#162 | May Q&A: Conversations with Your OB; Erythromycin; Mastitis; IUDs; Artificial Rupture of Membranes; Feeding Routines for Babies; Quickies!

Just walking through hospital doors, we immediately become afraid what to go to hospitals for usually illness and injury. So as a birthing woman walking through those hospital doors immediately your body instinctively is going to become more fear-based. A few of the women realize they come from really enmeshed families. So they haven't learned boundaries with their own families. And they're struggling to create them with their in laws. And

I'm wondering if the artificial rupture of my membranes made labor more painful.

That is a notoriously painful procedure. Some women vomit right afterwards, it's so uncomfortable. It has virtually no benefits, and it's loaded with risk. This never had to happen to this woman. She was called high risk because she was at 42 plus two, that's tetanus ridiculous,

and as often as you can, but you don't have to be like naked at all costs.

Yeah, you don't have to be naked at all costs.

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.

It is May it's our main q&a. Yes, it is May and it's our main q&a. And as always, we have excellent questions. You guys. Our community sends in the best questions.

The best. The best, the best. We have the best people. We really do. If you don't know who I'm doing right now, I just I don't even I don't I can't even help you. You don't know who I'm not okay. You know what? I'm not even telling you.

Is it a TV person? Because I don't watch TV person. I mean, audience are you listening to me? Please? Please flood Trisha on Instagram with who? I just did it again? No, I'm not doing it again. I didn't even hear it. You heard it. You had no idea what I was doing. That was so obvious. No, really? Yeah, that was you know, that's not me. Okay, somebody's gotta tell me, shall we? Okay. Hello, ladies. I'm hooked on your podcasts. Can you please provide references for me when speaking to my doctor if I need to about topics like, quote, The aging placenta, failure to progress not being a valid reason for C section, eating during labor, breech deliveries, etc. I really have minimal hospital options. So I'd like to be fully educated and equipped to deal with any questions that come from medical staff, the podcast, what do you mean, the podcast, our podcast, we cover all the space, you want to tell the doctor and medical staff to listen to our podcast, tell your doctor to listen to down barber down to birth and get it together.

We do have medical professionals listening to us but not the category that this woman is indicating her doctor and her hospital staff are right, because she doesn't seem to think she's got a provider who's on the same page. That's evident right now she wouldn't have asked a question. Agree? Yes. Okay. So basically, I'm getting the impression from her, she feels that the onus is on her to convince her doctor of the birth, she wants to have that utter responsibility to, to sell what she wants to have for her birth or the decision she's going to make or the intervention, she's going to decline that she has to convince her doctor of these things, and she doesn't.

That's right. The difference here is that you actually don't need to provide your doctor with resources, your doctor needs to provide those resources to you.

Your difficult job is making your own decisions and getting full information. That's a hard enough job. But once you've made up your own mind about what is right for you. You don't have to convince anyone else of that you need them to support you. And if you don't have their support, you know, that's obviously a red flag. And you do need to go to greater lengths to find a provider who supports you, who respects you as the parent of this child. But you don't and you should never have to convince them of anything. And you should be able to get the evidence from them, you should be able to say, is there a risk? Is there any true risks to an aging placenta? Is there any true risk to eating during labor? And you're having a hard time getting them to answer these questions, we can always go back to breaking it down in the form of the brain acronym, which is so helpful. Like you can ask the question what are the benefits of eating during labor? What are the risks? What are my alternatives? The AI stands for intuition. And the N stands for what happens if I do nothing and you can literally go through all those segments of the acronym and ask those questions of your doctor and see how they respond to it. and make sure they're not responding in rhetoric. That is a skill that you need to cultivate. You have to be able to hear rhetoric. If you hear rhetoric, just let it go in one ear and out the other because what you're looking for is actual information and not someone who's trying to sway you into one particular way of thinking.

Okay, this question is on erythromycin ointment. Hey, awesome, ladies. I am 26 weeks pregnant and have been binging your podcast. I've learned so much in capitals already. It has already helped develop an outline on my birth plan. And I am so grateful. I recently heard your episode on erythromycin must have been a q&a question. I think so a segment tweet segment. Yes, I started looking into the research on whether it helps prevent other bacterial infections. The research the research overall seems unclear on whether it can prevent pinkeye from other bacteria aside from the STDs. I'm negative for STDs, so I figured the eye ointment was a no brainer. But I do get UTIs and have had a yeast infection during this pregnancy. So I'm wondering if the erythromycin might help prevent my baby from getting pinkeye from any other bacteria that I might have during this pregnancy. UTIs are urinary tract infections and STDs are sexually transmitted diseases. Technically, STI is sexually transmitted infections. So it was for my son is given to prevent serious injury to the eye and blindness and babies from infection most often. Seriously with gonorrhea. You also can have chlamydia eye infection, but it's a little bit less dangerous to the baby. But the gonorrhea infection is very serious and can cause blindness and it's very easily treated with a rare throw my son ointment and that's why it's given but other bacteria that's on your skin that may be in your vagina can also cause irritation in the eye and cause a little bit of pink eye or conjunctivitis, but it's not harmful. And erythromycin isn't actually proven to improve the infection rate from other bacteria. So I would say you do not need to worry about it if you have no gonorrhea and no chlamydia at the time of vaginal birth, you do not need it ointment for your baby. Simple.

Just what's the concern about pinkeye? Is that and legit is that like a big concern. It's so I don't think it's now I don't think it's a big concern. And breast milk is a great treatment if your baby has any type of conjunctivitis, which can be from a clog tear duct. Or you know, if they do get a little irritation in the eye from something they've come in contact with.

Squirt the breast milk in the eye. That's right, which is shocking to anyone who hasn't had a baby hadn't heard that before. They're like shocked just little drops, you want to squirt it gently into your baby's eyes. The risk of using the Iron Man I guess we should touch on that squirting does spray that is that's just Yeah, little bit little drops a little gentle drops.

And that's good for that's good for many, many irritations and infections that come up in newborns. You can do it on the skin, you can do it in the eyes on a paper cut. Do it at a paper on your husband's paper cuts. Oh, on your husband's papercuts diaper rash. Umbilical, the umbilical cord healing.

I read an article in mothering magazine years ago that was all about the various things that breast milk could heal. And it was it was amazing. It was like eight or nine things. And the reason is that if you look at breast milk under a microscope, it is alive like produce is like fruits and vegetables. It has living white blood cells, which is exactly what does heal us. So as mystical as it sounds, that's precisely what does heal us.

That's this is what I always tell women when they pump their breast milk and why it's actually safe to leave it out at room temperature for far more than Google tells you many more hours than the CDC tells you. Because it's a live food. It's constantly cleansing itself. That's why we call it magic. It's magical. It's alive. It's not like your cow's milk. It's not like your formula. It's kind of like kombucha.

I went from understanding you to not understand Bucha last forever Amitava goes bad okay, the thing you know, I don't you know, I don't drink anything carbonated. So it went right over my head.

All right, but I just want to I need to go back and finish what I was saying about a wreath romidepsin the danger in using erythromycin is actually very little. There's very little risk to using it in terms of side effects of the medication except that it does interfere with your baby's vision there when they put that I know him and your baby can't actually see there. It's very blurry and babies don't have Super, super good vision when they're born anyway, but, you know, you just have this beautiful, perfect baby come out of your body, and then to kind of mask their eyes with this globby pointman and they have a hard time opening and hard time focusing. It's just not necessary unless you're at risk.

Oh, by the way, Trisha, quick question about erythromycin. It is an antibiotic, which is obviously a turnoff, because you don't want to give that to anyone who doesn't have a bacterial infection. Are you saying it's so minimal? And it's practically I mean, it's not topical, but it is topical? Well, it's sort of is the eye is an open orifice and it goes right on the eyeball. But you're saying it's basically topical very little that's into the bloodstream? That's why you're saying it's so much safer than a traditional antibiotic that is administered by other measures. Absolutely. Okay. Yes. So no one has to make a painstaking decision over this either way.

No. Okay. That's right. All right. Next question is on the same topic of breastfeeding and it says, quick question for Trisha, are there ways to prevent mastitis?

Definitely, absolutely. Mastitis results from two things, milk stasis, and an inflammatory response that is set off in the breast when the milk is sits in the breast for too long. And then the ducks get overly full and you get in gorged or you get a plug duct. The second way you get mastitis is infectious. And that can happen through an ascending infection through your nipple, if you have a break in the nipple skin from a bad latch, it can also happen when milk just sits in the breast for too long. And the milk gets sticky and it gets thick, and it starts to breed bacteria. And if your body isn't able to kind of keep that in check, or the milk sits there for too long, you can get mastitis. So the ways that you can prevent it or to have a good latch, and to frequently feed your breastfeeding baby and don't let milk sit in your breasts for too long. So that 10 to 14 times, I'm always saying it's not eight times eight times is the bottom of the barrel minimum amount of times that your baby needs to feed to gain weight effectively to stimulate your milk production effectively. To keep milk flowing. It's really more on average, 10 to 12, even up to 14 times a day is what we need babies doing in the early weeks.

All right, sounds good. Next one is on birth control. So you can also answer this one. Hi there. I just started listening to the podcast as part of my research for my upcoming pregnancy and birth and I'm finding it super helpful. Thanks for all the work you do and your advocacy. My question is about postpartum IUD insertion. I'm reading conflicting things about how soon after birth you can slash should have a non hormonal IUD inserted to decrease the risk of expulsion, uterine perforation, or other negative outcomes. Sources seem all over the place on this. My IUD insertion was the most traumatic medical experience of my life. But I love it as birth control. And I'd like to go back to having it after baby. What are your thoughts? Can you explain what expulsion is Trisha? Sure.

Well, first, I just want to say that the non hormonal IUD is an amazing form of birth control. And it's my number one go to for anybody who is thinking about some method of birth control other than cycle monitoring, fertility awareness method. So the nonhormonal excellent choice. So when you have an IUD inserted, it goes up through your cervix, and it's meant to sit at the very top of your uterus, they can just come out on its own. It can it shouldn't. But it can come out for a couple of reasons it can come out because you put it in too soon after giving birth Some women will get an IUD before they leave the hospital. Oh my gosh, that is, you know, that puts you at risk for expulsion. Because you're still bleeding you there's a lot of flow coming out of your uterus and that IUD can come out of the flow and your uterus isn't really back to its pre pregnant size. Obviously you just give birth. It can also get expelled expulsed the right pronunciation of that word expulsed.

If I thought the word was expelled, spelled it I thought was the verb.

I think that's correct. Yeah. Okay. So it can also be expelled from your uterus if it's not inserted properly. If it's too shallow inserted like it's just inside the cervix, and it's not up in the fundus or the top of the uterus. So your best bet to have it stay in your uterus is to put it in later like pastor at your six week beyond your six week maybe even you know three months postpartum. Most women are not ready to return to sexual intercourse at six weeks anyway. So really do we need to have an IUD that soon but if you are finding that you are having sex sooner and you're not exclusively breastfeeding, then you are at risk of getting pregnant, then you might get it sooner. It shouldn't be a traumatic experience getting an IUD inserted. It can be uncomfortable, but it certainly shouldn't be traumatic. Can you imagine feeling well rested while your baby is content and thriving? baby massage has been practiced around In the world throughout history, and it provides benefits such as deeper and longer sleep, up to 50% Less fussing breastfeeding benefits and a strong secure attachment. With just 10 minutes of daily massage, you can boost your baby's immunity with increased white blood cell count and facilitate the secretion of endorphins like oxytocin, serotonin and dopamine Vianna infant massage is teaching parents all the optimal strokes to incorporate into your daily routine. When you sign up, you can get lifetime access to all eight modules of pianos full course plus Downloadables and support visit Vianna infant massage.com That's vy ama infant massage, and use promo code down to birth.

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And our experience of pain is greatly influenced by our birthing environment. So one experience of pain related to breaking your bag of water in a home birth could feel really different than the experience breaking your bag of water in a hospital. Because of the hospital environment, you are so uncomfortable already. So everything is going to be a little bit heightened. We should just mention that. That bag of water is there to ease the contraction, it's there to provide cushion and when you break the bag of water and you lose all that cushion. Yes, the contractions are going to feel different and most likely a lot more intense harder to manage.

In our episode with Yvonne Strahovski Episode 159, Yvonne Strahovski from Handmaid's Tale, she talks about going to the hospital and freezing up right when she got there. And she really trusted her OB, but still just the number of strangers that were around her in an unfamiliar setting. She felt her body Clint clam up, she said, just walking through hospital doors, we immediately become afraid. What do you go to hospitals for usually illness and injury, right things that are scary things that don't feel good. So as birthing woman walking through those hospital doors, immediately, your body instinctively is going to become more fear base.

Alright, we have another one here about breastfeeding. And it says, I have a four week old baby and I'm breastfeeding on demand. We don't have a routine and the gap between feeds is random. Sometimes it's one hour, sometimes it's up to three hours. When can I expect some towards sort of routine?

Well, welcome to exclusive breastfeeding.

Where your life revolves around the baby one yes, is where the gap between feeds is totally random. And ranges from 30 minutes to three to four hours, maybe if you're lucky overnight. And when can you expect some sort of routine? I mean, honestly, you know, maybe maybe around eight to 12 weeks, maybe never eight to 12 weeks, I'd say eight to 12 months, I felt like I was breastfeeding on demand forever. And we are still breastfeeding on demand at eight to 12 weeks for sure. But I do some babies will fall into a little bit more of a pattern. That's true. Like they may start taking a four hour stretch of sleep consistently Italy, they may they wake up and breastfeed then they play then they breastfeed and take a nap. You're right there is some sor of ad is it but it is still on demand is still on queue all the way through till till you're done really, to me routine is different than schedule. So when can you expect to schedule? Never, when can you expect a routine, a little bit of predictability a little bit of pattern, each 12 weeks sometimes will fall into that if breastfeeding is going well. If all things are where they need to be babies gaining weight, well, milk supply is, you know, meeting babies demands, then it can happen in that timeframe. Any other thoughts?

I was just remembering when you taught the breastfeeding workshop over the weekend how, after all these years of hosting that workshop, I was so surprised to learn that throughout that, let's say first year of breastfeeding, when you were saying we really don't start producing more and more, and they are eating so much more in that course of the year they're grown so much, but your milk gets so much different in constitution. And I just thought oh my gosh, it's so true. And your breasts get actually smaller over the course of the year like you start off very engaged. It all regulates it all goes down. And somehow in my mind, I just, if you had asked me if I were answering a multiple choice question that would have gotten wrong, like I would have thought, yeah, you're producing much more to keep up with the baby's needs. But the baby's needs is met not by the quantity of milk, but the quality of the milk that just more so yes, right might increase a little right. But you know, eight fold, because they're eating eight times more than they did in the first week. I couldn't believe exactly, yes. And that scares moms a lot, because they'll see babies who are having an eight ounce bottle of formula at six months of age. And they're like, I'm only making two ounces right now. Like how am I ever going to make eight ounces. And I'm remind them that they never have to. And that is a beautiful thing. And also you can feel like your breast at some point weeks down the road into breastfeeding many weeks down the road. Your breasts can feel totally empty, like you know how you can sense that fullness when they're full and they're soft after a feed but they can be totally empty and you can put your baby on and you can make milk on the spot throughout the feed. You're just making milk in the moment and they get a full feeding. Yep. So it really changes and it never becomes entirely scheduled although some moms try and some are successful. but most are not. Their behavior at the breast and their weight are the most important variables, not even diapers at some point. They're not that they're not that useful as the weeks go on. They're still semi important, but it changes. But really, it's your baby's waking and your baby's behavior at the breast, what do you mean their behavior and just give one example of what you mean by that. So if you have a baby who is fussing every time they feed cranky, you know, kind of refusing the breast or fussy at the breast, then we probably have a supply problem. It'd be too much it could be too little like they're frustrated and upset, frustrated. Yeah, they're not coming off the breast calm. A even sometimes they literally will refuse the breast they won't go on the breast.

quickies. Next, my friend's prolactin levels high and it is preventing her from getting pregnant. Any advice? That's one of the purposes of high prolactin when you're breastfeeding is to prevent pregnancy. And as the beautiful result of exclusive breastfeeding is that it does suppress ovulation. And that's nature's way of protecting you from getting pregnant too soon after giving birth because it's not ideal for our physiology. So she is probably breastfeeding and she will likely have to decrease the amount of breastfeeding to get her prolactin level down and then her body will ovulate. Do we have prolactin when we're not breastfeeding? Yes, but not in high levels?

Well, what if this friend is not breastfeeding and has never had a baby and has high levels? Because that's when she she needs a medical evaluation for why she has private high prolactin because then there's some underlying medical reasons for it and it's not healthy. So next one, how important is three days of skin to skin? Like with no clothes for mom or baby? Is it totally necessary? Well, I don't I don't know. In this question. It sounds like three days of skin to skin with no clothes, for mom or baby is like a thing.

That's right. I've never heard that right, three days, 72 hours like yeah, I don't know where that's coming from. And we talked a lot about skin to skin post birth and being skin to skin as much as possible in those first two weeks, but there's no such thing as three days of around the clock, 72 hours of no clothes for mom or baby. You do not have to do that. The more your baby's skin to skin with you in a way that feels appropriate and good to you, the better. We had a mom on Instagram respond to this because we posted this in a story yesterday and one of them wrote and said I'm a few months out and we're we're skin to skin all the time. And I was like yeah, that's how it's done. So if your baby does have to be separated from you, if your baby is born prematurely has to be in the NICU or anything like that. That you will bond later. And the best way to bond is skin to skin and it doesn't have to be in the first three days. The it doesn't have a clock. The idea is do skin to skin as soon as that as a possibility for you. If that's a possibility from birth on, go for it. If it's not, then you begin it as soon as you can, and as often as you can, but you don't have to be like naked at all costs.

Yeah, you don't have to be naked at all costs. Not just skin to skin so like what we're talking about is, you know a baby that swaddled cannot be skin to skin with you other than their little cheek, a baby can be in a diaper. They can even be in a onesie on your chest and that can still be skin to skin contact.

I mean, their hands are an important part of contact and if they're swaddled, they can even use those hands. So that's that's the overarching message. I think I can still express milk a year after weaning, is this normal?

It is happened to me. Little bits, tiny amounts, so just ignore it and it will say tiny, tiny amounts. Yeah. Are there natural ways to deal with mastitis prevention?

Right? Massaging the breast, cabbage,

sometimes cabbage leaves, there's good for engorgement. Not necessarily not necessarily in gorge when you have mastitis.

If you have a good homebirth, midwife, do you also need a doula? It depends. It really does depend completely on you. It depends on you depends. So much. Depends on the midwife. You love having doulas there. Right. But I know homebirth midwife who doesn't because she feels like she does all that work. But you like the feeling of that team and that doula to do that part while you're doing the other stuff? The the waist up versus the waist down, right?

Yes, I think it's great. I mean, it depends on the person. It's not like you can have a great home birth experience without a doula. But it depends on the mother.

Yes, some months, some home birth clients of mine, ask if it's redundant. That's usually the word they use. And I say no, it's not redundant. Because I don't think it's ever done. I know it's not we've done it because the midwife is your medical professional. And a doula is, you know, a supportive person in the room. So there's a world of difference in that respect. But I think the reason it's a question for some people is that a doula in a traditional hospital setting is sometimes worth their absolute body weight in gold, keeping that births safer with lower intervention or let's say lower and unnecessary intervention. And that's why they think, well, at a home birth, I'm not at risk of all that unnecessary intervention. So right, that part of the doulas advocacy role is not going to be as necessary at birth, but they're still there to provide all of their other emotional and physical techniques for support.

And if it comes down to cost, you know, like, you're paying out of pocket for homebirth. midwife you got to pay out of pocket for a doula? Yes, you you know, if you need to not have one, you're going to not have the doula. It's up to the mother.

Absolutely. Like everything else. Right. Let's be honest. Last question, how can I run away from having good sneakers.

I mean, this comes up a lot. The people who lose the person you love, you have to be willing to set the boundary.

If you haven't learned about good boundaries before in your life, and you might not have because of your own family. We talked about this in my Postpartum Support Group. This week, we brought up the notion of how many close families are in meshed. When anything is going on between two members of the family, every other member of the family knows about it, and everyone's talking about it and everyone knows everyone else's opinion on it. And that is what we experienced in close families and in measurement is a problem. And then when we come from an enmeshed family, and we marry someone who doesn't come from an in meshed family, we realize they have very different boundaries, and we have a little learning to do and they have a little learning to do. So this came up in our group because a few of the women realized they come from really enmeshed families so they haven't learned boundaries with their own families and they're struggling to create them with their in laws now.

Practice slowly set small boundaries, and as you get good at that you'll be able to set firmer boundaries. Yeah, that's it for this week. I mean, we have some great very exciting episodes on the roster coming up to be recorded in May in June. So I am so so excited about one of them. And we are not going to tell you what it is. I'm so excited today if you have them but one of them I'm just like giddy Alright, um thanks everyone for being here and we'll catch you next week. Bye

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.