraid of stairs. I said, What are you eating? And she she picked up a big Costco sized box of granola bar. She said living on granola bars. Her husband hadn't noticed. She's been living in a cave, classic anxiety. And in her case, it was primarily around stairs. You can't rationally help the women who have that fear. You can say where the baby in a sling. Some of them sit on the stairs and bring themselves down in a seated position. But it's not that rational. I mean, we used to be in the top of a high rise with a balcony and I used to not. I used to insist we not open the balcony door greater than the way For the baby's head as if the baby could get out and on the balcony. And even if the baby were on the balcony, nothing could have happened. It's not rational. The common denominator in any perinatal mood and anxiety disorder is isolation. So the best thing you can do is involve your partner and everyone in anyone who supports you come out with it, talk openly about it, you have to keep talking about it. And you have to get the support that you need. You It's a must. There's nothing more important in that household than your physical and emotional wellness. Nothing. Private commission would be valuable. A support group would be important. It will pass this is never anything you've done. It's never your fault. It is out of your control. And it will 100% Pass. It is definitely temporary.

Yeah. So her question How do I know if I have postpartum anxiety? It's worth pursuing all the things that you just discussed.

Yep. This is for you Trisha. It says I'm pregnant with my first baby and I had the anatomy scan. Everything was fine, except I have, quote, many large placental lakes, making my placenta appear large one can you explain your perspective and knowledge on placental lakes? to will the large placenta cause a big baby even though lakes from what I've read can cause smaller babies? That's it.

Okay. Um, well, honestly, I don't have a tremendous amount of perspective and knowledge on placental lakes. What I do know is that they are in large spaces that are seen on the ultrasound where the placenta has spots that have been filled with maternal blood. They are normal for the most part, they can, when detected really early in pregnancy be associated with certain anomalies of pregnancy. But she said that she discovered these at the anatomy scan, which is between 18 and 20 weeks. So we're not talking about early pregnancy with her question about whether a large placenta cause a big baby. No, no, it would be more associated with intrauterine growth restriction, if these placenta lakes were problematic. But most of the time they are not.

That makes sense. Because it's not that it's a larger placenta, it's like they're portions of the placenta that aren't really placenta, right? making it appear larger. And larger placenta doesn't cause a larger baby of large placenta and a large baby go together. So one causes the other.

I remember when Vanessa was born at nine seven I remember Amy looking at my placenta and going wow, like big placenta, big baby the placenta they go to I guess that worked. Yeah, but I can't help but this question go without emphasizing that a big baby. There's no correlation whatsoever between a big baby and a more difficult birth or a longer birth, or a shoulder dystocia or a cesarean section. It's all about fetal positioning, despite what every single medical practitioner will want you to believe. We always have to kind of go back to this whole thing that you know, the concern about big babies is the truly macrosomic baby as a result of uncontrolled gestational diabetes, that can be a problem. But not all big babies are that and that's how they get lumped in.

Right. The next one says, Look at this. Can y'all hear it? Again? Now? They're just messing with us. You're doing their their New Yorkers. I'm changing the text.

I certainly am not why apostrophe. A ll you think I know how to spell that? Can we all talk kangaroo dinner? Can y'all talk about the purple line method of Can y'all talk about the purple line method of checking dilation? I'm so glad someone is asking you this because I've always wondered about it myself. Is it a reliable alternative to cervical checks? Does it indicate fetal head position? No. Does it? Does it?

I think it correlates with fetal head position that is amazing. Or about cervical dilation.

So first, wait, let's just slow this down. What is it? And does it show up on everyone? Let's start with that.

The I don't think like, like all things in birth. It doesn't apply 100% to anyone. I think there was a study once done on this that showed that it was present in about 75% of women, but more likely to be present and women who are having a physiologic birth, which makes sense. I mean, the easiest way to describe it is a line that appears along the bait from the base of your tailbone up toward the top of your butt crack. That's where it ends. I have definitely not seen it on every laboring woman, I always do look because I'm very curious about it, if I if it makes sense to look. So if they're in a hands and knees position, if it's visible. I'm not like I would not like something. Can I check here right now if they want to know how dilated they're I think don't want to serve a low exam. I might say we can. Maybe the purple line is present that might give us some indication.

So how accurate is that?

It's pretty accurate. That's Nuts. Yeah. So is it a reliable alternative to cervical checks? Well, first of all cervical checks are not necessary. You never need to have one if you don't want to. So you don't have to have a way of knowing how dilated the cervix is. But if you wanted a first line alternative, you know, if you felt that it was important to know, somewhat where you are, you could look at this and get a fairly close idea of where you are. But no, nobody's really taking out like a tape measure and measuring it, you can you can watch the progression of it. That's an interesting way to gauge it. So at the start of labor, you might see that it's barely there. And as a woman is progressing, you can know that it's a sign of progression, but I would never probably say I would never say Oh, well, you're probably eight centimeters dilated if I measured the purple line. But it is a good indicator, it is a decent indicator it is information, just like a woman having, you know, vomiting and transition or the urge to push when we know she's close to the full dilation. They're just all little signs that the body makes that help us know that things are progressing. And you know what a cervical exam isn't always accurate either. I mean, you can have one provider measure a woman's cervix and say she's six centimeters and another one will say she's she's eight, does any of it really matter that much to have accuracy, like doesn't matter that much. What we want to look for is progress, progression, culminating in the urge to push your baby down and up. To me, it's just very much along the same lines as watching a woman's behavior change in labor, watching her mood change, watching her sensations change, watching her instincts of how she moves change, it's, it's that kind of piece of information.

I love that. I mean, it's just really wonderful to hear you say that to just get that skill for being with a woman in labor and paying such close attention to her that you're noticing whether her eye contact has changed. Her breathing has changed whether she's speaking in continuous sentences has changed. It's so nice to imagine a woman being cared for in an attentive way That's disturbing.

Well, you know, when you attend a lot of births, you start to see the same patterns show up and you can you know, it's always the thing, you're looking at the other midwife, you'll just have these glances across the room to be like, You know what we're thinking, you know what we just heard, you know what that means to me now.

It reminds me of just when you love someone in general, you can walk into a room and say, What's the matter? Right? And it's just, you know, that's just to me that just, that's love. Because you're looking closely.

Yeah. I like that.

The last question says, This was so much fun. I I almost didn't believe it when I read it. I love all the education I've been getting from your ladies podcast. She put the apostrophe in the right place. I'm I really like that. She put it after the Yes. I love that. Great. Hold on. Are you sure that's correct.

Of course it is.

I'm sure you're all thrilled listening to this conversation about grammar. I love all the education I've been getting from your ladies podcast, my husband and I would want to start trying for a baby starting in May 2022. But have plans to visit Disney? Would it be wiser to wait until after Disney? This is our first Disney question for sure. I wasn't sure how much. park rides affect Oh, she misspelled a fair. She got that. She put she put an E instead of an A. I wasn't sure how no worries. No worries, Lee, we still respect you completely. I wasn't sure how much park rides affect an early pregnancy. Now I looked this up to the American pregnancy association because I don't know the first thing about whether park rides affect early pregnancy.

It's not in general counseling for prenatal care, that's for sure.

No, the concern is any I mean, it does seem like common sense. Once you read about it, their concern is any rapid starts, sudden stops Joining Forces. pressure against the body it is kind of funny when you think about how we humans do this all for pleasure because we do rigorous activity can potentially disrupt the placenta, there can be a risk there. It's very unlikely. This is the part that I found the most entertaining the most amuse me the most amusing, let's say because I'll do a play on the word since we're talking about amusement parks to begin with. The most amusing part of this publication from the American pregnancy association is that it says just to be safe. Go on all the rides after you deliver your baby. I'm sorry. Once you have a baby. Oh my gosh.

Okay, so for her question, I would say go to Disney. Do not delay your trip to Disney. Maybe just go on the toddler roller coasters instead.

I'm sorry, no. Okay to go there to sit In a little teacup

Oh, I don't know a lot of adults don't like to go on the insane crazy Gravitron rides or anything like that per day. But I think this comes from the fact that in in the event of an automobile accident sometimes women have been known to have a miscarriage or a placental abruption. I don't know. I mean, I rode horses and went skiing and pregnancy and I'm sure I would have gone on a roller coaster in early pregnancy.

And I've had many clients who have fallen slipped on ice falling down stairs, it's terrifying every time they spend the whole day in the hospital every time checking on whether everything is okay, um, knock on wood. Everything has been okay of course the risk exists. But nature has a way of making sure everything that needs to adhere internally is is going to if if it's not too extreme,

so you know, don't jump out of a plane don't do anything too crazy. But go to Disneyworld and have a good time. You're about to have a baby and we won't be going again for a while for everyone. Happy New Year everyone.

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.

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About Cynthia Overgard

Cynthia is a published writer, advocate, childbirth educator and postpartum support specialist in prenatal/postpartum healthcare and has served thousands of clients since 2007. 

About Trisha Ludwig

Trisha is a Yale-educated Certified Nurse Midwife and International Board Certified Lactation Counselor. She has worked in women's health for more than 15 years.

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